Search Results (2,210)

Large language model-based virtual patients (LLM-VPs) are an emerging simulation tool for health professions education, but their design and integration into curricula are not well characterized. This scoping review mapped how LLM-VPs are being used for simulated clinical learning across health professions. Following a protocol registered on OSF, we searched MEDLINE, EMBASE, CENTRAL, Scopus, and Web of Science to 11 April 2025, per PRISMA-ScR guidelines, and included 21 studies that used LLMs to generate virtual patients for simulated clinical encounters. Data were extracted on technical design, fidelity domains, curricular integration, human factors, and Technology Acceptance Model constructs, and synthesized narratively. Most studies (n = 11) were pilot or feasibility evaluations with small samples (median 21) and used GPT-based models with dynamic text chat. Integration was limited to 10 studies that operated as pilots, 7 as electives, and 3 as core curricular components. The outcomes focused on Level 2 learning (clinical reasoning and preclinical OSCE performance), with predominantly self-report assessments. No studies reported Level 3 or 4 outcomes. Fidelity was strongest in cognitive, socio-cultural, and emotional domains, and 11 studies reported hallucinations or inaccurate outputs. LLM-VPs appear feasible and well-received but remain early-stage, underscoring the need for fidelity-aligned design and more rigorous, longitudinal evaluations. Full article

Background: Speckle tracking echocardiography (STE) is a well-established tool in human cardiology for detecting subtle myocardial dysfunction using strain indices. In cats with hypertrophic cardiomyopathy (HCM), STE has been applied in several studies and has identified myocardial deformation abnormalities. This study aimed to identify sensitive echocardiographic markers of myocardial dysfunction in cats with HCM by comparing global strain and strain rate parameters with those of healthy cats. Methods: Sixty cats were examined, including 31 healthy controls and 29 HCM-affected cats. Echocardiographic assessments included global circumferential strain (GCS), global radial strain (GRS), global longitudinal strain (GLS), their corresponding strain rates (GCSR, GRSR, and GLSR), left atrial ejection fraction (LAEF), and atrial reservoir strain (RS). Results: GLS and GRS were significantly lower in HCM cats than in controls, while GCS showed no significant difference. Among strain rate parameters, only GRSR was significantly reduced in the HCM group. Additionally, both LAEF and RS were markedly decreased, suggesting atrial dysfunction associated with HCM. Conclusions: These findings indicate that GLS and GRS are reliable indicators of left ventricular dysfunction in feline HCM and that GRSR may offer additional insight into myocardial deformation dynamics. Overall, STE provides a useful, non-invasive tool for improving the diagnosis and clinical evaluation of feline HCM. Full article

Crohn’s disease (CD) is a complex inflammatory bowel disease, defined by chronic transmural inflammation and marked heterogeneity in both anatomical distribution and disease behavior, with potential involvement of any segment of the gastrointestinal tract and multiple phenotypes. Advanced cross-sectional imaging nowadays plays a central role in CD management, reliably assessing both luminal and extraluminal inflammatory manifestations, supporting initial diagnosis, phenotypic characterization, and longitudinal monitoring of disease activity, complications and treatment response. Over the last two decades, Intestinal Ultrasound (IUS), MR Enterography (MRE), and Computed Tomography Enterography (CTE) have become central components of the diagnostic pathway. MRE has emerged as the most comprehensive, radiation-free modality for evaluating intestinal extent, inflammatory activity, and complications in Crohn’s disease. Multiparametric MRE, combining T2-weighted imaging, contrast-enhanced sequences, diffusion-weighted imaging, and cine acquisitions, enables a real “Crohn’s disease staging”, namely a thorough evaluation of the transmural inflammation, of fibrotic and fistulizing lesions in the small and large bowel, as well as in the perianal region. IUS provides a dynamic, widely accessible, safe and repeatable imaging technique that is particularly well suited for tight-monitoring strategies, early assessment of therapeutic response, and routine follow-up, especially in experienced centers. Notably CTE, despite concerns related to cumulative ionizing radiation exposure, remains indispensable in acute clinical settings owing to its rapid acquisition, broad availability, and high diagnostic accuracy for detecting abscesses, perforation, and bowel obstruction. Combined, these three modalities offer a complementary and patient-tailored framework for optimal CD management. This review outlines the pathological complexity of Crohn’s disease, traces the evolution of imaging approaches, and provides a comparative overview highlighting the specific strengths and limitations of each modality. Full article

