Search Results (166)

With the rapid development of urban rail transit, train operation control is required to meet increasingly stringent demands in terms of energy consumption, comfort, punctuality, and precise stopping. The optimization and tracking control of speed profiles are two critical issues in ensuring the performance of automatic train operation systems. However, conventional model predictive control (MPC) methods are highly dependent on parameter settings and show limited adaptability, while heuristic optimization approaches such as the whale optimization algorithm (WOA) often suffer from premature convergence and insufficient robustness. To overcome these limitations, this study proposes an optimized model predictive controller using the multi-objective whale optimization algorithm (MPC-MOWOA) for urban rail train tracking control. In the improved optimization algorithm, a nonlinear convergence mechanism and the Tchebycheff decomposition method are introduced to enhance convergence accuracy and population diversity, which enables effective optimization of the initial parameters of the MPC. During real-time operation, the MPC is further enhanced by integrating a fuzzy satisfaction function that adaptively adjusts the softening factor. In addition, the control coefficients are corrected online according to the speed error and its rate of change, thereby improving adaptability of the control system. Taking the section from Lvshun New Port to Tieshan Town on Dalian Metro Line 12 as the study case, the proposed control algorithm was deployed on a TMS320F28335 embedded processor platform, and hardware-in-the-loop simulation experiments (HILSEs) were conducted under the same simulation environment, a unified train dynamic model, consistent operating conditions, and an identical evaluation index system. The results indicate that, compared with the Fuzzy-PID control method, the proposed control strategy reduces the integral of time-weighted absolute error nearly by 39.6% and decreases energy consumption nearly by 5.9%, while punctuality, stopping accuracy, and comfort are improved nearly by 33.2%, 12.4%, and 7.1%, respectively. These results not only verify the superior performance of the proposed MPC-MOWOA, but also demonstrate its capability for real-time implementation on embedded processors, thereby overcoming the limitations of purely MATLAB-based offline simulations and exhibiting strong potential for practical engineering applications in urban rail transit. Full article

The integration of artificial intelligence (AI) tools, such as the chat generative pre-trained transformer (ChatGPT), into health professions education is rapidly accelerating, creating new opportunities for personalized learning and clinical preparation. These tools have demonstrated the potential to enhance learning efficiency and critical thinking. However, concerns regarding reliability, academic integrity, and potential overreliance highlight the need to better understand how healthcare students adopt and perceive these technologies in order to guide their effective and responsible integration into educational frameworks. This nationwide, cross-sectional, survey-based study was conducted between February and April 2024 among undergraduate students enrolled in medical, pharmacy, nursing, dental, and allied health programs in Saudi Arabia. An online questionnaire collected data on ChatGPT usage patterns, satisfaction, perceived benefits and risks, and attitudes toward integrating them into the curricula. Among 1044 participants, the prevalence of ChatGPT use was 69.25% (n = 723). Students primarily utilized the tool for content summarization, assignment preparation, and exam-related study. Key motivators included time efficiency and convenience, with improved learning efficiency and reduced study stress identified as major benefits. Conversely, major challenges included subscription costs and difficulties in formulating effective prompts. Furthermore, concerns regarding overreliance and academic misconduct were frequently reported. In conclusion, the adoption of generative AI tools such as ChatGPT among healthcare students in Saudi Arabia was high, driven by its perceived ability to enhance learning efficiency and personalization. To maximize its benefits and minimize risks, institutions should establish clear policies, provide faculty oversight, and integrate AI literacy into the education of health professionals. Full article

