Search Results (96)

Objective: This study aims to evaluate the validity and reliability of the “e-Nabız Usage Behavior Scale” (eNUBS), developed to measure user behaviors toward Türkiye’s national personal health record system. Methods: This methodological study included 304 voluntary adult, non-healthcare participants at a hospital. Data were collected via an 8-item sociodemographic form and a 6-item draft scale. Construct validity was evaluated using Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA); reliability was assessed using Cronbach’s alpha and item-total correlations. Results: Participants were 61.8% male, with a mean age of 37.79 ± 9.40. EFA confirmed a unidimensional structure, explaining 46.21% of the total variance. The Cronbach’s alpha was 0.72, and corrected item-total correlations ranged from 0.43 to 0.59. CFA demonstrated adequate model fit indices. Conclusions: The eNUBS is a brief, valid, and reliable tool for assessing real-world digital health portal usage, offering valuable guidance for digital health policy and for monitoring patient engagement. Full article

Universities increasingly rely on digital self-service channels to manage high volumes of time-sensitive admissions enquiries. AI enabled chatbots represent a prominent solution because they can provide round-the-clock responses, standardize guidance, and potentially reduce uncertainty for applicants. Yet evidence on whether such chatbots meaningfully assist students and improve their satisfaction with admissions support remains limited in many developing higher education contexts. This quantitative study evaluates the perceived effectiveness of AI chatbots used for university admissions in Pakistan, with a focus on student assistance and satisfaction as key outcomes. Using a cross-sectional survey design, data were collected from students who had recently engaged with university admissions information services (e.g., website chat widgets, messaging-based virtual assistants, and admissions enquiry portals) across private universities in Pakistan. Admissions chatbot effectiveness was measured through established information systems and service quality constructs system quality (ease of use, responsiveness, accessibility), information quality (accuracy, clarity, completeness), and service quality and trust cues (assurance, privacy confidence, and appropriateness of conversational support). Student assistance captured the extent to which chatbot interactions helped participants complete admissions related tasks and navigate application procedures. Student satisfaction reflected overall evaluation of the admissions support experience. The results indicate a positive association between perceived chatbot quality and perceived student assistance, and a further positive association between student assistance and student satisfaction with admissions support. The overall pattern suggests that student assistance functions as a key mechanism through which chatbot effectiveness translates into satisfaction. At the same time, respondents highlighted limitations in resolving complex or exception based queries, emphasizing the importance of transparent escalation to human admissions staff. The study contributes context specific evidence from Pakistan and offers an empirically grounded framework that university administrators can use to evaluate and improve admissions chatbots. Practical implications emphasize maintaining accurate knowledge bases, designing clear handoff pathways, and implementing governance practices that strengthen students’ confidence in information reliability and data privacy. Full article

Necrotizing enterocolitis (NEC) remains one of the most serious gastrointestinal emergencies in preterm infants, and imaging plays a central role in diagnosis and clinical management. Historically, evaluation has relied primarily on abdominal radiography, which remains widely available and embedded in established diagnostic frameworks. However, the hallmark radiographic signs of NEC (i.e., pneumatosis intestinalis, portal venous gas, and free air) reflect relatively advanced manifestations of intestinal injury that indicate established mucosal disruption or transmural necrosis. Bowel ultrasound has increasingly complemented radiography by enabling real-time assessment of bowel wall integrity, perfusion, motility, and intra-abdominal fluid, providing physiologic information that may refine clinical interpretation and monitoring of disease progression. Expanding use of neonatologist-performed bowel ultrasound may further improve access to bedside intestinal imaging and facilitate more timely evaluation in neonatal intensive care settings. In parallel, emerging imaging technologies seek to extend the capabilities of conventional imaging by interrogating biologic processes that underlie intestinal injury. Modalities such as contrast-enhanced ultrasound, ultra-high-frequency ultrasound, and photoacoustic imaging offer the potential to characterize bowel microvascular perfusion, tissue oxygenation, and microstructural changes that may precede overt radiographic abnormalities. Complementary physiologic monitoring approaches are also being explored to identify infants at risk before clinical disease develops. Techniques including superior mesenteric artery Doppler, near-infrared spectroscopy, bowel acoustic monitoring, and electrogastrography aim to detect early alterations in intestinal perfusion, oxygenation, and motility. In addition, artificial intelligence applied to imaging and physiologic data may enhance pattern recognition, risk stratification, and clinical decision support. Together, these advances suggest that NEC evaluation is evolving from a paradigm focused on detecting late structural injury toward integrated approaches capable of identifying intestinal vulnerability earlier and monitoring disease more precisely. Full article

