Search Results (386)

Cardiovascular disease remains the world’s leading cause of mortality, yet everyday care still relies on episodic, symptom-driven interventions that detect ischemia, arrhythmias, and remodeling only after tissue damage has begun, limiting the effectiveness of therapy. A narrative review synthesized 183 studies published between 2016 and 2025 that were located through PubMed, MDPI, Scopus, IEEE Xplore, and Web of Science. This review examines CVD diagnostics using innovative technologies such as digital cardiovascular twins, which involve the collection of data from wearable IoT devices (electrocardiography (ECG), photoplethysmography (PPG), and mechanocardiography), clinical records, laboratory biomarkers, and genetic markers, as well as their integration with artificial intelligence (AI), including machine learning and deep learning, graph and transformer networks for interpreting multi-dimensional data streams and creating prognostic models, as well as generative AI, medical large language models (LLMs), and autonomous agents for decision support, personalized alerts, and treatment scenario modeling, and with cloud and edge computing for data processing. This multi-layered architecture enables the detection of silent pathologies long before clinical manifestations, transforming continuous observations into actionable recommendations and shifting cardiology from reactive treatment to predictive and preventive care. Evidence converges on four layers: sensors streaming multimodal clinical and environmental data; hybrid analytics that integrate hemodynamic models with deep-, graph- and transformer learning while Bayesian and Kalman filters manage uncertainty; decision support delivered by domain-tuned medical LLMs and autonomous agents; and prospective simulations that trial pacing or pharmacotherapy before bedside use, closing the prediction-intervention loop. This stack flags silent pathology weeks in advance and steers proactive personalized prevention. It also lays the groundwork for software-as-a-medical-device ecosystems and new regulatory guidance for trustworthy AI-enabled cardiovascular care. Full article

Genealogy is the study of family history and ancestral lineage, tracing relationships across generations through records and narratives. The digital revolution has shifted genealogical research from traditional archives to online platforms. Grounded in knowledge co-creation theory, this study examined the role of social media communities and their managers as knowledge hubs within the genealogical ecosystem. Its central innovation lies in identifying two emerging actors in modern genealogical knowledge ecology: the online community as a hub of expertise and the community manager as a key figure in knowledge creation. Drawing on interviews with fifteen Facebook managers of genealogical communities from diverse Jewish backgrounds worldwide, the study explored their perceptions of online genealogical spaces and their roles as facilitators of knowledge. Participants demonstrated a high level of professionalism and thoughtful engagement with sources; however, verifying the accuracy of genealogical claims was not within the scope of this study. Interviews were conducted in English and Hebrew based on participant preference. Thematic analysis revealed five key areas: two focused on the community’s role as a knowledge hub for both members and outsiders, and three on the manager’s role through self-perception, member engagement, and strategic initiatives. As part of a broader dissertation, this chapter deepens understanding of collaborative, community-driven genealogical knowledge in the age of social media. Full article

Diverse realities challenge the management capacity of public and private systems to ensure equitable quality and efficient access to resources, in line with the 2030 Agenda and the Sustainable Development Goals, which aim to close gaps in essential services and ensure quality of life. The reality in Spain, and more specifically in the Principality of Asturias, is that most resources are concentrated in urban areas rather than rural ones, partly due to the region’s geography. Background/Objectives: This study aimed to explore the perspectives of various stakeholders on the early childhood care system in the Principality of Asturias (Spain), with the purpose of analyzing the mechanisms and determinants involved in its functioning and identifying opportunities for improvement. Methods: A qualitative study was conducted using the theoretical framework of the National Institute on Minority Health and Health Disparities (NIMHD) as a conceptual basis. Semi-structured interviews were carried out with 24 participants selected based on their relationship with early childhood care systems, encompassing different levels of responsibility and operational roles. Data were analyzed using a phenomenological approach, employing inductive and deductive coding to identify recurring patterns and code co-occurrences within ATLAS.ti software. Conclusions: This study reveals major barriers to equitable early childhood intervention (ECI) in rural areas, such as geographic isolation, lack of specialists, long waiting times, and poor transport. Six key themes emerged, including the need for standardized system management, better family support, and digital tools like centralized electronic health records. Rural areas are directly limited regarding their access to services, highlighting the need for fair territorial planning and a holistic, inclusive care model. Improving coordination, accessibility, and technology is vital. Full article

