Search Results (899)

DIALOGUE (DIagnostic AI Learning through Objective Guided User Experience) is a generative artificial intelligence (GenAI)-based training program designed to enhance diagnostic communication skills in medical students. In this single-arm pre–post study, we evaluated whether DIALOGUE could improve students’ ability to disclose a type 2 diabetes mellitus (T2DM) diagnosis with clarity, structure, and empathy. Thirty clinical-phase students completed two pre-test virtual encounters with an AI-simulated patient (ChatGPT, GPT-4o), scored by blinded raters using an eight-domain rubric. Participants then engaged in ten asynchronous GenAI scenarios with automated natural-language feedback. Seven days later, they completed two post-test consultations with human standardized patients, again evaluated with the same rubric. Mean total performance increased by 36.7 points (95% CI: 31.4–42.1; p < 0.001), and the proportion of high-performing students rose from 0% to 70%. Gains were significant across all domains, most notably in opening the encounter, closure, and diabetes specific explanation. Multiple regression showed that lower baseline empathy (β = −0.41, p = 0.005) and higher digital self-efficacy (β = 0.35, p = 0.016) independently predicted greater improvement; gender had only a marginal effect. Cluster analysis revealed three learner profiles, with the highest-gain group characterized by low empathy and high digital self-efficacy. Inter-rater reliability was excellent (ICC ≈ 0.90). These findings provide empirical evidence that GenAI-mediated training can meaningfully enhance diagnostic communication and may serve as a scalable, individualized adjunct to conventional medical education. Full article

The social acceptance of Renewable Energy Sources (RESs) is a decisive factor in the successful implementation of clean energy projects. This study explores the attitudes, demographic profiles, and common misconceptions of citizens in the Region of Epirus, Greece, toward photovoltaic and wind energy installations. Special attention is given to the role of education, age, and access to information—as well as spatial factors such as visual exposure—in shaping public perceptions and influencing acceptance of RES deployment. A structured questionnaire was administered to 320 participants across urban and rural areas, with subdivision between regions with and without visual exposure to RES infrastructure. Findings indicate that urban residents exhibit greater acceptance of RES, while rural inhabitants—especially those in proximity to installations—express skepticism, often grounded in esthetic concerns or perceived procedural injustice. Misinformation and lack of knowledge dominate in areas without visual contact. Statistical analysis confirms that younger and more educated participants are more supportive and environmentally aware. The study highlights the importance of targeted educational interventions, transparent consultation, and spatially sensitive communication strategies in fostering constructive engagement with renewable energy projects. The case of Epirus underscores the need for inclusive, place-based policies to bridge the social acceptance gap and support the national energy transition. Full article

Residential green space is an important component of urban green space and one of the major indicators for evaluating the quality of a residential community. Traditional indicators such as the green space ratio only consider the relationship between green space area and total area of the residential community while ignoring the difference in the amount of green space enjoyed by household residents in high-rise and low-rise buildings. Therefore, it is meaningful to estimate household green space and its spatial distribution in residential communities. However, there are frequent difficulties in obtaining specific green space area and household number through ground surveys or consulting with property management units. In this study, taking a composite residential community in Chongqing, China, as the study site, we first employed a five-lens drone to capture its oblique RGB images and generated the DOM (Digital Orthophoto Map). Subsequently, the green space area and distribution in the entire residential community were extracted from the DOM using VDVI (Visible Difference Vegetation Index). The YOLACT (You Only Look At Coefficients) instance segmentation model was used to recognize balconies from the facade images of high-rise buildings to determine their household numbers. Finally, the average green space per household in the entire residential community was calculated to be 67.82 m², and those in the high-rise and low-rise building zones were 51.28 m² and 300 m², respectively. Compared with the green space ratios of 65.5% and 50%, household green space more truly reflected the actual green space occupation in high- and low-rise building zones. Full article

