Search Results (73)

Background/Objectives: Access to specialized care for patients with cognitive impairment in remote areas is often limited. Despite the increasing adoption of telemedicine, standardized guidelines have not yet been specified. This study aimed to develop a comprehensive protocol for the specialized neurological, neuropsychological, and neuropsychiatric assessment of patients with cognitive disorders in remote areas through telemedicine. Methods: We analyzed data from (i) a comprehensive literature review of the existing recommendations, reliability studies, and telemedicine models for cognitive disorders, (ii) insights from a three-year experience of a specialized telemedicine outpatient clinic for cognitive movement disorders in Greece, and (iii) suggestions coming from dementia specialists experienced in telemedicine (neurologists, neuropsychologists, psychiatrists) who took part in three focus groups. A critical synthesis of the findings was performed in the end. Results: The final protocol included: technical and organizational requirements (e.g., a high-resolution screen and a camera with zoom, room dimensions adequate for gait assessment, a noise-canceling microphone); medical history; neurological, neuropsychiatric, and neuropsychological assessment adapted to videoconferencing; ethical–legal aspects (e.g., data security, privacy, informed consent); clinician–patient interaction (e.g., empathy, eye contact); diagnostic work-up; linkage to other services (e.g., tele-psychoeducation, caregiver support); and instructions for treatment and follow-up. Conclusions: This protocol is expected to serve as an example of good clinical practice and a source for official telemedicine guidelines for cognitive disorders. Ultimate outcomes include the potential enhanced access to specialized care, minimized financial and logistical costs, and the provision of a standardized, effective model for the remote diagnosis, treatment, and follow-up. This model could be applied not only in Greece, but also in other countries with similar healthcare systems and populations living in remote, difficult-to-access areas. Full article

Background/Objectives: In 2024, Lithuania developed a national lung cancer screening program (the Program), targeting individuals aged 50 to 70 years, regardless of their smoking history, with screenings conducted once every three years. The Program aims not only to actively detect lung nodules (lung cancer) but also to identify clinically significant concomitant findings. The pilot study aimed to evaluate the screening process’s feasibility and organizational efficiency of the screening process, as well as its potential clinical effectiveness. Methods: Three family medicine centers were selected for participation. The Coordinating Center contacted individuals aged 50 to 70 sequentially and invited them to participate, regardless of smoking status. In total, 1014 individuals were prospectively enrolled and underwent low-dose chest computed tomography (LDCT) screening between 26 September 2024 and 14 February 2025. Results: Of the individuals invited, 76.1% agreed to participate. Lung-RADS v2022 category 4 nodules were identified in 1.4% of participants (n = 14), including six smokers and eight non-smokers. Additionally, one participant with a Lung-RADS category 2 nodule was diagnosed with squamous cell carcinoma originating from peripheral lung changes. Newly identified significant incidental findings were detected in 25.9% of participants: 5.1% had pulmonary or mediastinal findings (most commonly emphysema, interstitial lung changes, and bronchiectasis), 18.7% had cardiovascular findings (usually coronary artery calcification, aortic valve calcification, and aorta dilation), and 2.1% had other clinically relevant conditions (e.g., thyroid nodules, diaphragmatic changes). Following assessment by family physicians, 17.6% of all participants were referred to medical specialists, including pulmonologists, cardiologists, and others. Conclusions: This pilot study demonstrated that the Lithuanian lung cancer screening model is feasible, well-organized, and clinically valuable. The findings support the Program’s readiness for broader implementation at the national level. Full article

Leading multidisciplinary teams requires not only strong leadership skills, but also a supportive organizational environment. This study examines the key characteristics necessary for adaptive leadership and identifies the main organizational factors that facilitate its development. A systematic literature review, following the PRISMA-P protocol, was conducted, analyzing 33 studies on the traits of adaptive leaders and relevant organizational factors. Based on these findings, we propose a conceptual framework representing the feedback cycle of the adaptive leadership process within organizations and present three propositions associated with this model. The results indicate that the primary characteristics of adaptive leaders include flexibility, empathy, innovation, and long-term vision. Conversely, organizations possess factors that can either facilitate or hinder the development of adaptive leadership, such as organizational culture, structure, innovation history, and strategy. The findings emphasize that orchestrating adaptive teams during times of crisis is especially challenging, requiring additional competencies in resilience and adaptability. This study contributes to the literature by identifying the essential capabilities of adaptive leaders and discussing key considerations for leaders and practitioners seeking to transition from traditional to adaptive leadership. Full article

