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26 pages, 759 KiB  
Article
AI-Driven Process Innovation: Transforming Service Start-Ups in the Digital Age
by Neda Azizi, Peyman Akhavan, Claire Davison, Omid Haass, Shahrzad Saremi and Syed Fawad M. Zaidi
Electronics 2025, 14(16), 3240; https://doi.org/10.3390/electronics14163240 - 15 Aug 2025
Viewed by 176
Abstract
In today’s fast-moving digital economy, service start-ups are reshaping industries; however, they face intense uncertainty, limited resources, and fierce competition. This study introduces an Artificial Intelligence (AI)-powered process modeling framework designed to give these ventures a competitive edge by combining big data analytics, [...] Read more.
In today’s fast-moving digital economy, service start-ups are reshaping industries; however, they face intense uncertainty, limited resources, and fierce competition. This study introduces an Artificial Intelligence (AI)-powered process modeling framework designed to give these ventures a competitive edge by combining big data analytics, machine learning, and Business Process Model and Notation (BPMN). While past models often overlook the dynamic, human-centered nature of service businesses, this research fills that gap by integrating AI-Driven Ideation, AI-Augmented Content, and AI-Enabled Personalization to fuel innovation, agility, and customer-centricity. Expert insights, gathered through a two-stage fuzzy Delphi method and validated using DEMATEL, reveal how AI can transform start-up processes by offering real-time feedback, predictive risk management, and smart customization. This model does more than optimize operations; it empowers start-ups to thrive in volatile, data-rich environments, improving strategic decision-making and even health and safety governance. By blending cutting-edge AI tools with process innovation, this research contributes a fresh, scalable framework for digital-age entrepreneurship. It opens exciting new pathways for start-up founders, investors, and policymakers looking to harness AI’s full potential in transforming how new ventures operate, compete, and grow. Full article
(This article belongs to the Special Issue Advances in Information, Intelligence, Systems and Applications)
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20 pages, 3244 KiB  
Article
SOUTY: A Voice Identity-Preserving Mobile Application for Arabic-Speaking Amyotrophic Lateral Sclerosis Patients Using Eye-Tracking and Speech Synthesis
by Hessah A. Alsalamah, Leena Alhabrdi, May Alsebayel, Aljawhara Almisned, Deema Alhadlaq, Loody S. Albadrani, Seetah M. Alsalamah and Shada AlSalamah
Electronics 2025, 14(16), 3235; https://doi.org/10.3390/electronics14163235 - 14 Aug 2025
Viewed by 124
Abstract
Amyotrophic Lateral Sclerosis (ALS) is a neurodegenerative disorder that progressively impairs motor and communication abilities. Globally, the prevalence of ALS was estimated at approximately 222,800 cases in 2015 and is projected to increase by nearly 70% to 376,700 cases by 2040, primarily driven [...] Read more.
Amyotrophic Lateral Sclerosis (ALS) is a neurodegenerative disorder that progressively impairs motor and communication abilities. Globally, the prevalence of ALS was estimated at approximately 222,800 cases in 2015 and is projected to increase by nearly 70% to 376,700 cases by 2040, primarily driven by demographic shifts in aging populations, and the lifetime risk of developing ALS is 1 in 350–420. Despite international advancements in assistive technologies, a recent national survey in Saudi Arabia revealed that 100% of ALS care providers lack access to eye-tracking communication tools, and 92% reported communication aids as inconsistently available. While assistive technologies such as speech-generating devices and gaze-based control systems have made strides in recent decades, they primarily support English speakers, leaving Arabic-speaking ALS patients underserved. This paper presents SOUTY, a cost-effective, mobile-based application that empowers ALS patients to communicate using gaze-controlled interfaces combined with a text-to-speech (TTS) feature in Arabic language, which is one of the five most widely spoken languages in the world. SOUTY (i.e., “my voice”) utilizes a personalized, pre-recorded voice bank of the ALS patient and integrated eye-tracking technology to support the formation and vocalization of custom phrases in Arabic. This study describes the full development life cycle of SOUTY from conceptualization and requirements gathering to system architecture, implementation, evaluation, and refinement. Validation included expert interviews with Human–Computer Interaction (HCI) expertise and speech pathology specialty, as well as a public survey assessing awareness and technological readiness. The results support SOUTY as a culturally and linguistically relevant innovation that enhances autonomy and quality of life for Arabic-speaking ALS patients. This approach may serve as a replicable model for developing inclusive Augmentative and Alternative Communication (AAC) tools in other underrepresented languages. The system achieved 100% task completion during internal walkthroughs, with mean phrase selection times under 5 s and audio playback latency below 0.3 s. Full article
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33 pages, 3843 KiB  
Article
Investigation of ASR Models for Low-Resource Kazakh Child Speech: Corpus Development, Model Adaptation, and Evaluation
by Diana Rakhimova, Zhansaya Duisenbekkyzy and Eşref Adali
Appl. Sci. 2025, 15(16), 8989; https://doi.org/10.3390/app15168989 - 14 Aug 2025
Viewed by 90
Abstract
This study focuses on the development and evaluation of automatic speech recognition (ASR) systems for Kazakh child speech, an underexplored domain in both linguistic and computational research. A specialized acoustic corpus was constructed for children aged 2 to 8 years, incorporating age-related vocabulary [...] Read more.
