Search Results (2,521)

Design coordination is a critical process for avoiding spatial conflicts and ensuring design alignment in large-scale construction projects. While Building Information Modelling (BIM) tools have improved coordination through 3D model integration and clash detection, inefficiencies persist due to fragmented workflows, frequent tool switching, and challenges with issue documentation. Cloud-based BIM collaboration tools offer a promising alternative by enabling real-time model sharing, centralized issue tracking, and enhanced stakeholder communication. However, empirical evidence on their practical implementation and effects on coordination processes remains limited. Unlike prior cloud-BIM reviews that focus on technical capabilities or adoption barriers in isolation, this study provides an empirically grounded framework that links specific tool features to observable workflow changes and their downstream impacts on coordination outcomes. This study investigates the impact of cloud-based BIM collaboration tools on the design coordination process, with a focus on issue identification, resolution, and documentation. A framework was developed using a mixed-methods approach comprising action research, an ethnographic case study, and comparative analysis of three large infrastructure projects to categorize workflow changes resulting from tool adoption. The findings indicate that cloud-based BIM tools streamline coordination by reducing manual transitions, automating documentation, and improving information accessibility during meetings. Nevertheless, their effectiveness is constrained by organizational structures and contract limitations. This study provides a validated process-change framework and practical insights for engineering managers seeking to align digital collaboration tools with project delivery strategies, contributing to both theory and practice in BIM-based coordination and digital transformation in the AEC industry. Full article

Background: Reliable identification remains a cornerstone of forensic investigations, particularly when encountering degraded remains or suboptimal biological evidence. This study evaluates the potential of dentine metabolomics, utilizing proton nuclear magnetic resonance (¹H-NMR) spectroscopy, to detect cancer-associated metabolic signatures in dental tissues for forensic applications. Methods: Forty-four non-carious second molars were analyzed, comprising 22 samples from deceased individuals with a documented history of cancer and 22 age- and sex-matched controls. Metabolomic profiling was conducted using ¹H-NMR spectroscopy to identify and quantify dentine metabolites. Statistical evaluation included unsupervised principal component analysis (PCA), partial least squares discriminant analysis (PLS-DA), receiver operating characteristic (ROC) curve analysis, and exploratory binary logistic regression. Results: Among the 209 identified metabolites, inosinic acid and 2-ketobutyric acid were identified as the most robust discriminative biomarkers across both multivariate and univariate frameworks. The exploration within-sample predictive model achieved a Nagelkerke R² of 0.822 and an overall classification accuracy of 90.9%, with a specificity of 95.5% and a sensitivity of 86.4%. These key metabolites are fundamentally associated with purine metabolism and oxidative stress pathways frequently dysregulated in oncogenesis. Conclusions: This pilot study suggests that dentine may retain metabolomic information associated with cancer comorbidity under heterogeneous postmortem conditions. However, the findings remain exploratory and require validation in larger cohorts with standardized postmortem variables before practical forensic implementation. Full article

Poly(ADP-ribose) polymerase inhibitors (PARPi) have reshaped therapy for advanced prostate cancer, yet durable benefit remains concentrated in BRCA1/2-altered tumors, especially BRCA2, and most responders eventually relapse. Here, we frame PARPi response and resistance through a unifying model in which DNA damage response (DDR) rewiring (e.g., homologous recombination repair (HRR) restoration, fork protection, checkpoint tolerance, and altered drug handling) converges with treatment-induced dormancy and quiescent therapy-tolerant residual states that sustain minimal residual disease (MRD) under androgen receptor pathway inhibition (ARPI) and PARP blockade. We synthesize clinical and translational evidence for PARPi monotherapy and PARPi-based combinations across disease states. In first-line metastatic castration-resistant prostate cancer (mCRPC), PARPi plus ARPI consistently prolongs radiographic progression-free survival, with the greatest benefit in HRR-altered tumors, and emerging overall-survival signals in selected subgroups. In later-line settings, monotherapy activity is most robust in BRCA2-mutated disease, whereas non-BRCA HRR alterations show heterogeneous and often modest responses, underscoring the need for biomarkers beyond gene panels. We also discuss combination strategies with DDR-targeting agents, radioligand therapies, and immunotherapy, and summarize ongoing phase III programs in metastatic castration-sensitive prostate cancer (mCSPC). Finally, we outline practical considerations for biomarker-informed patient selection, monitoring, sequencing, and toxicity management, with particular emphasis on intercepting MRD and resistance evolution. Full article

