Search Results (2,124)

Modern healthcare remains structurally and conceptually fragmented, with profound clinical and policy implications. At its root lies an ontological fracture: the prevailing biomedical model reduces patients to discrete biological systems (organs, biomarkers, and symptoms) detached from the psychological, social, and ecological contexts in which health and illness are experienced. This is compounded by epistemological fragmentation, where medical knowledge is compartmentalized into increasingly narrow specialties, limiting holistic understanding. These philosophical divisions manifest in downstream operational, informational, financial, and policy dysfunctions duplicative testing, misaligned incentives, disconnected care pathways, and population health failures. To address these multilevel fractures, we propose a unified architecture grounded in three interlocking components. First, the Precision and Personalized Population Health (P3H) framework offers a principle-based realignment toward care that is integrated, personalized, proactive, and population wide. P3H addresses the conceptual shortcomings of fragmented care by focusing on the full human trajectory across time, systems, and determinants. Second, General Purpose Technologies including artificial intelligence, biosensors, mobile diagnostics, and multimodal data systems enable the operationalization of whole-person care at scale, especially in low-resource settings. Third, the AI-WHOLE policy framework (Alignment, Integration, Workflow, Holism, Outcomes, Learning, and Equity) provides governance principles to guide ethical, equitable, and context-specific implementation. We argue that this triadic blueprint is particularly critical for Global South nations, where the lack of legacy infrastructure offers an opportunity for leapfrogging toward integrated, intelligent systems of care. Early models illustrate how policy-aligned, technology-enabled care rooted in whole-person principles can yield improvements in continuity, cost-efficiency, and chronic disease outcomes. This manuscript offers a systems-level strategy to overcome fragmentation and reimagine healthcare delivery, not only by refining clinical tools, but by redefining what it means to care for the human being in full. Full article

Station-based car-sharing has been shown to reduce resource-intensive private car ownership. However, only a small proportion of the population uses station-based car-sharing, which could be improved by redesigning the service to reduce walking distances and increase availability. We developed a method for designing an efficient and cost-effective station-based car-sharing network for smart cities that emphasizes user comfort and convenience, while reducing the number of needed cars. To quantify the placements, we created a high-resolution synthetic population for Munich, Germany as a case study. The population was based on census and OpenStreetMap data, and each person was assigned to a suitable mobility plan derived from two mobility surveys. Since car ownership and station-based car-sharing are particularly associated with trips for vacations, we supplemented the mobility plans with long-distance travel data from a one-year tracking dataset. This allowed us to perform a spatial and temporal analysis of the theoretical potential of various station placements for station-based car-sharing. The tested station networks varied in user comfort, especially in the distance to the nearest station and the group size of car-sharing users. Our findings indicate that the best trade-off between convenience and efficiency is a station design with a group size of 217–949 people. We further found that the car-sharing fleet size is strongly influenced by long-distance trips, and that a substitution rate of 1:1.25 to 3.3 with private cars is possible. Full article

Background: Urticaria, particularly chronic urticaria (CU), is a highly prevalent inflammatory skin disorder characterized by recurrent wheals and/or angioedema with a fluctuating and unpredictable course that significantly impairs quality of life and requires long-term monitoring. Despite established therapeutic guidelines, disease control remains suboptimal in a considerable proportion of patients. Telemedicine has emerged as a promising adjunctive strategy for chronic disease management. This review aims to critically evaluate the role, applications, benefits, and limitations of telemedicine and digital health interventions in urticaria management. Methods: A scoping review of the literature was conducted focusing on studies addressing telemedicine, digital patient-reported outcomes, mobile health applications, and remote monitoring strategies in urticaria. Evidence from pandemic and post-pandemic telemedicine models was also analyzed to identify transferable approaches. Results: Telemedicine demonstrates significant potential in urticaria management by enabling structured symptom monitoring, facilitating remote follow-up during therapeutic escalation (including biologic therapies), improving patient empowerment and adherence, and reducing healthcare utilization and indirect costs. Digital tools such as electronic diaries and validated PRO-based applications support continuous disease assessment. However, telemedicine cannot replace direct clinical examination, and limitations include diagnostic uncertainty, digital inequalities, data privacy concerns, and lack of large disease specific trials. Conclusions: Telemedicine represents a valuable complementary and integrative model for urticaria care, particularly suited for chronic disease monitoring. Hybrid care pathways combining remote and in-person management appear to be the most effective and sustainable strategy. Further high-quality urticaria-specific studies and standardized digital frameworks are required to optimize its clinical implementation. Full article