This study focuses on the development and evaluation of automatic speech recognition (ASR) systems for Kazakh child speech, an underexplored domain in both linguistic and computational research. A specialized acoustic corpus was constructed for children aged 2 to 8 years, incorporating age-related vocabulary stratification and gender variation to capture phonetic and prosodic diversity. The data were collected from three sources: a custom-designed Telegram bot, high-quality Dictaphone recordings, and naturalistic speech samples recorded in home and preschool environments. Four ASR models, Whisper, DeepSpeech, ESPnet, and Vosk, were evaluated. Whisper, ESPnet, and DeepSpeech were fine-tuned on the curated corpus, while Vosk was applied in its standard pretrained configuration. Performance was measured using five evaluation metrics: Word Error Rate (WER), BLEU, Translation Edit Rate (TER), Character Similarity Rate (CSRF2), and Accuracy. The results indicate that ESPnet achieved the highest accuracy (32%) and the lowest WER (0.242) for sentences, while Whisper performed well in semantically rich utterances (Accuracy = 33%; WER = 0.416). Vosk demonstrated the best performance on short words (Accuracy = 68%) and yielded the highest BLEU score (0.600) for short words. DeepSpeech showed moderate improvements in accuracy, particularly for short words (Accuracy = 60%), but faced challenges with longer utterances, achieving an Accuracy of 25% for sentences. These findings emphasize the critical importance of age-appropriate corpora and domain-specific adaptation when developing ASR systems for low-resource child speech, particularly in educational and therapeutic contexts. Full article
(This article belongs to the Section Computing and Artificial Intelligence)
29 pages, 799 KiB  
Review
The Evolving Landscape of Novel and Old Biomarkers in Localized High-Risk Prostate Cancer: State of the Art, Clinical Utility, and Limitations Toward Precision Oncology
by Lilia Bardoscia, Angela Sardaro, Mariagrazia Quattrocchi, Paola Cocuzza, Elisa Ciurlia, Ilaria Furfaro, Maria Antonietta Gilio, Marcello Mignogna, Beatrice Detti and Gianluca Ingrosso
J. Pers. Med. 2025, 15(8), 367; https://doi.org/10.3390/jpm15080367 - 11 Aug 2025
Viewed by 312
Abstract
High-risk prostate cancer (PC) accounts for 50–75% of 10-year relapse after primary treatment. Routine clinicopathological parameters for PC patient stratification have proven insufficient to inform clinical decisions in this setting. Tumor genomic profiling allowed overcoming the limits of diagnostic accuracy in the field [...] Read more.
