Search Results (156)

Purpose: Adjuvant radiotherapy (RT) for ductal carcinoma in situ (DCIS) remains a widely discussed topic. While it has been shown to significantly reduce recurrence rates, it does not improve overall survival (OS) and may therefore lead to overtreatment in some cases. This study aimed to assess patient acceptance, quality of life (QoL), and decisional regret (DR) in relation to late adverse effects. Methods: Clinical data from patients who underwent RT for DCIS between 2008 and 2020 were retrospectively collected, while follow-up questionnaires evaluated QoL and DR. High-risk DCIS was defined as tumor size ≥ 2.5 cm, poor differentiation (G3), age ≤ 50, and symptomatic diagnosis. Low-risk disease was defined as tumor size < 2 cm, G1/G2, age > 50, and mammographic diagnosis. Patients who did not meet all criteria for either category were classified as intermediate risk, therefore reflecting everyday work and clinical practice. Questionnaire data were analyzed using both scale-level and item-level approaches and Ipsilateral breast recurrence-free survival (IBRFS) rates were calculated using the Kaplan–Meier method. Results: Among 307 cases offered RT, only 24 declined, indicating high treatment acceptance; an additional 20 cases lacked sufficient documentation, did not receive RT at our center despite acceptance, or discontinued RT prematurely. During the study period, late toxicities occurred at acceptable frequencies: fibrosis in 6.1%, hyperpigmentation in 6.8%, telangiectasia in 8%, and edema in 1.5% of cases with excellent control rates of 90.0%. The response rate to the EORTC QLQ-C30 and Ottawa Decisional Regret Scale (DRS) was 35.4%, of whom 70 cases belonged to the intermediate-risk group. These respondents reported high QoL and low levels of DR. Conclusions: RT for intermediate grade DCIS is accepted and tolerated well, and neither late adverse effects nor QoL outcomes were associated with DR. These findings support recommending RT in this borderline-indication group. Full article

Background/Objectives: Uncontrolled diabetes and associated comorbidities disproportionately affect African American (AA) adults. Medication adherence is key to diabetes control yet is often suboptimal, particularly among AA adults. This study examined associations between patient characteristics and adherence among AA adults with uncontrolled diabetes and compared two medication adherence instruments for predicting diabetes control. Methods: This cross-sectional analysis used baseline data from the Management of Diabetes in Everyday Life (MODEL) study, a clinical trial to improve diabetes self-care among AA adults with uncontrolled diabetes. Internal consistency of the 12-item Adherence to Medication Refills and Medications Scale for diabetes medications (ARMS-D) was evaluated by comparing its Cronbach α to the standardized Cronbach α calculated from MODEL data. Associations with variables were examined using correlations, t-tests, or ANOVA, as appropriate. Stepwise multiple regression identified predictors of diabetes control assessed by hemoglobin A1c (HbA1c). Results: Among 665 participants (mean age = 54 years, HbA1c = 10.24%; 67% female; 73% high health literacy), 75% reported perfect adherence on the Summary of Diabetes Self-Care Activities Medications Subscale (SDSCA-MS) versus 7.3% on ARMS-D. ARMS-D showed strong internal consistency (α = 0.81). Lower adherence by ARMS-D was associated with younger age, higher social complexity, and depression (all p ≤ 0.001). ARMS-D score, age, depression, and insulin, dipeptidyl peptidase 4 inhibitor, and sodium-glucose co-transporter 2 inhibitor use predicted baseline HbA1c. Conclusions: This study demonstrates that younger age, depression, and high social complexity are associated with lower medication adherence measured using the ARMS-D. Adherence gaps identified by ARMS-D may validly predict diabetes control and help guide interventions to improve diabetes care in AA adults with uncontrolled diabetes. Full article

