Search Results (3,310)

Background: Simulation-based education (SBE) is a key component of nursing training. It enables students to apply theoretical knowledge in practice, expand their clinical understanding, develop critical thinking, improve communication skills, and build self-confidence. Increasing the number of simulation hours in nursing curricula may enhance students’ ability to manage stress in clinical settings. Methods: This was a cross-sectional comparative study involving 113 nursing students during a practical exam. Participants graduated in three consecutive years: 2020, 2021, and 2022. SBE was introduced into the curriculum in 2020, resulting in varying levels of simulation experience. Stress and anxiety markers were measured during the exam and compared across groups. Results: Greater simulation experience was associated with lower heart rate (p = 0.007), lower diastolic blood pressure (p < 0.001), and lower cortisol levels (p < 0.001). Students with two years of simulation training reported the lowest perceived stress (p = 0.031). However, anxiety levels remained high across all groups and did not differ significantly. Conclusions: The study showed that OSCEs are associated with elevated stress in nursing students. Students with greater exposure to simulation-based education had significantly lower stress and anxiety indicators. SBE appears to reduce stress and improve students’ preparedness for clinical assessments. Full article

The Third Pole region, particularly the Hindu–Kush–Himalaya (HKH), is highly prone to lightning, causing thousands of fatalities annually. Skillful prediction and timely communication are essential for mitigating lightning-related losses in such observationally data-sparse regions. Therefore, this study evaluates kilometer-scale ICON-CLM-simulated atmospheric variables using six machine learning (ML) models to detect lightning activity over the Third Pole. Results from the ensemble boosting ML models show that ICON-CLM simulated variables such as relative humidity (RH), vorticity (vor), 2m temperature (t_2m), and surface pressure (sfc_pres) among a total of 25 variables allow better spatial and temporal prediction of lightning activities, achieving a Probability of Detection (POD) of ∼0.65. The Lightning Potential Index (LPI) and the product of convective available potential energy (CAPE) and precipitation (prec_con), referred to as CP (i.e., CP = CAPE × precipitation), serve as key physics aware predictors, maintaining a high Probability of Detection (POD) of ∼0.62 with a 1–2 h lead time. Sensitivity analyses additionally using climatological lightning data showed that while ML models maintain comparable accuracy and POD, climatology primarily supports broad spatial patterns rather than fine-scale prediction improvements. As LPI and CP reflect cloud microphysics and atmospheric stability, their inclusion, along with spatiotemporal averaging and climatology, offers slightly lower, yet comparable, predictive skill to that achieved by aggregating 25 atmospheric predictors. Model evaluation using the Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS) highlights XGBoost as the best-performing diagnostic classification (yes/no lightning) model across all six ML tested configurations. Full article

Over time, endoscopic retrograde cholangiopancreatography (ERCP) evolved into the preferred method for both diagnosing and treating diseases of the biliary, pancreatic, and ampullary systems. Traditionally performed under “conscious” sedation, anesthesiological management during ERCP increasingly involves the use of general anesthesia (GA) due to the complexity of procedures and patient comorbidities. This narrative review aims to underscore the current absence of definitive evidence supporting a single airway management strategy during ERCP. In each section, we examine the strengths and limitations of various airway management strategies, including spontaneous breathing, endotracheal intubation, and newer techniques such as high-flow nasal oxygen (HFNO) and supraglottic airway devices (SGAs), tailored for endoscopic procedures. We explore and discuss the multifactorial determinants that influence clinical decision-making, including patient-specific risk factors, procedural complexity, resource availability, and potential complications. Any anesthesiological choice must guarantee the immobility of the patient and the versatility of the position and must be integrated with the preferences and skills of the endoscopist, the available means in the endoscopic suite, and the internal protocols. Spontaneous breathing with sedation may be appropriate for low-risk, short-duration procedures but carries risks of hypoventilation and aspiration, while GA with a device to manage airways improves procedural conditions and perioperative risks. Still, it is resource-intensive and may delay recovery. Transitions between different strategies are inherently fluid, reflecting the need for a flexible, patient-centered approach tailored to the specific clinical context. Rigorous future research is essential to establish evidence-based guidelines that enhance both safety and efficiency of airway management in this setting. Full article

