Search Results (799)

Background: Growing disparities in development, governance, and logistics performance across countries pose challenges for global policymaking and Sustainable Development Goal (SDG) monitoring. This study proposes a classification of 137 countries based on multiple structural dimensions. The dataset for 2023 includes six components of the Logistics Performance Index (LPI), six dimensions of the Worldwide Governance Indicators (WGIs), and four proxies of the Human Development Index (HDI). Methods: The Uniform Manifold Approximation and Projection (UMAP) technique was used to reduce dimensionality and allow for meaningful clustering. Based on the reduced space, the K-means algorithm was employed to group countries with similar development characteristics. Results: The classification process allowed the identification of three distinct groups of countries, supported by a Hopkins statistic of 0.984 and an explained variance ratio of 87.3%. These groups exhibit structural differences in the quality of governance, logistics capacity, and social development conditions. Internal consistency checks and multivariate statistical analyses (ANOVA and MANOVA) confirmed the robustness and statistical significance of the clustering. Conclusions: The resulting classification offers a practical analytical tool for policymakers to design differentiated strategies aligned with national contexts. Furthermore, it provides a data-driven approach for comparative monitoring of the SDGs from an integrated and empirical perspective. Full article

Background/Objectives: Pressure injuries are a significant concern among older adults, particularly in community-based long-term care settings where prolonged immobility is prevalent. This study aimed to identify factors influencing sacral interface pressure in community-dwelling older adults, with an emphasis on support surface usage and clinical risk indicators. Methods: A total of 210 participants aged 65 years and older, all receiving long-term care services in South Korea, were enrolled in this study. Sacral interface pressure was measured in the supine position using a portable pressure mapping device (Palm Q7). General characteristics, Braden Scale scores, Huhn Scale scores, and mattress usage were assessed. Data were analyzed using descriptive statistics, t-tests, chi-square tests, and logistic regression. Results: Mattress non-use was identified as the strongest predictor of elevated sacral interface pressure (OR = 6.71, p < 0.001), followed by Braden Scale scores indicating moderate risk (OR = 4.8, p = 0.006). Huhn Scale scores were not significantly associated with interface pressure. These results suggest that support surface quality and skin condition have a stronger impact on interface pressure than mobility-related risk factors. Conclusions: The findings highlight the importance of providing high-quality pressure-relieving mattresses and implementing standardized nursing assessments to reduce the risk of pressure injuries. Integrating smart technologies and expanding access to advanced support surfaces may aid in developing tailored preventive strategies for vulnerable older adults. Full article

Background: Electrocardiograms (EKGs) are essential tools in emergency medicine, often used to evaluate chest pain, dyspnea, and other symptoms suggestive of cardiac dysfunction. Yet, EKGs are not universally administered to all emergency department (ED) patients. Understanding and predicting which patients receive an EKG may offer insights into clinical decision making, resource allocation, and potential disparities in care. This study examines whether integrating structured clinical data with free-text patient narratives can improve prediction of EKG utilization in the ED. Methods: We conducted a retrospective observational study to predict electrocardiogram (EKG) utilization using data from 13,115 adult emergency department (ED) visits in the nationally representative 2021 National Hospital Ambulatory Medical Care Survey–Emergency Department (NHAMCS-ED), leveraging both structured features—demographics, vital signs, comorbidities, arrival mode, and triage acuity, with the most influential selected via Lasso regression—and unstructured patient narratives transformed into numerical embeddings using Clinical-BERT. Four supervised learning models—Logistic Regression (LR), Support Vector Machine (SVM), Random Forest (RF) and Extreme Gradient Boosting (XGB)—were trained on three inputs (structured data only, text embeddings only, and a late-fusion combined model); hyperparameters were optimized by grid search with 5-fold cross-validation; performance was evaluated via AUROC, accuracy, sensitivity, specificity and precision; and interpretability was assessed using SHAP values and Permutation Feature Importance. Results: EKGs were administered in 30.6% of adult ED visits. Patients who received EKGs were more likely to be older, White, Medicare-insured, and to present with abnormal vital signs or higher triage severity. Across all models, the combined data approach yielded superior predictive performance. The SVM and LR achieved the highest area under the ROC curve (AUC = 0.860 and 0.861) when using both structured and unstructured data, compared to 0.772 with structured data alone and 0.823 and 0.822 with unstructured data alone. Similar improvements were observed in accuracy, sensitivity, and specificity. Conclusions: Integrating structured clinical data with patient narratives significantly enhances the ability to predict EKG utilization in the emergency department. These findings support a personalized medicine framework by demonstrating how multimodal data integration can enable individualized, real-time decision support in the ED. Full article