Flooding is a recurrent climate-related hazard in southern Thailand that frequently disrupts schooling and undermines educational continuity. Despite the critical importance of school-based disaster preparedness, there is limited empirical evidence explaining the drivers of flood preparedness among primary school teachers in climate-vulnerable regions. This study aimed to identify the cognitive, experiential, and topographic factors correlated with flood knowledge, flood risk perception (FRP), and flood preparedness (FP) among primary school teachers in Nakhon Si Thammarat province. A cross-sectional survey was conducted with 745 teachers using a structured questionnaire that covered sociodemographic characteristics, flood experience, training, information sources, and regional topography (elevation, slope, and distance to river). Spearman’s rank correlation and Generalized Linear Models (GLMs) were applied to examine the relationships and predictive factors. The findings revealed that topographic factors, specifically distance to the nearest river, were significantly associated with teachers’ flood knowledge, while school elevation was significantly related to FRP. Community-based information was a strong predictor of flood knowledge. Furthermore, prior flood experience, first-aid training, access to school-based information networks, and FRP were identified as key drivers of FP. Moreover, the negative relationships were found between flood knowledge and FP suggest that preparedness is influenced by complex cognitive and behavioral mechanisms rather than knowledge alone. These findings highlight the importance of integrating topographic risk information, experiential learning, and community-based information networks into school-based disaster preparedness programs rather than relying solely on knowledge. These findings offer practical implications for designing targeted teacher training and school-based disaster risk reduction (DRR) strategies in climate-vulnerable settings. Full article

Background/Objectives: Global estimates suggest that approximately 43% of individuals living with diabetes remain undiagnosed, underscoring the need for early identification of adults at high risk of type 2 diabetes mellitus (T2DM) to support timely preventive interventions. This scoping review aimed to map and summarize existing non-invasive screening tools for identifying adults at high risk of T2DM. Methods: PubMed (MEDLINE), Web of Science, ScienceDirect, and Scopus were searched in accordance with the PRISMA extension for Scoping Reviews (PRISMA-ScR). Studies published between 1995 and 2026 that described screening tools for adult populations were included. Results: A total of 58 studies describing screening tools were identified. The tools were developed and applied across diverse populations and ethnic groups. Most were questionnaire-based, easy to administer, and low cost. Commonly included variables comprised demographic characteristics, anthropometric measures, lifestyle factors, and clinical indicators associated with increased T2DM risk. Substantial heterogeneity was observed in tool structure and reported predictive components. Conclusions: This scoping review provides an overview of available screening tools for the early identification of adults at high risk of T2DM. The mapped evidence may inform future validation studies and support context-specific implementation in public health and clinical practice settings, including integration into digital platforms. Full article

Background/Objectives: Dietary behavior in eating disorders (EDs) is often framed through either nutritional or psychological perspectives, yet emerging evidence suggests that eating may involve a transdiagnostic, emotionally embedded, and relationally negotiated process. While research highlights the role of emotion regulation difficulties, perfectionism, control, and overvaluation of weight and shape in ED maintenance, less is known about how these processes are interpreted and managed in clinical practice across different cultural contexts. This study explored psychotherapists’ perspectives on dietary behavior, nutritional assessment, and interdisciplinary collaboration in ED treatment in Greece and the United Kingdom. Methods: Eighteen psychotherapists (9 Greek and 9 British) with experience in treating individuals with EDs participated in in-depth semi-structured interviews. Data were analyzed using reflexive thematic analysis. Results: Three themes were developed. First, therapists conceptualized dietary behavior as reflecting broader transdiagnostic psychological processes, particularly perfectionism, control, emotion regulation difficulties, and body image concerns. Second, nutritional assessment and intervention (e.g., food diaries and meal plans) were experienced as emotionally significant practices that required negotiation of timing, meaning, and clients’ readiness for change. Third, interdisciplinary collaboration was described as involving ongoing negotiation of nutritional authority, with therapists balancing nutritional considerations and psychological safety, influenced by contextual differences between UK and Greek mental health systems. Conclusions: Findings suggest that dietary behavior in ED treatment may benefit from approaches that integrate psychological and nutritional perspectives. Clinicians may consider attending to clients’ emotional readiness, the symbolic meanings of food, and the dynamics of multidisciplinary collaboration, offering insights that can inform clinical practice and future research. Full article

