Search Results (749)

Background and Objectives: Seroma formation is the most common postoperative complication following mastectomy and axillary dissection, negatively affecting wound healing and delaying adjuvant therapy. Despite numerous surgical and pharmacological approaches, no universally effective strategies have been established. This study aimed to comparatively evaluate the effects of porcine dermal collagen (PDC), tranexamic acid (TXA), and thymoquinone (TQ) on seroma formation and tissue repair. Materials and Methods: A randomized controlled experimental study was conducted using 40 female Wistar albino rats that underwent modified radical mastectomy and axillary dissection. All surgical and postoperative procedures were performed in accordance with the institutional animal welfare and ethical guidelines, including postoperative analgesic administration. The animals were divided into four groups: control, PDC, TXA, and TQ (n = 10 each). Seroma volume was measured on postoperative day 14. Histopathological evaluation, immunohistochemical analysis (FGF2, VEGF, TGF-β1, p53), and quantitative real-time PCR were performed to assess tissue remodeling and molecular responses. Results: All treatment groups demonstrated a significant reduction in seroma volume compared to the control group, with the most pronounced decrease observed in the TQ and TXA groups (p < 0.0001), while PDC showed a moderate effect (p < 0.01). Histopathological analysis revealed increased collagen deposition and fibrin formation in the PDC and TQ groups, whereas TXA exhibited a more limited remodeling profile than the others. Immunohistochemical and molecular analyses showed significant upregulation of VEGF across all groups, with broader and more consistent increases in the PDC and TQ groups. TGF-β1 and FGF2 expression demonstrated region-specific increases, particularly in the thoracic tissue. p53 expression remained relatively stable in the TXA group but was elevated in specific regions in the PDC and TQ groups. Importantly, the increased inflammatory infiltration, edema, vascular proliferation, and fibrin deposition observed in the TQ group may reflect not only active tissue remodeling processes but also prolonged inflammatory activation and enhanced fibrotic responses and should therefore be interpreted cautiously. Conclusions: PDC, TXA, and TQ differentially modulate postoperative seroma formation via distinct biological mechanisms. While TXA primarily exerts a targeted anti-seroma effect and PDC enhances extracellular matrix stabilization, TQ is associated with broader angiogenic, inflammatory, and tissue remodeling responses within this preclinical rat model. These findings should be considered exploratory and hypothesis-generating, and additional mechanistic studies and clinical investigations are necessary before definitive therapeutic conclusions can be established regarding the use of TQ in human breast surgery settings. Full article

Precision psychiatry promises a more objective and effective approach to psychiatric care, yet its implementation raises growing ethical challenges as technology advances. This narrative review offers a qualitative synthesis of the ethical issues reported in 62 studies, with emphasis on the practical tensions that arise when core principles conflict. Rather than organising concerns around traditional ethical principles, the review maps them across the main modalities of precision psychiatry, namely genomics, neuroimaging, digital phenotyping, and AI-driven interventions. Four explicit positions are advanced. First, equity must be engineered from the outset rather than assumed. Second, interpretability should outweigh marginal gains in accuracy in a field built on subjective report. Third, stigma is bidirectional and contingent on framing and the availability of meaningful intervention. Fourth, individualised care must demonstrate clinical and economic superiority over standardised approaches. Precision psychiatry is likely to reshape psychiatric practice and the therapeutic relationship itself. Interdisciplinary collaboration, clear guidelines, and continuous ethical vigilance will be essential for responsible adoption and sustained public trust. Full article

The increased use of technology-assisted distance counseling practices is one result of COVID’s impact on behavioral health, including in counselor education and the delivery of supervision. First, technology-assisted distance supervision needed for “real time” communication grew. Furthermore, there is an emergence of artificial intelligence (AI) technologies that have the potential to contribute to aspects of supervision; however, current evidence remains emerging, context-dependent, and at times mixed, warranting cautious interpretation of their effectiveness. The article offers an overview of using AI in clinical supervision, examines the benefits and potential concerns of AI from different perspectives, and considers the significance of using AI in counseling supervision. The role of AI is discussed as applied to counseling supervision including the use of AI tools, such as chatbots and reasoning AI, to detect and track sessions, note behavioral and emotional cues, aid/monitor communication and feedback, while also attending to ethical and legal consideration for its use. The article will report a range of benefits for supervisors and trainees using AI—for example, by enhancing data-driven supervision decisions, analyzing feedback trends, providing more efficient administrative monitoring, flexible/remote support, skill development, and promoting ethical decisions and self-reflection. Special attention is given to the challenges of using AI in supervision, including risks of undervaluing intuition and qualitative insights, potential for algorithms to reinforce systemic biases, risks of replacing human interaction, as well as non-compliance with HIPAA, FERPA, and ethical guidelines in data storage and privacy. The article will discuss privacy concerns, depersonalized feedback, and increased judgment-driven anxiety despite needed empathy when using AI as a tool for clinical supervision. Recommendations will also be offered for effective, ethical integration of AI in counseling supervision. Full article

