Search Results (984)

Romans 8 contains Paul’s most concentrated reflection on the human person transformed by the Spirit, and at its center stands the rare term φρόνημα. Appearing only four times in the New Testament, all in Romans 8 (6 [x2], 7, 27), φρόνημα is commonly translated as “mindset”, “disposition”, or “attitude”. These translations are useful but insufficient. They risk reducing Paul’s term to a merely psychological state, whereas in Romans 8 φρόνημα names the deep orientation of the human person before God. This study argues that φρόνημα functions as an ethical and anthropological key: it expresses the inner direction of a life either determined by σάρξ or shaped by πνεῦμα. Through linguistic analysis, rhetorical exegesis of Rom 8:5–8 and 8:27, and dialogue with Jewish and Greco-Roman moral discourse, this article proposes that φρόνημα denotes the deep structure of Christian orientation: the Spirit-formed disposition from which perception, desire, obedience, prayer, suffering, and hope are reordered toward God. Full article

Background/Objectives: Invasive coronary physiology has evolved from a tool for assessing intermediate stenoses to a comprehensive framework for guiding diagnosis and treatment across the spectrum of coronary artery disease (CAD). This review aims to provide an updated, catheterization laboratory-centered overview of contemporary invasive coronary physiology, emphasizing its role in optimizing percutaneous coronary intervention (PCI) and in evaluating patients with angina and non-obstructive coronary arteries (ANOCA/INOCA). Methods: A narrative review of contemporary evidence, including randomized trials, consensus documents, and guideline recommendations, was conducted. Key physiological indices—fractional flow reserve (FFR), non-hyperemic pressure ratios (NHPRs), coronary flow reserve (CFR), and index of microcirculatory resistance (IMR)—were examined alongside emerging tools such as longitudinal vessel analysis and the pullback pressure gradient (PPG). Applications in pre- and post-PCI assessment, physiology–imaging integration, and comprehensive functional testing in ANOCA/INOCA were evaluated. Results: Physiology-guided PCI improves clinical outcomes and resource utilization compared with angiography-guided strategies. Longitudinal vessel assessment and PPG enable characterization of focal versus diffuse CAD, improving procedural planning and prediction of post-PCI physiological results. Post-PCI physiological assessment identifies residual ischemia and guides optimization strategies. In patients without obstructive CAD, combined assessment of microvascular function and vasomotor reactivity allows identification of distinct pathophysiological endotypes, supporting mechanism-based, individualized therapy. Integration with intracoronary imaging further enhances procedural precision. Conclusions: Contemporary invasive coronary physiology provides a multidimensional approach integrating epicardial, microvascular, and vasomotor domains. This framework supports personalized decision-making, optimizes revascularization, and reduces unnecessary interventions, representing a cornerstone of modern coronary care. Full article

This study examines how emotional and reflexive processes jointly relate to transfer of learning in workplace training contexts. Drawing on organizational learning theory, it introduces Reflexivity on Emotions (RoE) as a metacognitive capability through which individuals become aware of, critically examine, and respond to their emotional experiences. Integrating RoE, reflexivity on practice, positive affect, and negative affect within a person-centered framework, the study applies Latent Profile Analysis (LPA) to data collected from 609 correctional officer cadets enrolled in a six-month training program. The analysis identified four emotional–reflexive profiles (Generative–Reflexive, Balanced–Reflexive, Detached–Unreflexive, and Inhibited–Unreflexive), which showed different levels of transfer of learning. Notably, the Generative–Reflexive profile, characterized by elevated negative affect alongside strong reflexive resources, was associated with the highest levels of transfer, suggesting that negative emotions are not uniformly associated with poorer learning outcomes. More broadly, the findings indicate that transfer of learning is better understood through emotional–reflexive configurations rather than through isolated factors. The study contributes to organizational learning research by extending reflexivity into the emotional domain and by demonstrating the value of person-centered approaches for understanding individual differences in workplace learning. Practical implications for training design and the development of emotionally reflective learning environments are discussed. Full article