Aims/Background: Polypharmacy, or the concurrent intake of five or more medications, is a significant issue in clinical practice, particularly in multimorbid elderly individuals. Despite its importance for patient safety, medical education often lacks systematic training in recognising and managing polypharmacy within the framework of patient-centred care. We investigated the impact of a structured learning intervention introducing polypharmacy as a chronic condition, assessing whether it enhances medical students’ diagnostic competence, confidence, and interprofessional collaboration. Methods: A prospective cohort study was conducted with 50 final-year medical students who received a three-phase educational intervention. Phase 1 was interactive workshops on the principles of polypharmacy, its dangers, and diagnostic tools. Phase 2 involved simulated patient consultations and medication review exercises with pharmacists. Phase 3 involved reflection through debriefing sessions, reflective diaries, and standardised patient feedback. Student knowledge, confidence, and attitudes towards polypharmacy management were assessed using pre- and post-intervention questionnaires. Quantitative data were analysed through paired t-tests, and qualitative data were analysed thematically from reflective diaries. Results: Students demonstrated considerable improvement after the intervention in identifying symptoms of polypharmacy, suggesting deprescribing strategies, and working in multidisciplinary teams. Confidence in prioritising polypharmacy as a primary diagnostic problem increased from 32% to 86% (p < 0.01), and knowledge of diagnostic tools increased from 3.1 ± 0.6 to 4.7 ± 0.3 (p < 0.01). Standardised patients felt communication and patient-centredness had improved, with satisfaction scores increasing from 3.5 ± 0.8 to 4.8 ± 0.4 (p < 0.01). Reflective diaries indicated a shift towards more holistic thinking regarding medication burden. The small sample size limits the generalisability of the results. Conclusions: Teaching polypharmacy as a chronic condition in medical school enhances diagnostic competence, interprofessional teamwork, and patient safety. Education is a structured way of integrating the management of polypharmacy into routine clinical practice. This model provides valuable insights for designing medical curricula. Future research must assess the impact of such training on patient outcomes and clinical decision-making in the long term. Full article

The renovation of old urban residential areas is and will continue to be an important part of urban renewal in China. The renovation of existing old urban residential areas focuses more on the physical level of renovation and pays insufficient attention to the improvement of collaborative community governance. However, collaborative community governance is the key to sustainable renovation. This study aims to explore the formation mechanism of multiple subjects’ collaborative governance in the renovation of old urban residential areas. A general collaborative governance theoretical framework was adopted and adjusted by innovatively introducing the improvement of collaborative community governance in old urban residential areas as an important variable in collaborative results. Data were collected through 853 questionnaires in 16 provinces across China and analyzed using Structural Equation Modeling. Data analysis reveals the following conclusions: (1) institution design and the collaborative process have significant positive impacts on collaborative results, while facilitative leadership has a negative impact; (2) the collaborative process is an important mediating variable on collaborative results; (3) government departments’ and residents’ self-governing organizations play important roles in improving collaborative community governance. Face-to-face dialogue and consultation, information disclosure and transparency, and reaching an intermediate consensus are important mediator variables. The research results provide theoretical support and practical suggestions for promoting the improvement of multiple-subject collaboration through old urban residential area renovation. Full article

Background: Despite their high prevalence and potential for significant morbidity, hemorrhoidal symptoms remain underreported and undertreated. Misconceptions and stigma may delay care-seeking behaviors and negatively influence patient outcomes. Methods: We conducted a cross-sectional, questionnaire-based study in Romania to assess public awareness, attitudes, and barriers related to hemorrhoidal disease. The survey included 185 participants and evaluated variables such as symptom severity, understanding of the condition, perceived stigma, and willingness to consult a physician. Results: Only 30.8% of participants had sought medical advice for hemorrhoidal symptoms. Younger age (p < 0.001), male sex (p = 0.013), and lower levels of perceived severity were significantly associated with reluctance to seek medical care. The most frequently reported barriers were embarrassment and fear of invasive diagnostic procedures. Colonoscopy and digital rectal examination were identified as major deterrents by 39.5% and 38.9% of respondents, respectively. Educational level influenced both the perceived understanding of the disease (p = 0.001) and comfort in discussing anal symptoms (p = 0.002). Gender preference for physicians was significantly associated with respondent sex (p = 0.007) but not with education or age. Conclusions: Hemorrhoidal disease remains a stigmatized and underestimated condition. Public health efforts should prioritize educational interventions, destigmatization campaigns, and improved physician–patient communication to facilitate earlier diagnosis and better disease management. Full article