Background: Patients with metabolic syndrome represent a particularly vulnerable population for alcohol-related liver disease progression. However, real-world longitudinal data evaluating the impact of alcohol abstinence on liver fibrosis dynamics in this group remain limited. Methods: We conducted a prospective observational study including hospitalized adults with metabolic syndrome and chronic alcohol consumption. Clinical, laboratory, and non-invasive fibrosis markers—fibrosis-4 index (FIB-4), aspartate aminotransferase-to-platelet ratio index (APRI), and transient elastography—were assessed at baseline and after 6 and 12 months of individual follow-up. Patients were classified according to alcohol consumption status during follow-up. Longitudinal and comparative analyses were performed. Results: At baseline, patients were classified as having alcoholic steatosis (56.3%), alcoholic steatohepatitis (25.0%), or alcoholic cirrhosis (18.7%). During follow-up, 72.9% of patients achieved sustained alcohol abstinence. Abstinent patients demonstrated significant improvements in liver stiffness, FIB-4, and APRI scores at 12 months (all p < 0.001), while non-abstinent patients showed progressive worsening of fibrosis markers. Gamma-glutamyl transferase levels were independently associated with fibrosis severity at baseline. Conclusions: This prospective real-world study suggests that alcohol abstinence is associated with favorable longitudinal changes in non-invasive liver fibrosis markers in patients with metabolic syndrome. Given the non-invasive nature of the diagnostic approach and the relatively small sample size, these findings should be considered hypothesis-generating. Further studies with larger cohorts are warranted to better elucidate the interaction between metabolic risk factors, alcohol consumption, and liver disease progression. Full article

This study empirically investigates how Environmental, Social, and Governance (ESG) discourses among major Korean Business-to-Business (B2B) corporations (POSCO, LG Chem, and HD Hyundai) were reconfigured in the context of former President Trump’s re-election campaign and the 2024 U.S. presidential election. The observation periods were divided into the Pre-Trump period (1 May 2023 to 30 April 2024) and the Post-Trump period (1 May 2024 to 30 April 2025). External discourses were examined using social media, news, and blog posts, while internal discourses were analyzed through the CEO’s New Year addresses from 2021 to 2025. Keyword frequency analysis and co-occurrence network analysis, conducted via the ‘Sometrend’ platform, were combined to trace structural transitions in corporate discourses. The results show that: (1) the relative share and network centrality of environmental (E) keywords declined in the Post-Trump period, with several environmental terms losing core positions and becoming peripheral or bridging nodes, while policy- and economic-related terms increased; (2) social (S) and governance (G) keywords appeared only sporadically and remained peripheral across periods; (3) temporal concentrations of policy–economic keywords coincided with significant political and market-related events, such as financial volatility in 2023 and the tariff policy announcement in February 2025, indicating temporal alignment rather than deterministic causality; (4) firm-level differences were evident: POSCO exhibited the most pronounced structural shift, LG Chem’s discourses increasingly emphasized supply chain and investment-related terms alongside environmental keywords, and HD Hyundai showed a shift toward more risk- and operation-oriented keywords in the later period; and (5) CEO New Year addresses displayed directionally consistent patterns with external discourse, supporting cross-textual alignment. These findings demonstrate that ESG discourse is not a fixed normative language but a strategically adaptive frame that varies according to political–economic contexts and industrial conditions. The relative weakening of the environmental frame in terms of discourse centrality, alongside the strengthening of the policy–economic frame, differed by industry, reflecting variations in regulatory exposure and operational characteristics. By observing ESG discourses longitudinally and comparatively, this study provides empirical evidence of how political and industrial dynamics reshape corporate discourses and CEO communication. Moreover, keyword frequency and co-occurrence network analysis are validated as effective methods for identifying discourse shifts, offering both academic contributions and practical implications for corporate communication analysis. Full article