Life satisfaction (LS) is an important indicator of subjective well-being among college students. However, relatively few studies have integrated variable-centered and person-centered approaches to examine the associations among physical activity (PA), social support (SS), and LS in female college students. This cross-sectional study surveyed 2097 female college students from 11 universities in Jiangxi Province, China. PA, SS, and LS were assessed using self-report questionnaires. A mediation model was used to examine whether SS statistically mediated the association between PA and LS after controlling for education level and place of origin. Latent profile analysis was then conducted using six LS items, and the BCH method was used to compare PA and SS across profiles. The results showed that PA was positively associated with SS and LS, and SS was positively associated with LS. The indirect association between PA and LS through SS was statistically significant, suggesting a partial statistical mediation pattern. Latent profile analysis identified three level-based LS profiles: low-, medium-, and high-LS profiles. PA and SS increased progressively across these profiles, with the highest levels in the high-LS profile and the lowest levels in the low-LS profile. These findings suggest that PA, SS, and LS are closely interrelated and that meaningful quantitative heterogeneity exists in LS among female college students. Given the cross-sectional design and convenience sampling, the findings should be interpreted as statistical associations rather than causal effects. Full article

Background/Objectives: Previous literature has linked nutrition with both psychological distress and well-being. However, less is known about how psychological and spiritual resources cluster within individuals or whether distinct psychospiritual profiles are associated with dietary and lifestyle behaviors. This study examined these associations using a person-centered approach. Methods: A community sample of 522 adults from the United States completed measures of perceived stress, depressive symptoms, coping self-efficacy, gratitude, forgiveness, religiousness/spirituality, daily spiritual experiences, religious/spiritual meaning and beliefs, and dietary and lifestyle behaviors. Latent profile analysis was conducted to identify psychospiritual profiles. Results: Four profiles were identified: Moderate (n = 195), Flourishing (n = 199), Vulnerable (n = 70), and Maladaptive (n = 58). The Flourishing profile demonstrated the most adaptive psychological functioning and was associated with healthier dietary behaviors, including lower breakfast skipping and fast-food consumption, greater whole-grain and vegetable intake, lower salt use, and lower sweets and dessert intake. The Vulnerable profile demonstrated the highest levels of perceived stress and depressive symptoms together with relatively elevated religiousness/spirituality, whereas the Maladaptive profile was characterized by elevated distress and consistently low levels of psychological and spiritual resources. Overall, the Vulnerable and Maladaptive profiles demonstrated less favorable dietary patterns relative to the Flourishing and Moderate profiles. However, the observed effects were generally modest and selective. Conclusions: Dietary and lifestyle behaviors may be associated with broader psychospiritual configurations rather than isolated psychological characteristics alone. The findings additionally highlight the heterogeneous nature of religiousness and spirituality within psychological functioning. Full article

Background/Objectives: The rising prevalence of multimorbid and complex chronically ill young and middle-aged adults necessitates the implementation of innovative care models and the creation of roles that can meet the complex healthcare needs of this patient group. Advanced Practice Nurses (APNs) can play a crucial role in the care of multimorbid and complex chronically ill young and middle-aged adults in APN-led clinics; however, in Switzerland, these roles are still evolving. The aim of this study was to explore APNs’ perspectives on the planned development of their roles in an APN-led clinic. Methods: To gain insights into the experiences of APNs in caring for this patient group, a qualitative study design was chosen. Data were collected through interviews with APNs from Switzerland, the USA, and Canada. In total, 19 APNs (12 from Switzerland and 7 from the United States and Canada) participated in the study. The data were collected through semi-structured online interviews. These data were analyzed using reflective thematic analysis in accordance with the approach presented by Braun and Clarke. Results: The analysis identified 10 themes that describe the competencies, components, and framework conditions required for the work of APNs in an APN-led clinic for multimorbid and complex chronically ill young and middle-aged adults within the Swiss clinical context. Required competencies include direct clinical practice, guidance and coaching, collaboration, and psychosocial support. Essential components include person-centered care, transitional care, and continuity of care. Key framework conditions include regulations of the legal and regulatory framework and eligibility for reimbursement of services, resources, and extended competencies and scope of practice. Conclusions: The perspectives of the APNs involved in this study show that multimorbid and complexly chronically ill young and middle-aged adults require complex and long-term care that extends beyond the hospital setting. The findings of this study show that Swiss APNs may be well positioned to contribute to this role. Full article