The adoption of Learning Management Systems (LMS) in Higher Education Institutions (HEI) offers a transformative potential to enhance educational quality, operational efficiency, and cost-effectiveness while promoting sustainable digital transformation. However, resistance to LMS implementation often undermines these benefits. Initial perceptions of an Organizational Change Readiness (OCR) play a crucial, as they shape attitudes and behaviors, often resulting in rumors, disengagement, and resistance. The objective of the study is to explore how attributes of change, leadership support, internal organizational context, and attributes of change targets impact OCR in the context of LMS implementation. Drawing from organizational change management and information systems literature, this study examines key factors influencing these early perceptions within LMS initiatives. A cross-sectional survey was conducted with 316 university personnel across seven public universities and three private colleges. Data were analyzed using partial least squares, revealing that vision clarity, change appropriateness, top-management support, project champion effectiveness, and organizational flexibility explaining 75% of the variance in perceived OCR. Conversely, factors such as change efficacy, organizational history of change, organizational conflicts, and group self-efficacy demonstrated limited influence. These findings underscore the importance of aligning LMS initiatives with institutional goals, fostering sustainable digital practices, and enhancing policy frameworks to facilitate smooth adoption. This study provides actionable insights for promoting sustainable educational transformation in HEIs, particularly in contexts where traditional teaching methods prevail and resistance to technological change is common. Full article

Background: In recent decades, the number of immunocompromised patients (ICPs) has increased significantly. ICPs have an impaired immune system, making them susceptible to complicated infections. To protect them from infections, ICPs are eligible to receive several medically indicated vaccines. To obtain insight into the uptake of these medically indicated vaccines, we determined the coverage of these vaccines in ICPs. Methods: This observational cohort study was conducted at the University Medical Centre Utrecht, the Netherlands, from September 2021 to April 2022. All adult ICPs admitted for COVID-19 were asked to complete a questionnaire on their vaccination history (pneumococcal, herpes zoster, human papillomavirus vaccination, influenza, and COVID-19 vaccines) and history of vaccine-preventable infections. In addition, patients’ vaccination history was reviewed in medical files. Results: A total of 115 patients completed the questionnaire and were included. Although all patients had an indication for pneumococcal vaccination, only 22 received it (19%). Coverage for herpes zoster was low (1%, 1/106 eligible patients). Coverage for human papillomavirus vaccination (HPV) was also low (40%, two out of five eligible patients). In contrast, 92% of patients received vaccination against SARS-CoV-2, and 77% of patients received seasonal influenza vaccination. Conclusions: Although coverage for influenza and COVID-19 vaccination was high in ICPs, coverage for other medically indicated vaccines was low. Identifying which factors contributed to high COVID-19 and influenza vaccine uptake can help to improve vaccination rates for the other recommended vaccines. Clear guidelines for clinicians and the removal of organizational obstacles are needed to improve vaccination coverage. Full article

Laboratory medicine has undergone a deep and multifaceted revolution in the course of human history, in both organizational and technical terms. Over the past century, there has been a growing recognition of the need to centralize numerous diagnostic activities, often similar or identical but located in different clinical departments, into a common environment (i.e., the medical laboratory service), followed by a progressive centralization of tests from smaller laboratories into larger diagnostic facilities. Nevertheless, the numerous technological advances that emerged at the beginning of the new millennium have helped to create a new testing culture characterized by a countervailing trend of decentralization of some tests closer to patients and caregivers. The forces that have driven this (centripetal) counter-revolution essentially include a few key concepts, namely “home testing”, “portable or even wearable devices” and “remote patient monitoring”. By their very nature, laboratory medical services and remote patient testing/monitoring are not contradictory, but may well coexist, with the choice of one or the other depending on the demographic and clinical characteristics of the patient, the type of analytical procedure and the logistics and local organization of the care system. Therefore, this article aims to provide a general overview of patient self-testing, with a particular focus on portable and wearable (including implantable) devices. Full article