Background/Objectives: Non-motor symptoms (NMS) in Parkinson’s disease (PD), particularly neuropsychiatric disturbances such as anxiety, significantly impact quality of life. The Holistic Care Clinic for Parkinson’s disease at St George’s Hospital offers multidisciplinary assessments and personalized care to address both motor and non-motor symptoms, aiming to improve patient well-being and empower patients to manage their health and enhance their quality of life. This study evaluated the effectiveness of a holistic management approach for PD patients with prominent non-motor symptoms, particularly neuropsychiatric issues, by analyzing clinical outcomes and patient feedback. Methods: A retrospective analysis was conducted on patients referred to the clinic between June 2022 and June 2023 for non-motor symptoms. Patients received comprehensive assessments, including clinical exams and interviews focused on neuropsychiatric symptoms, followed by individualized care plans. Interventions for anxiety included online psychoeducation and cardiac biofeedback. Outcomes were assessed using the Clinical Global Impression (CGI) scale and patient feedback on interventions. Results: Thirty patients (mean age 65.7 years, mean disease duration 7.8 years) were included. Anxiety was the primary referral reason (66%). CGI scores indicated that 62% of patients experienced improvement. Medications were adjusted in 14 patients and 65% improved. For anxiety, 13 patients attended the psychoeducation session, with 91% rating it “very likely”/”likely” to recommend. Ten patients completed cardiac biofeedback training, showing a significant reduction in Parkinson’s Anxiety Scale scores (p = 0.03), and 90% recommending it. Conclusions: The holistic care approach of PD patients resulted in significant improvements in clinical outcomes. Patient feedback indicates high satisfaction with the interventions, supporting their acceptability and overall satisfaction with the interventions. Full article

This study examines Lean 4.0, defined as the integration of Lean soft practices (LSPs) and Industry 4.0 technologies (I4Ts), from a socio-technical systems perspective. While prior research has mainly linked Lean and I4Ts to operational and cost-based performance indicators, far less is known about how their human and technological elements interact as one socio-technical system during digital transformation. We investigate how LSPs and I4Ts combine to form social and technical subsystems, how their interaction reshapes work systems, and how these configurations relate to organisational performance. An inductive qualitative design was used. Fifteen managers and professionals with direct experience in continuous improvement and digital transformation completed an open-ended online questionnaire. Data were analysed using Braun and Clarke thematic analysis, guided by socio-technical systems theory and complemented by a cross-case synthesis. The findings identify four interrelated subsystems, social, technical, work, and outcomes, that co-evolve in Lean 4.0 initiatives. LSPs such as training, empowerment, and stakeholder involvement constitute a social system that enables the adoption and effective use of I4Ts in the technical system. When both subsystems are strong, their combined operation drives more extensive digital transformation of operational processes and customer facing activities, and in some cases business models, and is associated with broader improvements in efficiency, quality, customer satisfaction, employee engagement, and financial performance than medium or unbalanced configurations. The analysis also highlights recurrent integration challenges, including skill gaps, legacy system constraints, resistance to change, and data security concerns. Overall, the study conceptualises Lean 4.0 as an integrated socio-technical configuration and extends socio-technical systems theory by showing how LSPs mediate and amplify the value created by I4Ts, providing an empirically grounded framework and configuration-based insights for future testing. Full article

Digital Competence (DC) is relevant among approaches aimed at educational innovation in the digital society. This work analyses the DC level of students of the Master’s Degree in Training for Teachers in a University of the Basque Country, and identifies the socio-academic and emotional factors that determine their development. A total of 137 students (56.93% women) completed an online questionnaire that collected the following information: sociodemographic characteristics, DC, motivation, creative self-efficacy and life satisfaction. The results revealed that the students present a basic-intermediate level of DC. They have appropriate knowledge about available digital platforms and systems and their general use, although notable lacks dealing with tasks that include the creation of content to energise exercises or solve problems. Gender was not a determining factor for DC, in contrast with the branch of knowledge: those specialised in natural sciences or technology show greater digital skills. Furthermore, creative self-efficacy and motivation were shown to be predictive factors of their DC level. In conclusion, training plans must be redefined to offer future teachers personalised and progressive training in DC. To achieve this, any educational intervention must consider the needs of students in each degree programme, as well as the various academic and emotional factors that influence learning. Full article