Objective: Based on the Person-Centered Approach, this study targeted parents of very preterm (VPT) infants in Neonatal Intensive Care Units (NICUs) from Italy and Portugal. The primary aim was to classify parents by identifying latent classes of perceived risks (NICU stressors) and resources (sources of social support). Potential specificities in class membership according to Country of Belonging and sociodemographic factors were also investigated. Methods: Overall, 303 parents (92 Italian; 211 Portuguese) completed a survey including sociodemographic factors, Parental-Stressor-Scale-NICU, and Multidimensional-Scale-of-Perceived-Social-Support. Data were analyzed by multigroup latent class analysis and multinomial logistic regression. Results: Three statistically valid and cross-country classes were identified and labelled as Class 1, Adjusted/Beneficial-and-Supported-System, Class 2, Stressed-and-Supported-System, and Class 3, Parental-Role-Alteration-with-Family-Supported-System. Portuguese parents were mainly grouped in Classes 1 and 2, while Italian parents were in Class 3. Men were less likely to belong to Classes 2 and 3, while older parents having another child were more likely to belong to Class 3. Conclusions: The experience of parents of VPT infants in NICUs is inherently challenging, yet identifying specific risk profiles featured by the unique nuances of stressors and sources of support while accounting for further factors (Country of Belonging, Gender, Age, Having another child) can foster the customization of interventions aimed at providing parents with the necessary resources for adjusting to this extremely demanding experience. Full article

Background: Digital twins and patient-specific computational models are emerging technologies in healthcare, enabling predictive, personalized, and adaptive interventions. Their integration with artificial intelligence (AI) facilitates the simulation of clinical scenarios, optimization of treatment strategies, and advancement of precision medicine. Despite growing interest, the evidence base is still evolving, highlighting the need for a comprehensive synthesis to identify current trends, applications, and gaps. Methods: A narrative review was conducted using PubMed, Web of Science, and Scopus to identify relevant literature on digital twins in healthcare. Priority was given to systematic reviews and meta-analyses in the selection process. From this process, 28 studies were selected for in-depth analysis, and their findings were complemented by primary research and conceptual, and synthesized evidence to capture emerging trends and real-world applications. Results and Discussion: The analysis revealed that digital twins are increasingly applied for patient-specific monitoring, predictive simulations, and adaptive interventions. Integration with AI enhances their ability to model complex clinical scenarios and support precision medicine. While the selected systematic reviews provide consolidated evidence of established applications, the complementary analysis indicates that these studies actively contribute to stabilizing clinical evidence, consolidating knowledge, and enabling the development of more robust patient-specific strategies. Conclusions: Digital twins are progressively shaping patient-centered healthcare by combining AI-driven simulations with clinical insights. Current research is not only consolidating existing evidence but also exploring novel applications, underscoring the potential of digital twins to enhance precision medicine. Further studies are required to fully integrate these technologies into routine clinical practice. Full article