The mechanical method has become a new construction method for connected aisles in metro tunnels due to its advantages of fast construction speed, high safety, and minimal ground disturbance. During the tunneling process, the interaction mechanism between the composite segment and the shield cutterhead is complex. Taking Shenzhen Metro Line 8 No. 1 Connected Aisle as the research object, a 3D refined model of the shield cutterhead, composite segments and bolt system were built with Abaqus to investigate their dynamic response under cutting. The Drucker–Prager damage model and contact algorithm were introduced to describe the nonlinear behavior of the cutting process. The reliability of the numerical model was verified by concrete cutting tests and on-site Fiber Bragg Grating monitoring, and good agreements were observed. Results show cutterhead cutting first induces circumferential squeezing, then extends longitudinally with a notable time lag, and longitudinal dynamic response is much stronger than transverse. Affected by cutterhead thrust–rotation coupling, cuttable segments have larger displacement with maximum 0.07 mm, forming an asymmetric deformation zone. Ring joint opening follows “a distal attenuation of the opening amount” rule with maximum 0.018 mm, while bolt stress and displacement show “near-end concentration with gradient attenuation”, with longitudinal bolts being more responsive. Mechanical disturbance from small-shield cutting is minimal, with tunnel segment deformation, joint openings, and bolt stress all remaining well below code-specified allowable values. Numerical results show good agreement with field monitoring data of ring joint openings obtained using Fiber Bragg Grating (FBG) sensors, confirming the reliability of the simulation. The results can provide references for structural design and construction parameter optimization of composite segments in a connected aisle. Full article

The parafoil is highly susceptible to deviations from its reference trajectory under wind disturbances. Given its constrained longitudinal control authority, it has limited capability to correct these deviations and regain the intended glide path. To overcome this limitation, we propose a dynamic planning framework based on a layered homing strategy. The airdrop mission trajectory is initially designed as a traditional multi-segment path. To approximate non-uniform glide characteristics under wind disturbances, this planning problem incorporates a predicted wind model as an external input. Node parameters of the segmented trajectory are then solved using an improved grey wolf optimizer (IGWO). By tracking this reference trajectory, the parafoil is guided into the proximity of the target. To ensure landing precision, the terminal phase is formulated and discretized using an adaptive pseudo-spectral method (APSM). The online planner computes a real-time trajectory to account for actual motion characteristics. This dynamic replanning (DRP) compensates for deviations caused by model mismatches and external disturbances. The proposed homing method is statistically verified via extensive Monte Carlo simulations under different wind conditions. Finally, the airdrop experiment is conducted to validate the DRP method. Full article

The adoption of electric vehicles (EVs) has posed new challenges to fire safety, especially when multiple EVs are transported on electric trailers, as limited studies exist on heavy electric vehicle transportation and little research has been conducted on fire development during EV tunnel transport. The aim of this study is to investigate the temperature, smoke, and tenability conditions produced by an electric trailer transporting eight EVs, where a fire initiates and spreads to all eight EVs, under two scenarios: natural ventilation and longitudinal tunnel ventilation. The Fire Dynamics Simulator (FDS) was used, and the combined peak heat release rate (HRR) of the vehicles was found to exceed 76 MW. Air temperatures around the fire source exceeded 1100 °C, while temperatures above 950 °C were recorded at the tunnel ceiling. The simulations captured thermal behaviour, smoke propagation, and the accumulation of carbon dioxide (CO₂) and carbon monoxide (CO). Longitudinal ventilation was shown to reduce upstream smoke spread and help maintain tenable conditions for evacuation and emergency response. These findings raise critical safety concerns regarding EV transportation in tunnels and support improved decision-making for tunnel infrastructure design and emergency responders. Full article

