Search Results (2,755)

Urbanization and the rapid growth of e-commerce have significantly increased delivery volumes in cities, creating challenges in terms of cost, efficiency, and sustainability in last-mile delivery (LMD). To address these challenges, this paper proposes an innovative methodological framework for selecting optimal delivery strategies in urban environments, grounded in the principles of collaboration. The framework integrates an Extended FullEx method, developed to calculate criteria weights while accounting for expert reputation based on education and experience, with the MARCOS multi-criteria decision-making (MCDM) method used to rank delivery strategies. The Extended FullEx method proposed in this paper differs from the original FullEx by providing two improvements. The first concerns the introduction of the normalization procedure in the calculation of experts’ reputations, while the second addresses the different scoring of educational degrees, providing a more precise mathematical basis for the process. Four collaborative delivery strategies are evaluated against twelve sustainability-related criteria identified through an extensive literature review. The proposed framework is applied to a real-life case study in Novi Sad, Republic of Serbia. Results indicate that the most suitable delivery strategy is a hybrid model that combines the use of a consolidation center with smaller urban delivery hubs, providing practical insights for enhancing the sustainability and efficiency of urban delivery. This study contributes both methodologically, by advancing MCDM techniques, and practically, by offering decision-makers a comprehensive tool that integrates subjective expert knowledge and objective criteria assessment in the selection of sustainable LMD solutions. Full article

Autism Spectrum Disorder (ASD) remains significantly underdiagnosed in women, resulting in a persistent gender gap with important clinical, functional, and psychosocial implications. This narrative review explores the multifactorial barriers contributing to diagnostic disparities, including the male-oriented structure of current diagnostic criteria, the prevalence of co-occurring psychiatric conditions, and the phenomenon of social camouflaging shaped by culturally reinforced gender norms. These factors frequently lead to delayed identification, clinical misinterpretation, and suboptimal care. The review synthesizes evidence from clinical, psychological, and sociocultural research to demonstrate how the under-recognition of ASD in women impacts mental health outcomes, access to education, occupational stability, and overall quality of life. Special emphasis is placed on the consequences of missed or late diagnoses for healthcare delivery and the educational needs of clinicians involved in ASD assessment and care. This article concludes with actionable, evidence-based recommendations for enhancing diagnostic sensitivity, developing gender-responsive screening strategies, and integrating training on female autism presentation into medical and allied health education. Addressing these challenges is essential to reducing diagnostic inequities and ensuring timely, accurate, and person-centered care for autistic women throughout their lifespan. Full article

Pediatric palliative care (PPC) aims to enhance the quality of life of children with life-limiting conditions and their families through individualized, interdisciplinary support. Among this population, children with neurological diseases represent a substantial and growing group, often facing prolonged disease courses, cognitive impairment, and high prognostic uncertainty. Effective communication is central to PPC; however, it remains deeply influenced by cultural, religious, and spiritual frameworks that shape family perceptions of illness, suffering, and decision-making. This narrative review explores communication strategies in PPC, with a specific focus on children with neurological conditions, highlighting conceptual foundations, cross-cultural variations, and emerging best practices. Key findings highlight the importance of culturally humble approaches, family-centered communication models, and structured tools, such as co-designed advance care planning and dignity therapy, to enhance communication. Additionally, the review highlights the presence of ethical and interdisciplinary challenges, particularly in neonatal and neurology settings, where misaligned team messaging and institutional hesitancy may compromise trust and timely referral to palliative care. Future research, policy, and clinical education priorities should advocate for models that are inclusive, ethically grounded, and tailored to the unique trajectories of neurologically ill children. Integrating cultural competence, team alignment, and family voices is essential for delivering equitable and compassionate PPC across diverse care settings. Full article