Wearable healthcare technologies are transforming the healthcare landscape by enabling remote, real-time health data collection, supporting early diagnosis, personalizing treatment plans, and reducing healthcare costs and medical burdens. Central to these advancements are wearable sensors, which continuously capture physiological data such as heart rate, temperature, activity levels, and biomarker concentrations. However, the large volume and complexity of this data demand effective processing to extract meaningful medical insights. Artificial intelligence (AI) and machine learning (ML) have significantly enhanced the capabilities of wearable sensors by enabling advanced data analysis, pattern recognition, and predictive modeling. AI-enhanced wearable sensors can detect early signs of health issues, such as heart attacks, chronic diseases, and mental health conditions like stress, often before clinical symptoms become apparent. This review examines the integration of AI/ML models with wearable sensors across physical activity recognition, stress assessment, cardiovascular monitoring, personal exposure monitoring, and sweat biomarker detection. Unlike prior application-centered reviews, we emphasize methodological and translational evaluation by comparing task formulations, sensing modalities, dataset scale, validation protocols, performance metrics, and deployment constraints across domains. We further discuss advanced architectures, multimodal fusion, explainable AI, edge deployment, privacy and regulatory considerations, and the translational gap between research prototypes and clinically deployable wearable AI systems. Full article

Artificial Intelligence (AI) shows significant potential across healthcare domains, including advanced diagnostics, clinical decision support, and personalized medicine. Despite these advancements, the opaque ‘black box’ nature of complex AI models necessitates the application of Explainable Artificial Intelligence (XAI) to ensure trust, accountability, interpretability, and regulatory compliance. This study systematically reviews 76 studies published between 2020 and 2025 that have used XAI in healthcare. Our findings show that XAI models such as SHAP and LIME are predominantly used for structured data applications, such as electronic health records, while other XAI models, such as Grad-CAM and Layer-wise Relevance Propagation (LRP), are mainly used in medical imaging. This study specifically investigates evaluation metrics for operationalizing explainability, including faithfulness, trustworthiness, and regulatory compliance, which distinguishes it from prior descriptive reviews. Our analysis shows that while XAI significantly enhances clinician trust, thorough explanation remains heterogeneous and largely confined to controlled settings and the employed benchmark datasets. Critical barriers to clinical adoption include inconsistent interpretability across data modalities and the lack of standardized evaluation frameworks. Existing XAI techniques often do not correspond with strict regulatory standards such as the EU AI Act, Food and Drug Administration (FDA) guidelines, and the Health Insurance Portability and Accountability Act (HIPAA). This review argues for the urgent standardization of XAI validation and the development of human-centered designs to move beyond algorithmic transparency toward reliable real-world hospital integration. Full article

Background: Chatbots are becoming increasingly valuable in clinical settings, offering rapid access to medical information, aiding documentation, and improving perioperative patient education. Their adaptability makes them promising tools for personalized perioperative risk stratification (PRS) and anesthesia planning, but their definitive role remains uncertain. We aimed to evaluate chatbot performance in PRS compared to standard clinical judgment and to assess the certainty of the evidence supporting their use. Methods: This systematic review (PROSPERO ID: CRD42025642357) followed PRISMA extended and PRISMA-S guidelines. The population was defined according to the PICO framework: we included adult surgical patients undergoing anesthesia assessment (P), evaluated with LLM-based chatbots for perioperative risk stratification and anesthesia planning (I), compared with traditional clinician assessment (C), and extracted performance metrics (O). Comprehensive searches of PubMed, MEDLINE, Scopus, Embase, Google Scholar, Open Gray, ClinicalTrials.gov, WHO ICTRP, and Cochrane Library Central were conducted through January 2026. Risk of bias and study quality were assessed using PROBAST-AI, RoB-2, and ROBINS-I. Certainty of the evidence was assessed using GRADE system. A random-effects meta-analysis of pooled chatbot accuracy was performed, with subgroup analyses by ASA status and perioperative risk stratification. A sensitivity analysis was performed with a leave-one-out exclusion test. Results: Eleven studies published between 2023 and January 2026 were included (N = 227,059 patients). Five prospective cohorts, two large retrospective cohorts, one randomized non-inferiority trial, and three non-clinical or mixed-methods studies were found. Meta-analysis showed that the pooled accuracy of LLM-based chatbots for AI–clinician concordance in perioperative risk stratification and ASA classification was 0.90 [95% CI: 0.42–0.99; 95% prediction interval 0.03–1.00]. Subgroup analyses indicated that the ASA status prediction subgroup reached a pooled accuracy of 0.91 (95% CI: 0.46 to 0.99), whereas the exploratory perioperative risk stratification subgroup showed an accuracy of 0.73 (95% CI: 0.10 to 0.98). Performance decreased with increasing patient complexity. Evidence is limited by small sample sizes, extreme sample size skew toward a single center, geographic bias, inconsistent outcome definitions and performance metrics, and incomplete reporting of adverse events. Most studies lacked prospective trial registration or robust control for confounding, and publication bias cannot be excluded. Conclusions: LLM-based chatbots show promising performance in routine perioperative risk stratification but remain unreliable in complex cases, with potential safety concerns. Given the overall very low GRADE certainty of evidence, these tools should be used as clinician-supervised decision support aids for routine ASA assessment, and should not be relied upon for autonomous use in complex cases or for general perioperative risk stratification. Other: This research received no external funding. PROSPERO ID: CRD42025642357. Full article