Organisations increasingly face complex cybersecurity threats shaped not only by internal capabilities but also by external regulatory, institutional, and environmental conditions. While existing cybersecurity standards and maturity models provide valuable guidance, they often offer limited support for assessing organisational readiness in a manner that is both context-sensitive and diagnostically meaningful. This paper presents a context-aware cybersecurity readiness assessment framework designed to support organisational evaluation of cybersecurity readiness while explicitly accounting for external environmental influences. The framework adopts a two-tier architecture. Tier 1 assesses organisational awareness of and engagement with the external cybersecurity environment, including national regulatory obligations, institutional support mechanisms, and international collaboration. Tier 2 evaluates internal organisational cybersecurity readiness across governance, operational controls, awareness and culture, and external collaboration practices. The two tiers are designed to operate independently, enabling complementary interpretation without assuming deterministic relationships between external context and internal capability. The framework is developed and evaluated using a Design Science Research approach and is operationalised through a structured assessment instrument and an interpretable scoring model. Empirical validation is conducted across multiple organisational contexts operating in developing and emerging environments, with qualitative case study evidence where available. The results demonstrate that the framework differentiates meaningfully across readiness domains, avoids artificial score inflation or compression, and supports interpretable diagnosis of alignment gaps between external expectations and internal practices. The study contributes a validated assessment artefact that extends cybersecurity awareness research into a broader organisational readiness perspective. From a practical standpoint, the framework provides organisations, policymakers, and researchers with a structured tool to support incremental improvement, informed decision-making, and reflective engagement with both internal cybersecurity practices and external environmental conditions. Full article

Authenticity verification for thangka artworks remains challenging in the market, as traditional physical authentication methods offer limited reliability, while modern spectroscopic and chemical testing technologies are costly and unsuitable for large-scale application. Although deep learning methods can achieve efficient authentication through image features, they rely on centralized databases to store feature information, making them susceptible to tampering risks and undermining the credibility of authentication results. To address these issues, this study proposes a digital authentication method for thangka paintings that integrates blockchain technology. This approach stores image features in the InterPlanetary File System (IPFS) and records their hash values on the blockchain, ensuring the immutability and verifiable evidence of feature data. Simultaneously, it employs convolutional neural networks for feature extraction and similarity analysis of thangka images, constructing an integrated platform system encompassing storage, authentication, and traceability. This enhances the reliability and automation of authentication outcomes. The platform further supports full-process traceability of thangka storage and authentication operations, providing a viable pathway for establishing a scientific and reliable digital authentication system for thangkas. Experimental evaluation on a dataset of 2847 thangka images demonstrates 99.2% authentication accuracy, with a precision of 98.7% and an F1-score of 99.1%, while end-to-end authentication latency averages 1247 ms, validating the system’s effectiveness for practical museum and market deployment scenarios. Full article

Background/Objectives: Liver fat represents an early metabolic lesion in the development of diabetes and its cardiometabolic complications. Diets high in free sugars, particularly from sugar-sweetened beverages (SSBs), are associated with abdominal obesity and increased cardiometabolic risk, prompting global guidelines to limit SSBs as a major public health strategy. Low-fat cow’s milk is promoted as the preferred caloric replacement strategy for SSBs due to its high nutritional value and cardiometabolic advantages. Fortified soymilk is a plant-based alternative with approved health claims for cholesterol and coronary heart disease risk reduction that offers an equivalent nutritional value to cow’s milk. However, given concerns about its classification as an ultra-processed food (UPF), it is unclear whether soymilk offers comparable metabolic health benefits to milk as part of clinical and public health strategies to reduce SSB intake. The Soy Treatment Evaluation for Metabolic (STEM) health trial seeks to evaluate the impact of replacing SSBs with either 2% soymilk or 2% cow’s milk on liver fat and other cardiometabolic risk factors in habitual adult consumers of SSBs with obesity. Methods: The STEM trial is a 24-week, pragmatic, 3-arm, parallel, randomized trial. We recruited adults with obesity (high BMI plus high waist circumference based on ethnic specific cut-offs) consuming ≥1 SSB/day. Participants were randomized to one of three groups based on their usual SSB intake at baseline (servings/day): continued SSB (355 mL can) intake; replacement with fortified, sweetened 2% soymilk (250 mL); or replacement with 2% cow’s milk (250 mL). The primary outcome is the change in intrahepatocellular lipid (IHCL) measured by ¹H-MRS at 24 weeks. Hierarchical testing will be done to reduce the familywise error rate. The superiority of cow’s milk to SSBs will be assessed first to establish assay sensitivity. If superiority is established, then the non-inferiority of soymilk to cow’s milk will be assessed using a pre-specified non-inferiority margin of 1.5% IHCL units (assessed by difference of means using a 90% confidence interval [CI]). Analyses will be conducted according to the intention-to-treat (ITT) principle using inverse probability weighting (IPW) for superiority testing and per-protocol analyses for non-inferiority testing, using ANCOVA adjusted for age, sex, metabolic dysfunction-associated steatotic liver disease (MASLD) status, medication use, intervention dose, and baseline levels. We hypothesize that soymilk will be non-inferior to cow’s milk (Clinicaltrials.gov NCT05191160). Results: Recruitment began in November 2021. A total of 3050 individuals were screened. We randomized 186 participants (62 per group) between 19 April 2022 and 16 April 2024. Participants are 57% male; with a mean [SD] age of 39.9 [11.8] years; BMI of 34.6 [6.1] kg/m², waist circumference of 112.6 [13.8] cm; IHCL of 10.0 [8.2] % with 64.1% meeting the criteria for MASLD; and SSBs intake of 2.3 [1.3] servings/day. Conclusions: Baseline characteristics were balanced across the study arms, with participants representing adults with a high-risk metabolic phenotype, and 64.1% meeting the criteria for MASLD. Findings will contribute to evidence on the cardiometabolic benefits of soymilk, informing clinical practice guidelines and public health policy. Full article

