Search Results (745)

Background/Objectives: Minimally invasive cardiac surgical (MICS) approaches to the implantation of left ventricular assist devices (LVADs) have gained increasing interest as alternatives to full median sternotomy (FS), particularly in patients with prior cardiac surgeries or elevated surgical risk. However, evidence regarding their safety, feasibility, and clinical outcomes remains fragmented. This systematic review aimed to evaluate the effectiveness and safety of minimally invasive techniques for LVAD implantation in comparison to standard sternotomy, with a focus on mortality, perioperative complications, intensive care unit (ICU) stay, and infection rates. Methods: A comprehensive literature search was conducted in PubMed, Web of Science, Science Direct, Cochrane Library, and Google Scholar up to 1 January 2025. Studies were included if they reported on adult patients undergoing LVAD implantation via minimally invasive thoracotomy or sternotomy-sparing approaches, with or without comparator groups. Data were extracted and synthesized qualitatively; the Newcastle–Ottawa Scale (NOS) was applied to assess the methodological quality of the included cohort and retrospective comparative studies. Results: A total of 12 studies involving 1448 patients were included (584 received MICS and 862 received FS). MICS techniques have demonstrated comparable short and mid-term survival outcomes, with trends toward reduced ICU stay, fewer reoperations for bleeding, and lower incidence of driveline infections. Some studies reported longer operative and cardiopulmonary bypass times in the MICS group. Among high-risk cohorts, such as patients with prior sternotomies or significant comorbidities, MICS was associated with lower morbidity and acceptable safety profiles. However, heterogeneity in patient selection, surgical protocols, and outcome definitions limited quantitative synthesis. Conclusions: Minimally invasive LVAD implantation is a viable alternative to conventional sternotomy in selected patient populations. While current data suggest favorable perioperative outcomes and equivalent survival, high-quality prospective studies are needed to confirm long-term benefits and to guide patient selection. MICS approaches should be considered within multidisciplinary teams experienced in advanced heart failure surgery. Full article

Understanding the social relationships and behaviours of pet rats is important, particularly because they are comparatively understudied compared to their laboratory and wild counterparts, and little is known about their welfare. Here, open-ended interviews, with a particular focus on rat social relationships and behaviours, were conducted with 23 pet rat owners in the United Kingdom and a reflective thematic analysis was conducted on the resulting, transcribed dataset. Seven main themes were generated: Social Behaviours, Social Life and Group Dynamics, Introducing New Rats and Repairing Social Bonds, Owner Practices, Participant and Rat Contextual Background, Owner Narratives and Shared Understandings, and Owner Research Interests. Owners described rat social relationships and behaviours with a high level of consistency and reported the techniques they employ to manage the social dynamics of their rat groups, including the first scientific report of rat introductions. We propose that these qualitative findings can inform future research, including observational studies of captive (pet and non-pet) rat management and welfare. Full article

Urbanization affects bird communities by reducing habitat and fragmenting ecosystems. Urban parks can help counteract these effects. However, anthropogenic noise can further alter bird composition. We examined the distribution and abundance of bird species in nine urban parks in Mexico City. We used a ten minute fixed-radius (25 m) point-counting technique to count birds along their annual cycle, with ten minutes allocated for bird counts. The quality of green areas was analyzed in terms of vegetation (Normalized Difference Vegetation Index), park size, and mean noise level dB(A) (based on MIN and MAX values), and species were grouped into trophic guilds. A total of 108 bird species were recorded, 5 of which are under special protection; we grouped all species into 14 trophic guilds, showing different responses to environmental gradients. Redundancy analysis (RDA) explained 89.98% of the variance, with noise and park size being the most influential variables. Granivores and omnivores were more tolerant to noise, while insectivores and frugivores preferred quieter areas with more vegetation. A positive association was observed between the presence of winter resident species and the park size. On the other hand, mean noise level dB(A) was negatively related to permanent resident species, winter resident species, and those with protected status. Conservation efforts should focus on maintaining ample green spaces and reducing noise pollution, as recorded high mean noise levels (>53 dB(A)) exceed the recommended thresholds for avifauna conservation. Full article