Background and Objective: Heart failure (HF) is a major cause of morbidity in adults with congenital heart disease (ACHD), who may also have limited access to transplant. Intermittent levosimendan administration has shown benefit in advanced HF due to acquired heart disease, but currently, there are no data on ACHD. We aimed to evaluate the effects of this treatment in ACHD patients with advanced heart failure, focusing on both clinical status and objective outcome measures. Materials and Methods: We conducted a single-center retrospective analysis of ACHD patients aged >18 years with advanced HF who received ≥ three intermittent levosimendan infusions (either 12.5 mg once monthly or 6.25 mg every two weeks over a 6 h infusion) between March 2020 and January 2025 at a tertiary ACHD center. Clinical outcomes during follow-up were compared with those in the year preceding treatment. Primary endpoints included safety and HF-related adverse events, particularly HF hospitalizations. Secondary endpoints included changes in New York Heart Association (NYHA) class, nt-pro-B-natriuretic peptide (nt-proBNP) values, and ventricular systolic function assessed by echocardiography. Results: Twelve patients (median age 44.6 years, 25% female) were included, with heterogeneous congenital diagnoses and advanced HF. Five patients had a systemic right ventricle (sRV) and one had a single ventricle with previous Fontan palliation. During a median follow-up of 1.3 years, intermittent levosimendan was well-tolerated, with no treatment-limiting adverse events. Two patients (16%) required hospitalization for HF during follow-up compared with 8 (66%) in the year preceding treatment. The incidence of HF hospitalizations decreased from 0.83 to 0.20 events per person-year during follow-up (p = 0.03), although findings should be interpreted cautiously given the small sample size and retrospective design. NYHA functional class improved significantly (p = 0.005). While no significant changes were observed in NT-proBNP or left ventricular ejection fraction, patients with a systemic right ventricle (sRV) showed an increase in right ventricular fractional area change (27 ± 7.4% to 30.6 ± 7%, p = 0.02); however, this observation should be regarded as exploratory given the limited sample size. Two deaths occurred, consistent with the severity of the underlying disease and not directly attributable to levosimendan and the Fontan patient received a successful heart and liver transplant. Conclusions: In a small, real-world cohort of ACHD and advanced HF, intermittent levosimendan administration was safe and associated with improved symptoms, reduced HF hospitalizations, and signals of enhanced systemic right ventricular function. These hypothesis-generating findings may help inform future multicenter studies in ACHD patients with advanced HF, suggesting a potential role for intermittent levosimendan in selected patients, while highlighting the need for prospective, adequately powered studies to confirm its efficacy and better define optimal patient selection. Full article