Background: Adults with type 2 diabetes increasingly use patient portals, telemonitoring systems, mobile applications, text messaging programs, and other digital services to support self-management. In practice, however, these approaches often still depend on nursing support to help patients understand, use, and sustain digital care in everyday settings. This scoping review mapped how nurses are involved in supporting adults with type 2 diabetes to use digital tools, information, and services for self-management across care settings. Methods: This scoping review followed Joanna Briggs Institute methodology and was reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. The review question was guided by the Population, Concept, and Context framework. A literature search was conducted in January 2026 in PubMed, Scopus, Embase, and EBSCO/CINAHL. A total of 230 records were identified, 71 duplicates were removed, and 159 records underwent title and abstract screening. Fifty-three full-text articles were assessed for eligibility, and 15 studies met the inclusion criteria. Data were extracted using a structured charting table and synthesized descriptively and thematically. Results: The 15 included studies were published between 2021 and 2026 and represented evidence from 10 countries across primary care, community health centers, telehealth programs, and hospital-linked services. Five interrelated themes were identified: nurses as digital self-management educators; nurses as remote monitors and care coordinators; nurses as facilitators of digital engagement, confidence, and supported use; nurses as implementation partners in digital diabetes care; and equity, access, and context as shaping conditions of digital diabetes support. Only one study directly measured digital health literacy, whereas the remaining studies addressed digital engagement more indirectly through onboarding, portal communication, telemonitoring, reminders, tailored feedback, and implementation work. Common barriers included workload, unclear responsibilities, technical difficulties, age- or literacy-related access challenges, language needs, and uneven infrastructure. Conclusions: The included studies suggest that nurses commonly contributed to making digital diabetes care more understandable, usable, and actionable for adults with type 2 diabetes. Their roles were described across education, monitoring, coordination, implementation, and support for digital engagement. Future studies could measure digital health literacy more explicitly, describe nursing tasks in greater detail, and examine how equity-related factors shape digital diabetes care. Full article

Recent research highlights the importance of effective teaching methodologies to enhance scientific learning from the earliest years of schooling. The present study investigates the effects of the Spaced Learning (SL) methodology in science education in Italian primary schools, with particular attention to scientific knowledge and students’ scientific reasoning skills. The study involved 401 third- and fourth-grade pupils (aged 8–11) from three primary schools in Palermo, Italy, during the 2024/2025 school year. A quasi-experimental design was adopted, with classes assigned to an experimental group that adopted SL or to a control group that followed traditional teaching. The intervention lasted seven months and was supported by continuous teacher training and collaboration with university researchers. The data were collected through a pre-test/post-test questionnaire developed and validated by experts in physics education. The tool assessed the students’ general scientific reasoning skills through multiple-choice items inserted in everyday life contexts. Descriptive statistics were calculated and between-group comparisons were made by Student’s t-test or Welch’s t-test when the assumption of homogeneity of variances was not met. The results indicate that students exposed to the SL methodology achieved higher post-test scores than those who received traditional education, suggesting a positive effect of time-distributed, movement-integrated learning on science learning outcomes. Such results support the effectiveness of SL as a promising teaching approach to promote meaningful and lasting scientific learning in primary school. Full article

The development of resin-regolith composites represents a promising In Situ Resource Utilization (ISRU) strategy for future lunar missions. While unsuitable for primary habitat construction due to the payload cost of transporting polymers from Earth, these composites offer a highly efficient solution for manufacturing non-structural, everyday items (e.g., containers, tools, and plant cultivation pots) directly on the Moon via mold–casting. This approach significantly reduces the volume and mass of pre-formed plastic payloads. In this work, the influence of the particle size distribution of a lunar highland simulant (LHS-1E) on the mechanical properties of epoxy-based composites was systematically investigated for such applications. First, the regolith-to-resin ratio was optimized for castability, establishing a maximum regolith content of 60 wt.%. Then, four different size fractions of the simulant were prepared by sieving (>200 µm, 200–100 µm, 100–50 µm, and <50 µm), and composite samples were cast maintaining this optimal ratio. X-ray microtomography revealed that using larger particles (>200 µm) increased composite porosity, whereas smaller fractions promoted more compact structures. Three-point bending tests showed that intermediate particle sizes (200–100 µm and 100–50 µm) led to enhanced flexural strength, while the smallest particles (<50 µm) decreased mechanical performance, likely due to a lower basalt content in this finer fraction. Finally, ball-on-disk tribological analyses highlighted that composites made with larger particles (>200 µm) exhibited superior wear resistance, whereas particle size had negligible effects on the coefficient of friction. Overall, the results demonstrate that both particle size and mineralogical composition significantly influence the performance of regolith–epoxy composites, providing essential guidelines for the in situ manufacturing of functional, non-structural objects for lunar outposts. Full article