The integration of artificial intelligence (AI) in education offers novel opportunities to enhance critical thinking while also posing challenges to independent cognitive development. In particular, Human-Centered Artificial Intelligence (HCAI) in education aims to enhance human experience by providing a supportive and collaborative learning environment. Rather than replacing the educator, HCAI serves as a tool that empowers both students and teachers, fostering critical thinking and autonomy in learning. This study investigates the potential for AI to become a collaborative partner that assists learning and enriches academic engagement. The research was conducted during the 2024–2025 winter semester within the Pedagogical and Teaching Sufficiency Program offered by the Audio and Visual Arts Department, Ionian University, Corfu, Greece. The research employs a hybrid ethnographic methodology that blends digital interactions—where students use AI tools to create artistic representations—with physical classroom engagement. Data was collected through student projects, reflective journals, and questionnaires, revealing that structured dialog with AI not only facilitates deeper critical inquiry and analytical reasoning but also induces a state of flow, characterized by intense focus and heightened creativity. The findings highlight a dialectic between individual agency and collaborative co-agency, demonstrating that while automated AI responses may diminish active cognitive engagement, meaningful interactions can transform AI into an intellectual partner that enriches the learning experience. These insights suggest promising directions for future pedagogical strategies that balance digital innovation with traditional teaching methods, ultimately enhancing the overall quality of education. Furthermore, the study underscores the importance of integrating reflective practices and adaptive frameworks to support evolving student needs, ensuring a sustainable model. Full article

In the context of increasing Artificial Intelligence integration in higher education, understanding the factors influencing university teachers’ adoption of AI tools is critical for effective implementation. This study adopts a perception–intention–behavior framework to explores the roles of perceived usefulness, perceived ease of use, perceived trust, perceived substitution crisis, and perceived risk in shaping teachers’ behavioral intention and actual usage of AI tools. It also investigates the moderating effects of peer influence and organizational support on these relationships. Using a comprehensive survey instrument, data was collected from 487 university teachers across four major regions in China. The results reveal that perceived usefulness and perceived ease of use are strong predictors of behavioral intention, with perceived ease of use also significantly influencing perceived usefulness. Perceived trust serves as a key mediator, enhancing the relationship between perceived usefulness, perceived ease of use, and behavioral intention. While perceived substitution crisis negatively influenced perceived trust, it showed no significant direct effect on behavioral intention, suggesting a complex relationship between job displacement concerns and AI adoption. In contrast, perceived risk was found to negatively impact behavioral intention, though it was mitigated by perceived ease of use. Peer influence significantly moderated the relationship between perceived trust and behavioral intention, highlighting the importance of peer influence in AI adoption, while organizational support amplified the effect of perceived ease of use on behavioral intention. These findings inform practical strategies such as co-developing user-centered AI tools, enhancing institutional trust through transparent governance, leveraging peer support, providing structured training and technical assistance, and advancing policy-level initiatives to guide digital transformation in universities. Full article

Family empowerment is a key component of effective family-centered practices in healthcare, mental health, and educational services. The Family Empowerment Scale (FES) is the most commonly used instrument to evaluate empowerment in families raising children with emotional, behavioral, or developmental disorders. Despite its importance, the FES for diverse populations, especially Latinx parents, has rarely been evaluated using innovative psychometric approaches. In this study, we evaluated key dimensions and psychometric evidence of the Family Empowerment Scale (FES) for 96 Latinx parents of children with intellectual and developmental disabilities (IDD) in the United States using an exploratory graph analysis (EGA). The EGA identified a five-dimensional structure, and EGA models outperformed the original CFA 3-factor models for both parents of children with autism and other disabilities. This study identified distinct, meaningful dimensions of empowerment that reflect both shared and unique empowerment experiences across two Latinx parent groups. These insights can inform the design of culturally responsive interventions, instruments, and policies that more precisely capture and boost empowerment in Latinx families. This study contributes to closing a gap in the literature by elevating the voices and experiences of Latinx families by laying the groundwork for more equitable support systems in special education and disability services. Full article

Background: Family caregivers are a vital yet often under-recognized part of the healthcare system. They provide essential emotional, physical, and logistical support to individuals with illness, disability, or frailty, and their contributions improve continuity of care and reduce system strain. However, many healthcare and social service providers are not equipped to meaningfully engage caregivers as partners. In Alberta, stakeholders validated the Caregiver-Centered Care Competency Framework and identified the need for a three-tiered education model—Foundational, Advanced, and Champion—to help providers recognize, include, and support family caregivers across care settings. This paper focuses on the development and early evaluation of the Advanced Caregiver-Centered Care Education modules, designed to enhance the knowledge and skills of providers with more experience working with family caregivers. The modules emphasize how partnering with caregivers benefits not only the person receiving care but also improves provider effectiveness and supports better system outcomes. Methods: The modules were co-designed with a 154-member interdisciplinary team and grounded in the competency framework. Evaluation used the first three levels of the Kirkpatrick–Barr health workforce education model. We analyzed pre- and post-surveys from the first 50 learners in each module using paired t-tests and examined qualitative feedback and SMART goals through inductive content analysis. Results: Learners reported a high level of satisfaction with the education delivery and the knowledge and skill acquisition. Statistically significant improvements were observed in 53 of 54 pre-post items. SMART goals reflected intended practice changes across all six competency domains, indicating learners saw value in engaging caregivers as partners. Conclusions: The Advanced Caregiver-Centered Care education improved providers’ confidence, knowledge, and skills to work in partnership with family caregivers. Future research will explore whether these improvements translate into real-world practice changes and better caregiver experiences in care planning, communication, and navigation. Full article