In the current data-driven era, effective data sharing is set to unlock billions in value for aerospace and complex manufacturing and their supply chains by enhancing product quality, boosting manufacturing and operational efficiency, and generating new value streams. However, current practices are hindered by fragmented data ecosystems, isolated silos, and reliance on paper-based documentation. Although the Digital Thread (DTh) initiative holds promise, its implementation remains impractical due to interoperability challenges, security and intellectual property risks, and the inherent difficulty of capturing and managing the overwhelming volume of data in such complex products as a holistic thread. This paper introduces the Manufacturing Digital Passport (MDP), a novel industry-driven concept that employs a product-centric, system-independent digital carrier to facilitate targeted, structured sharing of technical product data across the supply chain. The conceptual contribution of this work is the analytical formalisation of the MDP as a value-oriented carrier that shifts DTh thinking from costly, system-wide interoperability toward an incremental, ROI-driven record of lifecycle data. Rooted in real-world challenges and built on foundational principles of modularity, value creation, and model-based structures, the MDP, by design, enhances traceability, security, and trust through a bottom-up, incremental, use case-driven approach. The paper outlines its benefits through core design principles, definition, practical features, and integration strategies with legacy systems, laying the groundwork for a structured adoption roadmap in high-value manufacturing ecosystems. Full article

The Cau River Basin in northeastern Vietnam is an ecologically and economically important watershed, yet it has lacked comprehensive hydrological modelling to date. Characterised by highly complex topography, diverse land use/land cover, and limited hydrometeorological data, the basin presents challenges for water resource assessment and management. This study applies the SWAT hydrological model to simulate streamflow dynamics in the Cau River Basin over a 31-year period (1990–2020) using multiple-source geospatial data, including a 30 m digital elevation model, official soil and land use maps, and daily climate records from six meteorological stations. Model calibration (1997–2008) and validation (2009–2020) were conducted using the SWAT-CUP tool, achieving strong performance with a Nash–Sutcliffe Efficiency (NSE) of 0.95 and 0.90, and R² of 0.95 and 0.91, respectively. Sensitivity analysis identified four key parameters most influential on streamflow (curve number, saturated hydraulic conductivity, soil evaporation compensation factor, and available water capacity), supporting a more focused and effective calibration process. Model results revealed substantial spatio-temporal variability in runoff, with annual surface runoff ranging from 19.8 mm (2011) to 56.4 mm (2013), generally lower in upstream sub-watersheds (<30 mm) and higher in downstream areas (>60 mm). The simulations also showed a clear seasonal contrast between the wet and dry periods. These findings support evidence-based strategies for flood and drought mitigation, inform agricultural and land use planning, and offer a transferable modelling framework for similarly complex watersheds. Full article

Radiofrequency ablation (RFA) and pulsed radiofrequency (PRF) are non-pharmacological techniques employed in humans for chronic pain, but their veterinary application is unexplored. This pilot study evaluated clinical effects of RFA and PRF in twenty-four horses with chronic distal forelimb lameness. Ultrasound-guided RFA (N = 8; 60–90 °C, 2–8 min) or PRF (N = 16; 42 °C; 12 min) was applied to palmar digital nerves. Lameness was scored (American Association of Equine Practitioners scale) at baseline and monthly for six months (T1-T6). At T2, partial- and non-responders in both groups received PRF. Complications and return to previous work were recorded. At T2, the PRF group had significantly lower lameness scores (1, 0–3) than the RFA group (3, 2–4; p < 0.001) and significantly improved from baseline (3, 2–4; p < 0.01). RFA caused more complications (N = 6) than PRF (N = 1; p < 0.001), including increased lameness and allodynia. Sixteen horses (RFA: N = 7; PRF: N = 9) were retreated at T2. Overall, lameness significantly improved from T2 (2, 0–4) to T6 (0, 0–3; p < 0.001). At T6, 83% (19/23) of horses resumed previous work. RFA was ineffective and caused complications, whereas PRF appeared safer and more effective. Two PRF treatments yielded better outcomes with fewer side effects and may help manage lameness and associated pain for up to six months. Full article

