Search Results (9,952)

Background: Existing XR simulators for enteral feeding rely mainly on self-reported learning outcomes and procedural checklists. As a result, they offer limited opportunities to capture objective behavioral data or to present dynamic patient reactions. This two-stage pilot study evaluated an XR-based gastrostomy tube-feeding simulator (ESTE-TF) that integrates sensor-derived performance metrics and two biological-reaction presentation modalities (projection mapping and tablet display). Methods: In Experiment 1, nursing students completed pre- and post-experience questionnaires assessing perceived learning across seven domains, alongside sensor-based measurements of feeding-start timing, dosing-rate characteristics, and total procedure time. Experiment 2 employed a tablet-based version with four learning items assessed for students and post-experience evaluations collected from registered nurses. Participants also compared the two XR presentation methods. Results: Students demonstrated perceived learning gains of small-to-large magnitude across both experiments (Experiment 1: d = 0.455–0.974; Experiment 2: d = 0.014–0.886), with wide 95% confidence intervals reflecting the exploratory nature of this pilot work. Sensor-derived data showed greater dosing-rate variability and longer procedure times among students than nurses. Participants reported that projection mapping offered a more embodied experience, whereas tablet displays provided clearer visibility. Conclusions: These findings indicate the feasibility and preliminary educational potential of integrating sensing technologies with XR-based biological-reaction presentation for gastrostomy-feeding training. Given the small samples and non-validated measures, results should be interpreted as exploratory. Future research will refine sensor accuracy, establish standardized performance metrics, and evaluate learning outcomes using validated instruments and controlled study designs. Full article

Rural higher education in Latin America plays a crucial role in advancing both human and sustainable development. However, it continues to face persistent barriers related to access, equity, and systemic inequality. This scoping review investigates how rural higher education contributes to integral human development in the region, focusing on its theoretical underpinnings, contextual specificities, and methodological approaches. Following the PRISMA-ScR protocol, we analyzed qualitative and quantitative studies published between 2015 and 2024, drawing from Scopus, EBSCOhost, ERIC, Redalyc, and SciELO. The review protocol was registered in PROSPERO (CRD420251075119). After applying rigorous inclusion and exclusion criteria, seven peer-reviewed articles were selected. These studies address key issues such as educational access, territorial rurality, and human development, and highlight innovative strategies including community-based pedagogy, values-oriented curricula, and student support during crises. Our findings underscore the transformative capacity of rural universities in fostering students’ analytical, emotional, and civic competencies. To ensure inclusive and meaningful impacts, rural higher education must perform context-sensitive, integrative strategies aligned with local realities and broader sustainable development goals. Full article

Despite the pervasive role of digital platforms in contemporary higher education, existing measurement tools fail to capture students’ psychological dependence on online approval within academic contexts, focusing instead on technical competencies or clinical addiction symptoms. This study developed and psychometrically validated the Digital Validation Seeking Scale (DVSS), a multidimensional instrument measuring university students’ reliance on digital feedback for academic and identity confirmation. Two independent samples of Egyptian undergraduate students were recruited: an exploratory sample of 511 students and a confirmatory sample of 740 students from six universities. The DVSS underwent rigorous content validation by eleven experts, exploratory factor analysis (EFA) using Principal Axis Factoring with Promax rotation, and confirmatory factor analysis (CFA) comparing competing structural models. Results revealed a robust four-factor structure comprising Academic Self-Quantification (ASQ), Feedback Hyper-vigilance (FHV), Social Comparison (SC), and Performative Studiousness (PS), with the first-order four-factor model demonstrating superior fit indices. The final 19-item scale exhibited excellent internal consistency, with Cronbach’s alpha coefficients ranging from 0.807 to 0.938 for subscales and total score, respectively, and strong test–retest reliability. The DVSS provides researchers and practitioners with a theoretically grounded, psychometrically sound instrument for identifying maladaptive digital validation patterns before they compromise academic engagement or psychological well-being, enabling targeted interventions within hybrid educational environments. Full article