High-risk prostate cancer (PC) accounts for 50–75% of 10-year relapse after primary treatment. Routine clinicopathological parameters for PC patient stratification have proven insufficient to inform clinical decisions in this setting. Tumor genomic profiling allowed overcoming the limits of diagnostic accuracy in the field of PC, integrated with radiomic features, automated platforms, evaluation of patient-related factors (age, performance status, comorbidity) and tumor-related factors (risk class, volume, T stage). In this scenario, the use of biomarkers to guide decision-making in localized, high-risk PC is evolving actively and rapidly. Additional tests for prostate-specific antigen have demonstrated superior sensitivity and specificity for detecting clinically significant PC, as well as commercially available genomic classifiers improving the risk prediction of disease recurrence/progression/metastasis, in combination with common clinical variables. This narrative review aimed to summarize the state of the art on the utility and evolution of old and emerging biomarkers in the diagnosis and prognosis of localized, high-risk PC, and the potential for their application in clinical practice. We focused on the theoretical molecular foundation of prostate carcinogenesis and explored the impact of genomic profiling, next-generation sequencing, and artificial intelligence in the extrapolation of customized features able to predict disease aggressiveness and possibly drive personalized therapeutic decisions. Full article
(This article belongs to the Special Issue Urological Cancer: Clinical Advances in Personalized Therapy)
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23 pages, 776 KiB  
Article
Rehumanizing AI-Driven Service: How Employee Presence Shapes Consumer Perceptions in Digital Hospitality Settings
by Eeman Almokdad, Kamel Mouloudj and Chung Hun Lee
J. Theor. Appl. Electron. Commer. Res. 2025, 20(3), 209; https://doi.org/10.3390/jtaer20030209 - 11 Aug 2025
Viewed by 310
Abstract
This study explores the psychological and social impacts of the forced use of self-service technologies (SSTs) in South Korea’s hospitality and tourism sectors, focusing on perceptions of service dehumanization among different age groups. Grounded in symbolic interactionism theory, the research aims to uncover [...] Read more.
This study explores the psychological and social impacts of the forced use of self-service technologies (SSTs) in South Korea’s hospitality and tourism sectors, focusing on perceptions of service dehumanization among different age groups. Grounded in symbolic interactionism theory, the research aims to uncover how reduced interpersonal interaction affects perceived service quality and emotional response. A quantitative approach was employed using data collected from 300 Korean adults (150 older adults and 150 young adults). The study utilized the PROCESS Macro to test mediation effects of reduced human contact, empathy, and authenticity, as well as the moderating role of employee presence in shaping dehumanization perceptions. The results indicate that the mandatory use of SSTs significantly diminishes the perceived social value of service encounters, thereby increasing feelings of dehumanization. This effect is mediated by a reduction in human contact, empathy, and authenticity. Moreover, the presence of employees moderates this relationship, particularly intensifying dehumanization perceptions among older adult participants. Gender was not a significant factor in these perceptions. These findings suggest that while SSTs may improve operational efficiency, their forced implementation can negatively impact customer experience, especially for older adults. Hospitality and tourism providers should consider hybrid service models that maintain optional human interaction to mitigate adverse psychological effects. This study contributes to the limited research on SSTs and service dehumanization by integrating symbolic interactionism theory and highlighting the moderating role of employee presence. It offers novel insights into age-related differences in SST acceptance and the socio-emotional costs of automation in service contexts. Full article
(This article belongs to the Special Issue Human–Technology Synergies in AI-Driven E-Commerce Environments)
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25 pages, 7359 KiB  
Article
Street Art in the Rain: Evaluating the Durability of Protective Coatings for Contemporary Muralism Through Accelerated Rain Ageing
by Laura Pagnin, Sara Goidanich, Nicolò Guarnieri, Francesca Caterina Izzo, Jaime Jorge Hormida Henriquez and Lucia Toniolo
Coatings 2025, 15(8), 924; https://doi.org/10.3390/coatings15080924 - 7 Aug 2025
Viewed by 289
Abstract
Contemporary muralism has gained increasing cultural and social relevance in recent years, becoming a prominent form of urban artistic expression. However, its outdoor exposure makes it highly vulnerable to environmental degradation, raising significant challenges for long-term preservation. While solar radiation is widely recognized [...] Read more.
Contemporary muralism has gained increasing cultural and social relevance in recent years, becoming a prominent form of urban artistic expression. However, its outdoor exposure makes it highly vulnerable to environmental degradation, raising significant challenges for long-term preservation. While solar radiation is widely recognized as a main agent of deterioration, the impact of rainfall has received comparatively little attention. This study addresses this gap by evaluating the durability of commercial protective coatings applied to modern paints (alkyd, acrylic, and styrene-acrylic) under simulated rain exposure. The ageing protocol replicates approximately 10 years of cumulative rainfall in Central-Southern Europe. A key innovation of this research is the use of a custom-built rain chamber, uniquely designed to expose a large number of samples simultaneously under highly uniform and controlled rain conditions. The system ensures reproducible exposure through a precision-controlled moving platform and programmable rain delivery. A comprehensive set of analytical techniques was employed to assess morphological, chemical, and functional changes in the coatings and paints before and after ageing. Results highlight the limited performance of current protective materials and the need for more effective solutions for the conservation of contemporary outdoor artworks. Full article
(This article belongs to the Section Surface Characterization, Deposition and Modification)
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36 pages, 1202 KiB  
Article
Exploring Service Needs and Development Strategies for the Healthcare Tourism Industry Through the APA-NRM Technique
by Chung-Ling Kuo and Chia-Li Lin
Sustainability 2025, 17(15), 7068; https://doi.org/10.3390/su17157068 - 4 Aug 2025
Viewed by 293
Abstract
With the arrival of an aging society and the continuous extension of the human lifespan, the quality of life has not improved in a corresponding manner. People’s demand for happiness and health is increasing. As a result, a model emerged that integrates tourism [...] Read more.