The development of E-commerce and digitalization drives the rapid change in logistics management practices and poses challenges to traditional talent training modes in logistics field. Nowadays, companies expect university graduates equipped with more practical logistics skills to connect tighter with the industry. This motivates universities to establish more practically relevant curriculums to enhance students’ career competitiveness. Under such background, industry–university collaboration courses are increasingly adopted in higher education institutes in logistics discipline. Due to the difference between this type of course and the traditionally taught courses, the learning outcome of it can be difficult to guarantee. Therefore, it is necessary to identify the influential factors of the learning outcomes of industry–university collaboration courses and establish the actionable strategies to enhance course quality. However, the current literature in logistics management education has little focus on this topic, resulting in gaps on clarifying the influential factors of learning outcomes of industry–university collaboration courses in this discipline. Applying a mixed method, this study conducted a case study for an industry–university collaboration course of a logistics discipline in a Chinese university. The interval-valued Pythagorean fuzzy (IVPF) numbers and the Weighted Aggregated Sum Product Assessment (WASPAS) methods were used. The results showed that there are 15 factors which can influence the outcomes of industry–university collaboration courses in logistics discipline. Among them, the most important factor is the working environment, followed by the students’ own ability. Also, the results indicated that students’ optimistic attitudes towards the course, whether students take the course seriously, and course evaluations can be influential factors for good learning outcomes. The sensitivity analysis was then conducted, showing that the results were robust. This study can contribute to the existing literature by providing a theoretical framework to understand and assess the quality of industry–university collaboration courses in logistics and relevant subjects, as well as offering new analytical tools for management educational studies. Moreover, this study can provide practical implications for educators to develop and maintain good industry–university collaboration courses and trainings. Specifically, a practical life-cycle view was suggested to put pertinent efforts in all periods before/during/after the course to achieve high course outcomes. Full article

Background/Objectives: Lucid dreaming (LD), during which the dreamer becomes aware of the dream state, offers a unique opportunity for a variety of applications, including motor practice, personal well-being, and nightmare therapy. However, these applications largely depend on the dreamer’s ability to control their dreams. While LD research has traditionally focused on induction techniques to increase dream frequency, the equally important skill of dream control remains largely underexplored. This study provides an exploration into the mechanisms of LD motor practice, dream control, and its potential influencing factors. We specifically examined whether a complex motor skill—juggling—could be performed during LD, calling for relatively high levels of dream control and access to procedural memory. Methods: Four healthy participants underwent overnight polysomnography (PSG), provided detailed dream reports, and completed questionnaires assessing dream control and self-efficacy. Dream-task success was assessed using predefined in-dream motor performance criteria. Differences between high and low LD control participants were examined, and two detailed case reports of lucid dream juggling attempts provide insight into the challenges of executing complex motor tasks during LD. Results: Dream control varied between and within participants. Both dream control and self-efficacy seemed to predict participants’ ability to execute the LD motor task. Conclusions: Despite the low sample size, this study highlights the potential roles of individual traits like self-efficacy in shaping dream control abilities and motor performance during LD. By using empirical, task-based measures, this study helps build the foundation for future research aimed at optimizing LD applications in clinical and non-clinical fields. Full article

This paper reports on the development and implementation of a digital pathology platform aimed at improving veterinary students’ learning experiences. Traditional pathology labs limit individual access to physical slides, restricting independent study and detailed examination. The platform provides on-demand access to a comprehensive library of high-resolution digital slides, enabling flexible and personalized learning. Using a mixed-method approach, including surveys and usage analytics, we evaluated its impact on student outcomes. Results showed a significant increase in student engagement and satisfaction, with median usefulness ratings of 5 on a 5-point scale. Usage data indicated enhanced study habits, including increased incidence of students reviewing digital slides independently compared to traditional methods. Qualitative feedback highlighted the platform’s high-resolution imaging and zoom functionality as key features improving students’ understanding of histopathological details. Minor challenges during digitization were addressed to optimize accessibility and interactivity. Overall, this digital platform supports the development of essential diagnostic skills and aligns with contemporary veterinary education skills. The findings demonstrate that integrating digital pathology resources can effectively complement conventional teaching, fostering deeper learning and greater flexibility in study practices. Full article