Critical Thinking (CT) is recognized as a foundational competency for professional readiness, innovation, and ethical reasoning in higher education, enabling students to analyze information, evaluate evidence, and make reasoned decisions in complex environments. The rapid integration of Generative Artificial Intelligence (GenAI) tools, such as large language models, presents new opportunities and risks for CT development. This study conducts a systematic literature review to synthesize empirical evidence on the pedagogical implications and cognitive impact of GenAI on students’ CT. Following PRISMA guidelines, and search terms around GenAI Tools, Critical Thinking And Higher Education, on five major education research databases—Web of Science; Scopus; EBSCOhost (Education Source, ERIC, and APA PsycInfo); and Compendex and Inspec (Elsevier)—63 empirical studies published between January 2023 and April 2025 were analyzed across higher education contexts, disciplines, and intervention designs. Results indicate that GenAI offers notable cognitive affordances, including scaffolding reflective reasoning, promoting self-regulation, and facilitating iterative dialogue and argument evaluation. Pedagogical strategies clustered into four primary integration typologies: AI-based feedback prompts, dialogue simulation and reflection, AI-supported peer review, and critical engagement with AI-generated content. Nearly half of the studies reported statistically significant CT improvements, particularly when GenAI use was guided by structured prompts, reflective activities, and performance-based assessment. However, multiple risks persist, including cognitive offloading, uncritical acceptance of AI outputs, and diminished intellectual autonomy, especially in unguided or surface-level usage. This review highlights the need for intentional pedagogical design, validated CT assessment tools, and longitudinal studies to ensure GenAI acts as a catalyst rather than a substitute for human reasoning. By identifying effective integration strategies and outlining potential pitfalls, this study provides evidence-informed guidance for educators and institutions aiming to responsibly leverage GenAI to strengthen students’ CT skills. Full article

Effective team formation strategies must account for baseline behavioral diversity within student populations, yet most approaches apply uniform parameters regardless of section characteristics. This exploratory, quasi-experimental study proposes a context-sensitive framework for Team Role Experience and Orientation (TREO)-based team formation across two sections of a road geometric design course (N = 77 civil engineering undergraduates). We systematically evaluated 80 team formation configurations per section (16 thresholds × 5 group sizes) to maximize structural differentiation between role-balanced and role-redundant teams. Baseline diagnostics revealed substantial differences in role diversity, justifying independent optimization. Section A (role-redundant) achieved strong structural separation, whereas Section B (role-diverse) showed weak or negative separation across all configurations, reflecting limitations in achieving consistent complementarity contrasts. Post-project surveys assessed perceived role complementarity, team dynamics, and performance. Across both sections, perceptual differences between conditions were small and non-significant, indicating that structural role differentiation does not automatically translate into subjective team experience. However, perceptual trends varied systematically by baseline diversity, highlighting the moderating role of section composition. These findings emphasize the importance of diagnostic indices (R_ef, IDR) for selecting and interpreting team formation strategies and support the use of adaptive, context-sensitive approaches in engineering education. Full article

Background/Objectives: A persistent mismatch between organ supply and transplant demand affects healthcare systems worldwide, particularly in underdeveloped and transitional systems. Intensive care units (ICUs) represent the primary setting for donor identification following brain death, placing intensive care physicians at the center of organ donation pathways. This nationwide cross-sectional survey aimed to evaluate Romanian intensivists’ knowledge, attitudes, and reported clinical practices regarding brain death determination, communication with families, and system-level barriers to organ donation, to identify modifiable factors relevant to transplant policy development. Methods: A prospective, nationwide, questionnaire-based survey was conducted among intensive care physicians in Romania. The structured questionnaire explored their knowledge and attitudes regarding brain death, communication with families, involvement in donation processes, ethical perceptions, and views on the organization of the transplant system. The survey was distributed through the Romanian Society of Anesthesia and Intensive Care, and descriptive exploratory analyses were performed. Results: A total of 117 ICU physicians participated (mean age 41.0 ± 9.9 years). Although 84.6% agreed with the current brain death diagnostic criteria, and 83% considered the protocol sufficiently clear. The mean number of brain-dead patients managed annually was 8.25 ± 12.90. 69.3% of respondents perceived communication competencies as insufficient. 77.8% considered family consent decisive in donation decisions, while 87% supported the establishment of a national donor registry and 77% favored a donor card system. Organ procurement was reported as a priority in only 38.5% of ICUs. Institutional prioritization of organ procurement and structured training was inconsistent. Conclusions: This nationwide survey identifies key educational, organizational, and systemic barriers limiting organ donation performance in Romania. Targeted training, improved communication strategies, integration of donation pathways into routine intensive care practice, and the adoption of national consent instruments represent essential clinical and policy priorities for low-performing transplant systems. Full article