Based on a literature review, the present article aims to present ecotourism as a transformative factor in the economic, social, cultural, and environmental contexts, revealing key elements for the sustainable development of ecotourism. To ensure that this objective is met, the review combines the insights of classical authors and many recent authors who have best addressed the subject. The review carefully selected consensual and contradictory arguments, reflecting on the relevance of each group, particularly in aspects such as the influence of emotional experience on behaviour and satisfaction, strategy and competitive advantage, cooperation and sustainability, and the influence of resilience on ecotourism. The impact of each perspective was presented without ignoring the major constraints that ecotourism faces in its search for a position in the tourism industry. This led the study to accept the fact that the active participation of the community is indispensable in the formula for the success of ecotourism. Some statistical data were consulted and analysed, which enabled the study to determine the quantitative impact of ecotourism on economic, social, and environmental life. In terms of benefits to communities, the review clarifies the fact that ecotourism serves as an instrument that mobilizes not only the additional value of products and services traded in the process, but also the return on investments and job creation. The combination of visiting activities with the involvement of tour guides contributes to maximizing profits in the destinations, thus supporting solid economic, social, and environmental development for the benefit of both ecotourism promoters and local communities. However, the analysis makes it clear that the economic, social, and environmental benefit depends on the degree of involvement of the local population. In terms of usability, for other studies, this review can contribute to the understanding and positioning of ecotourism in the search for a balance between satisfying socioeconomic and environmental interests. Additionally, it can serve as an aid to policy makers in their decisions related to ecotourism. Full article

The Mutanchis, known by their derogatory exonymic term ‘Lepcha’, are autochthonous to Sikkim, India. The name ‘Mutanchi’ derives from the phrase ‘Mutanchi Rumkup Rongkup’, eliciting the response ‘Achulay’, meaning ‘Beloved children of It-bu-mu, who have come from the snowy peaks’. The nomenclature prompts an ontological understanding rooted in the community’s eco-geographical context. Despite possessing a well-developed script categorised within the Tibeto-Burman language family, the Mutanchis remain a largely oral community. Their diminishing, scarcely documented repository of Mutanchi clan narratives underscores this orality. As a Mutanchi, I recognise these narratives as a medium for expressing Indigenous value systems upheld by my community and specific villages. Mutanchi clan narratives embody spiritual and cultural significance, yet their fantastic rationale reveals complex epistemological tensions. Ideally, each Mutanchi clan reveres a chyu (peak), lhep (cave), and doh (lake), which are propitiated annually and on specific occasions. The transmigration of an apil (soul) is tied to these three sacred spatial geographies, unique to each clan. Additionally, clan etiological explanations, situated within natural or supernatural habitats, manifest beliefs, values, and norms rooted in a deep ecology. This article presents an ecosophical study of selected Mutanchi clan narratives from Dzongu, North Sikkim—a region that partially lies within the UNESCO Khangchendzonga Man-Biosphere Reserve. Conducted in close consultation with clan members and in adherence to the ethical protocols, this study examines clans in Dzongu governed by Indigenous knowledge systems embedded in their narratives, highlighting biocentric perspectives that shape Mutanchi lifeways. Full article

Background: Psychological problems post-stroke can negatively impact stroke survivors. Although general psychological services exist (e.g., NHS Talking Therapies), access remains limited, particularly for individuals with post-stroke communication and cognitive impairments. Stroke service staff report low confidence in managing psychological distress. This study is the first to explore the barriers and facilitators to implementing a novel intervention package comprising a cross-service care pathway and staff training to enhance post-stroke psychological provision. Methods: Staff from stroke and mental health services in four UK regions, recruited through purposive sampling to ensure diversity of services and professional roles, participated in semi-structured interviews or focus groups, guided by the Theoretical Domains Framework (TDF), before and after implementation of the intervention package. Pre-implementation interviews/groups identified anticipated barriers and facilitators to implementation and training needs, informing the development of site-specific intervention packages; post-implementation interviews/groups explored experienced barriers, facilitators and perceptions of the intervention. Interviews underwent thematic analysis using the TDF. Results: Fifty-five staff participated pre-implementation and seventeen post-implementation, representing stroke (e.g., nurse, physiotherapist, consultant) and psychology (e.g., counsellor, psychological therapist) roles across acute, rehabilitation, community, and voluntary services. Challenges anticipated pre-implementation included: limited specialist post-stroke psychological support; low staff confidence; and fragmented service pathways. Post-implementation findings indicated increased staff knowledge and confidence, enhanced screening and referral processes, and stronger inter-service collaboration. Implementation success varied across sites (with some sites showing greater ownership and sustainability of the intervention) and across staff roles (with therapy staff more likely than nursing staff to have received training). Conclusions: Effective implementation of an intervention package to increase psychological provision post-stroke requires staff engagement at all levels across all services. Staff investment influenced ownership of the intervention package, beliefs about priorities and overall enhancement of service capability. Full article