As medical technology develops and digital demands grow, personal health records (PHRs) are becoming more patient-centered than before based on cloud-based health information exchanges. While enhancing data accessibility and sharing, these systems present privacy and security issues, including data breaches and unauthorized access. We developed a post-quantum, group-oriented encryption scheme using the Crystal-Kyber Key encapsulation mechanism (KEM). Leveraging lattice-based post-quantum cryptography, this scheme ensures quantum resilience and chosen ciphertext attack security for layered cloud PHR environments. It supports four encryption modes: individual, group, subgroup-specific, and authorized subgroup decryption, meeting diverse data access needs. With efficient key management requiring only one private key per user, the developed scheme strengthens the privacy and security of PHRs in a future-proof, flexible, and scalable manner. Full article

This study synthesizes the rapidly expanding evidence on how digital technologies reshape international trade, with a particular focus on small and medium-sized enterprises (SMEs). Guided by two research questions—(RQ1) How do digital tools influence the volume and composition of cross-border trade? and (RQ2) How do these effects vary by countries’ development level and firm size?—we conducted a PRISMA-compliant systematic literature review covering 2010–2024. Searches across eight major databases yielded 1857 records; after duplicate removal, title/abstract screening, full-text assessment, and Mixed Methods Appraisal Tool (MMAT 2018) quality checks, 86 peer-reviewed English-language studies were retained. Findings reveal three dominant technology clusters: (1) e-commerce platforms and cloud services, (2) IoT-enabled supply chain solutions, and (3) emerging AI analytics. E-commerce and cloud adoption consistently raise export intensity—doubling it for digitally mature SMEs—while AI applications are the fastest-growing research strand, particularly in East Asia and Northern Europe. However, benefits are uneven: firms in low-infrastructure settings face higher fixed digital costs, and cybersecurity and regulatory fragmentation remain pervasive obstacles. By integrating trade economics with development and SME internationalization studies, this review offers the first holistic framework that links national digital infrastructure and policy support to firm-level export performance. It shows that the trade-enhancing effects of digitalization are contingent on robust broadband penetration, affordable cloud access, and harmonized data-governance regimes. Policymakers should, therefore, prioritize inclusive digital-readiness programs, while business leaders should invest in complementary capabilities—data analytics, cyber-risk management, and cross-border e-logistics—to fully capture digital trade gains. This balanced perspective advances theory and practice on building resilient, equitable digital trade ecosystems. Full article

Background: This study aims to compare the logistical challenges of Home Health Care (HHC) services in Portugal and Brazil, highlighting the structural and operational differences between both systems. Methods: Guided by an abductive research approach, data were collected using a semi-structured survey with open-ended questions, applied to 13 HHC teams in Portugal and 18 in Brazil, selected based on national coordination recommendations. The data collection process was conducted in person, and responses were analyzed using descriptive statistics and qualitative content analysis. Results: The results reveal that Portugal demonstrates higher productivity, stronger territorial coverage, and a more integrated inventory management system, while Brazil presents greater multidisciplinary team integration, more flexible fleet logistics, and more advanced digital health records. Despite these strengths, both countries continue to address key logistical aspects, such as scheduling, supply distribution, and data management, largely through empirical strategies. Conclusions: This research contributes to the theoretical understanding of international HHC logistics by emphasizing strategic and systemic aspects often overlooked in operational studies. In practical terms, it offers insights for public health managers to improve resource allocation, fleet coordination, and digital integration in aging societies. Full article