Perfluoroalkyl substances (PFASs) possess immunosuppressive properties. However, their association with rheumatoid arthritis (RA) risk remains inconclusive across epidemiological studies. This study integrates population-based and mechanistic evidence to clarify the relationship between PFAS exposure and RA. We analyzed 8743 U.S. adults from the NHANES (2005–2018), assessing individual and mixed exposures to PFOA, PFOS, PFNA, and PFHxS using multivariable logistic regression, Bayesian kernel machine regression, quantile g-computation, and weighted quantile sum models. Network toxicology and molecular docking were utilized to identify core targets mediating immune disruption. The results showed that elevated PFOA (OR = 1.63, 95% CI: 1.41–1.89), PFOS (OR = 1.41, 1.25–1.58), and PFNA (OR = 1.40, 1.20–1.63) levels significantly increased RA risk. Mixture analyses indicated a positive joint effect (WQS OR = 1.06, 1.02–1.10; qgcomp OR = 1.26, 1.16–1.38), with PFOA as the primary contributor. Stratified analyses revealed stronger effects in females (PFOA Q4 OR = 3.75, 2.36–5.97) and older adults (≥60 years). Core targets included EGFR, SRC, TP53, and CTNNB1. PFAS mixtures increase RA risk, dominated by PFOA and modulated by sex/age. These findings help reconcile prior contradictions by identifying key molecular targets and vulnerable subpopulations, supporting regulatory attention to PFAS mixture exposure. Full article

Educational admission systems, particularly in developing countries, often suffer from opaque decision processes, unstructured data, and limited analytic insight. This study proposes a novel methodology that integrates structural causal models (SCMs), ontological modeling, and machine learning to uncover and apply interpretable knowledge from an admission database. Using a dataset of 12,043 records from Benue State Polytechnic, Nigeria, we demonstrate this approach as a proof of concept by constructing a domain-specific SCM ontology, validate it using conditional independence testing (CIT), and extract features for predictive modeling. Five classifiers, Logistic Regression, Decision Tree, Random Forest, K-Nearest Neighbors (KNN), and Support Vector Machine (SVM) were evaluated using stratified 10-fold cross-validation. SVM and KNN achieved the highest classification accuracy (92%), with precision and recall scores exceeding 95% and 100%, respectively. Feature importance analysis revealed ‘mode of entry’ and ‘current qualification’ as key causal factors influencing admission decisions. This framework provides a reproducible pipeline that combines semantic representation and empirical validation, offering actionable insights for institutional decision-makers. Comparative benchmarking, ethical considerations, and model calibration are integrated to enhance methodological transparency. Limitations, including reliance on single-institution data, are acknowledged, and directions for generalizability and explainable AI are proposed. Full article