Families play a central role in shaping young children’s learning and development through everyday interactions and shared activities in the home environment. As digital technologies have become increasingly embedded in family life, digital home learning activities have emerged as a meaningful dimension of the broader Home Learning Environment, although research in this area remains limited. The present study examined the psychometric structure and characteristics of digital home learning activities and explored their associations with preschool children’s socio-emotional difficulties, as well as demographic factors related to variation in these activities across families. Data were collected from two independent parent samples (N = 308) of families with preschool-aged children. Digital home learning activities were assessed using the digital home learning activities subscale of the Home Learning Environment Questionnaire, while children’s socio-emotional difficulties were measured using the Strengths and Difficulties Questionnaire (Group A) and selected items from the Child Behavior Checklist (Group B). Confirmatory factor analyses supported a unidimensional structure with satisfactory reliability across both samples. Hierarchical regression analyses showed that digital home learning activities were generally not associated with children’s socio-emotional difficulties after demographic characteristics were taken into account. However, parent age and parent education were associated with variation in these activities across families. Full article

Existing adult-report survey measures provide crucial information about children’s executive function (EF) development across contexts, but lack cultural relevance and ecological validity. To address these limitations, we introduce the Executive Function from Observation and Reflection Tool (EFFORT), a publicly available, open-source item bank designed for cross-cultural adaptation that includes 32 parallel items for caregivers and teachers across six EF domains: sustained attention, response inhibition, interference suppression, working memory, cognitive flexibility, and planning/organization. EFFORT additionally includes 10 assessor report items intended for use following a structured, standardized assessment session. This study presents the first validation of the tool within seven countries (Argentina, Australia, Bangladesh, Haiti, South Africa, Sri Lanka, United States) leveraging caregiver, teacher, and assessor observations of 1738 children (aged 3–11 years). Findings revealed acceptable fit for a six-factor structure for caregiver and teacher reports that were not empirically distinct, but yielded highly reliable composites. We further validated a 12-item short form for caregivers and teachers that demonstrated strong unidimensionality, gender invariance, and age-related increases. We demonstrated significant convergence of a short-form caregiver and teacher composite with the assessor-reported measures, as well as convergence of all three adult reports with direct assessments of children’s EF skills. This new tool holds promise to advance the science of how children develop and apply EFs to accomplish everyday goals across different cultural settings and in understudied populations. Full article

The article introduces the Hylomorphism Inventory (HI), a new instrument designed to measure lay beliefs about the soul–body relationship that are congruent with the Aristotelian–Thomistic framework of hylomorphism. Although research on intuitive ontology has predominantly focused on dualist and monist models, the hylomorphic perspective—central to Catholic anthropology yet difficult to articulate in everyday cognition—remains largely unexplored. Drawing on research in intuitive anthropology, we conceptualize hylomorphic beliefs as endorsing the human person as a psychophysical unity in which the soul functions as the organizing form of the body. Using a theory-driven approach and expert evaluation, we developed an initial 10-item scale and tested it in a nationwide online sample of Polish adults (n = 407). Exploratory (EFA) and confirmatory factor analyses (CFA), supported by nonparametric Mokken scaling, converged on a primarily unidimensional 9-item solution with high internal consistency (α = 0.89, ordinal α = 0.91, ω ≈ 0.90). Validity analyses revealed that HI scores were strongly associated with beliefs emphasizing the integration of body, mind, and soul, but only weakly related to their mere endorsement as components. This pattern suggests that what distinguishes hylomorphism at the psychological level is not belief in the soul per se, but belief in the unity of the human person. The HI provides a parsimonious tool for differentiating lay anthropological models and enables empirical investigation of how hylomorphism-congruent beliefs relate to moral reasoning, spiritual practices, and broader psychological functioning. Full article