This study investigates Project-Based Learning (PBL) to boost student engagement in a Transport Phenomena course at the Federal University of Mato Grosso do Sul (UFMS). Through a hands-on project involving Floating Treatment Islands (FTIs) for water quality improvement, PBL was hypothesized to enhance student involvement and analytical skills. Students designed and optimized FTIs, experimenting with configurations like root length and plant type. Quantitative outcomes reveal a standard deviation of 1.5 in project scores among top performers (course average > 6), reflecting diverse problem-solving strategies, while a standard deviation of 0.8 near the passing threshold (course average ≈ 6) indicates consistent efforts to improve grades. Additionally, 80% of students rated their experience ≥ 4 on a 5-point scale, signaling high satisfaction, although 40% identified data interpretation as a challenge requiring targeted support. Outcomes were assessed by analyzing score variability, revealing higher standard deviations among top performers, indicating diverse problem-solving approaches, while lower deviations near the passing threshold suggested uniform efforts to improve grades. Despite general satisfaction, some students faced data interpretation challenges, highlighting areas for instructional refinement. The results affirm PBL’s effectiveness in fostering engagement and practical skills but suggest that adaptive teaching methods are essential to support comprehension and maintain engagement across different performance levels. Full article

High-performance musical instrument training is a demanding discipline that engages cognitive, neurological, and physical skills. Professional musicians invest substantial time and effort into mastering their repertoire and developing the muscle memory and reflexes required to perform complex works in high-stakes settings. While existing surveys have explored the use of music in therapeutic and general training contexts, there is a notable lack of work focused specifically on the needs of professional musicians and advanced instrumental practice. This topical review explores the potential of EEG-based brain–computer interface (BCI) technologies to integrate real-time feedback of biomechanic and cognitive features in advanced musical practice. Building on a conceptual framework of technology-enhanced musical practice (TEMP), we review empirical studies of broad contexts, addressing the EEG signal decoding of biomechanic and cognitive tasks that closely relates to the specified TEMP features (movement and muscle activity, posture and balance, fine motor movements and dexterity, breathing control, head and facial movement, movement intention, tempo processing, ptich recognition, and cognitive engagement), assessing their feasibility and limitations. Our analysis highlights current gaps and provides a foundation for future development of BCI-supported musical training systems to support high-performance instrumental practice. Full article

Mental health conditions affect many young people in sub-Saharan Africa (SSA), where stigma is high and access to care is limited. Digital tools accessible on basic mobile phones offer a scalable way to promote mental health, but evidence on their effectiveness in SSA is limited. This study evaluated the reach, feasibility, acceptability, and knowledge outcomes of Digital MindSKILLZ, an interactive voice response (IVR) mental health intervention implemented in the Democratic Republic of Congo, Ghana, Nigeria, Rwanda, Uganda, and Zambia. Over seven months, 700,138 people called the platform, and 425,395 (61%) listened to at least one message. Of these users, 63.6% were under 25 and 68.3% were from rural areas. The three content branches—mental health information, mental health skills, and soccer quizzes—were accessed by 36.5%, 46.4%, and 50.9% of users, respectively. Among users who accessed the mental health branch of the intervention, the mean number of messages completed was 7.6 out of 18 messages. In a follow-up survey, 91% of users understood the content, 85% would recommend the intervention, and 38% found the mental health content most helpful. Average knowledge scores were 62%, with lower scores on common disorders and stigma. The intervention showed strong reach and acceptability, but content and implementation improvements are needed to boost engagement and retention. Full article

Non-nutritive sucking (NNS) is an instinctive behavior in newborns, consisting of two stages: sucking and expression. It plays a critical role in preparing the infant for oral feeding. In neonatal and pediatric units, NNS assessment is routinely performed to determine feeding readiness. However, these evaluations are often subjective and rely heavily on the clinician’s experience. While other medical devices that support the development of NNS skills exist, they are not specifically designed for the comprehensive assessment of NNS, and their high cost limits accessibility for many hospitals and tertiary care units globally. This paper presents the development and pilot testing of a low-cost, portable device and accompanying software for assessing NNS in newborns hospitalized in neonatal care units. Methods: The device uses force-sensitive resistors to capture expression pressure and a differential pressure sensor to measure NNS. Data were acquired through the analog–digital converter of a microcontroller and transmitted via Bluetooth for real-time graphical analysis. Pilot testing was conducted with six hospitalized preterm newborns, measuring intensity, number of bursts, and sucks per burst. Results demonstrated that the system reliably captures both stages of NNS. Significance: This device provides an affordable, portable solution to support clinical decision-making in clinical units, facilitating accurate, objective monitoring of feeding readiness and developmental progression. Full article