Many hospitals still lack digital traceability in hygiene and cleaning management, leading to operational inefficiencies and inconsistent quality control. This study aims to establish cleaning and hygiene processes in healthcare services that are planned in accordance with standards, as well as to enhance the traceability and sustainability of these processes through digitalization. This study proposes a Hyperledger Fabric-based blockchain architecture to establish a reliable and transparent quality assurance system in process management. The proposed Quality Assurance Model utilizes digital technologies and IoT-based RFID devices to ensure the transparent and reliable monitoring of cleaning processes. Operational data related to cleaning processes are automatically recorded and secured using a decentralized blockchain infrastructure. The permissioned nature of Hyperledger Fabric provides a more secure solution compared to traditional data management systems in the healthcare sector while preserving data privacy. Additionally, the execute–order–validate mechanism supports effective data sharing among stakeholders, and consensus algorithms along with chaincode rules enhance the reliability of processes. A working prototype was implemented and validated using Hyperledger Caliper under resource-constrained cloud environments, confirming the system’s feasibility through over 100 TPS throughput and zero transaction failures. Through the proposed system, cleaning/hygiene processes in patient rooms are conducted securely, contributing to the improvement of quality standards in healthcare services. Full article

Background: Despite significant advancements in diabetes care, many individuals with type 2 diabetes (T2D) do not receive optimal care and treatment. Digital interventions promoting behavioral changes have shown promising long-term results in supporting healthier lifestyles but are not implemented in most healthcare offerings, maybe due to lack of general practice support and collaboration. This study evaluates the efficacy of the Digital, Individualized, and Collaborative Treatment of T2D in General Practice Based on Decision Aid (DICTA), a randomized controlled trial integrating a patient-centered smartphone application for lifestyle support in conjunction with a clinical decision support (CDS) tool to assist general practitioners (GPs) in optimizing antidiabetic treatment. Methods: The present randomized controlled trial aims to recruit 400 individuals with T2D from approximately 70 GP clinics (GPCs) in Denmark. The GPCs will be cluster-randomized in a 2:3 ratio to intervention or control groups. The intervention group will receive one year of individualized eHealth lifestyle coaching via a smartphone application, guided by patient-reported outcomes (PROs). Alongside this, the GPCs will have access to the CDS tool to optimize pharmacological decision-making through electronic health records. The control group will receive usual care for one year, followed by the same intervention in the second year. Results: The primary outcome is the one-year change in estimated ten-year cardiovascular risk, assessed by SCORE2-Diabetes calculated from age, smoking status, systolic blood pressure, total and high-density lipoprotein cholesterol, age at diabetes diagnosis, HbA1c, and eGFR. Conclusions: If effective, DICTA could offer a scalable, digital-first approach for improving T2D management in primary care by combining patient-centered lifestyle coaching with real-time pharmacological clinical decision support. Full article

Healthcare Information Systems (HISs) are essential for improving care quality, managing chronic diseases, and supporting clinical decision-making. Despite significant investments, HIS implementations often fail due to the complexity of healthcare environments. Maturity Models (MMs) have emerged as tools to guide organizational improvement by assessing readiness, process efficiency, technology adoption, and interoperability. This study presents a comprehensive literature review identifying 45 Maturity Models used across various healthcare domains, including telemedicine, analytics, business intelligence, and electronic medical records. These models, often based on Capability Maturity Model Integration (CMMI), vary in structure, scope, and maturity stages. The findings demonstrate that structured maturity assessments help healthcare organizations plan, implement, and optimize HIS more effectively, leading to enhanced clinical and operational performance. This review contributes to an understanding of how different MMs can support healthcare digital transformation and provides a resource for selecting appropriate models based on specific organizational goals and technological contexts. Full article

This comprehensive review maps the fast-evolving landscape in which artificial intelligence (AI) and deep-learning (DL) techniques converge with the Internet of Things (IoT) to manage energy, comfort, and sustainability across smart environments. A PRISMA-guided search of four databases retrieved 1358 records; after applying inclusion criteria, 143 peer-reviewed studies published between January 2019 and April 2025 were analyzed. This review shows that AI-driven controllers—especially deep-reinforcement-learning agents—deliver median energy savings of 18–35% for HVAC and other major loads, consistently outperforming rule-based and model-predictive baselines. The evidence further reveals a rapid diversification of methods: graph-neural-network models now capture spatial interdependencies in dense sensor grids, federated-learning pilots address data-privacy constraints, and early integrations of large language models hint at natural-language analytics and control interfaces for heterogeneous IoT devices. Yet large-scale deployment remains hindered by fragmented and proprietary datasets, unresolved privacy and cybersecurity risks associated with continuous IoT telemetry, the growing carbon and compute footprints of ever-larger models, and poor interoperability among legacy equipment and modern edge nodes. The authors of researches therefore converges on several priorities: open, high-fidelity benchmarks that marry multivariate IoT sensor data with standardized metadata and occupant feedback; energy-aware, edge-optimized architectures that lower latency and power draw; privacy-centric learning frameworks that satisfy tightening regulations; hybrid physics-informed and explainable models that shorten commissioning time; and digital-twin platforms enriched by language-model reasoning to translate raw telemetry into actionable insights for facility managers and end users. Addressing these gaps will be pivotal to transforming isolated pilots into ubiquitous, trustworthy, and human-centered IoT ecosystems capable of delivering measurable gains in efficiency, resilience, and occupant wellbeing at scale. Full article