Over the past decade, developments in artificial intelligence (AI) have sparked a new wave of debate and research across nearly all areas of life, including education. In English as a Foreign Language (EFL) education, AI-based technologies are also widely adopted to support learners and instructors. This trend has led to numerous studies focused on understanding AI’s role in identifying potential opportunities and challenges. This study offers a systematic review of relevant research, highlighting the benefits and obstacles of AI use in the Saudi EFL context. About 60 peer-reviewed articles were selected following PRISMA guidelines. The findings reveal multiple opportunities for AI integration in Saudi Arabia, such as improved language skills, personalized learning experiences, increased self-regulated learning, boosted motivation and confidence among learners, expanded learning opportunities, and support for pedagogy and institutional performance. Major challenges include biased and inaccurate data, students’ overdependence on technology, ethical concerns, and a lack of technological skills among users. The study also suggests future directions, including localizing AI tools, conducting long-term impact studies, providing faculty and student training, and establishing ethical guidelines within institutions. Full article

The rapid development of generative artificial intelligence (GenAI) is transforming both the health sector and health profession education, although AI-based systems have existed in these sectors for decades. GenAI-integrated virtual agents and simulations now play novel and critical roles in simulation-based education and are potential solutions to enhance the adaptability of health profession education. This systematic review was conducted using the PRISMA guidelines and explores how GenAI-integrated virtual agents and simulations are being applied in health profession education, with a particular focus on their educational impact, technical features and functionalities, and current limitations. This review aims to synthesize the pedagogical value and technological design of GenAI-integrated simulations and to inform health professionals and educators about the effective use, impact, and challenges of GenAI in health education simulations. A total of 16 papers were reviewed. Results show that GenAI-integrated virtual agents and simulations have potential to enhance clinical communication, diagnostic accuracy, multilingual interactions, and learner confidence for health profession education. Related theoretical, technological, and educational implications of generative AI-integrated virtual agents and simulations are discussed to inform future design and application. Limitations include insufficient educational effectiveness, response accuracy issues, and unresolved ethical and privacy concerns. Future studies should focus on long-term efficacy, ethical considerations, and optimizing AI–human collaboration in various health profession education contexts. Full article

Background: Follicular unit extraction (FUE) has become the dominant donor site harvesting technique in modern hair transplantation due to its ability to avoid linear scar formation and its procedural flexibility. However, the donor site is a limited non-regenerative source. Excessive or poorly planned extraction can lead to visible thinning, hypopigmented scarring, and reduced reserve for future procedures. Objective: This study aimed to synthesize current evidence on donor biology, preoperative assessment, extraction strategy, and complication prevention in FUE, and to propose a reproducible clinical framework for donor preservation. Methods: A structured narrative review was conducted using PubMed/MEDLINE, Scopus, and Google Scholar to identify English-language publications related to donor site biology, donor evaluation, extraction density thresholds, complication prevention, repeat session planning, and emerging FUE technologies. Priority was given to recent reviews, clinical trials, consensus statements, and practice-oriented surgical literature. Articles were selected not for formal meta-analytic pooling, but because of their relevance to donor conservation and long-term donor management. Results: The literature reviewed consistently identifies excessive local extraction density, harvesting beyond conservative limits, donor miniaturization, and inadequate reassessment before repeated procedures as the primary drivers of donor morbidity. Evidence from reviews, clinical trials, and expert guidelines supports conservative extraction thresholds, widespread spatial distribution, individualized donor mapping, and phased long-term planning as key strategies for preserving donor aesthetics and reserve. Conclusions: Donor preservation is central to ethical and sustainable FUE surgery. Integration of biologically informed assessment, disciplined extraction control, and mandatory reassessment protocols can reduce morbidity while preserving long-term graft flexibility in patients with progressive androgenetic alopecia. Full article