Emotional recognition relies on the integration of multiple affective cues. In everyday contexts, however, facial expressions, vocal prosody, and semantic content may convey incongruent emotional information, generating emotional conflict and increasing cognitive demands. The present study examined how multimodal emotional conflict affects emotion recognition during video viewing, focusing on short videos in which a single actor simultaneously conveyed incongruent emotional cues across facial, vocal, and semantic channels. Forty-seven undergraduate students completed a gaze-based response task in which, after each short video, they provided a single judgment of the overall emotion conveyed by the stimulus. The videos depicted either congruent or incongruent combinations of semantic content, facial expressions, and vocal prosody across six basic emotions and a neutral condition. Data were analyzed using repeated-measures ANOVAs and generalized linear mixed-effects models. Accuracy was consistently higher for congruent than incongruent stimuli across all domains, indicating a robust emotional interference effect. Critically, the magnitude of this effect differed by domain. Semantic content showed the largest performance reduction under incongruence, followed by facial expression and vocal prosody. Mixed-effects models confirmed these effects while accounting for participant- and item-level variability and revealed a significant Congruency × Domain interaction. In a gaze-based response task requiring a single overall emotion judgment, emotional conflict disrupted recognition in a domain-specific manner, with semantic information being particularly vulnerable to multimodal interference. Full article

Early identification of language and literacy disorders (LLDs) in multilingual children remains a challenge in linguistically diverse educational systems shaped by ongoing migration. In many contexts, including Greece and Cyprus, where LLDs have been poorly investigated, teachers lack screening tools that can reliably distinguish typical multilingual development from possible indicators of LLDs. This study presents the development and preliminary piloting of two teacher-report screening questionnaires for multilingual children aged 4–6 and 6–9 years, designed for use in everyday classroom settings to support early identification and referral. A structured multi-stage procedure guided development. First, items were derived from internationally established clinical markers of multilingual LLDs, covering oral language, phonological awareness, communication, literacy, and related cognitive domains. Second, a scoring framework was created to support consistent, referral-oriented interpretation across languages. Third, the questionnaires were reviewed by specialists in linguistics, education, and speech-language therapy. Fourth, pilot testing with teachers evaluated clarity, feasibility, and classroom relevance. Expert and teacher feedback indicated that the questionnaires are practical and support differentiation between multilinual language differences and potential underlying difficulties. Overall, this study introduces two promising cross-linguistic screening tools for educators in multilingual educational settings, currently undergoing psychometric validation. Full article

The early and widespread access of children to digital technologies has increased the need to develop digital competence from a young age, particularly regarding online safety and digital well-being. While schools play an important role in digital education, the family environment constitutes a key context in which children’s digital practices are shaped. This study analyses children’s digital competence around safety by analyzing parental mediation strategies, family context and patterns of Internet use as perceived by primary education students. Using data from 277 children aged 8–13 and items adapted from the EU Kids Online questionnaire, inferential and correlational analyses were conducted. These analyses focused on Internet use time, active parental mediation, communicative proactivity and parental supervision. The results show that active parental mediation and communication are negatively associated with time spent online. They are positively associated with indicators of responsible and secure Internet use. These findings are discussed within the framework of DigComp 3.0, highlighting the role of the home as a fundamental space for the construction of children’s digital safety competence. The study concludes that children’s digital safety competence is not acquired spontaneously or exclusively through formal education but is directly linked to everyday educational practices developed within the family context. Full article

This study offers a descriptive analysis of complex thinking as a form of cognitive competency among a group of 52 public servants holding local leadership positions in the Philippines. By extending the empirical examination of complex thinking beyond educational contexts and into local public leadership, the study contributes to an emerging line of research on the cognitive competencies associated with decision making in decentralized governance environments. Drawing on complexity theory applied to public decision making, it assumes that local governance requires the capacity to integrate heterogeneous information, anticipate interdependencies, and act under conditions of uncertainty. The assessment employed the eComplexity instrument using an adapted 21-item version structured into four dimensions: systemic, scientific, critical, and innovative thinking. Scores were rescaled to a 0–100 metric and, after confirming non-normality (Shapiro–Wilk), non-parametric tests were applied (Mann–Whitney, Kruskal–Wallis, and Dunn’s post hoc test with Bonferroni correction), along with Spearman’s rho correlations to examine dimensional coherence. No significant differences were observed by gender or income. Age showed overall variation across several dimensions, but robust pairwise differences were concentrated between the 31–40 and 41–50 age groups in systemic thinking and in the global score. Employment status differentiated only scientific thinking, with higher medians among permanent staff than contractual/project personnel. Correlations among dimensions were positive and significant, with particularly strong associations between systemic, critical, and innovative thinking, supporting the interpretation of complex thinking as an integrated competency in local public leadership. The findings should be interpreted considering the study’s descriptive design, localized convenience sample, and reliance on self-reported measures, which limit statistical generalizability beyond the analyzed context. Beyond its descriptive findings, the study offers initial empirical evidence relevant to governance research on the cognitive competencies associated with decision making among grassroots public leaders operating in decentralized institutional contexts. Examining complex thinking at this level helps illuminate how public actors interpret interdependencies, evaluate information, and navigate uncertainty in everyday governance practice. Full article