Miniprobe endoscopic ultrasonography (mEUS) combines high-resolution imaging of the gastrointestinal (GI) wall and bile ducts with ease of applicability during routine endoscopy. This narrative review aims to provide an overview of known and emerging fields of application for mEUS in gastrointestinal endoscopy. After its initial development in pancreatobiliary scenarios in the early 1990s, mEUS has been recently reconsidered a third-space endoscopic technique that is progressively developing and spreading for the treatment of early gastrointestinal neoplastic lesions. The high spatial resolution of mEUS provides an accurate assessment of the degree of submucosal invasion in early esophageal, gastric, and colorectal neoplasia, while the small caliber of catheters allows for mEUS employment in settings where standard echoendoscopes are impractical (e.g., severe stenoses or proximal colonic lesions). Beyond cancer staging, mEUS offers point-of-care characterization of subepithelial lesions by defining the layer of origin and echo-pattern, eventually defining endoscopic resectability, but definitive diagnosis remains histological. In pancreatobiliary diseases, miniprobe intraductal ultrasonography (IDUS) shows its strongest application for indeterminate biliary strictures when endoscopic retrograde cholangiopancreatography (ERCP)-based sampling strategies and brushing cytology show inconclusive diagnoses, and in choledocholithiasis, particularly for the detection of small stones/sludge and confirmation of duct clearance. IDUS is also valuable for the staging of ampullary tumors, for longitudinal extension mapping in hilar cholangiocarcinoma and for selected portal biliopathy scenarios. Overall, mEUS and IDUS are high-resolution adjuncts that can meaningfully refine local decision-making in the treatment of superficial epithelial/subepithelial tumors or lesions involving the bile ducts. Limitations include shallow penetration, lack of tissue acquisition capability, a relative increase in post-ERCP pancreatitis risk for intraductal use, and substantial cost with limited availability in lower-volume centers. Full article

Academic staff face workplace stressors such as high workloads, job insecurity, and limited institutional support, which contribute to psychological distress and burnout. While workplace-based interventions are important for maintaining well-being, their effectiveness in academic settings remains underexplored. This systematic review including qualitative, quantitative, and mixed methods studies synthesized evidence on individual-level mental health interventions for university academic staff. Five databases (PsycINFO, MEDLINE, Web of Science, SCOPUS, ERIC) were searched for peer-reviewed studies published between 2003 and 2023. From 1058 records, seven studies met the inclusion criteria. Methodological quality was appraised using the Mixed Methods Appraisal Tool (MMAT) and the GUIDance for the rEporting of intervention Development (GUIDED) framework. Interventions included lifestyle regimens, mindfulness, yoga, community therapy, and institutionally embedded wellness programs. The findings suggest that brief, structured, and theoretically grounded interventions can improve psychological well-being, reduce burnout, and enhance coping. Facilitators included leadership support, institutional integration, peer networks, and flexible delivery; barriers included stigma, workload pressures, attrition, and digital challenges. Most studies were conducted in the Global North, limiting transferability to resource-constrained contexts. Overall, individual-level interventions show promise, but sustainable, culturally adapted, and multilevel strategies are needed to strengthen mental health support in higher education. These insights also contribute to broader efforts to promote health and safety in the workplace by identifying practical strategies to enhance well-being across diverse occupational settings. Full article