Background/Objectives: Cardiac rehabilitation (CR) is a cornerstone of secondary prevention, traditionally delivered through supervised center-based models. However, significant logistical barriers and high healthcare costs necessitate a paradigm shift. This review aims to assess the impact of emerging digital frontiers, specifically telerehabilitation (CTR) and artificial intelligence (AI), on overcoming these challenges and improving clinical outcomes. Methods: This study is a narrative, clinically oriented review informed by a structured search of PubMed/MEDLINE and EMBASE for literature published between January 2015 and January 2026. Results: Evidence indicates that CTR is non-inferior to center-based programs in terms of exercise capacity and quality of life (QoL). Digital tools, such as wearable devices and mobile health (mHealth) applications, have significantly increased program participation and improved adherence to lifestyle modifications. Furthermore, the integration of AI facilitates early detection of cardiac events and personalized exercise prescription, while prehabilitation models have been shown to reduce postoperative hospital stays. Conclusions: Digitalization of CR may represent a cost-effective alternative that bridges the gap in global access. While technology serves as an essential diagnostic partner, a robust regulatory and privacy framework is required to protect data sovereignty. Ultimately, multidisciplinary synergy between human expertise and digital innovation is important for providing an equitable and personalized pathway to recovery. Full article

Gender-based violence in public transportation is a global phenomenon that restricts women’s rights and autonomy. Most of the documentation relies on harassment and physical aggression, but the subtle internalized mechanisms that reproduce gender inequities remain insufficiently analyzed. This study involves the concept of symbolic violence as an analytical category to unveil how resignation and normalization of violence perpetuate gender power relations and limit women’s mobility. A cross-sectional survey of 263 women aged 15–60 was conducted in Querétaro, Mexico, a rapidly growing city with significant mobility challenges. The questionnaire included items on perceptions of safety, violent experiences, responses to acts of violence, and prevention strategies. An inductive–abductive analysis was implemented to construct empirical indicators derived from Bordieu’s concept of symbolic violence and habitus. Findings reveal that fear, avoidance, and self-regulation are normalized responses to violence in public transport. Women implement strategies such as changing routes, limiting night travel, or increasing their expenses to access safer options. Six empirical indicators were identified: perceived insecurity as normality, resignation to harassment, bodily and emotional self-regulation, preventive reorganization of mobility, personal costs of safety, and collective inaction. In conclusion, the study demonstrates how symbolic violence operates through behaviors, actions, perceptions, and thoughts that reproduce inequities. Operationalizing symbolic violence provides a methodological and conceptual tool to advance gender equality and inform gender-sensitive mobility policies. Full article

Public transport is vital for social and economic life, but many people with disabilities still face exclusion due to both physical and psychosocial barriers. This study examined how psychosocial barriers influence public transport travel behavior among people with mobility, vision, and hearing disabilities in the City of Tshwane, South Africa. A quantitative survey was conducted using a structured questionnaire among 214 respondents. The results showed that fear of crime, lack of personal safety, anxiety when travelling alone or to unfamiliar places, and negative treatment by drivers and co-passengers are major deterrents to public transport use. Psychosocial barriers were significantly associated with travel behavior and a strong preference for private cars as well as ride-hailing services. Group comparisons revealed that individuals with vision disabilities experience significantly higher levels of transport-related fear compared to other groups. People with mobility and vision disabilities are more affected by negative attitudes from co-passengers compared to people with hearing disabilities. Psychosocial barriers are associated with low trip frequencies for non-essential activities, indicating suppressed travel. The study concludes that achieving inclusive urban mobility requires addressing psychosocial barriers alongside physical accessibility to ensure safe, dignified, and independent travel for people with disabilities. Full article