This study investigates the evolving pedagogical strategies and professional identity development of two novice college English teachers in China through a semester-long classroom-based inquiry. Drawing on Norris’s Multimodal (Inter)action Analysis (MIA), it analyzes 270 min of video-recorded lessons across three instructional stages, supported by visual transcripts and pitch-intensity spectrograms. The analysis reveals each teacher’s transformation from textbook-reliant instruction to student-centered pedagogy, facilitated by multimodal strategies such as gaze, vocal pitch, gesture, and head movement. These shifts unfold across the following three evolving identity configurations: compliance, experimentation, and dialogic enactment. Rather than following a linear path, identity development is shown as a negotiated process shaped by institutional demands and classroom interactional realities. By foregrounding the multimodal enactment of self in a non-Western educational context, this study offers insights into how novice EFL teachers navigate tensions between traditional discourse norms and reform-driven pedagogical expectations, contributing to broader understandings of identity formation in global higher education. Full article

Quantum sensing based on NV-centers in diamonds has been demonstrated many times in multiple publications. The majority of publications use lasers in free space or lasers with fiber optics, expensive optical components such as dichroic mirrors, or beam splitters with dichroic filters and expensive detectors, such as Avalanche photodiodes or single photon detectors, overall, leading to custom and expensive setups. In order to provide an inexpensive NV-based magnetometer setup for educational use in schools, to teach the three topics, fluorescence, optically detected magnetic resonance, and Zeeman splitting, inexpensive, miniaturized, off-the-shelf components with high reliability have to be used. The cheaper such a setup, the more setups a school can afford. Hence, in this work, we investigated LEDs as light sources, considered different diamonds for our setup, tested different color filters, proposed an inexpensive microwave resonator, and used a cheap photodiode with an appropriate transimpedance amplifier as the basis for our quantum magnetometer. As a result, we identified cheap and functional components and present a setup and show that it can demonstrate the three topics mentioned at a hardware cost <EUR 100. Full article

This study investigates the foundational causes of unsustainability that obstruct efforts to address global challenges such as climate change, environmental degradation, water crises, and public health deterioration. Using qualitative research with in-depth expert interviews from education, environmental studies, and business, it finds that these global challenges, while visible on the surface, are deeply rooted in worldviews that shape human behavior, societal structures, and policies. Building on this insight, the thematic analysis manifests three interrelated systemic paradigms as the fundamental drivers of unsustainability: a crisis of wholeness, reflected in fragmented identities and collective disorientation; a disconnection from nature, shaped by human-centered perspectives; and the influence of dominant political-economic systems which prioritize growth logics over ecological and social concerns. These paradigms underlie both structural and cognitive barriers to systemic transformation, which influence the design and implementation of education for sustainability. By clarifying a body of knowledge and systemic paradigms regarding unsustainability, this paper calls for transformative education that promotes a holistic, value-based approach, eco-empathy, and critical thinking, aiming to equip future generations with the tools to challenge and transform unsustainable systems. Full article