With the arrival of an aging society and the continuous extension of the human lifespan, the quality of life has not improved in a corresponding manner. People’s demand for happiness and health is increasing. As a result, a model emerged that integrates tourism and medical services, which is health tourism. This growing demand has prompted many service providers to see it as a business opportunity and enter the market. Tourism can help travelers release work stress and restore physical and mental balance; meanwhile, health check-ups and disease treatment can help them regain health. Consumers have long favored health and medical tourism because it helps relieve stress and promotes overall well-being. As people age, some consumers experience a gradual decline in physical functions, making it difficult for them to participate in regular travel services provided by traditional travel agencies. Therefore, this study aims to explore the service needs of health and medical tourism customers (tourists/patients) and the interrelationships among these service needs, so that health and medical tourism service providers can develop more customized and diversified services. This study identifies four key drivers of medical tourism services: medical services, medical facilities, tour planning, and hospitality facilities. This study uses the APA (attention and performance analysis) method to assess each dimension and criterion and utilizes the DEMATEL method with the NRM (network relationship map) to identify network relationships. By combining APA and NRM techniques, this study develops the APA-NRM technique to evaluate adoption strategies and identify suitable paths for health tourism services, providing tailored development strategies and recommendations for service providers to enhance the service experience. Full article
(This article belongs to the Special Issue Inclusive Tourism and Its Place in Sustainable Development Concepts)
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33 pages, 5056 KiB  
Article
Interpretable Deep Learning Models for Arrhythmia Classification Based on ECG Signals Using PTB-X Dataset
by Ahmed E. Mansour Atwa, El-Sayed Atlam, Ali Ahmed, Mohamed Ahmed Atwa, Elsaid Md. Abdelrahim and Ali I. Siam
Diagnostics 2025, 15(15), 1950; https://doi.org/10.3390/diagnostics15151950 - 4 Aug 2025
Viewed by 756
Abstract
Background/Objectives: Automatic classification of ECG signal arrhythmias plays a vital role in early cardiovascular diagnostics by enabling prompt detection of life-threatening conditions. Manual ECG interpretation is labor-intensive and susceptible to errors, highlighting the demand for automated, scalable approaches. Deep learning (DL) methods are [...] Read more.
Background/Objectives: Automatic classification of ECG signal arrhythmias plays a vital role in early cardiovascular diagnostics by enabling prompt detection of life-threatening conditions. Manual ECG interpretation is labor-intensive and susceptible to errors, highlighting the demand for automated, scalable approaches. Deep learning (DL) methods are effective in ECG analysis due to their ability to learn complex patterns from raw signals. Methods: This study introduces two models: a custom convolutional neural network (CNN) with a dual-branch architecture for processing ECG signals and demographic data (e.g., age, gender), and a modified VGG16 model adapted for multi-branch input. Using the PTB-XL dataset, a widely adopted large-scale ECG database with over 20,000 recordings, the models were evaluated on binary, multiclass, and subclass classification tasks across 2, 5, 10, and 15 disease categories. Advanced preprocessing techniques, combined with demographic features, significantly enhanced performance. Results: The CNN model achieved up to 97.78% accuracy in binary classification and 79.7% in multiclass tasks, outperforming the VGG16 model (97.38% and 76.53%, respectively) and state-of-the-art benchmarks like CNN-LSTM and CNN entropy features. This study also emphasizes interpretability, providing lead-specific insights into ECG contributions to promote clinical transparency. Conclusions: These results confirm the models’ potential for accurate, explainable arrhythmia detection and their applicability in real-world healthcare diagnostics. Full article
(This article belongs to the Section Machine Learning and Artificial Intelligence in Diagnostics)
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20 pages, 4292 KiB  
Article
A Novel Method for Analysing the Curvature of the Anterior Lens: Multi-Radial Scheimpflug Imaging and Custom Conic Fitting Algorithm
by María Arcas-Carbonell, Elvira Orduna-Hospital, María Mechó-García, Guisela Fernández-Espinosa and Ana Sanchez-Cano
J. Imaging 2025, 11(8), 257; https://doi.org/10.3390/jimaging11080257 - 1 Aug 2025
Viewed by 241
Abstract
This study describes and validates a novel method for assessing anterior crystalline lens curvature along vertical and horizontal meridians using radial measurements derived from Scheimpflug imaging. The aim was to evaluate whether pupil diameter (PD), anterior lens curvature, and anterior chamber depth (ACD) [...] Read more.