This work investigates the geometric design and optimisation of a dynamic inductive power transfer coupler for two-wheeled electric vehicles under misalignment and magnetic-field exposure constraints. A computational three-dimensional finite-element model of a shielded rectangular coupler is developed to characterise coupling coefficients and magnetic flux density levels on control planes along the longitudinal travel range and under lateral and angular misalignments. Two simulation datasets are generated: one varying only geometric parameters at a nominal position for surrogate construction and global sensitivity analysis, and a second jointly sampling geometry, the travel range and misalignments for optimisation. Sparse Polynomial Chaos Expansions and Canonical Low-Rank Approximation surrogates are built to quantify Sobol’ indices, revealing that a small subset of primary-side geometric variables dominates both coupling efficiency and magnetic field levels. Random forest regressors are then trained on the extended dataset and embedded in the Non-dominated Sorting Genetic Algorithm II to solve a multi-objective optimisation problem that maximises worst-case coupling, improves robustness to misalignment, and enforces magnetic-field leakage limits. Optimal designs were obtained, and a subset was selected for re-evaluation using the finite-element method. The results confirm that the proposed surrogate-assisted framework yields coupler geometries with enhanced coupling and reduced magnetic field leakage while respecting the mechanical constraints for the electric motorcycle system. Full article

Kidney transplantation (KTx) corrects many uremia-related metabolic disturbances; however, dyslipidemia remains common in kidney transplant recipients and contributes to persistent cardiovascular risk. Lipoprotein(a) [Lp(a)] is a largely genetically determined proatherogenic lipoprotein that increases in advanced chronic kidney disease (CKD) and may decrease after restoration of renal function. Autotaxin (ATX), an enzyme involved in proinflammatory lipid signaling through the ATX–lysophosphatidic acid axis, has also been implicated in cardiovascular pathology, but its early post-transplant dynamics remain poorly characterized. In addition to quantitative lipid abnormalities, CKD is associated with high-density lipoprotein (HDL) dysfunction and reduced paraoxonase-1 (PON-1) activity; however, data on early post-transplant changes in PON-1 activity are limited. In this prospective observational study, lipid profile parameters, Lp(a) concentration, ATX activity, and PON-1 activity were assessed in 55 Caucasian patients with CKD stage 5, most of whom were dialysis-dependent, before and 2–3 weeks after KTx. All recipients received tacrolimus-based maintenance immunosuppression with corticosteroids and mycophenolate mofetil. After KTx, Lp(a) levels decreased by a median of 21% and ATX activity by 28% (both p < 0.001). Lp(a) and ATX showed no cross-sectional or longitudinal association either before or after transplantation, and their percentage changes were not correlated. In contrast, conventional lipid fractions increased significantly, including total cholesterol (+22%), LDL cholesterol (+27%), HDL cholesterol (+24%), and triglycerides (+55%) (all p < 0.001). PON-1 activity increased by approximately 13% after KTx (p < 0.001), and its percentage change correlated positively with the increase in HDL cholesterol. In exploratory analyses, the magnitude of Lp(a) reduction was associated with early graft function: patients with eGFR <45 mL/min/1.73 m² exhibited a significantly smaller decline in Lp(a) than those with better graft function (−4.8% vs. −26.7%, p = 0.009). Multivariable analysis showed that demographic characteristics, body mass index, tacrolimus exposure, and post-transplant eGFR did not independently predict the magnitude of Lp(a) reduction. Tacrolimus trough concentrations and cumulative corticosteroid exposure were not associated with lipid parameters or their changes, except for a single subgroup difference in PON-1 activity of uncertain clinical significance. In the early period after KTx under tacrolimus-based immunosuppression, Lp(a) concentration and ATX activity decrease, whereas conventional lipid fractions increase and PON-1 activity improves. These changes were not associated with tacrolimus exposure or cumulative corticosteroid dose. The reduction in Lp(a) was associated with early graft function in exploratory analyses, suggesting that recovery of renal function may contribute to early post-transplant Lp(a) dynamics; however, no independent causal relationship was established, and the findings should be interpreted cautiously given the limited sample size and exploratory design. The clinical significance of these changes for long-term cardiovascular and graft outcomes requires further investigation. Full article