Background: Cardiac involvement is common in Fabry disease (FD) and typically manifests with left ventricular hypertrophy (LVH). Patients with FD are frequently misdiagnosed, and this is mainly related to the lack of disease awareness among clinicians. The aim of this study was to determine whether providing a targeted educational intervention on FD may enhance FD diagnosis. Methods. This research was designed as a single-arm before-and-after intervention study and evaluated the impact of providing a specific training on FD to cardiologists from different Italian centers, without experience in rare diseases. In the 12-month period after the educational intervention, the rate of FD screening and diagnosis was assessed and compared with those conducted in the two years preceding the study initiation. Results: Fifteen cardiologists participated to this study, receiving a theoretical and practical training on FD. In the two previous two years, they conducted 12 FD screening (6/year), and they did not detect any cases of FD. After the training, they performed 45 FD screenings, with an eight-fold rise in the annual screening rate. The screened population (age: 61 ± 11 years, men: 82%) was mainly composed of patients with unexplained LVH (n = 43). There were four new FD diagnoses and, among of them, three had a late-onset GLA variant. After the cascade genetic screening, 11 affected relatives and 8 heterozygous carriers were also detected. Conclusions: A targeted educational intervention for cardiologists allowed the identification of four new families with FD. Enhancing FD awareness is helpful to reduce the diagnostic and therapeutic delay. Full article

Background: Artificial intelligence (AI) and machine learning (ML) have been reshaping maternal, fetal, neonatal, and reproductive healthcare by enhancing risk prediction, diagnostic accuracy, and operational efficiency across the perinatal continuum. However, no comprehensive synthesis has yet been published. Objective: To conduct a scoping review of reviews of AI/ML applications spanning reproductive, prenatal, postpartum, neonatal, and early child-development care. Methods: We searched PubMed, Embase, the Cochrane Library, Web of Science, and Scopus through April 2025. Two reviewers independently screened records, extracted data, and assessed methodological quality using AMSTAR 2 for systematic reviews, ROBIS for bias assessment, SANRA for narrative reviews, and JBI guidance for scoping reviews. Results: Thirty-nine reviews met our inclusion criteria. In preconception and fertility treatment, convolutional neural network-based platforms can identify viable embryos and key sperm parameters with over 90 percent accuracy, and machine-learning models can personalize follicle-stimulating hormone regimens to boost mature oocyte yield while reducing overall medication use. Digital sexual-health chatbots have enhanced patient education, pre-exposure prophylaxis adherence, and safer sexual behaviors, although data-privacy safeguards and bias mitigation remain priorities. During pregnancy, advanced deep-learning models can segment fetal anatomy on ultrasound images with more than 90 percent overlap compared to expert annotations and can detect anomalies with sensitivity exceeding 93 percent. Predictive biometric tools can estimate gestational age within one week with accuracy and fetal weight within approximately 190 g. In the postpartum period, AI-driven decision-support systems and conversational agents can facilitate early screening for depression and can guide follow-up care. Wearable sensors enable remote monitoring of maternal blood pressure and heart rate to support timely clinical intervention. Within neonatal care, the Heart Rate Observation (HeRO) system has reduced mortality among very low-birth-weight infants by roughly 20 percent, and additional AI models can predict neonatal sepsis, retinopathy of prematurity, and necrotizing enterocolitis with area-under-the-curve values above 0.80. From an operational standpoint, automated ultrasound workflows deliver biometric measurements at about 14 milliseconds per frame, and dynamic scheduling in IVF laboratories lowers staff workload and per-cycle costs. Home-monitoring platforms for pregnant women are associated with 7–11 percent reductions in maternal mortality and preeclampsia incidence. Despite these advances, most evidence derives from retrospective, single-center studies with limited external validation. Low-resource settings, especially in Sub-Saharan Africa, remain under-represented, and few AI solutions are fully embedded in electronic health records. Conclusions: AI holds transformative promise for perinatal care but will require prospective multicenter validation, equity-centered design, robust governance, transparent fairness audits, and seamless electronic health record integration to translate these innovations into routine practice and improve maternal and neonatal outcomes. Full article

The rapid emergence of generative AI technologies has sparked significant transformation across educational landscapes worldwide. This study presents a comprehensive bibliometric analysis of GAI in education, mapping scholarly trends from 2022 to 2025. Drawing on 3808 peer-reviewed journal articles indexed in Scopus, the analysis reveals exponential growth in publications, with dominant contributions from the United States, China, and Hong Kong. Using VOSviewer, the study identifies six major thematic clusters, including GAI in higher education, ethics, technological foundations, writing support, and assessment. Prominent tools, especially ChatGPT, are shown to influence pedagogical design, academic integrity, and learner engagement. The study highlights interdisciplinary integration, regional research ecosystems, and evolving keyword patterns reflecting the field’s transition from tool-based inquiry to learner-centered concerns. This review offers strategic insights for educators, researchers, and policymakers navigating AI’s transformative role in education. Full article