A substantial proportion of wildfires in Mediterranean regions continue to be recorded without information about the cause or source of ignition, limiting our ability to understand ignition drivers and design effective prevention strategies. In this study, we develop a spatially harmonised wildfire database for mainland Spain by integrating ignition records from the Spanish General Fire Statistics (EGIF) with fire perimeters generated from satellite images. We then apply a Random Forest classifier to infer ignition causes for events lacking cause attribution. To interpret model behaviour, we use Shapley Additive Explanation (SHAP) values at both global and local scales. Results indicate that human-caused ignitions are dominant, with intentional and negligence-related fires accounting for 52.13% of all known events, although they are associated with contrasting climatic and land-use settings. Negligence-related fires tend to occur under hot, dry and windy conditions, often in agricultural interfaces, whereas intentional fires are more frequent under cooler and wetter conditions and in areas with higher population density and land-use change. Lightning-caused fires represent a small fraction of total ignitions (3%) but exhibit a distinct climatic signature, occurring primarily in sparsely populated areas, under intermediate moisture conditions, and often leading to larger burned areas. Despite strong overall model performance (F1-score = 0.82), minority classes (e.g., lightning and fire rekindling, 0.17%) remain challenging to classify, reflecting both data imbalance and uncertainty in causal attribution. Overall, the combined use of machine learning and explainable AI provides a coherent spatial characterisation of wildfire ignition drivers across mainland Spain, highlights systematic differences among ignition causes, and identifies key limitations in existing fire cause records. This framework represents a practical step towards improving fire cause information by integrating remote sensing products with field-based fire reports, thereby supporting more targeted and evidence-based fire risk management. Full article

Emergent tracheal intubation in critically ill patients is a common, yet high-risk, intervention. It is frequently complicated by peri-intubation hypoxemia, hemodynamic instability, and metabolic derangements that increase the risk of arrhythmias, hypotension, cardiac arrest, and death. Because the highest-risk interval often occurs in the minutes surrounding induction, when apnea, derecruitment, and abrupt cardiopulmonary shifts converge, oxygenation failure frequently reflects a mismatch between preoxygenation strategy and the underlying physiology rather than inadequate oxygen delivery alone. This review proposes a phenotype-based approach to peri-intubation oxygenation and focuses on four high-risk phenotypes in whom standard preoxygenation strategies commonly fail: obesity, neuromuscular disease, right ventricular dysfunction or pulmonary hypertension, and post-operative respiratory failure with altered respiratory mechanics or airway anatomy. We summarize the key mechanisms that shorten safe apnea time, including reduced functional residual capacity, intrapulmonary shunt, elevated oxygen consumption, rapid derecruitment after induction, and impaired oxygenation–hemodynamics coupling. We then compare preoxygenation modalities as physiologic tools, including facemask oxygen, high-flow nasal cannula (HFNC), noninvasive ventilation (NIV), and controlled bag-mask ventilation (BMV), and integrate contemporary randomized trial evidence that informs bedside selection and combination of these approaches. Finally, we synthesize these concepts into a practical, physiology-informed framework to guide clinicians in choosing and troubleshooting preoxygenation strategies in high-risk patients undergoing emergent intubation. Full article