Background: Cyclic vomiting syndrome (CVS) is a functional gastrointestinal disorder characterized by recurrent episodes of intense nausea and vomiting. Despite increasing awareness, a standardized treatment approach remains lacking in pediatric populations. Lifestyle factors and anxiety are common triggers, yet their systematic management has not been fully incorporated into therapeutic strategies. Objective: To evaluate the effectiveness of lifestyle modifications and selective serotonin reuptake inhibitors (SSRIs) in the management of pediatric CVS and to compare their outcomes with standard cyproheptadine prophylaxis. Methods: This retrospective study included 119 patients aged 1.2–17.5 years who were diagnosed with CVS according to Rome IV criteria between September 2021 and January 2025. Clinical, psychiatric, and lifestyle data were retrieved from the university’s digital medical records. Patients were grouped according to treatment modality: cyproheptadine, SSRI, or acute attack management alone. Treatment success at 12 weeks was defined as complete cessation of vomiting episodes or absence of hospitalization, prolonged attacks, and school/work absenteeism. Results: Anxiety symptoms were present in 78.2% of patients. SSRIs were prescribed to 34 patients with moderate to severe anxiety, all of whom achieved treatment success. Lifestyle adherence was observed in 73.9% and was found to be a predictor of treatment success. Cyproheptadine was administered to 66 patients but did not provide additional benefit over effective lifestyle modification. Six patients discontinued cyproheptadine due to drowsiness or weight gain. Conclusions: Lifestyle interventions significantly improve outcomes in pediatric CVS. SSRIs represent a safe and effective prophylactic option for patients with comorbid anxiety or poor adherence to behavioral recommendations. These findings support the integration of psychosocial and lifestyle-based strategies into standard CVS treatment protocols. Full article

Background/Objectives: Severe jawbone atrophy, particularly in elderly or medically compromised patients, presents a significant challenge for conventional implant placement. In cases where bone augmentation is not feasible, alternative techniques—such as short, narrow, tilted, and zygomatic implants—may be indicated for the rehabilitation of the atrophic jaw. Subperiosteal implants have re-emerged as a further viable alternative, especially with recent advancements in digital planning and custom fabrication. This study aims to evaluate the clinical outcomes and complications associated with subperiosteal implants through a literature review and a supporting case series, and to propose clinical preliminary guidelines for their use. Methods: Fourteen studies—including case reports, case series, retrospective studies, and systematic reviews—were analyzed to assess the effectiveness and risk profile of subperiosteal implants. Additionally, we present a case series of nine patients with advanced vertical and horizontal alveolar bone atrophy treated using custom-made, digitally-designed subperiosteal implants. Surgical techniques, prosthetic workflows, and complications were recorded and assessed. Results: Subperiosteal implants were found to be particularly suitable for patients with narrow alveolar crests and severe atrophy where traditional implants are contraindicated. Literature and case series data indicated favorable outcomes, with early complications such as soft tissue inflammation and prosthetic misfit being manageable. A low complication rate was recorded in our series, with digital workflows contributing to improved implant fit and reduced technical errors. Conclusions: Subperiosteal implants could offer an effective solution for complex atrophic cases, provided that patient selection, surgical precision, and prosthetic design are meticulously managed. Based on our findings, clinical recommendations are proposed to guide their application in contemporary practice. Full article