This study presents the design, implementation, and evaluation of a Massive Open Online Course (MOOC) on the Internet of Things (IoT), developed to upskill adult educators by equipping them with both technical and pedagogical competencies. Following a structured, multi-phase instructional design model grounded in the DigComp framework and supported by Open Educational Resources (OERs), the course was delivered over three training cycles via a MOODLE-based platform. The research employed pre- and post-course competence tests to assess the course’s impact, as well as post-course surveys with both quantitative and qualitative elements to assess participant experiences. The findings indicate high levels of satisfaction and perceived effectiveness. Full article

Objective: This cross-sectional survey aimed to comprehensively gather data on radial forearm free flap (RFFF) utilization and practices in head and neck reconstructive surgery. Methods: An online questionnaire was organized into seven sections: demographics, surgeon experience, harvesting techniques, microsurgical considerations, postoperative care, flap monitoring, and outcomes. It was distributed by email to 216 head and neck reconstructive surgeons who attended the International Federation of Head and Neck Oncologic Societies (IFHNOS) congress in Rome (21–25 June 2023) using the congress mailing list. Responses were collected from 54 surgeons (25% response rate), representing 15 countries across Europe, Asia, the Americas, and Oceania, underscoring the international scope of the survey between 5 February and 25 March 2024. The questionnaire was not formally piloted or validated. Missing data were managed on a per-question basis. Descriptive statistics were used, and 95% confidence intervals (CIs) were calculated for key surgical outcomes to indicate estimate precision. Associations between categorical variables were analyzed using Pearson’s χ² test with Cramér’s V as an effect size, and relationships between continuous variables were examined using Spearman’s rank correlation (ρ) with 95% confidence intervals (CIs). Given the exploratory design and limited sample size, no correction for multiple comparisons was applied, and the risk of both Type I and Type II errors was acknowledged. Results: Variations were observed in harvesting techniques, microsurgical preferences, and postoperative care protocols. Most surgeons initiated flap harvesting concurrently with tumor resection, primarily preserving superficial sensory nerves. Regarding venous outflow, 50% of respondents preferred the cephalic vein, 19% used comitant veins, and 29% utilized both systems when possible. Perioperative antibiotic use was standard practice, though anticoagulant preferences and flap monitoring methods varied. The study achieved a high success rate for RFFF procedures, exceeding 95%, with venous thrombosis identified as the main cause of flap failure. No significant correlations were found between flap failure rate and training method (p = 0.21), specialty (p = 0.37), annual number of RFFF procedures (p = 0.89), surgeon age (p = 0.42), or hospital type (p = 0.48). Effect sizes were small to moderate, indicating weak or negligible associations. Similarly, perioperative factors such as anticoagulant use (p = 0.84), preoperative antibiotics (p = 0.42), surgical instruments (p = 0.61), suture techniques (p = 0.51), and donor vein selection (p = 0.20) showed no statistically significant associations with flap loss. Patient satisfaction assessments were inconsistent, with only 39% of surgeons routinely performing them. Conclusions: The study provides valuable insights into current RFFF practices and outcomes across an international cohort of head and neck surgeons, highlighting patterns and variability in techniques, perioperative care, and monitoring strategies. Full article