Background: Clear cell renal cell carcinoma (ccRCC) is a prevalent urological malignancy, accounting for approximately 1.6% of all cancer-related deaths in 2022. While endocrine-disrupting chemicals (EDCs) have been implicated as risk factors for ccRCC, the toxicological profiles and immune mechanisms underlying Bisphenol A (BPA) exposure in ccRCC progression remain inadequately understood. Materials and Methods: Protein–protein interaction (PPI) analysis and visualization were performed on overlapping genes between ccRCC and BPA exposure. This was followed by Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses to elucidate potential underlying mechanisms. Subsequently, 108 distinct machine learning algorithm combinations were evaluated to identify the optimal predictive model. An integrated CoxBoost and Ridge regression model was constructed to develop a prognostic signature, the performance of which was rigorously validated across two independent external datasets. Finally, molecular docking analyses were employed to investigate interactions between key genes and BPA. Results: A total of 114 overlapping targets associated with both ccRCC and BPA were identified. GO and KEGG analyses revealed enrichment in cancer-related pathways, including pathways in cancer, endocrine resistance, PD-L1 expression and PD-1 checkpoint signaling, T-cell receptor signaling, endocrine function, and immune responses. Machine learning algorithm selection identified the combined CoxBoost-Ridge approach as the optimal predictive model (achieving a training set concordance index (C-index) of 0.77). This model identified eight key genes (CHRM3, GABBR1, CCR4, KCNN4, PRKCE, CYP2C9, HPGD, FASN), which were the top-ranked by coefficient magnitude in the prognostic model. The prognostic signature demonstrated robust predictive performance in two independent external validation cohorts (C-index = 0.74 in cBioPortal; C-index = 0.81 in E-MTAB-1980). Furthermore, molecular docking analyses predicted strong binding affinities between BPA and these key targets (Vina scores all <−6.5 kcal/mol), suggesting a potential mechanism through which BPA may modulate their activity to promote renal carcinogenesis. Collectively, These findings suggested potential molecular mechanisms that may underpin BPA-induced ccRCC progression, generating hypotheses for future experimental validation. Conclusions: These findings enhance our understanding of the molecular mechanisms by which BPA induces ccRCC and highlight potential targets for therapeutic intervention, particularly in endocrine and immune-related pathways. This underscores the need for collaborative efforts to mitigate the impact of environmental toxins like BPA on public health. Full article

Background/Objectives: With digital transformation, patient portals and phone consultations are increasingly integrated into hybrid primary care workflows that combine in-person and remote services. This study aimed to assess the acceptability of these tools among patients and identify factors associated with acceptability. Methods: Between April and June 2025, a multicenter cross-sectional survey was conducted in four primary healthcare centers in Slovenia. The sample included 214 people who had used both patient portals and phone consultations within the previous 12 months. Data collected covered socio-demographic and clinical profile, digital communication skills, quality of life, and annual use of digital tools. Acceptability was assessed using the Theoretical Framework of Acceptability (TFA) tool. Univariate and multivariable linear regression analyses were performed to identify factors associated with acceptability. Results: Among the 214 participants (mean age 42.9 ± 14.1 years; 61.2% female), both patient portals and phone consultations were generally acceptable, with similar overall TFA scores (3.9/5). Patient portals were considered as significantly less time-consuming and better for communication, whereas phone consultations were preferred for accessibility and reliability. Multivariable analyses showed that higher digital communication skills and better quality of life predicted greater acceptability for both methods, whereas lower education level and more frequent use were associated with higher acceptability of phone consultations. Conclusions: Acceptability of patient portals and phone consultations varies by education, digital communication skills, and quality of life. This highlights the need for personalized hybrid care solutions. Healthcare providers should offer flexible digital options, invest in digital literacy programs, and develop interoperable eHealth infrastructure to enable safe and sustainable integration of advanced tools such as video consultations. Full article