Background: Hearing loss is one of the most common yet often overlooked sensory deficits worldwide, with consequences extending well beyond auditory function. Mounting evidence highlights the complex interrelationships among hearing loss, cognitive decline, and psychosocial well-being. Neural mechanisms underlying this association include increased cognitive load, cortical reorganisation, and social isolation, which mediate the impact of auditory deprivation on the brain and mental health. Furthermore, hearing impairment is consistently associated with a higher risk of depression and anxiety, particularly when the duration of untreated deafness is prolonged. Methods: This narrative review summarises recent longitudinal and neuroimaging studies investigating the effects of hearing loss and the timing of intervention with hearing aids. The review focuses on evidence addressing cognitive, psychological, and neural outcomes in relation to early versus delayed amplification. Results: Across multiple studies, early adoption of hearing aids within a limited timeframe after diagnosis is linked to better cognitive performance, lower depressive symptom scores, and more preserved neural network integrity. Experimental evidence supports the existence of sensitive periods for auditory intervention, during which brain plasticity allows for optimal reorganisation and recovery of function. Conversely, delayed amplification may lead to irreversible cortical changes and persistent psychosocial distress. Despite this, several barriers—healthcare accessibility, patient attitudes, and economic constraints—continue to delay timely intervention. Conclusions: Early identification and management of hearing loss are critical to preserve cognitive and emotional health. An integrated approach addressing both hearing and cognitive well-being, supported by patient education and personalised care strategies, may maximise the benefits of amplification and improve overall quality of life. Full article

Background: In recent years, aesthetic medicine and cosmetic surgery have seen significant growth, reflecting changing sociocultural views on beauty and self-care; however, public knowledge and awareness of associated risks remain inconsistent. This study aimed to assess knowledge, attitudes, and behaviours toward aesthetic medicine and cosmetic surgery in a large metropolitan population in Southern Italy using the Knowledge–Attitude–Practice (KAP) framework. Methods: A cross-sectional survey was conducted between June 2021 and January 2022 among 1079 adults aged 18–72 years residing in the metropolitan area of Naples. A structured questionnaire collected socio-demographic data and assessed knowledge, attitudes, and behaviours related to surgical and non-surgical aesthetic procedures. Descriptive statistics and multiple linear regression analyses were performed to identify predictors of knowledge, attitudes, and behaviours. Results: Overall, 66.8% of participants reported having undergone general beauty treatments, while 9.8% declared the use of cosmetic medicine procedures. A total of 5.1% had undergone botulinum toxin treatments, 11% reported filler injections, and 9.8% had experienced plastic surgery. A majority had strong knowledge, especially on non-surgical procedures, but there were gaps in their knowledge on side effects, regulations, age limits, and qualifications. Most viewed appearance as important, though with critical views of excessive aesthetic treatments and claimed limited social media influence. Female sex and parental status were positively associated with aesthetic behaviours, while attitudes emerged as the strongest predictor of engagement. Conclusions: Aesthetic practices are widely accepted within this urban population, yet important informational deficiencies persist. Targeted educational interventions based on the KAP framework are warranted to enhance health literacy, promote safe decision-making, and foster realistic expectations regarding aesthetic medicine and cosmetic surgery. Full article