Achieving societal goals of sustainability will require businesses to leverage scientific results and advanced technologies and thereby promote the distribution of new solutions in society. Therefore, a key recommendation from the sustainability transition literature is to promote direct collaboration between industry and academia. However, existing research suggests that successful collaboration is difficult to achieve due to institutional complexity. This paper applies a set of theoretical concepts regarding institutional complexity—namely hybrid organizations, academic engagement, and institutional logics—to a case study of a university–industry centre for sustainability. The longitudinal process of collaboration from initiating to dismantling a centre is first described. This process understanding enables an analysis of the management challenges with regard to the different institutional logics held by stakeholders including financiers, firms and research institutions, as they attempt to work together to achieve desired sustainable innovation outcomes. The conclusions point out a novel capability—latent flexibility—that we have identified in hybrid organizations. This refers to where institutional and task complexity are dynamically resolved by managers preserving the ability to reconfigure a project’s assets and hence determine how logics should recede or advance depending on interpretations of achieved outputs and shifting expectations for collaborative research. Full article

Background: Diagnosis of leptomeningeal disease (LMD) remains a clinical challenge due to nonspecific neurological symptoms, limitations of imaging, and the low sensitivity of cerebrospinal fluid (CSF) cytology. Molecular biomarkers, such as circulating tumor DNA (ctDNA) variant allele frequencies (VAFs), offer potential for improved detection and disease monitoring. Methods: Gene-level VAFs were analyzed from 118 Summit™ positive CSF specimens and evaluated in the context of clinical diagnosis, neurological presentation, neuroimaging, and CSF cytology. Longitudinal analyses were performed on serial CSF samples to assess VAF dynamics following therapy. Results: Longitudinal assessment demonstrated that decreases in VAF post-treatment aligned with clinical stabilization, whereas rising or persistent VAFs reflected disease progression, therapeutic resistance, or evolving clonal mutations. Elevated VAFs correlated strongly with clinically confirmed LMD and were concordant with radiographic and clinical indicators of disease. Conclusions: VAF analysis in CSF provides a quantitative biomarker for the detection and monitoring of metastatic CNS disease. These findings support its utility as a complementary tool to conventional diagnostics, offering real-time insights into disease burden, therapeutic response, and clonal evolution in LMD. Full article

Background/Objectives: Alcohol-related liver cirrhosis is a systemic disorder characterized by profound immune, metabolic and gut–liver axis dysregulation. Emerging evidence highlights a bidirectional interaction between the intestinal microbiota and host microRNAs (miRNAs), positioning this axis as a potential regulator of systemic homeostasis. However, human data exploring the impact of microbiota modulation on miRNA expression in advanced liver disease remain limited. Methods: Six patients with alcohol-induced liver cirrhosis underwent fecal microbiota transplantation (FMT). Safety was assessed through clinical and paraclinical monitoring at predefined intervals. Quality of life was evaluated pre- and post-intervention using a validated liver-specific questionnaire. Fecal expression of miR-21-5p, miR-122-5p, miR-125-5p, miR-146-5p and miR-155-5p was analyzed and correlations with clinical domains, demographic variables and hepatic encephalopathy severity were explored. Results: FMT was well tolerated, with no severe adverse events reported. Preliminary improvements were observed in total clinical score (3.22 [3.06–3.57] vs. 4.25 [4.20–4.26], p = 0.001) and in several quality-of-life domains, including abdominal symptoms, fatigue, systemic manifestations, activity and emotional function (p < 0.05), while worry/concern scores remained unchanged. miR-125 and miR-146 demonstrated consistent associations with clinical status both before and after FMT, whereas miR-21 correlated mainly with age and body mass index. Notably, miR-125 and miR-146 were also associated with post-FMT hepatic encephalopathy severity, supporting their potential value as molecular correlates of clinical response in this exploratory study. Conclusions: In this pilot study, FMT appeared safe and was temporally associated with improvements in clinical parameters in alcohol-related cirrhosis, alongside dynamic changes in fecal miRNA expression. These preliminary findings support a potential microbiota–miRNA interaction and warrant validation in larger, controlled longitudinal studies. Full article