The rapid integration of artificial intelligence (AI) in content generation has encouraged the development of AI detection tools aimed at distinguishing between human- and AI-authored texts. These tools are increasingly adopted not only in academia but also in sensitive decision-making contexts, including candidate screening by hiring agencies in government and private sectors. This extensive reliance raises serious questions about their reliability, fairness, and appropriateness for high-stakes applications. This study evaluates the performance of six widely used AI content detection tools, namely Undetectable AI, Zerogpt.com, Zerogpt.net, Brandwell.ai, Gowinston.ai, and Crossplag, referred to as Tools A through F in this study. The assessment focused on the ability of the tools to identify human versus AI-generated content across multiple domains. Verified human-authored texts were gathered from reputable sources, including university websites, pre-ChatGPT publications in Nature and Science, government portals, and media outlets (e.g., BBC, US News). Complementary datasets of AI-generated texts were produced using ChatGPT-4o, encompassing coherent essays, nonsensical passages, and hybrid texts with grammatical errors, to test tool robustness. The results reveal significant performance limitations. The accuracy ranged from 14.3% (Tool B) to 71.4% (Tool D), with the precision and recall metrics showing inconsistent detection capabilities. The tools were also highly sensitive to minor textual modifications, where slight changes in phrasing could flip classifications between “AI-generated” and “human-authored.” Overall, the current AI detection tools lack the robustness and reliability needed for enforcing academic integrity or making employment-related decisions. The findings highlight an urgent need for more transparent, accurate, and context-aware frameworks before these tools can be responsibly incorporated into critical institutional or societal processes. Full article

The real-time forecast estimates of total water levels (TWL) associated with coastal storms by the Boston Office of the National Weather Service (NWS), and the analysis, identification, and field mapping of storm tide pathways (STP) by the Center for Coastal Studies (CCS) within the forecast region, has led to improved model forecasts, enhanced allocation of resources prior to storm impact (e.g., placement of flood control measures, identification of evacuation routes, development of applications to visualize and communicate threats, etc.), and increased public awareness of the practical implications of sea level rise and storm-related coastal flooding. Both NWS modeling and STP mapping are discussed here. The coupling of these methods began in 2016–2017 in Provincetown, MA, and its utility was highlighted during the new storm of record for most of southern New England, a nor’easter in January 2018. The use of this information by managers, stakeholders, and the public has increased since combining the TWL modeling and STP mapping in an online portal in 2021, and it continues to be used by emergency managers and the public to plan for approaching coastal storms. Full article

Herpesviruses are prevalent infectious agents in humans, with complex structures and life cycles. The viability and detail of a model of capsid assembly and maturation can now be examined against the recently available mature herpesvirus capsids structures. The first large assembly product is the icosahedral procapsid with an outer shell composed of major capsid proteins (MCPs) connected by triplexes (heterotrimers composed of one Tri1 protein and two Tri2 proteins), and an inner shell of scaffold proteins. The asymmetric triplexes have specific and conserved orientations, suggesting a key role in assembly. In the mature capsid structures, triplexes bound to three MCPs may represent an assembly unit where, in most cases, the N-terminus of one MCP wraps around the E-loop of another MCP. The model accommodates the incorporation of a portal into capsid, required for genome encapsidation and viral viability. Cleavage of the scaffold triggers maturation of procapsid. Each of the MCPs rotates mostly as a rigid body, except for the flexible peripheral parts that remodel to close the capsid inner surface. Angularization of the capsid shifts the portal outward to a better contact with the capsid shell. Understanding these events in the herpesvirus life cycle to atomic detail could facilitate the development of drugs that uniquely target assembly and maturation. Full article

The isotopic shift of the bound-electron g factor in highly charged ions (HCI) provides a sensitive probe for testing physics beyond the Standard Model, particularly through interactions mediated by a hypothetical scalar boson. In this study, we analyze the sensitivity of this method within the Higgs portal framework, focusing on the uncertainties introduced by quantum electrodynamics corrections, including finite nuclear size, nuclear recoil, and nuclear polarization effects. All calculations are performed for the ground-state $1s$ configuration of hydrogen-like HCI, where theoretical predictions are most accurate. Using selected isotope pairs (e.g., ${\mathrm{He}}^{4/6}$, ${\mathrm{Ne}}^{20/22}$, ${\mathrm{Ca}}^{40/48}$, ${\mathrm{Sn}}^{120/132}$, ${\mathrm{Th}}^{230/232}$), we demonstrate that the dominant source of uncertainty arises from finite nuclear size corrections, which currently limit the precision of new physics searches. Our results indicate that the sensitivity of this method decreases with increasing atomic number. These findings highlight the necessity of improved nuclear radius measurements and the development of alternative approaches, such as the special differences method, to enable virtually the detection of fifth-force interactions. Full article