Adversarial attacks in Natural Language Processing (NLP) present a critical challenge, particularly in sentiment analysis, where subtle input modifications can significantly alter model predictions. In search of more robust defenses against adversarial attacks on sentimental analysis, this research work introduces two novel defense mechanisms: the Lexicon-Based Random Substitute Model (LRSM) and the Word-Variant Voting Model (WVVM). LRSM employs randomized substitutions from a dataset-specific lexicon to generate diverse input variations, disrupting adversarial strategies by introducing unpredictability. Unlike traditional defenses requiring synonym dictionaries or precomputed semantic relationships, LRSM directly substitutes words with random lexicon alternatives, reducing overhead while maintaining robustness. Notably, LRSM not only neutralizes adversarial perturbations but occasionally surpasses the original accuracy by correcting inherent model misclassifications. Building on LRSM, WVVM integrates LRSM, Frequency-Guided Word Substitution (FGWS), and Synonym Random Substitution and Voting (RS&V) in an ensemble framework that adaptively combines their outputs. Logistic Regression (LR) emerged as the optimal ensemble configuration, leveraging its regularization parameters to balance the contributions of individual defenses. WVVM consistently outperformed standalone defenses, demonstrating superior restored accuracy and F1 scores across adversarial scenarios. The proposed defenses were evaluated on two well-known sentiment analysis benchmarks: the IMDB Sentiment Dataset and the Yelp Polarity Dataset. The IMDB dataset, comprising 50,000 labeled movie reviews, and the Yelp Polarity dataset, containing labeled business reviews, provided diverse linguistic challenges for assessing adversarial robustness. Both datasets were tested using 4000 adversarial examples generated by established attacks, including Probability Weighted Word Saliency, TextFooler, and BERT-based Adversarial Examples. WVVM and LRSM demonstrated superior performance in restoring accuracy and F1 scores across both datasets, with WVVM excelling through its ensemble learning framework. LRSM improved restored accuracy from 75.66% to 83.7% when compared to the second-best individual model, RS&V, while the Support Vector Classifier WVVM variation further improved restored accuracy to 93.17%. Logistic Regression WVVM achieved an F1 score of 86.26% compared to 76.80% for RS&V. These findings establish LRSM and WVVM as robust frameworks for defending against adversarial text attacks in sentiment analysis. Full article

Background: Pancreatic cystic lesions (PCLs), including intraductal papillary mucinous neoplasms (IPMNs) and mucinous cystic neoplasms (MCNs), pose a diagnostic challenge due to their variable malignant potential. Current guidelines, such as Fukuoka and American Gastroenterological Association (AGA), have moderate predictive accuracy and may lead to overtreatment or missed malignancies. Artificial intelligence (AI), incorporating machine learning (ML) and deep learning (DL), offers the potential to improve risk stratification, diagnosis, and management of PCLs by integrating clinical, radiological, and molecular data. This is the first systematic review to evaluate the application, performance, and clinical utility of AI models in the diagnosis, classification, prognosis, and management of pancreatic cysts. Methods: A systematic review was conducted in accordance with PRISMA guidelines and registered on PROSPERO (CRD420251008593). Databases searched included PubMed, EMBASE, Scopus, and Cochrane Library up to March 2025. The inclusion criteria encompassed original studies employing AI, ML, or DL in human subjects with pancreatic cysts, evaluating diagnostic, classification, or prognostic outcomes. Data were extracted on the study design, imaging modality, model type, sample size, performance metrics (accuracy, sensitivity, specificity, and area under the curve (AUC)), and validation methods. Study quality and bias were assessed using the PROBAST and adherence to TRIPOD reporting guidelines. Results: From 847 records, 31 studies met the inclusion criteria. Most were retrospective observational (n = 27, 87%) and focused on preoperative diagnostic applications (n = 30, 97%), with only one addressing prognosis. Imaging modalities included Computed Tomography (CT) (48%), endoscopic ultrasound (EUS) (26%), and Magnetic Resonance Imaging (MRI) (9.7%). Neural networks, particularly convolutional neural networks (CNNs), were the most common AI models (n = 16), followed by logistic regression (n = 4) and support vector machines (n = 3). The median reported AUC across studies was 0.912, with 55% of models achieving AUC ≥ 0.80. The models outperformed clinicians or existing guidelines in 11 studies. IPMN stratification and subtype classification were common focuses, with CNN-based EUS models achieving accuracies of up to 99.6%. Only 10 studies (32%) performed external validation. The risk of bias was high in 93.5% of studies, and TRIPOD adherence averaged 48%. Conclusions: AI demonstrates strong potential in improving the diagnosis and risk stratification of pancreatic cysts, with several models outperforming current clinical guidelines and human readers. However, widespread clinical adoption is hindered by high risk of bias, lack of external validation, and limited interpretability of complex models. Future work should prioritise multicentre prospective studies, standardised model reporting, and development of interpretable, externally validated tools to support clinical integration. Full article