In today’s fast-changing world, the higher education system must evolve to enhance the quality of learning and teaching. Fulfilling the role of a university is a major challenge. Universities must implement strategies that place the student at the center of their concerns; so, these strategies must be designed for and by the student. However, the high university dropout rate is one of the current problems faced by many universities. This suggests that there are some issues that hinder the learning process. Several studies have highlighted the advantage of artificial intelligence (AI) technologies in providing explorative and predictive analyses that explain why students are dropping out, with the aim of improving the quality of teaching and providing an integrated learning environment. This paper proposes a framework that predicts student dropout rates using machine learning techniques, based on data collected from various sources. Data collection was carried out between 2022 and 2024. We used a quantitative analysis method employed through a questionnaire distributed to 120 students (aged 18–26) from open access faculties of a Moroccan public university to identify the factors leading to an increase in university dropout rates. We discuss the impact of selected variables, and the findings show that several factors are related to university dropout rates, such as social background, psychological and health problems, insufficient motivation of professors, limited perspective on educational programs, changes in language and teaching methodologies, absenteeism, student attitude, and a lack of interaction between professors and students. Full article

Introduction: Congestive heart failure (CHF), a complex clinical syndrome characterized by the heart’s inability to pump blood effectively due to structural or functional impairments, is a growing public health concern, with profound implications for patients’ physical and emotional well-being. In India, the burden of CHF is rising due to aging demographics and increasing prevalence of lifestyle-related risk factors. Among the subtypes of CHF, heart failure with preserved ejection fraction (HFpEF), i.e., heart failure with left ventricular ejection fraction of ≥50% with evidence of spontaneous or provokable increased left ventricular filling pressure, and heart failure with reduced ejection fraction (HFrEF), i.e., heart failure with left ventricular ejection fraction of 40% or less and is accompanied by progressive left ventricular dilatation and adverse cardiac remodeling, may present differing impacts on health-related quality of life (HRQoL), i.e., an individual’s or a group’s perceived physical and mental health over time, yet comparative data remains limited. This study assesses HRQoL among CHF patients using the Minnesota Living with Heart Failure Questionnaire (MLHFQ), one of the most widely used health-related quality of life questionnaires for patients with heart failure based on physical and emotional dimensions and identifies sociodemographic and clinical variables influencing these outcomes. Methods: A cross-sectional analytical study was conducted among 233 CHF patients receiving inpatient and outpatient care at the Department of Cardiology at a quaternary care teaching hospital in coastal Karnataka in India. Participants were enrolled using convenience sampling. HRQoL was evaluated through the MLHFQ, while sociodemographic and clinical characteristics were recorded via a structured proforma. Statistical analyses included descriptive measures, independent t-test, Spearman’s correlation and stepwise multivariable linear regression to identify associations and predictors. Results: The mean HRQoL score was 56.5 ± 6.05, reflecting a moderate to high symptom burden. Patients with HFpEF reported significantly worse HRQoL (mean score: 61.4 ± 3.94) than those with HFrEF (52.9 ± 4.64; p < 0.001, Cohen’s d = 1.95). A significant positive correlation was observed between HRQoL scores and age (r = 0.428; p < 0.001), indicating that older individuals experienced a higher burden of symptoms. HRQoL also varied significantly across NYHA functional classes (χ² = 69.9, p < 0.001, ε² = 0.301) and employment groups (χ² = 17.0, p < 0.001), with further differences noted by education level, gender and marital status (p < 0.05). Multivariable linear regression identified age (B = 0.311, p < 0.001) and gender (B = –4.591, p < 0.001) as significant predictors of poorer HRQoL. Discussion: The findings indicate that patients with HFpEF experience significantly poorer HRQoL than those with HFrEF. Older adults and female patients reported greater symptom burden, underscoring the importance of demographic-sensitive care approaches. These results highlight the need for routine integration of HRQoL assessment into clinical practice and the development of comprehensive, personalized interventions addressing both physical and emotional health dimensions, especially for vulnerable subgroups. Conclusions: CHF patients, especially those with HFpEF, face reduced HRQoL. Key factors include age, gender, education, employment, marital status, and NYHA class, underscoring the need for patient-centered care. Full article