Background/Objective: Advances in intensive care medicine have substantially improved the survival of critically ill patients; however, they have also revealed the growing burden of neurological complications that affect both short-term outcomes and long-term functioning. Neurological complications in the intensive care unit (ICU) include a wide spectrum of disorders, ranging from acute brain dysfunction such as delirium, coma, and encephalopathy to persistent cognitive impairment after discharge, which represents a key component of Post-Intensive Care Syndrome (PICS). Delirium affects approximately one-third of ICU patients and is independently associated with increased mortality, prolonged hospitalization, and worse long-term neurocognitive outcomes. Due to the limited effectiveness of pharmacological therapies, current clinical approaches emphasize prevention, early diagnosis, and non-pharmacological strategies in line with PADIS guidelines. This narrative review aims to provide a clinically relevant synthesis of neurological complications in adult ICU patients, conceptualized as a continuum from acute brain dysfunction to long-term cognitive impairment. Methods: A narrative review of the literature was conducted, focusing on studies addressing epidemiology, pathophysiology, risk factors, diagnostic strategies, and prevention of neurological complications in critically ill adults. Attention was given to delirium, ICU-acquired cognitive impairment, and their association with PICS, as well as to current guideline-based and non-pharmacological interventions. Results: Available evidence indicates that neurological complications in the ICU are multifactorial and result from the interaction between patient vulnerability, severity of illness, systemic inflammation, sedative exposure, and environmental factors. Delirium remains the most common manifestation of acute brain dysfunction and is strongly associated with adverse outcomes. Increasing evidence supports the effectiveness of structured screening, early mobilization, sleep optimization, and multidisciplinary care bundles in reducing delirium incidence and duration. Moreover, growing attention is directed toward post-ICU follow-up and rehabilitation to reduce long-term cognitive decline. Conclusions: Neurological complications should be considered a central component of critical illness and a continuum extending beyond ICU discharge. Early identification of high-risk patients, implementation of preventive strategies, and integration of acute and post-ICU care are essential to improve survival and long-term cognitive outcomes. Further research should focus on personalized preventive and neuroprotective approaches in critically ill patients. Full article

Background/Objectives: Assistive technologies are commonly used as a compensatory strategy for individuals with neurological conditions. However, several negative factors have been associated with their use, leading to their non-use or interruption. Therefore, the aim of the present study was to examine the potential of the Assistive Technology Device Predisposition Assessment (ATD-PA) as an outcome measure to identify psychosocial and user-perceived factors associated with the non-use or interruption of assistive technology, particularly mobility devices. Methods: A descriptive, cross-sectional and non-experimental design was employed, as no variables were manipulated. The sample was selected using non-probability convenience sampling and consisted of 80 participants, of which 14 participants discontinued or interrupted the use of assistive technology. An ad hoc sociodemographic questionnaire was administered, along with the Assistive Technology Device Predisposition Assessment, based on the Matching Person and Technology (MPT) model. Results: Factors related to non-use or interruption appeared to be associated with higher perceived levels of global health, self-care, and physical well-being. Findings from the ATD-PA, used as an indicator of subjective satisfaction, showed strong associations between the perceived level of loss and the need for assistive technologies in domains such as comfort, self-care, and general health (r = 0.72–0.90). The perceived benefit of the device was closely linked to knowledge of its use, safety, fit with personal habits, and perceived capability and stamina (r = 0.69–0.94). Comfort using the device was mainly reported in familiar environments such as with family and friends. In contrast, comfort in broader community contexts did not demonstrate meaningful associations. Conclusions: Findings are consistent with Lauer’s model of non-use and highlight the importance of psychosocial determinants such as perceived health, safety, support, and contextual comfort in understanding the interruption or non-use of assistive technology, in line with the International Classification of Functioning, Disability and Health framework. The ATD-PA shows potential as an outcome-oriented tool to support follow-up and the early identification of risk factors for non-use. Longitudinal studies are needed to better understand usage patterns over time. In Spain, the lack of standardized outcome evaluation protocols and systematic follow-up processes underscore the need for structured monitoring strategies in assistive technology provision. Full article