Background: Diabetes and mental health conditions frequently co-occur, with depression and anxiety affecting up to 20–30% of people with diabetes. These comorbidities worsen glycemic control, adherence, and quality of life, yet mental health is often neglected in diabetes care. Integrating mental health services into diabetes management is recommended by international organizations to improve patient outcomes. Objectives: To systematically review the evidence on integrated mental health interventions in diabetes care, compared to usual diabetes care, in improving patient outcomes (glycemic control, mental health, adherence, quality of life). Methods: We searched PubMed/MEDLINE, Embase, PsycINFO, and Scopus (2000 through July 2024) for studies of diabetes care integrating mental health support (e.g., collaborative care, co-location, stepped care, or digital interventions). Inclusion criteria were controlled trials or cohort studies involving individuals with type 1 or type 2 diabetes receiving an integrated mental health intervention, with outcomes on glycemic control and/or mental health. Two reviewers independently screened titles/abstracts and full texts, with disagreements resolved by consensus. Data on study design, population, intervention components, and outcomes were extracted. Risk of bias was assessed using Cochrane or appropriate tools. Results: Out of records identified, 64 studies met inclusion criteria (primarily randomized controlled trials). Integrated care models consistently improved depression and anxiety outcomes and diabetes-specific distress, and yielded modest but significant reductions in glycated hemoglobin (HbA1c) compared to usual care. Many interventions also enhanced treatment adherence and self-management behaviors. For example, collaborative care trials showed greater depression remission rates and small HbA1c improvements (~0.3–0.5% absolute reduction) relative to standard care. Co-located care in diabetes clinics was associated with reduced diabetes distress, depression scores, and HbA1c over 12 months. Digital health integrations (telepsychiatry, online cognitive-behavioral therapy) improved psychological outcomes and adherence, with some reporting slight improvements in glycemic control. Integrated approaches often increased uptake of mental health services (e.g., higher referral completion rates) and showed high patient satisfaction. A subset of studies reported fewer emergency visits and hospitalizations with integrated care, and one economic analysis found collaborative care cost-effective in primary care settings. Conclusions: Integrating mental health into diabetes care leads to better mental health outcomes and modest improvements in glycemic control, without adverse effects. Heterogeneity across studies is noted, but the overall evidence supports multidisciplinary, patient-centered care models to address the psychosocial needs of people with diabetes. Healthcare systems should prioritize implementing and scaling integrated care, accompanied by provider training and policy support, to improve outcomes and bridge the persistent treatment gap. Future research should focus on long-term effectiveness, cost-effectiveness, and strategies to reach diverse populations. Full article

This study describes the design, implementation, and evaluation of a Competency-Based Pharmacy Education (CBPE) program for 120 direct-to-patient (DTP) pharmacists in China, aimed at improving pharmaceutical care and pharmacotherapy skills. The program, which integrated Case-Based Learning (CBL) and Objective Structured Clinical Examination (OSCE), included both online and in-person sessions. A cross-sectional analysis of participant performance and satisfaction showed a mean total OSCE score of 68.31. Participants demonstrated strengths in communication and documentation, with one-third of participants achieving high scores, while weaknesses were noted in patient education and care planning. Participant surveys revealed significant perceived improvements in communication and patient education skills among 62.5% of the participants. These findings suggest that CBPE is a promising approach for pharmacist training, advocating for its broader adoption to meet the evolving demands of healthcare and improve patient outcomes. Full article

(1) Background/Purpose: Our research focuses on stakeholders’ attitudes in the Slovak SME sector, which we assessed through a questionnaire. The ability to evolve and adapt continuously is critical for micro-enterprises in competitive markets. (2) Study Design/Methodology/Approach: The primary objective of our research is to gain a comprehensive understanding of the new work organization processes in SMEs operating in a rapidly changing economic environment. Our research employed a single-sample cross-sectional sampling method, wherein respondents completed a questionnaire within a defined time frame. The primary data collection was carried out using a questionnaire containing closed questions. The research assesses the opinions of the respondents regarding the problem under study over a given period of time. The survey was conducted online. (3) Findings: 31% of the companies surveyed considered that introducing new work organization processes would make the company more adaptable to the changing economic environment. Only one-third considered involving employees in the processes the most important means to achieve this. Higher employee satisfaction is reported as a positive by 24% of companies. However, only a quarter of them believe the best way to achieve this is to involve employees in processes. For micro-enterprises, limited resources and smaller staff prioritize effective communication, and gaps can cause significant difficulties. Regarding the sample examined, among the hypotheses based on the literature background, we were only able to accept hypothesis H3 with modifications, which states that the biggest challenge for micro-companies in the industrial sector in a competitive market is understanding new technologies when improving employee skills. (4) Originality/Value: The research shows that micro-enterprises are particularly sensitive to the challenges associated with new technologies, which can be important information for designing training programs and developing support strategies for enterprises. Full article