The private healthcare sector in Romania, led by prominent players such as Medlife, Regina Maria, Medicover and Sanador, has become a cornerstone of the country’s healthcare system. However, achieving sustainability in this sector remains a challenge. This study evaluates sustainability practices in Romania’s private medical sector using the Triple Bottom Line (TBL) framework, comparing them to those of the EU, USA and Japan. Using statistical methods and benchmarking, we identify correlations between healthcare expenditures, financing schemes and sustainability metrics. A bibliographic review highlights global trends in sustainable healthcare management, including environmental, social and economic strategies and provides insights into the cost-effectiveness of green initiatives. Special focus is given to the role of technology in driving sustainability through innovations in telemedicine, digital health records and operational optimization. Using statistical methods (Pearson and Spearman correlation coefficients), we have performed an analysis of health expenditure data for EU countries, the USA and Japan. The dataset was extracted from the Organisation for Economic Co-operation and Development (OECD) data portal and included various health expenditure indicators, financing schemes and administrative data for all EU countries, the USA and Japan for the period 2018–2023. We have performed a structured analysis that explores correlations between these indicators, with a focus on financial schemes, expenditures and management sustainability. The analysis shows strong correlations between healthcare expenditures, financing schemes and administrative costs. Countries with efficient governance, balanced financing and proactive population health strategies (e.g., Japan and Nordic countries) demonstrate better management sustainability. However, countries like the USA and Eastern EU nations face challenges due to high administrative costs and inefficient financing models, respectively. Addressing these issues is critical to sustaining healthcare systems in the long term. The findings reveal that while Romanian providers excel in patient satisfaction and technological innovation, they lag behind their European counterparts in environmental sustainability and equitable access. Recommendations are proposed to address these gaps, drawing on successful strategies implemented in other European healthcare systems. This study fills a gap in the literature by providing a structured analysis of sustainability practices in Romania’s private healthcare sector, contextualized within a global comparative framework. Full article

This study analyzes publicly available RNA-seq data to comprehensively include the complex heterogeneity of prostate cancer (PCa) etiology. It combines prostate and prostate cancer (PCa) cell lines, representing primary PCa cells, Gleason scores, ages, and PCa of different racial origins. Additionally, some cell lines were exposed to endocrine-disrupting chemicals (EDCs). The research aims to identify hub genes and transcription factors (TFs) of the prostate carcinogenesis pathway as molecular targets for clinical investigations to elucidate EDC-induced aggressiveness and to develop potential biomarkers for their exposure risk assessments. PCa cells rely on androgen receptor (AR)-mediated signaling to survive, develop, and function. Fifteen various RNA-seq datasets were normalized for distribution, and the significance (p-value < 0.05) threshold of differentially expressed genes (DEGs) was set based on |log2FC| ≥ 2 change. Through integrated bioinformatics, we applied cBioPortal, UCSC-Xena, TIMER2.0, and TRRUST platforms, among others, to associate hub genes and their TFs based on their biologically meaningful roles in aggressive prostate carcinogenesis. Among all RNA-Seq datasets, we found 75 overlapping DEGs, with BUB1B (32%) and CCNB1 (29%) genes exhibiting the highest degree of mutation, amplification, and deletion. EDC-associated CCNB1, BUB1B, and CCNA2 in PCa cells exposed to EDCs were consistently shown to be associated with high Gleason scores (≥4 + 3) and in the >60 age group of patients. Selected TFs (E2F4, MYC, and YBX1) were also significantly associated with DEGs (NCAPG, MKI67, CCNA2, CCNB1, CDK1, CCNB2, AURKA, UBE2C, BUB1B) and influenced the overall survival (p-value < 0.05) of PCa cases. This is one of the first comprehensive studies combining 15 publicly available RNA-seq datasets to demonstrate the association of EDC-associated hub genes and their TFs aligning with the aggressive carcinogenic pathways in the higher age group (>60 years) of patients. The findings highlight the potential of these hub genes as candidates for further studies to develop molecular biomarkers for assessing the EDC-related PCa risk, diagnosing PCa aggressiveness, and identifying therapeutic targets. Full article