This study describes and validates a novel method for assessing anterior crystalline lens curvature along vertical and horizontal meridians using radial measurements derived from Scheimpflug imaging. The aim was to evaluate whether pupil diameter (PD), anterior lens curvature, and anterior chamber depth (ACD) change during accommodation and whether these changes are age-dependent. A cross-sectional study was conducted on 104 right eyes from healthy participants aged 21–62 years. Sixteen radial images per eye were acquired using the Galilei Dual Scheimpflug Placido Disk Topographer under four accommodative demands (0, 1, 3, and 5 dioptres (D)). Custom software analysed lens curvature by calculating eccentricity in both meridians. Participants were analysed as a total group and by age subgroups. Accommodative amplitude and monocular accommodative facility were inversely correlated with age. Both PD and ACD significantly decreased with higher accommodative demands and age. Relative eccentricity decreased under accommodation, indicating increased lens curvature, especially in younger participants. Significant curvature changes were detected in the horizontal meridian only, although no statistically significant differences between meridians were found overall. The vertical meridian showed slightly higher eccentricity values, suggesting that it remained less curved. By enabling detailed, meridionally stratified in vivo assessment of anterior lens curvature, this novel method provides a valuable non-invasive approach for characterizing age-related biomechanical changes during accommodation. The resulting insights enhance our understanding of presbyopia progression, particularly regarding the spatial remodelling of the anterior lens surface. Full article
(This article belongs to the Special Issue Current Progress in Medical Image Segmentation)
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23 pages, 458 KiB  
Article
Cross-Cultural Competence in Tourism and Hospitality: A Case Study of Quintana Roo, Mexico
by María del Pilar Arjona-Granados, Antonio Galván-Vera, José Ángel Sevilla-Morales and Martín Alfredo Legarreta-González
World 2025, 6(3), 108; https://doi.org/10.3390/world6030108 - 1 Aug 2025
Viewed by 1129
Abstract
Economic growth, especially in emerging economies, has altered the composition of international tourism. It is therefore essential to possess the skills necessary to understand the influence of culture on human behaviour, thereby enabling an appropriate response to the traveller. This research aims to [...] Read more.
Economic growth, especially in emerging economies, has altered the composition of international tourism. It is therefore essential to possess the skills necessary to understand the influence of culture on human behaviour, thereby enabling an appropriate response to the traveller. This research aims to develop a tool for identifying openness, flexibility, awareness, and intercultural preparedness. It focuses on the metacognitive and cognitive aspects of cultural intelligence that shape the development of empathy in customer service staff in hotels in Quintana Roo. The variables were validated and incorporated into a quantitative study using multivariate analysis and inferential statistics. A sample of 77 questionnaires was analysed using simple random sampling under a proportional design. Multiple Correspondence Analysis (MCA) was employed as a discriminatory technique to identify the most significant independent variables. These were subsequently entered as regressors into ordinal logistic regression (OLR), along with age and work experience, in order to estimate the probabilities associated with each level of the dependent variable. The results indicated that age had minimal influence on the metacognitive and cognitive variables, whereas years of experience among tourism staff exerted a significant effect. Full article
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13 pages, 436 KiB  
Article
Hospital Pharmacists’ Perspectives on Adverse Drug Reaction Reporting in Developed and Developing  Countries: A Comparative Pilot Study
by Javeria Khalid, Tarilate Temedie-Asogwa, Marjan Zakeri and Sujit S. Sansgiry
Pharmacy 2025, 13(4), 103; https://doi.org/10.3390/pharmacy13040103 - 29 Jul 2025
Viewed by 343
Abstract
Adverse drug reactions (ADRs) significantly affect patient safety and healthcare spending worldwide. Hospital pharmacists are uniquely positioned to address ADRs due to their crucial role in medication management. However, underreporting remains a global concern, especially in developing countries, where pharmacovigilance systems are inadequately [...] Read more.