Salinization of olive orchards constitutes a front-line agronomic challenge for farmers, consumers, and the scientific community as food security, olive logistics, and land use become more unsustainable and problematic. Plantlets of two olive varieties (var. Kalamon and var. Koroneiki) were tested for their performance under soil saline conditions, in which L-methionine, choline-Cl, and L-proline betaine were applied foliarly to alleviate adverse effects. The ‘Kalamon’ variety ameliorated its photosynthetic rates when L-proline betaine and L-methionine were administered at low saline exposure. The stressed varieties achieved higher leaf transpiration rates in the following treatment order: choline-Cl > L-methionine > L-proline betaine. Choline chloride supported stomatal conductance in stressed var. Kalamon olives without this pattern, which was also followed by var. Koroneiki. Supplementation regimes created a mosaic of responses on varietal water use efficiency under stress. The total phenolic content in leaves increased in both varieties after exogenous application only at the highest levels of saline stress. None of the substances applied to olive trees could stand alone as a tool to mitigate salinity stress in order to be recommended as a solid agronomic practice. The residual exploitation of amino acids by the olive orchard microbiome must also be considered as part of an environmentally friendly, integrated strategy to mitigate salinity stress. Full article

Background: Digital transformation is increasingly present in modern logistics, especially in the context of sustainability and circularity pressures. The integration of technologies such as Internet of Things (IoT), Radio Frequency Identification (RFID), and automated platforms involves not only infrastructure but also a strategic vision, a flexible organizational culture, and the ability to support decisions through artificial intelligence (AI)-based systems. Methods: This study proposes an extended conceptual model using structural equation modelling (SEM) to explore the relationships between five constructs: technological change, strategic and organizational readiness, transformation environment, AI-enabled decision configuration, and operational redesign. The model was validated based on a sample of 217 active logistics specialists, coming from sectors such as road transport, retail, 3PL logistics services, and manufacturing. The participants are involved in the digitization of processes, especially in activities related to operational decisions and sustainability. Results: The findings reveal that the analysis confirms statistically significant relationships between organizational readiness, transformation environment, AI-based decision processes, and operational redesign. Conclusions: The study highlights the importance of an integrated approach in which technology, organizational culture, and advanced decision support collectively contribute to the transition to digital and circular logistics chains. Full article

Landslides are among the most hazardous natural phenomena affecting Greater Abidjan, causing significant economic and social damage. Strategic planning supported by geographic information systems (GIS) can help mitigate potential losses and enhance disaster resilience. This study evaluates landslide susceptibility using logistic regression and frequency ratio models. The analysis is based on a dataset comprising 54 mapped landslide scarps collected from June 2015 to July 2023, along with 16 thematic predictor variables, including altitude, slope, aspect, profile curvature, plan curvature, drainage area, distance to the drainage network, normalized difference vegetation index (NDVI), and an urban-related layer. A high-resolution (5-m) digital elevation model (DEM), derived from multiple data sources, supports the spatial analysis. The landslide inventory was randomly divided into two subsets: 80% for model calibration and 20% for validation. After optimization and statistical testing, the selected thematic layers were integrated to produce a susceptibility map. The results indicate that 6.3% (0.7 km²) of the study area is classified as very highly susceptible. The proportion of the sample (61.2%) in this class had a frequency ratio estimated to be 20.2. Among the predictive indicators, altitude, slope, SE, S, NW, and NDVI were found to have a positive impact on landslide occurrence. Model performance was assessed using the area under the receiver operating characteristic curve (AUC), demonstrating strong predictive capability. These findings can support informed land-use planning and risk reduction strategies in urban areas. Furthermore, the prediction model should be communicated to and understood by local authorities to facilitate disaster management. The cost function was adopted as a novel approach to delineate hazardous zones. Considering the landslide inventory period, the increasing hazard due to climate change, and the intensification of human activities, a reasoned choice of sample size was made. This informed decision enabled the production of an updated prediction map. Optimal thresholds were then derived to classify areas into high- and low-susceptibility categories. The prediction map will be useful to planners in helping them make decisions and implement protective measures. Full article