Workplace health and safety issues have long plagued the construction industry. While safety efforts have traditionally focused on physical risks, increasing attention is being paid to mental health and work-related stressors, which can negatively affect both productivity and safety. In Saudi Arabia, the construction sector presents a unique context because of its highly diverse, multinational workforce. Workers of different nationalities often operate on the same job site, leading to potential communication barriers, cultural misunderstandings, and inconsistent safety practices, all of which may amplify stress and safety risks. This research aims to investigate the influence of work-related stressors on construction workers’ safety in Saudi Arabia and identify which stressors most significantly contribute to the risk of injury. A structured questionnaire was distributed to 349 construction workers across 16 job sites in Saudi Arabia. The survey measures ten key stressors identified in the literature, including job site demand, job control, job certainty, skill demand, social support, harassment and discrimination, conflict with supervisors, interpersonal conflict, and job satisfaction. Data were analyzed using logistic regression and Pearson correlation to examine relationships between stressors and self-reported injuries. The findings indicated that work-related stressors significantly predict workplace injury. While the first regression model showed a modest effect size, it was statistically significant. The second model identified job site demand and job satisfaction as the most influential predictors of injury risk. Work-related stressors, particularly high job demands and low job satisfaction, substantially increase the likelihood of injury among construction workers. These findings emphasize the importance of incorporating psychosocial risk management into construction safety practices in Saudi Arabia. Future studies should adopt longitudinal designs to explore causal relationships over time and include qualitative methods such as interviews to gain a deeper understanding. Additionally, factors such as nationality, organizational policies, and management style should be investigated to better understand their moderating effects on the stress–injury relationship. Full article

Background: Cardiovascular morbidity and mortality are alarmingly high in Bulgaria, partly due to behavioral risk factors such as smoking. Purpose: This study aimed to assess and compare smoking habits, second-hand smoke exposure, and attitudes of Bulgarian and foreign medical students to better understand smoking behavior in this population. Methods: A cross-sectional survey was conducted among 1063 medical students at the Medical University of Plovdiv (60.8% women; 53% Bulgarian). Results: More Bulgarian students were active smokers and ever-smokers than foreign students (24.7% vs. 14% and 29.3% vs. 18.8%, p < 0.001). Bulgarian women smoked nearly as much as Bulgarian men (24.1% vs. 25.6% for active smokers, p > 0.05), whereas foreign women smoked less than foreign men (15.7% vs. 23.7%, p = 0.034). Women more often replaced classic cigarettes with tobacco heating systems (THSs) than men (40.7% vs. 25.3%, p = 0.020). Nearly 85% of the respondents started smoking by the age of 19. Exposure to second-hand smoke among friends, among colleagues, and in the family was associated with a higher risk of being an ever-smoker (ORs ~8.9; 3.4 and 3.7, respectively). About 20% of students were unsure or disagreed that smoking fewer cigarettes, THSs, or e-cigarettes posed health risks. The majority (61.3%) of active smokers acknowledged negative health effects. Conclusions: These findings highlight a concerning smoking prevalence among Bulgarian medical students and emphasize the need to strengthen medical education and health policies with updated tobacco risk information and targeted prevention programs to reduce smoking and improve future physicians’ cessation counseling skills. Smoking likely contributes significantly to Bulgaria’s high cardiovascular morbidity. Full article