Background: Type 2 diabetes mellitus (T2DM) is commonly managed with complex pharmacotherapy combined with dietary modification, which increases the risk of clinically relevant drug–food interactions (DFIs). Despite their potential impact on treatment efficacy and safety, patient knowledge of DFIs—particularly in the context of modern therapies such as glucagon-like peptide-1 receptor agonists (GLP-1 RAs)—remains insufficiently explored. Methods: This cross-sectional study assessed knowledge of DFIs among 103 adults with T2DM using a self-administered, expert-validated questionnaire. Data on sociodemographic characteristics, clinical variables, anti-diabetic therapy (including GLP-1 RAs), sources of education, and attendance at dietary consultations were collected. Knowledge scores were calculated based on correct responses and categorized into tertiles (low, moderate, high). Associations were analyzed using non-parametric tests. Multivariable logistic regression was performed to identify independent predictors of moderate-to-high DFI knowledge. Results: Substantial gaps in DFI knowledge were identified, particularly regarding interactions involving dietary fiber, dairy products, grapefruit juice, and nutrient deficiencies associated with long-term pharmacotherapy. Knowledge level was not significantly associated with age, educational attainment, diabetes duration, or GLP-1 RA use. Female sex was associated with higher knowledge in univariate analysis (p = 0.026); however, this association did not remain significant in the multivariable regression model. Attendance at at least one dietary consultation in the previous year was significantly associated with higher knowledge levels (p = 0.041) and remained an independent predictor in multivariable analysis (OR = 2.31; 95% CI: 1.04–5.15; p = 0.039). Most participants reported not receiving prior education on DFIs, while expressing a strong need for more frequent counseling. Conclusions: Patients with T2DM demonstrate insufficient knowledge of clinically relevant DFIs, including selected issues related to GLP-1 RA therapy. Attendance at structured dietary consultations was independently associated with higher levels of DFI knowledge; however, the directionality and causality of this relationship cannot be established. Given the cross-sectional design and the assessment of knowledge rather than behavioral or clinical outcomes, these findings should be interpreted as hypothesis-generating. Further longitudinal and interventional studies are required to determine whether improved DFI knowledge translates into meaningful changes in dietary behavior, treatment adherence, or metabolic outcomes. Full article

Nicolau syndrome, also known as embolia cutis medicamentosa, is a rare iatrogenic reaction that may occur following parenteral drug administration, including inadvertent intra-arterial or periarterial injection. Its pathophysiology remains poorly understood; however, several mechanisms have been proposed, including vasospasm, embolization, cytotoxic inflammation, and secondary tissue necrosis. We report the case of a 22-year-old transgender woman who received intravenous benzathine penicillin in the left arm without a medical prescription following a reactive syphilis screening performed outside a formal healthcare setting. She subsequently developed severe pain, livedoid dermatitis, pallor, distal cyanosis, and blister formation. Radial and brachial pulses remained palpable, and Doppler ultrasonography revealed no evidence of arterial or venous thrombosis. Medical management included daily wound care, anticoagulation, corticosteroids, peripheral vasodilators, antibiotic therapy, and analgesia. The patient was hospitalized for nine days, with partial clinical improvement. However, persistent distal ischemic changes involving the second through fifth fingers raised concern for evolving necrosis and potential amputation. After counseling regarding these risks, the patient requested voluntary discharge. This case underscores the importance of safe medication administration and appropriate injection practices, particularly in low-resource settings. It also highlights the need for improved training of healthcare personnel to ensure early recognition and prompt management of Nicolau syndrome, as well as strengthened patient education to discourage self-medication and promote timely care by qualified healthcare professionals. Full article

Background: The Perri Auditory Verbal Learning Test (Perri-AVLT) is a cognitive tool designed to assess verbal learning and memory. Currently, demographically adjusted norms for the Perri-AVLT are not available for elderly Mexican adults. Objective: This study aimed to develop regression-based norms from elderly Mexican adults to enable demographic adjustments for clinical interpretation. Methods: The sample included 294 elderly Mexican adults aged 60–89 (224 cognitively normal individuals, and 70 clinical cases) from Mexico (Jalisco, Guanajuato, and Mexico City). Participants were administered the Perri-AVLT. A multivariate regression-based norming approach was used to evaluate the effects of age, sex, and years of education on test performance. Results: The multivariate regression model showed that years of education were a significant predictor of cognitive performance across all Perri-AVLT trials. The Pearson correlation for all Perri-AVLT trials was high. Conclusion: This study provides regression-based normative data for the Perri-AVLT adjusted for sociodemographic factors. These norms can be used to evaluate verbal learning and memory in elderly Mexican adults. This information can support a neuropsychologist in cognitive assessment, rehabilitation, and research. Full article