In recent years, artificial intelligence (AI) has been increasingly used in criminal justice systems across the world. To achieve objectives set out through Sustainable Development Goals (SDGs), adoption of technology is inevitable and undeniable. The press release dated 25 February 2025 from India’s Ministry of Law and Justice, quoting Prime Minister of India Narendra Modi to make a “justice system that will be fully future-ready”, confirmed that the Indian law enforcement agencies are integrating AI into policing and law enforcement to enhance crime detection, criminal investigation, etc. It is intended to enhance their capabilities in solving criminal cases and delivering justice speedily and more efficiently. However, the usage of AI tools in such contexts presents a double-edged sword, as evidenced by their application in a number of cases across the world like Christopher Gatlin, Nijeer Parks, the Harm Assessment Risk Tool (HART), and in India during the 2020 Delhi riots cases. As reported by the Washington Post, in Christopher Gatlin’s case it was found that the police arrested him on the basis of the facial recognition programme matching his face with the captured video footage. He spent 17 months in jail before his release by the court, observing that the police failed to conduct fair investigation. A similar incident was reported by NJ.com and CNN Business. In the investigations following the 2020 Delhi riots, Delhi Police effected over 1900 arrests in 758 riot-related cases, relying predominantly on AI-driven facial recognition matches. Subsequent court scrutiny in decided cases raised questions about reliability, leading to widespread acquittals and discharges of the accused in 82% of decided cases as of early 2025. In certain cases, AI-driven solutions have failed, leading to criminal prosecutions of innocent people based on AI-generated evidence. This study examines the reliability, validity, and ethics of AI technology in the criminal justice system in India’s unique socio-legal and political environment. The researchers analyse three interrelated axes. First, a comprehensive review of the international algorithmic policing literature to identify successes and failures. In addition, cases of AI-assisted investigations during the Delhi riots show how facial recognition systems and other AI techniques were used for inquiry. Finally, stakeholders’ perspectives, including a preliminary survey of 27 legal experts showing strong consensus on classifying AI-FRT outputs strictly as corroborative evidence and highlighting BSA insufficiencies for addressing opacity and explainability, help identify practical, procedural, and normative fault lines. Researchers noted that while AI has the potential to revolutionise resource-constrained investigative agencies, its unquestioning and uncritical adoption risks amplify pre-existing biases, undermine presumptions of innocence, and shift the burden of refuting algorithmic inference onto the accused. Independent algorithmic audits, transparent documentation of error rates and confidence thresholds, statutory guidelines on AI tool use and admissibility, and sustained capacity-building throughout the justice delivery chain are needed to integrate it into the Indian criminal justice system. Without such measures, the very tools designed and introduced to enhance accuracy threaten to undermine the fundamental norms of the criminal justice system such as fairness and due process. This fills a gap in doctrinal analysis of AI-specific evidentiary admissibility in non-Western contexts like India. This study aims to propose policy reforms, enhance judicial discourse, and promote a more circumspect trajectory for AI adoption in Indian law enforcement by mapping the potential and risks of algorithmic evidence in a non-Western legal order. Full article

Automatic gesture and movement recognition techniques are mainly used with adults for various purposes in public, clinical, and laboratory settings. Growing interest in this field has led to the increasing application of these methods in child behavioural analysis to serve different societal and educational functions. However, manual human annotation of behaviours remains the predominant method, and only a limited number of studies have explored the use of automatic recognition for children. This review aims to evaluate the rapidly developing techniques of automatic gesture and movement recognition that focus on child behaviour analysis across different settings and for different purposes. More specifically, it analyzes their purposes, target groups, settings, accuracy, and limitations, as well as the ethical issues and data privacy frameworks that should be considered in child-centred AI. Using a systematic review approach following the PRISMA guidelines, this study examines research published between 2021 and 2025 in four databases: Web of Science (WoS), Scopus, PubMed, and IEEE Xplore. From a total of 27 included studies, the findings reveal that automatic gesture and movement recognition is being applied across multiple fields, with consideration of children’s developmental needs. However, a critical gap in technical reporting was identified: fewer than half of the included studies (44%) provided accuracy metrics or clinical validity. Furthermore, evidence of robust ethical safeguards remains limited. To support children’s well-being, future studies must bridge the lab-to-field gap, prioritize natural research settings and enforce ethical and data protection measures. Full article