This article discusses unattributable small-scale marine oil spills, particularly focusing on their environmental and socio-economic impacts in Musandam, Oman. There is a research gap in the literature on unattributable small-scale marine oil spills that reflects the lack of attention paid to these minor yet frequent spills, whose perpetrators invariably escape detection and accountability. The research method combines a literature review with extensive fieldwork, including community mapping, key informant interviews, and focus group discussions, to understand the extent, causes, and challenges of untraceable spills. The findings reveal significant ecological damage, economic losses for local fishers and tourism, and systemic issues of untraceability, limited enforcement, and inadequate compensation mechanisms. The article recommends establishing a regional compensation scheme, deploying advanced detection technologies, improving spill reporting, and fostering regional cooperation to enhance spill traceability, upgrade remediation techniques, and obtain redress for affected communities. These recommendations aim to inform policy actions that mitigate environmental risks and uphold environmental justice in the Arabian Gulf region. Full article

The aim of this research is to understand the events and experiences that contribute to the development of top leaders who are capable of thinking of their organization pedagogically and strategically to respond to present-day challenges. The uniqueness of the objective itself justified the choice of narrative research based on the interdependent relationship between leaders and institutions. Methodologically, the autobiographical narrative was used as the method and data collection technique. We studied the life stories of two headmasters from two school clusters in Portugal, as well as the dynamics of their leadership. The analysis of the life stories was complemented by a chronotopography, documentary analysis, focus groups with middle managers and interviews with members of the Portuguese Ministry of Education. The analysis of the data collected through the life narratives enabled a series of milestones to be identified that, due to their authors’ ability to reflect, were decisive in their professional development, namely, further education; initial training; experience in management bodies and lifelong learning; the participation in the Educational Territories of Priority Intervention programme, the Pedagogical Innovation Pilot Project and school networks. Full article

This study investigates the certification outcomes of intermediate-level ICs in The National Fire Service Academy in South Korea through a comprehensive quantitative analysis of their evaluated competencies. Using assessment data from 141 candidates collected from 2022 to 2024, we examine how scores on six higher-order competencies—comprising 35 sub-competencies—influence pass or fail results. Descriptive statistics, correlation analysis, logistic regression (a statistical model for binary outcomes), random forest modeling (an ensemble decision-tree machine-learning method), and principal component analysis (PCA; a dimensionality reduction technique) were applied to identify significant predictors of certification success. Visualization techniques, including heatmaps, box plots, and importance bar charts, were used to illustrate performance gaps between successful and unsuccessful candidates. Results indicate that competencies related to decision-making under pressure and crisis leadership most strongly correlate with positive outcomes. Furthermore, unsupervised clustering analysis (a data-driven grouping method) revealed distinctive performance patterns among candidates. These findings suggest that current evaluation frameworks effectively differentiate command readiness but also highlight specific skill domains that may require enhanced instructional focus. The study offers practical implications for fire training academies, policymakers, and certification bodies, particularly in refining curriculum design, competency benchmarks, and evaluation criteria to improve fireground leadership training and assessment standards. Full article

Cardiovascular diseases, which are among the most common diseases of the population and among the leading causes of death, are a constant topic of many research centers. A deeper understanding of their pathogenesis may contribute to the development of innovative diagnostic and therapeutic techniques. Recently, the role of myokines—a group of cytokines secreted mainly by muscle cells—has been increasingly emphasized in the development of these diseases. Both their excess and deficiency can cause undesirable effects that are involved in the pathomechanism of these diseases. In this review, we focus on the latest studies on the role of myonectin, irisin, musclin, follistatin-like1 (FSTL1), dermcidin, apelin, and myostatin in the pathogenesis of coronary artery disease, heart attack, heart failure, and hypertension. In particular, we look at myostatin and irisin in the context of the development of heart failure and decreased levels of apelin with higher cardiovascular risk in a group of patients with rheumatoid arthritis. Full article