Vocational education systems face increasing pressure to deliver high-quality skills training while ensuring resource efficiency, safety, and scalability. In machining programs, traditional hands-on training relies heavily on physical equipment, consumables, and close supervision, posing challenges for sustainable management. This study employs a quasi-experimental design with pretest–posttest measures and a comparison group to examine the effects of VR-based pre-training with 50 first-year vocational students. The findings indicate that VR-based preparation supports learners’ cognitive and experiential readiness and contributes to perceived preparedness for subsequent hands-on activities. No statistically significant differences in posttest performance were observed between groups. VR-based preparatory training supports risk mitigation in learning contexts by enabling cognitive rehearsal and structured procedural familiarization before physical practice. At the system level, VR-based pre-training transforms early-stage trial-and-error learning into a guided virtual environment that incorporates predefined operational sequences, procedural cues, and embedded safety prompts. This approach helps reduce safety risks for inexperienced learners and supports the more strategic use of instructional resources. Rather than establishing generalized or causal effects, the findings provide exploratory, empirically grounded insights derived from a single institutional context, offering a structured reference framework to inform the design, scaling, and validation of future multi-site or longitudinal research in vocational education management. Furthermore, the study explicitly aligns with Sustainable Development Goals 4 (Quality Education) and 8 (Decent Work and Economic Growth). This alignment underscores the study’s relevance to sustainability-focused vocational training initiatives. Full article

Newborn screening helps identify sickle cell disorder (SCD) early and to promptly initiate effective measures. It is estimated that India accounts for approximately 16% of global annual births with SCD. Multiple reports of screening for SCD in India have emerged in the last decade. Our aim was to pool the birth prevalence of SCD and sickle cell trait (SCT). A systematic review of published evidence on nontargeted, universal screening for SCD or SCT in newborns was performed (16 studies). The pooled prevalence of SCD was 1100 per 100,000 (10 studies, 88,276 neonates, 95% CI: 432, 1768), while that of SCT was 9639 per 100,000 (7 studies, 72,702 neonates, 95% CI: 6283, 12,995) in endemic regions. Limited data exist from nonendemic regions. Only three studies had data on follow-up and confirmatory genetic diagnosis. Sparse data exist on cost-effectiveness, long-term follow-up, and the impact of early screening on mortality. Concerted ongoing efforts in the identification of the burden are needed. The needs of the hour are universalization of NBS, integration into existing health systems, and maintenance of birth cohorts with early introduction of penicillin prophylaxis, hydroxyurea, parental education, appropriate immunization, and continued follow-up by an experienced medical team. Full article

This study investigated whether resting-state EEG coherence in the alpha, beta, and theta frequency bands predicts working memory performance in healthy middle-aged adults (N = 27, aged 49–64). Unlike prior research focusing on young adults or clinical populations, we examined the relationship between EEG coherence during eyes-open rest and performance on a range of working memory tasks, including updating (n-back task), switching, Stroop, and complex operation span (OSPAN task). Hierarchical regression analyses revealed that demographic variables (age, education) were generally not significant predictors, except for education in the updating task. Inclusion of EEG coherence significantly increased explained variance: alpha, beta, and theta coherence predicted performance in the updating task, while alpha and beta coherence predicted outcomes in the OSPAN task. Specifically, higher alpha coherence was associated with better performance, whereas lower theta and beta coherence predicted superior outcomes, suggesting enhanced neural flexibility and efficient cognitive resource allocation. EEG coherence did not significantly predict performance in the switching or Stroop tasks, likely because these tasks rely more on rapid reactive responses and local neural activity not captured by resting-state synchronization. These findings indicate that resting-state EEG coherence may serve as a frequency-specific neurophysiological marker of working memory in middle age. Future research should explore longitudinal changes and potential interventions, such as neurofeedback, to modulate coherence and enhance cognitive function. Full article

Digital literacy has become central to educational participation and social inclusion worldwide. Yet significant disparities persist in low-resource schooling contexts, where unequal access to digital infrastructure may shape learners’ confidence in engaging with technology. This study examines the relationship between socioeconomic access and digital self-efficacy among underserved high school students in South Africa through the lens of the UNESCO Digital Literacy Global Framework (DLGF). Data were collected from 286 learners in three Eastern Cape secondary schools in South Africa using a structured questionnaire measuring constructs derived from the DLGF. Focusing on two core constructs, socioeconomic access and digital self-efficacy, a partial PLS-SEM model was estimated with SmartPLS 4. The reflective measurement model showed acceptable reliability and convergent validity (CR = 0.83, AVE = 0.51 for socioeconomic access; CR = 0.79, AVE = 0.65 for digital self-efficacy). Socioeconomic access was positively associated with digital self-efficacy ($\beta$ = 0.38, t = 7.04, p < 0.001), explaining 15% of its variance ($R^2$ = 0.15). These findings suggest that policies aimed at improving device availability and reliable connectivity in underserved schools may strengthen learners’ confidence in performing foundational digital literacy tasks, particularly information search and source evaluation. Full article