Biological systems have a unique ability inherited through their genome. It allows them to build, operate, and manage a society of cells with complex organizational structures, where autonomous components execute specific tasks and collaborate in groups to fulfill systemic goals with shared knowledge. The system receives information from various senses, makes sense of what is being observed, and acts using its experience while the observations are still in progress. We use the General Theory of Information (GTI) to implement a digital genome, specifying the operational processes that design, deploy, operate, and manage a cloud-agnostic distributed application that is independent of IaaS and PaaS infrastructure, which provides the resources required to execute the software components. The digital genome specifies the functional and non-functional requirements that define the goals and best-practice policies to evolve the system using associative memory and event-driven interaction history to maintain stability and safety while achieving the system’s objectives. We demonstrate a structural machine, cognizing oracles, and knowledge structures derived from GTI used for designing, deploying, operating, and managing a distributed video streaming application with autopoietic self-regulation that maintains structural stability and communication among distributed components with shared knowledge while maintaining expected behaviors dictated by functional requirements. Full article

The paper characterizes four Polish and Italian Catholic organizations that operate within the ecological field. The study of these organizations zooms in on the process of “greening of Catholicism” in Poland and Italy taking place. Studied Catholic organizations in Poland and Italy operate within different social and religious contexts. They face challenges, including resistance from traditionalists who view ecology as a leftist notion. To overcome this, the organizations studied frame ecological issues as religious duties, drawing on diverse traditions within Catholicism and emphasizing figures like John Paul II. They use religious resources such as Catholic identities, values, and symbols to appeal to a broader audience beyond traditional activists. Yet, their emphasis on Catholicism hinders cooperation with secular environmental groups and limits engagement with left-wing environmental politics. Full article

During the development and evolution of settlements, space morphology created unique local cultural features and played an important role in guiding rural planning in the context of new-type urban development. The in situ characteristics of the space morphology of the ancient historical and cultural towns along the Grand Canal of China reflect the prints of the local culture and history over thousands of years and integrate modern life and the cultural memories of the citizens there. Using Yangliuqing Town, a famous historical and cultural town, as an example, this study quantitatively analyzes the in situ characteristics of the space morphology. It applies the UAV 3D model, POI data, actual site measurements, and other data to establish detailed models of the streets and lanes, quantifies the in situ characteristics of the space morphology of the streets and lanes in terms of space organizational characteristics and VGA manifestation, analyzes the influencing factors of the characteristics of in situ space morphology, and proposes guidelines for renewing ancient towns according to the in situ characteristics of space morphology. The research results indicate that ① multidimensional factors influencing the historical development of the research area have been clarified for the three aspects of its status as a canal transport hub, canal settlement industries, and traditional residential courtyards in ancient towns; ② the in situ space morphology of the streets in Yangliuqing Town is reflected in three aspects such as the core guiding and control of historical and cultural resources, the inherent influence of space element layout, and the attractiveness of street space; ③ it extracts the guidelines for the renewal of the ancient towns in terms of the space morphology strategy, the environmental element strategy, the interface attribute strategy, and the business attribute strategy. The research methods and conclusions boast great significance for clarifying the characteristics of the space morphology of the ancient towns along the Grand Canal and improving the practice of preservation there. Full article