The integration of artificial intelligence (AI), big data analytics, and blockchain technologies within the digital economy presents transformative opportunities for promoting low-carbon urban development. However, a systematic understanding of how these digital innovations influence urban carbon mitigation remains limited. This study addresses this gap by proposing two research questions (RQs): (1) What are the key success factors for artificial intelligence, big data, and blockchain in urban carbon emission reduction? (2) How do these technologies interact and support the transition to low-carbon cities? To answer these questions, the study employs a hybrid methodological framework combining the decision-making trial and evaluation laboratory (DEMATEL) and interpretive structural modeling (ISM) techniques. The data were collected through structured expert questionnaires, enabling the identification and hierarchical analysis of twelve critical success factors (CSFs). Grounded in sustainability transitions theory and institutional theory, the CSFs are categorized into three dimensions: (1) digital infrastructure and technological applications; (2) digital transformation of industry and economy; (3) sustainable urban governance. The results reveal that e-commerce and sustainable logistics, the adoption of the circular economy, and cross-sector collaboration are the most influential drivers of digital-enabled decarbonization, while foundational elements such as smart energy systems and digital infrastructure act as key enablers. The DEMATEL-ISM approach facilitates a system-level understanding of the causal relationships and strategic priorities among the CSFs, offering actionable insights for urban planners, policymakers, and stakeholders committed to sustainable digital transformation and carbon neutrality. Full article

Students, particularly those in the medical field, are exposed to various stressors that can affect their health-related behaviors, including smoking habits, with implications for oral health and quality of life. Background and Objectives: to analyze the relationship between smoking, oral health, perceived stress level, and self-assessed quality of life in a sample of dental students. Materials and Methods: The cross-sectional study included 338 students, who completed validated questionnaires and were clinically examined. Lifestyle was assessed using a smoking behavior questionnaire, stress levels were measured with the Student Stress Inventory (SSI), and quality of life was evaluated using the EQ-5D-5L instrument. The DMFT index was calculated to determine oral health status. Results: Among the 338 participating students, 53.8% were smokers. The lifestyle analysis revealed slightly higher average scores among non-smokers across all domains—social (3.26 vs. 3.09), attitudinal (2.75 vs. 2.97), and behavioral (3.82 vs. 3.49), but without statistically significant differences (p > 0.25). The mean DMFT score was 12.48, with no significant differences between smokers and non-smokers (p = 0.554). The SSI total score averaged 83.15, indicating a moderate level of perceived stress, again with no statistically significant differences between the groups (p > 0.05). However, slightly higher average stress scores among smokers may suggest the use of smoking as a coping mechanism. In contrast, quality of life as measured by EQ-5D-5L showed significantly worse outcomes for smokers across all five dimensions, including mobility (78.6% vs. 95.5%, p = 0.000) and self-care (93.4% vs. 100%, p = 0.001). Multivariable logistic regression identified smoking (OR = 1.935; p = 0.047) and moderate stress levels (OR = 0.258; p < 0.001) as independent predictors of oral health status. Conclusions: The results obtained suggest that smoking may function as a stress management strategy among students, supporting the relevance of integrating specific psychobehavioral interventions that address stress reduction and oral health promotion among student populations. Full article

This study synthesizes the rapidly expanding evidence on how digital technologies reshape international trade, with a particular focus on small and medium-sized enterprises (SMEs). Guided by two research questions—(RQ1) How do digital tools influence the volume and composition of cross-border trade? and (RQ2) How do these effects vary by countries’ development level and firm size?—we conducted a PRISMA-compliant systematic literature review covering 2010–2024. Searches across eight major databases yielded 1857 records; after duplicate removal, title/abstract screening, full-text assessment, and Mixed Methods Appraisal Tool (MMAT 2018) quality checks, 86 peer-reviewed English-language studies were retained. Findings reveal three dominant technology clusters: (1) e-commerce platforms and cloud services, (2) IoT-enabled supply chain solutions, and (3) emerging AI analytics. E-commerce and cloud adoption consistently raise export intensity—doubling it for digitally mature SMEs—while AI applications are the fastest-growing research strand, particularly in East Asia and Northern Europe. However, benefits are uneven: firms in low-infrastructure settings face higher fixed digital costs, and cybersecurity and regulatory fragmentation remain pervasive obstacles. By integrating trade economics with development and SME internationalization studies, this review offers the first holistic framework that links national digital infrastructure and policy support to firm-level export performance. It shows that the trade-enhancing effects of digitalization are contingent on robust broadband penetration, affordable cloud access, and harmonized data-governance regimes. Policymakers should, therefore, prioritize inclusive digital-readiness programs, while business leaders should invest in complementary capabilities—data analytics, cyber-risk management, and cross-border e-logistics—to fully capture digital trade gains. This balanced perspective advances theory and practice on building resilient, equitable digital trade ecosystems. Full article