Adverse drug reactions (ADRs) significantly affect patient safety and healthcare spending worldwide. Hospital pharmacists are uniquely positioned to address ADRs due to their crucial role in medication management. However, underreporting remains a global concern, especially in developing countries, where pharmacovigilance systems are inadequately developed. Therefore, this pilot study aimed to evaluate and compare the knowledge, attitudes, perceived barriers, and facilitators regarding ADR reporting by hospital pharmacists in a developed (US) and a developing (Pakistan) country. A cross-sectional survey was conducted, using a pre-validated questionnaire. The pharmacists, possessing a minimum of one year’s hospital experience, were selected via convenience sampling. Out of 151 respondents, included in the final analysis (US: n = 51; Pakistan: n = 100), the majority were female (62.3%), aged 29–35 years (38%), and possessed a Pharm. D degree (49.7%). The knowledge (US: 6.03 ± 0.27 vs. Pakistan:5.69 ± 0.25, p-value = 0.193) and attitude scores (US: 32.02 ± 0.73 vs. Pakistan: 32.63 ± 0.67; p-value = 0.379) exhibited no significant differences between the groups. Nonetheless, barriers at both the individual and systemic levels were more pronounced in the developing country. Important facilitators reported were mobile applications for ADR reporting, specialized training, and intuitive reporting tools. In conclusion, we found that pharmacists in both settings exhibit comparable knowledge and positive attitudes towards ADR reporting, though specific contextual barriers are present. Interventions customized to the local hospital infrastructure are crucial for enhancing ADR reporting, particularly in resource-constrained settings. Full article
(This article belongs to the Section Pharmacy Practice and Practice-Based Research)
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8 pages, 232 KiB  
Article
Clinical Analysis of TMJ Replacement Using a Customized Prosthesis
by Sergio Olate, Víctor Ravelo, Gonzalo Muñoz, Carlos Gaete, Rodrigo Goya and Rômulo Valente
J. Clin. Med. 2025, 14(15), 5314; https://doi.org/10.3390/jcm14155314 - 28 Jul 2025
Viewed by 268
Abstract
Background/Objectives: This study aims to uncover the variables related to the success of the intervention. Methods: A retrospective study was conducted on patients who underwent joint replacement surgery utilizing a customized alloplastic system between 2018 and 2023, comprising subjects with complete records for [...] Read more.
Background/Objectives: This study aims to uncover the variables related to the success of the intervention. Methods: A retrospective study was conducted on patients who underwent joint replacement surgery utilizing a customized alloplastic system between 2018 and 2023, comprising subjects with complete records for both the planning and follow-up phases. The Student’s t-test was applied with a significance threshold of p < 0.05. Results: Forty-eight subjects were admitted for initial analysis, and 31 subjects were evaluated with a minimum follow-up of 1 year and a maximum of 7 years, with a mean age of 36.37 ± 15.53. The TMJ diagnosis was mainly with degenerative TMJ disease, followed by ankylosis and craniofacial syndromes, and an average of 2.1 ± 1.2 previous surgeries were noted. Degenerative joint disease correlated with increased pain (p < 0.0001) and a higher prevalence of prior joint surgery (p < 0.0001). Thirty-one subjects were followed up with 47 prostheses installed; 74.4% underwent complementary surgery with other facial osteotomies. Significant improvements (p < 0.0001) were observed when comparing pain levels pre- and postoperatively, with a decrease from 5.5 (±2.3) to 2.2 (±0.4). Concerning the interincisal opening, there was a significant increase (p < 0001) from 25.85 (±10.2) mm to 35.93 (±4.2) mm in mouth opening. TMJ replacement treatment is efficient and effective, demonstrating stability in follow-up assessments for up to 7 years. Conclusions: The indications for replacement are diverse and may benefit patients who have not yet progressed to end-stage TMJ disease. Full article
(This article belongs to the Special Issue Innovations in Plastic and Reconstructive Research)
14 pages, 285 KiB  
Article
Effects of Stretching and Resistance Training on Psychophysical Awareness: A Pilot Study
by Giovanni Esposito, Rosario Ceruso, Pietro Luigi Invernizzi, Vincenzo Manzi and Gaetano Raiola
Appl. Sci. 2025, 15(15), 8259; https://doi.org/10.3390/app15158259 - 24 Jul 2025
Viewed by 469
Abstract
Muscle–joint flexibility is defined as the ability of a muscle to stretch in a controlled manner, allowing a wide range of movement at the joints. While numerous methodologies exist for improving flexibility, few studies have investigated the role of athletes’ perceptual processes and [...] Read more.