Virus taxonomy uses a Linnaean-like subsumption hierarchy to classify viruses into taxonomic units at species and higher rank levels. Virus species are considered monophyletic groups of mobile genetic elements (MGEs) often delimited by the phylogenetic analysis of aligned genomic or metagenomic sequences. Taxonomic units are assumed to be independent organizational, functional and evolutionary units that follow a ‘natural history’ rationale. Here, I use phylogenomic and other arguments to show that viruses are not self-standing genetically-driven systems acting as evolutionary units. Instead, they are crucial components of holobionts, which are units of biological organization that dynamically integrate the genetics, epigenetic, physiological and functional properties of their co-evolving members. Remarkably, phylogenomic analyses show that viruses share protein domains and loops with cells throughout history via massive processes of reticulate evolution, helping spread evolutionary innovations across a wider taxonomic spectrum. Thus, viruses are not merely MGEs or microbes. Instead, their genomes and proteomes conduct cellularly integrated processes akin to those cataloged by the GO Consortium. This prompts the generation of compositional hierarchies that replace the ‘is-a-kind-of’ by a ‘is-a-part-of’ logic to better describe the mereology of integrated cellular and viral makeup. My analysis demands a new paradigm that integrates virus taxonomy into a modern evolutionarily centered taxonomy of organisms. Full article

The first systematic attempts to straighten the River Inn in Tyrol for shipping and land reclamation date back to the middle of the 18th century. A dedicated hydraulic engineering authority—the so-called Main Ark Inspection—was established to realize this challenging task. The one-man authority was unable to straighten the Alpine river through the period of its existence up to 1792. The reasons for this were by no means related to a lack of technical resources and knowledge. On the contrary, a micro- and environmental-historical analysis of the attempts to straighten the River Inn highlights the complexity of the causes, which were mutually reinforcing and multifactorial. In this paper, four key causes are examined in more detail: (1) the social organization of water engineering, (2) social conflicts between riparian communities among themselves and with the hydraulic engineering authority, (3) conflicts between Tyrol and Bavaria at the wet border downstream of Kufstein, and (4) increased bedload discharge into the main river by tributaries. To illustrate the causes mentioned above, historical river maps are analyzed in great detail, drawing on contemporaneous written sources. The approach thereby highlights the overall complexity of pre-modern hydraulic engineering in all its facets, be they social, technical, natural, administrative, or organizational. To conclude, the results of this environmental history research are embedded and discussed in the context of integrated river management in the Anthropocene. Full article

Background: Artificial intelligence (AI) algorithms can be applied in breast cancer risk prediction and prevention by using patient history, scans, imaging information, and analysis of specific genes for cancer classification to reduce overdiagnosis and overtreatment. This scoping review aimed to identify the barriers encountered in applying innovative AI techniques and models in developing breast cancer risk prediction scores and promoting screening behaviors among adult females. Findings may inform and guide future global recommendations for AI application in breast cancer prevention and care for female populations. Methods: The PRISMA-SCR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) was used as a reference checklist throughout this study. The Arksey and O’Malley methodology was used as a framework to guide this review. The framework methodology consisted of five steps: (1) Identify research questions; (2) Search for relevant studies; (3) Selection of studies relevant to the research questions; (4) Chart the data; (5) Collate, summarize, and report the results. Results: In the field of breast cancer risk detection and prevention, the following AI techniques and models have been applied: Machine and Deep Learning Model (ML-DL model) (n = 1), Academic Algorithms (n = 2), Breast Cancer Surveillance Consortium (BCSC), Clinical 5-Year Risk Prediction Model (n = 2), deep-learning computer vision AI algorithms (n = 2), AI-based thermal imaging solution (Thermalytix) (n = 1), RealRisks (n = 2), Breast Cancer Risk NAVIgation (n = 1), MammoRisk (ML-Based Tool) (n = 1), Various MLModels (n = 1), and various machine/deep learning, decision aids, and commercial algorithms (n = 7). In the 11 included studies, a total of 39 barriers to AI applications in breast cancer risk prediction and screening efforts were identified. The most common barriers in the application of innovative AI tools for breast cancer prediction and improved screening rates included lack of external validity and limited generalizability (n = 6), as AI was used in studies with either a small sample size or datasets with missing data. Many studies (n = 5) also encountered selection bias due to exclusion of certain populations based on characteristics such as race/ethnicity, family history, or past medical history. Several recommendations for future research should be considered. AI models need to include a broader spectrum and more complete predictive variables for risk assessment. Investigating long-term outcomes with improved follow-up periods is critical to assess the impacts of AI on clinical decisions beyond just the immediate outcomes. Utilizing AI to improve communication strategies at both a local and organizational level can assist in informed decision-making and compliance, especially in populations with limited literacy levels. Conclusions: The use of AI in patient education and as an adjunctive tool for providers is still early in its incorporation, and future research should explore the implementation of AI-driven resources to enhance understanding and decision-making regarding breast cancer screening, especially in vulnerable populations with limited literacy. Full article