Segmental mandibular resection may be indicated as a treatment in, for example, advanced stages of oral squamous cell carcinoma (OSCC). Osseous reconstruction of these defects is a fundamental part of static and dynamic masticatory rehabilitation, particularly when dental implants are required. The Segmental Mandibular Defect Reconstruction (SMDR) Registry aims to generate real-world evidence on SMDR through an international, prospective, multicentre case series designed as a registry. While OSCC is a common indication for segmental mandibular resection, the SMDR Registry also aims to capture outcomes for rarer mandibular conditions and the increasing number of collateral damage cases resulting from systemic medication therapies (antiresorptive drugs, immunotherapeutics) or irradiation, which may likewise lead to medication-related osteonecrosis of the mandible (MRONJ) or osteo(radio)necrosis with tumour-like segmental resection of the mandible, highlighting the value of an international database for these less frequent pathologies. Primary objectives are to describe the patient population and current treatment modalities, describe the outcomes and adverse events (AEs) for different treatment modalities, and identify potential predictors for successful autologous reconstruction of SMDs. Approximately 300 patients with a mandibular lesion resulting from bisphosphonate- and immunomodulatory drug-induced osteonecrosis of the mandible, ameloblastoma or osteosarcoma of the mandible, oral metastases related mandibular lesions indicated for segmental resection, or OSCC undergoing SMDR or intending to undergo one- or two-stage reconstruction will be prospectively recruited over a 36-month period. Baseline information, treatment details, and outcome measures will be documented. All treatments will be per the usual practice at participating sites. Outcome measures include clinical, patient-reported, and radiological outcomes; AEs related to the condition and/or treatment with a possible influence on the outcome will be recorded. Full article

The accelerated expansion of advanced technologies—particularly artificial intelligence, intelligent systems, and interactive digital environments—is influencing contemporary media ecosystems and contributing to changes in educational practices. This study provides a systematic and descriptive bibliometric mapping of recent scientific production on artificial intelligence in education, algorithmic ethics, and digital inequality. A total of 229 Scopus-indexed documents published between 2021 and 2026 were analyzed using Biblioshiny and VOSviewer to examine publication patterns, influential authors and sources, and the conceptual structure of the field. Results indicate a marked increase in research output since 2024, with an annual growth rate of 47.58%, an average of 8.68 citations per document, and an international co-authorship rate of 24.45%. These indicators reflect an expanding and increasingly collaborative research landscape, accompanied by a diversification of thematic priorities within the field. The analysis identifies five thematic clusters: (1) the technical foundations of AI and digital transformation; (2) intelligent and immersive learning environments; (3) personalized and adaptive learning systems; (4) AI literacy and pedagogical integration; and (5) ethical considerations, including algorithmic bias and educational robotics. The findings highlight the need for explicit justification of database selection, strengthened critical AI literacy, and context-sensitive strategies that address disparities in access, skills, and institutional capacity. Overall, this study offers a coherent overview of a research area that is currently expanding and undergoing conceptual reorganization, providing evidence-informed insights for future research, policy development, and the design of equitable AI-driven educational technologies. Full article

Rural educators face persistent structural barriers to accessing professional development that supports instructional change, particularly in disciplines such as engineering that require specialized knowledge and resources. This study examines a needs-driven professional development initiative designed to support rural K–12 educators in integrating engineering concepts through a school–university partnership in Southwest Virginia. Using a mixed-methods needs assessment consisting of a regional survey and in-depth interviews with teachers and administrators, we identified key challenges related to professional development access, relevance, and sustainability. These findings informed the design of a two-day professional development workshop grounded in place-based education and teacher pedagogical choice. Results highlight educators’ preferences for contextually relevant, hands-on learning experiences and the importance of ongoing support and professional community-building. While situated in a rural region, the findings have broader implications for professional development policy and practice across diverse educational settings. By explicitly examining how needs assessment findings were translated into professional development design decisions, this study contributes practice-based evidence for creating more equitable and context-responsive professional learning models. Full article

The term asphyxia refers to a disruption in brain function due to rapid and persistent cerebral hypoxia or anoxia as a consequence of accidental or non-accidental injury. Considering the different mechanisms that may determine asphyxiation, such injuries can be referred to different categories: strangulation (death by hanging, ligature or manual strangulation), suffocation (smothering, choking, confined spaces and vitiated atmosphere), mechanical asphyxia (positional and traumatic asphyxia) and drowning (submersion or immersion in liquid). In both human and veterinary forensic practice, fatal asphyxia is considered among the most diagnostically challenging categories of sudden death, as it often produces only subtle and non-pathognomonic macroscopic signs, which can be easily covered by post-mortem alterations. Therefore, a wide range of information is often needed for the diagnosis of asphyxiation, including medical history, crime scene analysis, testimonies and physical evidence, along with the macroscopic and histological findings. The following review addresses the main lesions, ancillary tests and diagnostic issues associated with non-drowning asphyxia in veterinary forensic pathology. Full article