Suicide is a leading cause of death among construction workers, particularly younger and lower-skilled employees. Barriers such as stigma, low mental health literacy, and traditional masculine norms hinder help-seeking in this male-dominated sector. Few mental health interventions are tailored to this context. This study developed a co-designed, theory-informed training to improve mental health literacy, reduce stigma, and increase help-seeking among construction workers in Ireland. Using the Medical Research Council’s framework, the training was developed with the Theory of Planned Behavior (TPB), Behavior Change Techniques, and extensive stakeholder co-design. Two systematic reviews, a broad literature review, and focus groups with industry managers informed the content and structure. The training will be pilot-tested using validated measures: the Literacy of Suicide Scale (LOSS), the Stigma of Suicide Scale (SOSS), and the General Help-Seeking Questionnaire (GHSQ), the results of which will be the subject of a separate study. CAIRDE is a promising, evidence-based training that addresses key mental health barriers in Irish construction. Embedding the TPB within a co-design methodology has resulted in the development of a training program that is underpinned by theoretical fidelity and cultural relevance and provides a framework for other male-dominated industries to draw upon. Future work should address remaining challenges related to stigma and help-seeking, and explore broader implementation through integration into mandatory safety training. Full article

Objectives: To examine the rate of meniscal re-tear in patients with concomitant ACL reconstruction, with specific focus on surgical factors and patient demographic factors. Methods: A retrospective chart review was performed on all patients who underwent meniscal repair with concomitant ACL reconstruction at our institution over a seven-year period. Demographic and case variables were assessed, including sex, age, height, weight, BMI, medial versus lateral repairs, ACL graft type, ACL reconstruction technique, meniscus repair technique, and post-operative weight bearing status. Failure of repair was defined as need for repeat surgery on the same meniscus. Results: There were 191 patients included in the study; of those 118 did not need further surgery on the meniscus at a minimum of 2 years post operation while 73 did have a re-operation on the same meniscus (rate of failure 38.2%). There were significant differences between re-operation and non-re-operation groups based on ACL graft type (54% failure for allograft vs. 30/23% failure for both autograft cohorts) and meniscal repair side (46% re-tear rate for medial meniscus vs. 17% for lateral meniscus). The pediatric (under 18 years old) cohort included 57 patients; 28 patients required additional meniscal surgery and 29 did not (rate of re-operation 49%). Conclusions: The overall failure rate of meniscus repair was nearly 40%. Risk factors for re-tear of the meniscus were repair of the medial meniscus and allograft usage for ACL reconstruction. The rate of re-tear in patients under 18 was nearly 50%, which is higher than in the adult population. Full article

This research aims to examine the effect of artificial intelligence (AI)-supported sustainable geography education on the preparation process for the International Geography Olympiad (IGEO). Research was designed according to the simultaneous triangulation design, which is one of the mixed-methods designs. The research is a quasi-experimental model in terms of revealing the effects of independent variables (IGEO) on dependent variables (artificial). In this study, a quasi-experimental design with a pre-test–post-test control group was used. In this mixed-method study, quantitative data were obtained from questionnaires and achievement tests, while qualitative data were obtained from semi-structured interviews with students and teachers. The quantitative data collection tools used in the study were a mapping literacy achievement test and a problem-solving skills perception scale. The data were obtained from students across various class sections of the same school. Qualitative data were collected through semi-structured individual interview forms, observation forms, participant diaries, and focus group interview forms. Hierarchical regression analysis and ANOVA were used to analyze the statistical data, and the inductive analysis technique was used to analyze the qualitative data. The findings show that AI-supported sustainable geography education improves spatial thinking skills, individualized learning, and learning motivation. In the IGEO exam, students answered the field questions. Full article