Background: The legal dimensions of nursing practice have become increasingly complex, yet the concept of legal literacy in clinical nurses remains insufficiently defined. Existing studies use terms such as legal knowledge, legal awareness, legal cognition, and law-based practice capacity inconsistently, which hinders conceptual clarity, valid measurement, and targeted educational intervention. This study aimed to clarify the conceptual boundaries, defining attributes, antecedents, consequences, empirical referents, and operational definition of legal literacy in clinical nurses. Methods: A concept analysis was conducted using Walker and Avant’s eight-step method. A systematic literature search was performed across six databases and supplemented by searches in JSTOR and HeinOnline for non-clinical uses of the concept. The search covered database inception to December 2024. Screening and reporting followed PRISMA 2020 guidelines. Fifty-six papers were included. Data extraction and analysis were conducted using content analysis with independent dual-reviewer coding. Results: Legal literacy in clinical nurses was distinguished from four related concepts: legal knowledge, legal awareness, legal cognition, and medical ethics. Three defining attributes were identified: normative understanding, value internalization oriented toward rights and responsibilities, and law-based situational practice. Antecedents were identified at macro, meso, and micro levels, while consequences were observed for individual nurses, healthcare organizations, and patient rights. Analysis of empirical referents revealed a persistent gap between conceptualization and measurement, particularly in assessing law-based situational practice. An operational definition was developed accordingly. Conclusions: Legal literacy in clinical nurses is a multidimensional professional competency integrating legal understanding, rights- and responsibility-oriented value internalization, and the ability to translate these into lawful clinical action. The findings provide a conceptual basis for future instrument development and targeted educational and management interventions. Full article

Artificial intelligence has been effectively integrated into every stage of undergraduate research, significantly improving students’ learning efficiency. Against this backdrop, artificial intelligence is no longer merely an optional external tool, but has become an extension of college students’ personal capabilities—that is, “AI identity.” The study constructs a moderated dual-mediation model from the perspective of ambidextrous learning. Moving beyond prior work on AI usage frequency or literacy, this study centers on AI identity and reveals the double-edged effect of AI identity on research creativity, with a positive indirect effect via exploratory learning and a negative indirect effect via exploitative learning, along with the asymmetric moderating role of ethical dilemmas on these two pathways. Using questionnaire surveys analyzing 451 college student responses, the results demonstrate that AI identity positively correlates with research creativity, where exploratory learning serves as a positive mediator while exploitative learning acts as a negative mediator. Ethical dilemmas moderate the relationship between AI identity and ambidextrous learning. These findings provide actionable insights for higher education institutions to foster students’ exploratory AI use, mitigate overreliance, and establish ethical governance frameworks for AI-assisted research, thereby assisting universities in guiding students toward developing a healthy understanding of AI identity and refining ethical guidelines for AI applications. Full article

Introduction: The ethics of dental care in children are complex and involve the dentist’s approach, the child’s perception, and the parents’ attitudes. Aim: This study aims to analyse children’s experiences, parents’ perceptions, and the dentist’s approach to dental pain in relation to ethical principles, communication, and informed consent. Methodology: This cross-sectional study included 116 paediatric patients, using a semi-structured questionnaire. We assessed demographic data, children’s overall experiences and pain during dental visits, parent–dentist communication, and parents’ ethical approaches to pain management in paediatric patients. Results: The majority of children were informed by their parents about the dental visit (97.4%) and the reason for the visit (94.8%). Communication between the dentist and child during the procedure was the main factor that helped reduce fear (61.2%). Most children reported no pain (45.8%) or only minimal pain (51.8%), with needle puncture being the most commonly reported source of dental pain. Overall, parents demonstrated positive ethical attitudes towards paediatric dental care, high satisfaction with dental services (96.6%), and strong support for the development of legal and written guidelines for pain management in children. Discussion: The ethical framework for children’s pain management in our dental services is well established, resulting in a high level of satisfaction with the care provided and strong trust in dental professionals. Conclusions: This study provides a basis for the promotion of ethical standards for dental procedures in pain management in paediatric patients, and other measures to reduce anxiety and fear should be part of future strategies. Full article