Background/Objective: Video games offer an innovative tool for delivering active aging interventions. The objective of this study was to analyze the efficacy of an enhanced version of a cognitive–behavioral intervention to promote active aging, administered through a video game, on perceived health and healthy lifestyle habits. Methods: A total of 556 participants aged 45 or older (74.3% women, mean age of 60.8 [SD = 8.0]) were randomly assigned to a cognitive–behavioral intervention to promote active aging administered via an interactive, multimedia, online, and serious video game with a complementary smartphone app (CBI-V; n = 279) or to a control group receiving non-specific online information (CG; n = 277). Perceived health (General Health, Body Pain, Physical Functioning, Physical Role, Vitality, Social Functioning, Emotional Role, Mental Health, Physical and Mental Summary Indices); healthy habits, including sleep hygiene behaviors, physical activity, and eating habits; dropouts; adherence to the intervention (completed modules; total playtime; time devoted to cognitive training; number of cognitive task attempts and tasks completed between modules); and satisfaction with the intervention were assessed by independent, blind evaluators via an online platform before and after the intervention. Results: At the post-intervention, the CBI-V group obtained significantly better scores in General Health (p < 0.001), Mental Health (p = 0.015), sleep hygiene (p < 0.001), physical activity (p = 0.024), and eating habits (p = 0.001) than the CG. The effect sizes were small (d = −0.188 to 0.334). Clinically significant changes were higher in the CBI-V group than in the CG in General Health (p = 0.029), Physical Function (p = 0.028), Social Function (p = 0.011), Emotional Role (p = 0.008), Mental Health (p = 0.026), Physical Summary Index (p = 0.010), sleep hygiene (p = 0.020), and eating habits (p = 0.019). Participants reported a high level of satisfaction with the intervention, with a mean score of 25.4 (SD = 4.0) out of a maximum of 32 on the intervention satisfaction measure. Conclusions: These findings support the efficacy of a cognitive–behavioral video game intervention in enhancing perceived health and promoting healthy lifestyle habits among people aged 45 and above. Full article

Patient education is a crucial component of a physician’s responsibility, and effective patient education can improve patient health outcomes and satisfaction. However, there is currently no formalized training for residents to develop and practice these skills at our large, academic internal medicine residency program. We created a virtual, case-based, interactive session for all residents to practice patient education skills and receive real-time feedback. Residents were given three scenarios: heart failure (HF), breast cancer (BC), and chronic kidney disease (CKD), and role-played as the physician, patient, and observer. The intervention was studied with single-group, pre-post intervention surveys. The session was virtual due to restrictions related to the COVID-19 pandemic. Mean Likert scale scores were compared by paired Wilcoxon rank-sign tests. The sessions were attended by 177 residents; 95 completed both pre- and post-session surveys (53.6%). Participants felt significantly more comfortable teaching patients about HF, BC, and CKD pathophysiology and treatments after the session (HF: pre-median = 4, post-median = 4, p = 0.0032; BC: pre-median = 2, post-median = 4, p < 0.0001; CKD: pre-median = 3, post-median = 4, p = 0.0016). There was a trend towards a significant increase in belief that teaching patients about common diseases should be integrated into the residency curriculum, but this did not reach statistical significance (pre-median = 4, post-median: 5, p = 0.0548). A targeted session for residents to practice patient education improved resident comfort with explaining three common diseases. These data suggest that the session was effective in a virtual format, demonstrating feasibility to be adapted in the increasingly online realm of patient encounters. Full article