This qualitative study examines how culturally responsive pedagogy (CRP) and transformative learning are fostered in higher education when structured reflection, dialogic engagement, and feedback are intentionally embedded in teacher education coursework. Drawing on data from two university courses—one undergraduate course for preservice teachers and one graduate course for in-service educators (n = 44)—the study explores how equity-focused instructional design supports development toward inclusive, globally informed practice. Data sources included student reflective writing, an anonymous pre- and post-semester survey aligned with InTASC dispositions, instructor reflexive journals, peer observation reports, and course feedback artifacts. Of the 44 enrolled participants, 39 completed the pre-survey and 19 completed the post-survey; survey results were analyzed descriptively at the group level because responses were anonymous and could not be matched across time. Analysis followed Braun and Clarke’s thematic analysis procedures, with trustworthiness strengthened through triangulation, peer debriefing, member checking with a subset of participants, and reflexive journaling. Findings revealed seven interconnected themes demonstrating how reflective writing, critical scholarship, multimedia exemplars, dialogic feedback, and iterative course design supported movement from awareness toward equity-oriented pedagogical praxis. Four overarching outcomes were especially salient: (a) expanded understandings of CRP as justice-oriented praxis; (b) increased capacity to identify and interrogate personal and systemic bias; (c) stronger connections between global and intercultural perspectives and locally grounded teaching commitments; and (d) reported pedagogical shifts toward more inclusive, equity-centered practice. Survey findings indicated a group-level shift from Agree toward Strongly Agree across equity-oriented dispositions, suggesting strengthened professional commitments while warranting cautious interpretation given unmatched responses and post-survey attrition. Comparative analysis also highlighted cohort-differentiated developmental trajectories, underscoring the importance of scaffolded, context-responsive approaches in equity-focused teacher education. Overall, the study demonstrates how intentional instructional design can position reflection as an ethical and professional stance that supports equity, inclusion, and global readiness across educator career stages. Full article

Pesticide-residue risk perceptions among agricultural professionals are shaped by factors that extend beyond knowledge gaps. This study examines how trust in regulatory systems and information sources jointly shape residue-related attitudes among Greek agronomists. We used principal components analysis (PCA) to identify coherent domains and then latent profile analysis (LPA) to derive person-centered profiles based on standardized component scores. Two dominant profiles emerged, differing in regulatory confidence, reliance on institutional/scientific information channels, and comparative risk framing. Residue-Concerned Skeptics expressed lower confidence in enforcement capacity (implementation and staffing) and in the system’s alignment with other EU Member States, together with concerns about chronic pesticide exposure. The System-Confident profile reported higher regulatory confidence and greater reliance on official and scientific channels, as well as stronger endorsement of IPM effectiveness and comparative risk rankings. External validation supported profile differences in perceived training adequacy, IPM beliefs, and organic avoidance behavior. Professional involvement in plant protection and older age were associated with membership in the System-Confident profile. These findings suggest that interventions should emphasize clear communication, capacity building, and address concerns about chronic exposure, beyond information provision alone. Full article

Background/Objectives: This study aimed to verify a prediction model identifying the relationships and pathways among factors associated with Korean nursing students’ provision of person-centered care to patients with dementia. Methods: This was a covariance structure analysis study to establish a hypothetical model of 313 Korean nursing students located in a metropolitan area. IBM SPSS version 18.0 (Chicago, IL, USA) and AMOS version 5.0 (Chicago, IL, USA) were used to analyze the data. Structural equation modeling analysis was applied to verify convergent and discriminant validity using higher-order factor analysis in the final model analysis. Results: The model fit indices of the research model were as follows: χ²/df = 1.83 (p < 0.001), GFI = 0.91, AGFI = 0.88, NFI = 0.91, CFI = 0.90, RMR = 0.04, and RMSEA = 0.05. The factors affecting person-centered care, nursing professionalism (γ = 0.45, p = 0.024), and empathy (γ = 0.21, p = 0.036) showed significant associations, whereas clinical practice adaptation (γ = 0.21, p = 0.013) and nursing professionalism (γ = 0.08, p = 0.004) had indirect effects. These factors explained 40% of the variance in person-centered care. Conclusions: This study is significant because it provides basic data for developing an educational program that can improve the person-centered care capacity of domestic nursing students by confirming that clinical practice adaptation, nursing professionalism, and empathy are important factors related to person-centered care. Full article