Single-wheel brake failure in electromechanical brake (EMB) systems breaks the left-right symmetry of wheel forces and yaw moments, creating a critical conflict between emergency braking effectiveness and lateral stability. To address this symmetry-breaking condition, this paper proposes a bimodal, adaptive, coordinated fault-tolerant control strategy that integrates dynamic brake torque redistribution with active front steering (AFS). A novel dynamic interaction model linking deceleration demand with tire adhesion utilization enables real-time assessment and optimization of the balance between longitudinal braking performance and yaw stability. Braking forces are allocated based on adhesion utilization through a layered two-mode strategy—balanced distribution prioritizing lateral stability and compensatory distribution engaging the healthy front wheel when rear axle capacity is exceeded. An integral sliding-mode controller computes the additional yaw moment needed to suppress yaw-rate deviation, with rigorous Lyapunov stability analysis confirming closed-loop stability. AFS is triggered only when yaw-rate deviation exceeds 0.05 rad/s or adhesion utilization reaches 90%, incorporating hysteresis to ensure smooth transitions and minimize unnecessary steering intervention. Comprehensive co-simulations using Carsim and MATLAB/Simulink under diverse failure locations (left-front and right-rear wheels), road adhesion levels ($\mu$ = 0.85 and 0.5), and braking intensities (0.2 g–0.6 g) demonstrate that the proposed strategy reduces lateral displacement by up to 85.3% compared to full-time AFS control while maintaining over 99% deceleration satisfaction. The results establish an effective dual-objective fault-tolerant framework that enhances both robustness and functional safety of EMB systems under symmetry-breaking faults, offering a physically interpretable, computationally efficient solution well-suited for real-time automotive applications. Full article

Dynamic mechanical thermal analysis (DMTA) is widely used to assess the effects of process- and environment-induced changes in polymer matrix composites, with the glass transition temperature (T_g) often reported from the tan d peak at a single excitation frequency. However, such an approach neglects the inherently kinetic nature of the glass transition and may obscure thermally induced changes in relaxation response. Multi-frequency DMTA was employed to investigate the evolution of glass transition response of a wet-layup unidirectional carbon/epoxy composite subjected to thermal aging at temperatures ranging from 66 °C to 260 °C for periods up to 72 h, using unexposed (23 °C) results as an ambient baseline reference. Tests were conducted using a single cantilever mode in both longitudinal and transverse configurations over a range of excitation frequencies from 0.3 to 30 Hz. Results demonstrate that thermal exposure affects not only the absolute value of the glass transition temperature, but also its frequency sensitivity and directional dependence. A frequency sensitivity parameter and a directional amplification factor are introduced to quantify frequency–direction coupling. While post-cure-dominated aging regimes exhibit relatively stable coupling behavior, degradation-dominated conditions at elevated temperatures and longer periods of thermal exposure lead to pronounced increases in transverse frequency sensitivity, which reflects early evolution of matrix- and interphase-level deterioration. These findings highlight the value of multi-frequency DMTA with tests in both primary directions for the mechanistic assessment of effects of thermo-oxidative response in polymer matrix composites. Full article