Numerous studies on specific cannabis compounds (cannabinoids and phenolic acids) have demonstrated their therapeutic potential, with their administration methods remaining a key research focus. Transdermal drug delivery (TDD) systems are gaining attention due to their advantages, such as painless administration, controlled release, direct absorption into the bloodstream, and its ability to bypass hepatic metabolism. The thin films obtained via pulsed laser deposition consist of micro- and nanoparticles capable of migrating through skin pores upon contact. This study investigates the interaction of phenolic compounds in hemp seeds with pulsed laser beams. The main goal is to achieve the ablation and deposition of these compounds as thin films suitable for TDD applications. The other key objective is optimizing laser energy to enhance the industrial feasibility of this method. Thin layers were deposited on glass and hemp fabric using dual pulsed laser (DPL) ablation on a compressed hemp seed target held in a stainless steel ring. The target was irradiated for 30 min with two synchronized pulsed laser beams, each with parameters of 30 mJ, 532 nm, pulse width of 10 ns, and a repetition rate of 10 Hz. Each beam had an angle of incidence with the target surface of 45°, and the angle between the two beams was also 45°. To improve laser absorption, two approaches were used: (1) HS-DPL/glass and HS-DPL/hemp fabric, in which a portion of the stainless steel ring was included in the irradiated area, and (2) HST-DPL/glass and HST-DPL/hemp fabric—hemp seeds were mixed with turmeric powder, which is known to improve laser interaction and biocompatibility. The FTIR and Micro-FTIR spectroscopy (ATR) performed on thin films compared to the target material confirmed the presence of hemp-derived phenolic compounds, including tetrahydrocannabinol (THC), cannabidiol (CBD), ferulic acid, and coumaric acid, along with other functional groups such as amides. The ATR spectra have been validated against Gaussian 6 numerical simulations. Scanning electron microscopy (SEM) and substance transfer tests revealed the microgranular structure of thin films. Through the analyzes carried out, the following were highlighted: spherical structures (0.3–2 μm) for HS-DPL/glass, HS-DPL/hemp fabric, HST-DPL/glass, and HST-DPL/hemp fabric; larger spherical structures (8–13 μm) for HS-DPL/glass and HST-DPL/glass; angular, amorphous-like structures (~3.5 μm) for HS-DPL/glass; and crystalline-like structures (0.6–1.3 μm) for HST-DPL/glass. Microparticle transfer from thin films on the hemp fabric to the filter paper at a human body temperature (37 °C) confirmed their suitability for TDD applications, aligning with the “whole plant medicine” or “entourage effect” concept. Granular, composite, thin films were successfully developed, capable of releasing microparticles upon contact with a surface whose temperature is 37 °C, specific to the human body. Each of the microparticles in the thin films obtained with the DPL technique contains phenolic compounds (cannabinoids and phenolic acids) comparable to those in hemp seeds, effectively acting as “microseeds.” The obtained films are viable for TDD applications, while the DPL technique ensures industrial scalability due to its low laser energy requirements. Full article

Background/Objectives: Heart failure (HF) often develops from a prolonged asymptomatic phase where early detection could prevent progression. Pre-heart failure (pre-HF) populations—those with risk factors (Stage A) or subclinical myocardial changes (Stage B)—are critical for intervention. Cardiac magnetic resonance (CMR) with T1 and extracellular volume (ECV) mapping offers a non-invasive approach to detect early myocardial changes in these groups. This systematic review evaluates the role of T1 and ECV mapping in pre-HF populations, focusing on their diagnostic and prognostic utility. Methods: A systematic search of PubMed, EMBASE, and Cochrane was conducted up to April 2025, identifying 17 studies that met inclusion criteria. Data was extracted directly into Excel, and methodological quality was assessed using the Newcastle–Ottawa Scale (NOS) for cohort and cross-sectional studies and AMSTAR-2 for systematic reviews and meta-analyses. A meta-analysis was performed using Review Manager (RevMan) to compare T1 and ECV values between pre-HF and control groups. Results: Studies consistently reported elevated T1 (989.6–1415.41 milliseconds) and ECV (25.7–42.81%) in pre-HF groups compared to controls (T1: 967–1310.63 ms, ECV: 23.5–29.9%). Meta-analysis showed a significant increase in T1 (MD: 27.62 ms, 95% CI: 8.04–47.19, p < 0.006) and ECV (MD: 2.97%, 95% CI: 1.88–4.06, p < 0.00001) in pre-HF groups. RQS scores ranged from 17.2% to 77.8% (mean: 37.9%), and NOS scores ranged from 5 to 8 (mean: 6.2), reflecting variability in study quality. The AMSTAR-2 rating for the systematic review was moderate. Conclusions: T1 and ECV mapping enhance CMR-based detection of early myocardial changes in pre-HF, offering a promising non-invasive approach to predict HF risk. However, variability in study quality, small sample sizes, and methodological inconsistencies limit generalisability. Future research should focus on standardised protocols, prospective designs, and multi-center studies to integrate these techniques into clinical practice, potentially guiding preventive therapies such as SGLT2is and tafamidis. Full article