Microplastics (<5 mm) are an increasing concern for environmental and human health, continuously detected in ecosystems worldwide and a variety of human tissues. While health effects remain unclear, experimental studies on microplastic particles have suggested adverse outcomes. Microplastic fibers, which shed from everyday items, are more toxic than particles and twice as prevalent, yet remain understudied. Microplastic studies vary widely and use various extraction techniques, with few validating recovery accuracy. These limited recovery studies primarily examine particles, raising concerns about the true abundance of microfibers. This study establishes baseline recovery rates of polyethylene terephthalate (PET) and polypropylene (PP) microfibers of varying lengths from formalin-fixed human cadaveric lung tissue. Following enzymatic and oxidative digestion, PET microfibers showed a recovery rate of 47%, while 87% of PP microfibers was recovered. Chemical alterations were assessed using laser direct infrared (LDIR) spectroscopy; optical microscopy and scanning electron microscopy (SEM) evaluated physical changes post-digestion. These findings provide insights into microfiber recovery, highlight potential over- and underestimations, and characterize the chemical and physical behavior of fibers within human tissue studies. Establishing accurate recovery methods is essential for advancing microfiber toxicology research and assessing potential health risks. Full article

Teen dating violence (TDV) is a relevant threat to adolescent wellbeing, and schools may contribute to prevention by promoting gender equity through both the explicit curriculum (formal content and materials) and the hidden curriculum (everyday norms, interactions, and climate). This convergent mixed-methods study descriptively compared teachers’ and students’ perceptions of gender equity practices in three technical upper secondary schools in Southern Italy. Thirty-five teachers and 82 students completed an online, mirrored questionnaire developed for this study, including Likert-type items across three domains (explicit curriculum, hidden curriculum, and affective relationships/TDV-related education) and brief open-ended prompts. Closed-ended responses were summarized using descriptive frequencies and stacked distributions based on aggregated Likert categories, and open-ended responses were analyzed through reflexive thematic analysis. Across domains, teachers reported higher endorsement of equity-oriented practices than students, whereas students more often indicated limited visibility of gender equity in materials and activities, greater neutrality/uncertainty in everyday practices, and weaker perceptions of school-wide consistency. Qualitative themes aligned with these descriptive patterns, emphasizing variability across contexts and requests for clearer, more consistent practices. These findings should be interpreted as perceptions within a context-specific convenience sample and may inform future school-based research and program development on gender equity and TDV-related education. Full article

This article examines how Ecuadorian digital media have portrayed the phenomenon of vacunas—an extortion practice targeting small businesses—between January and July 2025. Through qualitative content analysis and semiotic analysis, this study reviews news items, reports, interviews, editorials and chronicles published in eight major national outlets (Expreso, El Universo, El Comercio, El Mercurio, La Hora, GK, Primicias and Extra). Findings reveal that the media frame vacunas not only as a criminal act but also as a structural threat that deepens unemployment, territorial disputes, economic decline, business closures and migration. Symbolic representations of fear, power and vulnerability permeate both textual and visual narratives, reinforcing imaginaries of crisis and uncertainty. The article concludes that media coverage does more than inform; it constructs interpretative frameworks that shape how citizens, institutions and policymakers perceive insecurity, linking everyday extortion with broader debates on governance, economic fragility and social cohesion in Ecuador. Full article