Background/Objectives: Vitamin B12 deficiency can cause variable symptoms, which may be irreversible if not diagnosed and treated in a timely manner. We aimed to develop a widely accepted expert consensus to guide the practice of diagnosing and treating B12 deficiency. Methods: We conducted a scoping review of the literature published in PubMed since January 2003. Data were used to design a two-round Delphi survey to study the level of consensus among 42 experts. Results: The panelists agreed on the need for educational and organizational changes in the current medical practices for diagnosing and treating B12 deficiency. Recognition of clinical symptoms should receive the highest priority in establishing the diagnosis. There is agreement that the serum B12 concentration is useful as a screening marker and methylmalonic acid or homocysteine can support the diagnosis. Patient lifestyle, disease history, and medications can provide clues to the cause of B12 deficiency. Regardless of the cause of the deficiency, initial treatment with parenteral B12 was regarded as the first choice for patients with acute and severe manifestations of B12 deficiency. The use of high-dose oral B12 at different frequencies may be considered for long-term treatment. Prophylactic B12 supplementation should be considered for specific high-risk groups. Conclusions: There is a consensus that clinical symptoms need to receive more attention in establishing the diagnosis of B12 deficiency. B12 laboratory markers can support the diagnosis. The severity of clinical symptoms, the causes of B12 deficiency, and the treatment goals govern decisions regarding the route and dose of B12 therapy. Full article

The adverse impacts of childhood maltreatment (CM) on an individual’s health and economic welfare are widely recognized, yet its occupational and organizational effects remain less explored. Employee absenteeism, known as absenteeism, is often a sign of workplace maladjustment and may be linked to a history of CM. Some individuals in the helping professions, who exhibit a strong sense of purpose in their employment and pursue it in demanding environments, are CM survivors. This study investigates whether a heightened sense of meaningfulness in their work is associated with increased absenteeism among this subgroup. We recruited 320 helping professionals from a variety of social and mental health settings, one third of whom reported experiencing CM. As hypothesized, CM was positively correlated with work absenteeism. Furthermore, the relationship between work meaningfulness and absenteeism was moderated by their CM history: among those with CM experiences, greater work meaningfulness was associated with higher absenteeism rates. Our findings highlight the possibility that work meaningfulness may operate as a double-edged sword, and the importance of better understanding the challenges that high-functioning survivors of CM face within organizational contexts. Full article

Trauma-informed care (TIC) is a comprehensive approach that focuses on the whole individual. It acknowledges the experiences and symptoms of trauma and their impact on health. TIC prioritizes physical and emotional safety through a relationship of trust that supports patient choice and empowerment. It provides a safe and respectful healing environment that considers specific needs while promoting a greater sense of well-being, patient engagement, and partnership in the treatment process. Given the prevalence of trauma, this descriptive cross-sectional study examined the attitudes and perspectives of U.S. physicians (N = 179; 67% males; 84% White; 43% aged 56–65) in providing trauma-informed care using an anonymous 29-item online survey administered by Reaction Data. Findings showed that 16% (n = 18) of physicians estimated that >50% of their patients have a history of trauma. Commonly perceived barriers to providing TIC were resource/time/administrative constraints, provider stress, limited awareness of the right provider to refer patients who experienced trauma, and inadequate TIC emphasis in medical education/training. Expanding physicians’ knowledge base of trauma through training and organizational policy/support is crucial in enhancing their TIC competence, particularly in caring for patients with complex care needs whose social determinants increase their risk of exposure to adverse experiences that carry lasting physical and psychological effects. Full article