Background: The outbreak of the COVID-19 pandemic has highlighted the importance of online health consultations, as they can help reduce the risk of contagion and infection. However, due to limited trust, these services have not yet gained widespread adoption and usage among patients. Objective: This research aims to examine the impact of perceived quality on patients’ adoption and usage of online health consultations from three perspectives: emotional support, responsiveness, and service continuity. Additionally, this research further explores the moderating effects of online service prices on these relationships. Methods: Based on trust theory, this research constructs theoretical models and empirically tests them by using a panel dataset that comprises 1255 physicians and 65,314 physician–patient communication records. Results: The empirical results confirm that emotional support, responsiveness, and service continuity positively influence patients’ adoption and usage behaviors. Additionally, higher online service prices negatively moderate the impact of emotional support and responsiveness on adoption behavior. Moreover, increased online service prices weaken the positive relationship between emotional support and usage behavior while strengthening the positive relationship between service continuity and usage behavior. Conclusions: This research extends the existing literature on online health services and provides practical guidance for platform managers, physicians, and policymakers to improve overall service acceptance. Full article

Phewa Lake, Nepal’s second-largest natural lake, is under increasing ecological stress due to sedimentation, shoreline encroachment, and water quality decline driven by rapid urban growth, fragile mountainous catchments, and changing climate patterns. This study employs an integrated approach combining sediment yield estimation from its catchment using RUSLE, shoreline encroachment analysis via satellite imagery and historical records, and identification of pollution sources and socio-economic factors through field surveys and community consultations. The results show that steep, sparsely vegetated slopes are the primary sediment sources, with Harpan Khola (a tributary of Phewa Lake) contributing over 80% of the estimated 339,118 tons of annual sediment inflow. From 1962 to 2024, the lake has lost approximately 5.62 sq. km of surface area, primarily due to a combination of sediment deposition and human encroachment. Pollution from untreated sewage, urban runoff, and invasive aquatic weeds further degrades water quality and threatens biodiversity. Based on the findings, this study proposes a way forward to mitigate sedimentation, encroachment, and pollution, along with a sustainable revitalization plan. The approach of this study, along with the proposed sustainability measures, can be replicated in other lake systems within Nepal and in similar watersheds elsewhere. Full article

The objective is to present the theoretical contributions offered by the methodology for studying sustainable tourism in protected natural areas, capable of promoting environmental protection and sustainable local development in communities. This research was carried out in Machalilla National Park. The deductive method was applied, which allowed for the analysis of the problem, the consultation of general theories related to the topic studied, and the establishment of premises and objectives that led to conclusions on the topic studied. A mixed research approach was used, integrating contributions from the analyses carried out for the treatment and processing of information. The techniques used included a survey of tourism stakeholders, a semantic differential for tourists, and an expert evaluation method to validate the proposal under study. The theoretical and methodological systematisation of tourism sustainability in protected natural areas was achieved. The results show the need to broaden the scientific debate and transfer knowledge on the relevance of sustainable tourism as an alternative for sustainable development in rural communities. Full article

Despite advances in cancer care, disparities persist. The collection of the social determinants of health (SDOH) is fundamental to addressing disparities. However, SDOH are inconsistently collected in many regions of the world. This two-phase multiple methods study examined patient and community perspectives regarding SDOH data collection in Canada. In phase 1, a survey was administered to patients at a cancer centre (n = 549) to assess perspectives on an SDOH data collection tool. In phase 2, broader perspectives were sought through a community consultation with patient partners experiencing structural inequality (n = 15). Most participants were comfortable with SDOH data collection. Of survey respondents, 95% were comfortable with the collection of language, birthplace, sex, gender, education, and disability, and 82% to 94% were comfortable with SES, sexual orientation, social support, and race/ethnicity. Discomfort levels did not differ across subgroups, except women were more uncomfortable disclosing SES (OR: 2.00; 95%CI: 1.26, 3.19). Most (71%) preferred face-to-face data collection with a healthcare professional and only half were comfortable with storage of SDOH in electronic health records. Open-ended survey responses (n = 1533) and the community consultation revealed concerns about privacy, discrimination, relevance to care, and data accuracy. SDOH data collection efforts should include a clear rationale for patients, training for providers, strong data privacy and security measures, and actionable strategies to address needs. Full article