Background/Objectives: People are better at recognizing the faces of racial in-group members than out-group members. This own-race bias relies on pattern recognition and memory processes, which rely on hemispheric specialization. We hypothesized that handedness, a proxy for hemispheric specialization, would moderate own-race bias. Specifically, consistently handed individuals perform better on tasks that require the hemispheres to work independently, while inconsistently handed individuals perform better on tasks that require integration. This led to the hypothesis that inconsistently handed individuals would show less own-race bias, driven by an increase in accuracy. Methods: 281 participants completed the study in exchange for course credit. Of those, the sample was isolated to Caucasian (174) and African American individuals (41). Participants were shown two target faces (one Caucasian and one African American), given several distractor tasks, and then asked to identify the target faces during two sequential line-ups, each terminating when participants made an identification judgment. Results: Continuous handedness score and the match between participant race and target face race were entered into a binary logistic regression predicting correct/incorrect identifications. The overall model was statistically significant, Χ² (3, N = 430) = 11.036, p = 0.012, Nagelkerke R² = 0.038, culminating in 76% correct classifications. Analyses of the parameter estimates showed that the racial match, b = 0.53, SE = 0.23, Wald Χ² (1) = 5.217, p = 0.022, OR = 1.703 and the interaction between handedness and the racial match, b = 0.51, SE = 0.23, Wald test = 4.813, p = 0.028, OR = 1.671 significantly contributed to the model. The model indicated that the probability of identification was similar for own- or cross-race targets amongst inconsistently handed individuals. Consistently handed individuals, by contrast, showed an increase in accuracy for the own-race target and a decrease in accuracy for cross-race targets. Conclusions: Results partially supported the hypotheses. Inconsistently handed individuals did show less own-race bias. This finding, however, seemed to be driven by differences in accuracy amongst consistently handed individuals rather than a hypothesized increase in accuracy amongst inconsistently handed individuals. Underlying hemispheric specialization, as measured by proxy with handedness, may impact the own-race bias in facial recognition. Future research is required to investigate the mechanisms, however, as the directional differences were different than hypothesized. Full article

Purpose: Predicting colorectal cancer liver metastasis (CRLM) is essential for prognostic assessment. This study aims to develop and validate an interpretable multimodal machine learning framework based on multiparametric MRI for predicting CRLM, and to enhance the clinical interpretability of the model through SHapley Additive exPlanations (SHAP) analysis and deep learning visualization. Methods: This multicenter retrospective study included 463 patients with pathologically confirmed colorectal cancer from two institutions, divided into training (n = 256), internal testing (n = 111), and external validation (n = 96) sets. Radiomics features were extracted from manually segmented regions on axial T2-weighted imaging (T2WI) and diffusion-weighted imaging (DWI). Deep learning features were obtained from a pretrained ResNet101 network using the same MRI inputs. A least absolute shrinkage and selection operator (LASSO) logistic regression classifier was developed for clinical, radiomics, deep learning, and combined models. Model performance was evaluated by AUC, sensitivity, specificity, and F1-score. SHAP was used to assess feature contributions, and Grad-CAM was applied to visualize deep feature attention. Results: The combined model integrating features across the three modalities achieved the highest performance across all datasets, with AUCs of 0.889 (training), 0.838 (internal test), and 0.822 (external validation), outperforming single-modality models. Decision curve analysis (DCA) revealed enhanced clinical net benefit from the integrated model, while calibration curves confirmed its good predictive consistency. SHAP analysis revealed that radiomic features related to T2WI texture (e.g., LargeDependenceLowGrayLevelEmphasis) and clinical biomarkers (e.g., CA19-9) were among the most predictive for CRLM. Grad-CAM visualizations confirmed that the deep learning model focused on tumor regions consistent with radiological interpretation. Conclusions: This study presents a robust and interpretable multiparametric MRI-based model for noninvasively predicting liver metastasis in colorectal cancer patients. By integrating handcrafted radiomics and deep learning features, and enhancing transparency through SHAP and Grad-CAM, the model provides both high predictive performance and clinically meaningful explanations. These findings highlight its potential value as a decision-support tool for individualized risk assessment and treatment planning in the management of colorectal cancer. Full article