Muscle–joint flexibility is defined as the ability of a muscle to stretch in a controlled manner, allowing a wide range of movement at the joints. While numerous methodologies exist for improving flexibility, few studies have investigated the role of athletes’ perceptual processes and awareness related to their own body and movement control during such training. In this pilot study, we explored how two different training protocols—static and dynamic stretching (control group, CON) and multi-joint resistance training (experimental group, EXP)—influence both flexibility and psychophysical awareness, understood as a multidimensional construct involving perceived flexibility improvements, self-assessed control over exercise execution, and cognitive-emotional responses such as engagement, motivation, and satisfaction during physical effort. The study involved 24 male amateur track-and-field athletes (mean age 23 ± 2.5 years), randomized into two equal groups. Over 12 weeks, both groups trained three times per week. Flexibility was assessed using the Sit and Reach Test at three time points (pre-, mid-, and post-intervention). A 2 × 3 mixed ANOVA revealed a significant group × time interaction (F = 20.17, p < 0.001), with the EXP group showing greater improvements than the CON group. In the EXP group, Sit and Reach scores increased from pre = 28.55 cm (SD = 4.91) to mid = 29.39 cm (SD = 4.67) and post = 29.48 cm (SD = 4.91), with a significant difference between pre and post (p = 0.01; d = 0.35). The CON group showed minimal changes, with scores of pre = 28.66 cm (SD = 4.92), mid = 28.76 cm (SD = 5.03), and post = 28.84 cm (SD = 5.10), and no significant difference between pre and post (p = 0.20; d = 0.04). Psychophysical awareness was assessed using a custom questionnaire structured on a 5-point Likert scale, with items addressing perception of flexibility, motor control, and exercise-related bodily sensations. The questionnaire showed excellent internal consistency (Cronbach’s α = 0.92). Within the EXP group, psychophysical awareness increased significantly (from 3.50 to 4.17; p = 0.01; d = 0.38), while no significant change occurred in the CON group (p = 0.16). Post-hoc power analysis confirmed small to moderate effect sizes within the EXP group, although between-group differences lacked sufficient statistical power. These results suggest that resistance training may improve flexibility and concurrently enhance athletes’ psychophysical self-awareness more effectively than traditional stretching. Such findings offer practical implications for coaches seeking to optimize flexibility training by integrating alternative methods that promote both physical and perceptual adaptations. Full article
(This article belongs to the Section Applied Biosciences and Bioengineering)
19 pages, 794 KiB  
Article
Implementation and Adherence of a Custom Mobile Application for Anonymous Bidirectional Communication Among Nearly 4000 Participants: Insights from the Longitudinal RisCoin Study
by Ana Zhelyazkova, Sibylle Koletzko, Kristina Adorjan, Anna Schrimf, Stefanie Völk, Leandra Koletzko, Alexandra Fabry-Said, Andreas Osterman, Irina Badell, Marc Eden, Alexander Choukér, Marina Tuschen, Berthold Koletzko, Yuntao Hao, Luke Tu, Helga P. Török, Sven P. Wichert and Thu Giang Le Thi
Infect. Dis. Rep. 2025, 17(4), 88; https://doi.org/10.3390/idr17040088 - 24 Jul 2025
Viewed by 308
Abstract
Background: The longitudinal RisCoin study investigated risk factors for COVID-19 vaccination failure among healthcare workers (HCWs) and patients with inflammatory bowel disease (IBD) at a University Hospital in Germany. Since the hospital served as the study sponsor and employer of the HCW, [...] Read more.