The growing prevalence of AI chatbots in everyday life has prompted educators to explore their potential applications in promoting student success, including support for classroom engagement and communication. This exploratory study emerged from semester-long observations of class participation apprehensions in an introductory educational psychology course, examining how chatbots might scaffold students toward active and independent classroom contribution. Four students experiencing situational participation anxiety voluntarily participated in a pilot intervention using AI chatbots as virtual peer partners. Following comprehensive training in AI use and prompt design given to the entire class, participants employed systematic consultation frameworks for managing classroom discourse trepidations. Data collection involved regular instructor meetings documenting student experiences, challenges, and developmental trajectories through qualitative analysis emphasizing contextual interpretation. While students reported general satisfaction with chatbot integration, implementation revealed three critical complexities: temporal misalignment between AI consultation and real-time discussion dynamics; feedback inflation creating disconnects between AI reassurance and classroom reception; and unintended progression from supportive scaffolding toward technological dependency. Individual outcomes varied, with some students developing independence while others increased reliance on external validation. AI-assisted participation interventions demonstrate both promise and limitations, requiring careful consideration of classroom dynamics. Effective implementation necessitates rehearsal-based rather than validation-focused applications, emphasizing human mentorship and community-centered approaches that preserve educational autonomy while leveraging technological scaffolding strategically. Full article

Background: Data accessibility remains a significant barrier in healthcare AI due to privacy constraints and logistical challenges. Synthetic data, which mimics real patient information while remaining both realistic and non-identifiable, offers a promising solution. Large Language Models (LLMs) create new opportunities to generate high-fidelity clinical conversations between patients and physicians. However, the value of this synthetic data depends on careful evaluation of its realism, accuracy, and practical relevance. Objective: To assess the performance of four leading LLMs: ChatGPT 4.5, ChatGPT 4o, Claude 3.7 Sonnet, and Gemini Pro 2.5 in generating synthetic transcripts of patient–physician interactions in plastic surgery scenarios. Methods: Each model generated transcripts for ten plastic surgery scenarios. Transcripts were independently evaluated by three clinically trained raters using a seven-criterion rubric: Medical Accuracy, Realism, Persona Consistency, Fidelity, Empathy, Relevancy, and Usability. Raters were blinded to the model identity to reduce bias. Each was rated on a 5-point Likert scale, yielding 840 total evaluations. Descriptive statistics were computed, and a two-way repeated measures ANOVA was used to test for differences across models and metrics. In addition, transcripts were analyzed using automated linguistic and content-based metrics. Results: All models achieved strong performance, with mean ratings exceeding 4.5 across all criteria. Gemini 2.5 Pro received mean scores (5.00 ± 0.00) in Medical Accuracy, Realism, Persona Consistency, Relevancy, and Usability. Claude 3.7 Sonnet matched the scores in Persona Consistency and Relevancy and led in Empathy (4.96 ± 0.18). ChatGPT 4.5 also achieved perfect scores in Relevancy, with high scores in Empathy (4.93 ± 0.25) and Usability (4.96 ± 0.18). ChatGPT 4o demonstrated consistently strong but slightly lower performance across most dimensions. ANOVA revealed no statistically significant differences across models (F(3, 6) = 0.85, p = 0.52). Automated analysis showed substantial variation in transcript length, style, and content richness: Gemini 2.5 Pro generated the longest and most emotionally expressive dialogues, while ChatGPT 4o produced the shortest and most concise outputs. Conclusions: Leading LLMs can generate medically accurate, emotionally appropriate synthetic dialogues suitable for educational and research use. Despite high performance, demographic homogeneity in generated patients highlights the need for improved diversity and bias mitigation in model outputs. These findings support the cautious, context-aware integration of LLM-generated dialogues into medical training, simulation, and research. Full article