Informed consent is a core ethical and legal requirement in clinical practice. For individuals with aphasia, language impairments can hinder communication during consent processes. However, aphasia is primarily a language disorder and does not inherently imply cognitive impairment, a distinction frequently overlooked in clinical and legal settings. This scoping review examines how decision-making capacity (DMC) is assessed and supported in adults with aphasia, and outlines the clinical, ethical, and medico-legal implications for consent procedures. The review followed PRISMA-ScR guidelines. A systematic search of biomedical and legal databases was conducted without time restrictions. Studies addressing informed consent or DMC in adults with aphasia were included and analyzed using a qualitative thematic approach. Out of 519 records, 9 studies (2010–2024) from Australia, Canada, the United Kingdom, and Ireland met inclusion criteria. These studies often referenced national legislation and rights-based frameworks to define clinical responsibilities. Three main themes emerged: (1) DMC assessments rely heavily on language, with limited involvement of speech–language pathologists (SLPs), despite their role in reducing bias; (2) supported communication strategies—such as simplified language, visual aids, alternative response formats, and structured tools—can uncover “hidden competence”; and (3) structural barriers, including time constraints, insufficient training, and limited access to aphasia services, restrict implementation. Current evidence remains limited, largely qualitative, and insufficient to support definitive clinical recommendations. Incorporating supported communication, multidisciplinary assessment, and thorough documentation may enhance fairness and legal robustness. Future research should focus on validating aphasia-sensitive tools and evaluating their impact on outcomes and medico-legal risk. Full article

Conversational search systems (CSSs) are emerging as a transformative interface for health information seeking, enabling multi-round, natural language interactions that integrate diverse medical resources. This scoping review synthesizes evidence on the capabilities, limitations, applications, and future directions of CSSs in healthcare. Following PRISMA-ScR guidelines, we systematically searched multidisciplinary databases (2010–2025), screened 3789 records, and included 325 studies addressing CSSs in health contexts. Analysis identified six thematic domains: (1) capabilities and limitations, (2) enhancement methods, (3) clinical applications, (4) trust, user experience, and interaction design, (5) readability, health literacy, and patient communication, and (6) cross-lingual and domain-specific adaptation. Findings show CSSs offer advantages in personalization, structured output, and patient education, but face challenges in accuracy, timeliness, and semantic consistency, particularly in high-risk clinical decision-making. Enhancement strategies such as retrieval-augmented generation (RAG), knowledge graphs (KG), fine-tuning, and composite approaches improve performance, while trust-building requires transparency, empathy, and ethical safeguards. Cross-lingual disparities and cultural adaptability remain critical gaps. Overall, CSSs hold substantial potential to improve health information access and literacy, but safe, equitable, and culturally sensitive integration demands multidimensional optimization in knowledge updating, bias control, and interaction design, alongside clinician oversight, to ensure reliability and maximize public health impact. Full article

Galleria mellonella (wax moth) larvae are increasingly used as model organisms in biomedical research, yet ethical guidelines for their anesthesia and euthanasia are lacking. A review of published papers revealed that most projects involving G. mellonella either did not use any anesthesia or euthanasia, or employed suboptimal methods that may cause pain. This study demonstrates that brief exposure to isoflurane at 2 μL/cm³ provides rapid, long-lasting anesthesia without impairing immune functions of the larvae. Additionally, combining isoflurane anesthesia with subsequent freezing at −20 °C offers an effective euthanasia method. The described anesthesia and euthanasia methods are simple, scalable, humane, and well-suited for laboratory use in G. mellonella, supporting improved welfare standards in invertebrate research. Full article

Background/Objectives: Precision medicine has moved into routine practice, but its evaluation through Health Technology Assessment (HTA) remains ethically underdeveloped. Existing instruments do not address the distinctive ethical demands of genomic profiling, AI-based clinical decision-support, and the equitable distribution of benefits from high-cost targeted therapies. Methods: A modified two-round Delphi study was conducted with a multidisciplinary panel of 18 Greek experts in bioethics, HTA, genomic medicine, nursing, and health policy. In Round 1, 32 candidate ethical statements across seven thematic domains were rated on a three-point scale; retention required a Content Validity Ratio (CVR) ≥ 0.42 and ≥80% agreement. Retained statements were re-evaluated in Round 2 with consensus defined as median ≥ 2.0 and ≥80% agreement. Reporting follows ACCORD guidelines. Results: Fifteen of 32 statements satisfied retention criteria. In Round 2, all 15 achieved consensus with a median of 3.0 and agreement of 94.4–100% (interquartile range, IQR = 0.00). Five domains constituted the final framework: fundamental ethical principles; transparency, stakeholder participation, and institutional accountability; equity and access; digital health and artificial intelligence (AI); and pandemic preparedness and system resilience. Domains addressing environmental sustainability and social acceptability did not meet the threshold. Conclusions: This study presents, to our knowledge, one of the first empirically grounded ethical frameworks for precision medicine HTA developed within an EU Member State through a formal Delphi process. The framework is operationalised through a ready-to-use ethics checklist designed for direct integration into national HTA submission and appraisal processes. Conducted in Greece—a late-aligning EU Member State—the study provides a transferable methodological template for comparable health systems across Europe. Full article