This research addresses the challenge of bias in Remotely Sensed Rainfall (RSR) datasets used for hydrological planning in Uganda’s data-scarce, ungauged catchments. Four bias correction methods, Quantile Mapping (QM), Linear Transformation (LT), Delta Multiplicative (DM), and Polynomial Regression (PR), were evaluated using daily rainfall data from four gauged stations (Gulu, Soroti, Jinja, Mbarara). QM consistently outperformed other methods based on statistical metrics, e.g., for National Oceanic and Atmospheric Administration Climate Prediction Center (NOAA_CPC) RSR data at Gulu, Root-Mean-Square Error (RMSE) was reduced from 29.20 mm to 19.00 mm, Mean Absolute Error (MAE) reduced from 22.44 mm to 12.84 mm, and Percent Bias (PBIAS) reduced from −19.23% to 1.05%, and improved performance goodness-of-fit tests (KS = 0.03, p = 1.00), while PR, though statistically strong, failed due to overfitting. A bias correction framework was developed for ungauged catchments, using predetermined bias factors derived from observed station data. Validation at Arua (tropical savannah) and Fort Portal (tropical monsoon) demonstrated significant improvements in RSR data when the bias correction framework was applied. At Arua, bias correction of Climate Hazards Group InfraRed Precipitation with Station (CHIRPS) data reduced RMSE from 49.14 mm to 21.41 mm, MAE from 45.74 mm to 17.38 mm, and PBIAS from −59.83% to −8.18%, while at Fort Portal, bias correction of the CHIRPS dataset reduced RMSE from 28.35 mm to 15.02 mm, MAE from 25.28 mm to 11.35 mm, and PBIAS from −46.2% to 4.74%. Our research concludes that QM is the most effective method, and that the framework is a tool for improving RSR data in ungauged catchments. Recommendations for future work includes machine learning integration and broader regional validation. Full article

Novel direct antiviral-acting (DAA) molecules significantly improved efficacy and ameliorated outcomes of patients with chronic hepatitis C (CHC). The extensive use of DAA from 2015, due to large access to therapy, maximized rates of viral eradication with a safety profile in the majority of cases. Aims: We evaluated risk factors and the incidence of related clinical events and hepatocellular carcinoma (HCC) in cases with sustained virologic response (SVR) after DAA. We also aimed to apply a score assessment to identify the individual patient with unfavorable outcomes during an average follow-up (FU) of five years. Methods: In total, 470 cases consecutively recruited with CHC have been compared by non-invasive tests (NIT), as APRI, FORNS, FIB-4, LSPS, and transient elastography (TE) liver stiffness measurement (LSM), to identify cutoff related to major event onset. Results: Grouping of cases without or with related events development of both types hepatic (HE) (i.e., HCC or further cirrhosis decompensation or/with hospitalized septic state) or extrahepatic (EHE) (i.e., other tumors, bleeding, or thrombotic episodes and other organs pathologic conditions not liver related)allowed us to select the parameters to propose a novel risk stratification system (RISS) for the identification of the remnant individual patient’s risk for HCC occurrence, orthotopic liver transplant (OLT) need, or death during long-term follow-up (FU). Conclusions: Patients with cirrhosis and portal hypertension (PH) maintained a higher LSM mean value (>25 kPa), showed the lowest reduction of NIT scores, and developed events in 80/108 (74%) cases (67 and 13 of HE and EHE type), even after long-term successful DAA therapy. Furthermore, cases with RISS score ≥ 8 demonstrated a significant incidence of HCC (37/46, 80.4%) and a reduction in survival rate to 65.4% at 5-year FU. Full article