Background: Multiple sclerosis (MS) is the most prevalent neurological disorder in young adults, characterised by physical, psychological and cognitive dysfunction. Exercise training is a safe management strategy. Healthcare providers (HCPs) acknowledge deficiencies in awareness, counselling strategies, and resources that prevent them from promoting and prescribing this effective treatment. We implemented an online evidence-based educational programme and evaluated the effect, acceptability, appropriateness, and feasibility of the programme in improving HCP confidence, knowledge, and attitudes towards remote exercise prescription to persons with MS. Methods: Physiotherapists and exercise physiologists were recruited and received the educational programme (online theory and 16-week experience of prescribing to persons with MS). Participants’ confidence, knowledge and attitudes towards exercise prescription, as well as their professional quality of life, were our primary outcomes—baseline (T1), immediately post-online theoretical learning (T2), post-application with clients (T3; approximately 16 weeks after T2), and at 12-month follow-up (T4). We gathered participants’ acceptability, appropriateness, and feasibility evaluation at T2, T3 and T4. We analysed the effect on primary outcomes using generalised linear mixed models, with secondary and evaluative outcomes analysed as counts and qualitative themes. Results: Of 40 participants who provided baseline data, 24 completed the theoretical programme, and 16 completed the experiential programme. Self-confidence improved significantly (|βs| ≥ 1.27, SEs ≤ 0.31, |zs| ≥ 5.28, ps < 0.001), with large effect sizes (percentage change: 256.8–479.4%). Some theoretical domains framework-based domains have improved, such as beliefs about skills to prescribe evidence-based principles. Participants expressed high satisfaction with the programme and showed increased delivery of implementation behaviour change strategies. Conclusions: An online evidence-based education programme for MS care improved HCPs’ self-confidence, perceived skills and delivery of evidence-based exercise behaviour-based prescription. Full article

Background: Cultural sensitivity during intrapartum care is a critical determinant of maternal satisfaction and quality of care, particularly in multicultural settings. In Saudi Arabia, the diversity of birthing women underscores the need for midwives to provide culturally competent, respectful, and individualized care. Objective: To assess women’s perceptions of midwives’ cultural sensitivity during intrapartum care in Riyadh, Saudi Arabia, and identify demographic factors influencing these perceptions. Methods: A quantitative cross-sectional study was conducted using a validated cultural sensitivity questionnaire. Data were collected online through purposive sampling from women who had given birth in the past 12 months. Descriptive statistics summarized participant characteristics and perception scores, while inferential tests examined associations between perceptions and demographic variables. Results: women reported moderate to high perceptions of cultural sensitivity. Age and nationality significantly influenced perception scores (p < 0.05). While communication and respect for religious practices scored highest, areas such as shared decision making and language-concordant support were identified as needing improvement. Conclusions: Women in Riyadh often perceive midwives as culturally sensitive; however, gaps remain in communication and involvement in decision making. Training programs that strengthen midwives’ cultural competence—especially in language services and patient engagement—could enhance the intrapartum experience. Full article

Background: Assistive technology (AT) can support autistic adults in navigating employment-related challenges. However, limited research has explored autistic adults’ actual needs and experiences with AT in the workplace. Existing studies often overlook how well current AT solutions align with the real-world demands autistic adults face across the employment process. To address this gap, this study conducted a needs assessment to explore autistic adults’ perceived AT and AT service needs across employment stages, identify satisfaction and discontinuation patterns, and examine barriers and facilitators to effective use. Methods: A total of 501 autistic adults were recruited through an online crowdsourcing platform, Prolific. Participants completed a needs assessment that included Likert-scale items and open-ended questions. Quantitative data were analyzed using descriptive statistics and weighted needs scoring procedures. Thematic analysis was applied to qualitative responses regarding satisfaction, discontinuation, and general reflections on AT use. Results: Job retention received the highest total weighted needs score, followed closely by skill development and job performance. Participants reported lower perceived needs for AT in the job development and placement domain. Qualitative findings revealed that AT was described as essential for daily functioning and independence, but barriers such as limited access, inadequate training, and social stigma affected use. Participants also emphasized the need for more person-centered and context-specific AT services. Conclusions: AT has the potential to significantly enhance employment outcomes for autistic adults. However, current services often lack personalization and alignment with real-world needs. Findings support the development of more inclusive, tailored, and accessible AT solutions across all employment stages. Full article