Projects play a vital role in achieving organizational success, where artificial intelligence (AI) has a transforming impact in project management (PM). The integration of AI techniques into PM practices has the potential to significantly improve project success rates and enable more effective project management. This article adopted a systematic literature review (SLR) methodology, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and employing a content analysis strategy to review 61 peer-reviewed academic journal articles published between 2015 and 2025 in the Web of Science and Scopus. This study investigates the key project success dimensions influenced by AI throughout the project lifecycle, and identifies the AI sub-fields and algorithms employed in relation to project success, where time and cost are found to be the most significantly affected factors in project success. Machine learning (ML), along with its corresponding algorithms, emerged as the most frequently applied AI subfield. This study overviews key AI-influenced project success factors and the main AI subfields and algorithms in recent literature, providing actionable insights for diverse project stakeholders aiming to enhance outcomes through AI. Limitations, including the lack of industry or regional focus, exclusion of project management process groups, and omission of gray literature, were also acknowledged, which suggest valuable directions for future research. Full article

The objective of this study is to evaluate the trabecular structure in hypodivergent individuals using fractal analysis, with a particular focus on specific mandibular regions. This study aims to assess the impact of hypodivergent growth patterns on bone microarchitecture. This research involved a methodological approach using panoramic radiographs to assess trabecular structure at specific regions of the mandible using fractal analyses. The dimensions of the fractals were calculated with the use of the box-counting technique by the software Image J (v1.53c; Bethesda, MD, USA, National Institutes of Health), while the statistical evaluations were carried out with the Jamovi Software (The Jamovi Project, version 2.3.21.0). The study found significant differences in fractal dimension values between hypodivergent individuals and the control group, particularly in the condyle and angulus regions, indicating a less complex trabecular structure in hypodivergent individuals. This study concludes that individuals with a hypodivergent growth pattern exhibit alterations in trabecular bone structure within the mandibular condyle and angulus regions, characterized by reduced complexity. These findings suggest that increased occlusal forces and mechanical stress associated with this growth pattern may contribute to changes in trabecular architecture. Understanding these variations is essential for orthodontic and maxillofacial diagnosis, treatment planning, and biomechanical considerations, particularly in cases requiring vertical dimension management or anchorage control. Full article

Background/Objectives: The transformation of nursing and midwifery education through digital technologies has gained momentum worldwide, with algorithm-based video instruction and virtual reality (VR) emerging as promising tools for improving clinical learning. This quasi-experimental study explores the impact of an enhanced flipped classroom model on Bulgarian nursing and midwifery students’ self-perceived competence. Methods: A total of 228 participants were divided into a control group receiving traditional instruction (lectures and simulations with manikins) and an experimental group engaged in a digitally enhanced preparatory phase. The latter included pre-class video algorithms, VR, and clinical problem-solving tasks for learning and improving nursing skills. A 25-item self-report questionnaire was administered before and after the intervention to measure perceived competence in injection techniques, hygiene care, midwifery skills, and digital readiness. Results: Statistical analysis using Welch’s t-test revealed significant improvements in the experimental group in all domains (p < 0.001). Qualitative data from focus group interviews further confirmed increased student engagement, motivation, and receptiveness to digital learning tools. Conclusions: The findings highlight the pedagogical value of integrating structured video learning, VR components, and case-based learning within flipped classrooms. The study advocates for the wider adoption of blended learning models to foster clinical confidence and digital competence in healthcare education. The results of the study may be useful for curriculum developers aiming to improve clinical readiness through technology-enhanced learning. Full article