Background: The longitudinal RisCoin study investigated risk factors for COVID-19 vaccination failure among healthcare workers (HCWs) and patients with inflammatory bowel disease (IBD) at a University Hospital in Germany. Since the hospital served as the study sponsor and employer of the HCW, we implemented a custom mobile application. We aimed to evaluate the implementation, adherence, benefits, and limitations of this study’s app. Methods: The app allowed secure data collection through questionnaires, disseminated serological results, and managed bidirectional communication. Access was double-pseudonymized and irreversibly anonymized six months after enrollment. Download frequency, login events, and questionnaire submissions between October 2021 and December 2022 were analyzed. Multivariable logistic regression identified factors associated with app adherence. Results: Of the 3979 participants with app access, 3622 (91%) used the app; out of these, 1016 (28%) were “adherent users” (≥12 submitted questionnaires). App adherence significantly increased with age. Among HCW, adherent users were more likely to be non-smokers (p < 0.001), working as administrators or nursing staff vs. physicians (p < 0.001), vaccinated against influenza (p < 0.001), and had not travelled abroad in the past year (p < 0.001). IBD patients exposed to SARS-CoV-2 (p = 0.0133) and those with adverse events following the second COVID-19 vaccination (p = 0.0171) were more likely adherent app users. Despite technical issues causing dropout or non-adherence, the app served as a secure solution for cohort management and longitudinal data collection. Discussion: App-based cohort management enabled continuous data acquisition and individualized care while providing flexibility and anonymity for the study team and participants. App usability, technical issues, and cohort characteristics need to be thoroughly considered prior to implementation to optimize usage and adherence in clinical research. Full article
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13 pages, 879 KiB  
Article
Mortality Trends and Characteristics in a Tertiary Hospital in Southwest Saudi Arabia: A 5-Year Retrospective Study
by Layla Ali Shaabi, Mohamed Salih Mahfouz, Ahmed Essa Shamakhi, Fathadin Ali Abdu Alahdal, Ali Hakamy and Fatma Rajhi
Medicina 2025, 61(8), 1334; https://doi.org/10.3390/medicina61081334 - 24 Jul 2025
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Abstract
Background and Objectives: Hospital mortality rates have repeatedly been used as important indicators of the quality of care provided and as a good monitoring and evaluation tool. Studies on hospital mortality in Saudi Arabia are scant, with most of the available literature focusing [...] Read more.
Background and Objectives: Hospital mortality rates have repeatedly been used as important indicators of the quality of care provided and as a good monitoring and evaluation tool. Studies on hospital mortality in Saudi Arabia are scant, with most of the available literature focusing on the COVID-19 era. In this study, the patterns and trends in inpatient mortality at King Fahad Central Hospital in southwest Saudi Arabia from 2018 to 2022 were analyzed. Mortality characteristics, including age-specific mortality rates and associated factors, were also investigated. Materials and Methods: This was a retrospective study analyzing hospital mortality data in King Fahad Central Hospital (KFCH) from 2018 to 2022 using the largest hospital discharge database in the Jazan region. The mortality rates were calculated, and 95% confidence intervals (CIs) were reported. The analysis also documented some associations using logistic regression models. Results: Of the 62,534 patients admitted, 36,971 (59.1%) were females, and 25,543 (40.9%) were males. The mean age (standard deviation) was 24.6 (22.8) years. The overall hospital mortality was 4.8% [95% CI: 4.6–5.0] and was significantly higher among males [7.0%, 95% CI: 6.7–7.3] than females [3.2% 95% CI: 3.1–3.4] (p < 0.05). Mortality was significantly higher in the population aged 60 years and above [17.25%, 95% CI: 16.3–18.2] (p < 0.001). During the five-year period analyzed, mortality was low in 2018 (3.3%), with remarkably high rates during the COVID-19 period of 2020 and 2021 (5.6% and 6.0%, respectively). The disease groups with the highest prevalence of mortality include certain conditions originating in the perinatal period. In the logistic regression model, the male sex [odds ratio OR = 2.3, 95% CI = 2.01–2.43) was associated with an increased mortality risk. Compared to intensive care beds, general bed departments are associated with a 98% lower risk of mortality [OR = 0.015, 95% CI = 0.014–0.017]. Conclusions: This analysis of hospital data statistics revealed a relatively low hospital mortality rate in Jazan. However, the high mortality rates among male patients require further analysis and investigation. Customized interventions targeting high-mortality diseases are recommended. Full article
(This article belongs to the Section Epidemiology & Public Health)
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