Poorly differentiated thyroid malignancy, a rare histological type of aggressive thyroid malignancy with associated difficulties and gaps in its histological and molecular characterization, might lead to challenging clinical presentations that require a prompt multimodal approach. This case study involved a 56-year-old, non-smoking male with a rapidly developing goiter (within 2–3 months) in association with mild, non-specific neck compressive symptoms. His medical history was irrelevant. A voluminous goiter with substernal and posterior extension up to the vertebral bodies was detected using an ultrasound and computed tomography (CT) scan and required emergency thyroidectomy. He had normal thyroid function, as well as negative thyroid autoimmunity and serum calcitonin. The surgery was successful upon “Y” incision, which was used to give better access to the retrosternal component in order to avoid a sternotomy. Post-operatively, the subject developed hypoparathyroidism-related hypocalcemia and showed a very high serum thyroglobulin level (>550 ng/mL). The pathological report confirmed poorly differentiated, multifocal thyroid carcinoma (with an insular, solid, and trabecular pattern) against a background of papillary carcinoma (pT3b, pN0, and pM1; L1; V2; Pn0; R1; and stage IVB). The subject received 200 mCi of radioiodine therapy for 6 weeks following the thoracic surgery. Whole-body scintigraphy was performed before radioiodine therapy and showed increased radiotracer uptake at the thyroid remnants and pre-tracheal levels. Additionally, single-photon emission computed tomography combined with CT (SPECT/CT) was performed, and confirmed the areas of intense uptake, in addition to a moderate uptake in the right and left pulmonary parenchyma, suggesting lung metastasis. To conclude, an overall low level of statistical evidence exists regarding poorly differentiated malignancy in substernal goiters, and the data also remains scarce regarding the impact of genetic and molecular configurations, such as the BRAF-positive profile, in this specific instance. Furthermore, multimodal management includes additional diagnosis methods such as SPECT/CT, while long-term multilayered therapy includes tyrosine kinase inhibitors if the outcome shows an iodine-resistant profile with a poor prognosis. Awareness remains a key factor in cases of a poorly differentiated carcinoma presenting as a rapidly growing goiter with substernal extension in an apparently healthy adult. A surgical approach, while varying with the surgeon’s skills, represents a mandatory step to ensure a better prognosis. In addition to a meticulous histological characterization, genetic/molecular features provide valuable information regarding the outcome and can further help with the decision to use new anti-cancer drugs if tumor response upon radioiodine therapy is no longer achieved; such a development is expected in this disease stage in association with a BRAF-positive configuration. Full article

Background/Objectives: The study aimed to investigate how cognitive variables (performance IQ, verbal short-term memory, working memory, and ADHD symptomatology) impact lexical representations in children with high-functioning autism spectrum disorder (HF-ASD). Methods: Participants were two groups (n1 = n2 = 20) of monolingual Greek-speaking children, aged 7 to 12 years, with and without HF-ASD matched in age, gender, and cognitive skills. Results: Overall, the HF-ASD group had more immature lexical representations than the control group, even though the two groups were similar in naming. In both groups, naming was correlated moderately with verbal short-term memory but only age predicted significantly semantic knowledge. In the ASD group, a bilateral predictive relationship was revealed between output motor programming skills and stored phonological knowledge, supporting theoretical assumptions of the psycholinguistic model of speech. Finally, a different pattern of interrelations was observed between cognitive and lexical variables in the two groups. Conclusions: The findings of the current study indicate that ASD children may map and process new vocabulary differently compared to typically developing peers. Full article

We developed and validated an animation-based assessment (ABA) method for evaluating high school students’ inquiry competencies in Taiwan’s 12-Year Curriculum. Contextualized in atmospheric chemistry involving methane and hydroxyl radicals, ABA integrated dynamic simulations, tiered multiple-choice and open-ended tasks, and process tracking on the CloudClassRoom platform, the assessment focused on measuring two inquiry skills: causal reasoning and critical thinking. The results of 26,823 students revealed that the ABA effectively differentiated student performance across ability levels and academic disciplines, with open-ended items sensitive to higher-order reasoning. Gender difference was not observed, indicating the gender-free design of the developed ABA. While the ABA supports diagnostic insights, limitations need to be addressed, including the underassessment of modeling and creative experimentation skills. Therefore, it is necessary to include open modeling tasks and AI-powered semantic scoring. The developed ABA contributes a scalable, competency-aligned framework for inquiry-based science assessments. Full article