Moving beyond traditional sociodemographic models, this study investigates the psychometric drivers of lexical change. Using Swiss German as a case study, we compare historical data from the Sprachatlas der deutschen Schweiz (1939–1958) with a recent large-scale app-based survey (N = 1013) to quantify trajectories over the past century. We identify four distinct mechanisms: exogenous convergence (Schmetterling), endo-normative leveling (Rande), endogenous innovation and divergence (schlittschuhlaufen), and diachronic persistence (Stäge). For the locally rooted speakers in our dataset, structural analysis indicates that traditional variables carry less weight than expected. While age remains the primary vertical predictor, psychological factors outperform traditional variables (e.g., gender, social networks) in this environment of ubiquitous exposure. Multivariate models demonstrate that lexical choices are strongly influenced by individual disposition: traits such as agreeableness accelerate the adoption of supraregional forms, whereas a strong local identity functions as a “brake” against standardization. Ultimately, while macro-factors create the pressure for change, individual micro-factors determine whether it takes hold. A speaker’s attitude acts as a “filter” and their personality as a “gate,” deciding whether they accept or resist new forms. These findings challenge purely structural accounts, suggesting that for these locally rooter speakers, even without high physical mobility, lexical change is shaped by a psychometric architecture. Full article

Osteoarthritis (OA) represents a degenerative joint disease which advances through cartilage breakdown, synovial inflammation, and subchondral bone transformation until it causes persistent pain and mobility loss. The scientific community lacks complete knowledge about OA disease mechanisms and post-operative healing processes despite arthroplasty surgery providing effective symptom relief. This study investigated plasma proteomic changes in OA patients before and after arthroplasty. The cohort included eight OA patients undergoing knee or hip arthroplasty and ten age-, sex-, and body mass index-matched healthy controls. Plasma proteins were analyzed using liquid chromatography–tandem mass spectrometry following enzymatic digestion and depletion of high-abundance components. The bioinformatic analysis together with quantitative methods showed that OA patients experienced changes in inflammatory pathways, extracellular matrix remodeling, immune system regulation and coagulation processes. A total of 93 proteins were differentially abundant in the pre-operative comparison. Among these, 63 proteins were consistently up-regulated and 23 were consistently down-regulated across both pre- and post-operative time points. In addition, 20 proteins exhibited post-operative-specific changes. These findings highlight both persistent disease-associated alterations and transient proteomic shifts linked to post-operative recovery. Overall, this study identifies candidate plasma proteomic signatures associated with OA and surgical intervention, providing exploratory insights into disease monitoring and potential personalized therapeutic strategies. Full article

This systematic review maps the landscape of microlearning research within software engineering education, critically examining how this pedagogical approach is being applied to develop the multifaceted competencies required of modern software professionals. Following PRISMA-ScR guidelines, the review synthesized 21 empirical studies from 2015 to 2026, analyzing their pedagogical approaches, technological integrations, curriculum coverage, and evidence of effectiveness. The findings reveal a field marked by creative experimentation yet significant fragmentation: while microlearning effectively engages students and conveys discrete programming and project management knowledge through gamified, mobile, and project-based formats, its application remains narrowly concentrated on introductory coding, leaving advanced competencies such as software architecture, requirements engineering, and testing strategies virtually unexplored. The review further exposes critical gaps in the evidence base, including the absence of longitudinal and transfer studies, the conflation of platform engagement with learning, and methodologically fragile claims of effectiveness. Enthusiasm for microcredentials and AI-personalized learning considerably outstrips empirical support, with implemented systems relying on rule-based logic rather than adaptive intelligence and credentialing frameworks lacking validation of employer recognition or employment outcomes. This review concludes that while microlearning holds genuine potential for just-in-time skill development in a rapidly evolving discipline, its role in software engineering education must be strategic and supplemental rather than comprehensive. The field must urgently move from promotional advocacy toward rigorous, comparative, and longitudinal research that assesses higher-order competencies and authentic professional capability, lest its promise remain unfulfilled. Full article

Engagement is essential in informal learning contexts, as it fosters meaningful learning, personal relevance, and sustained motivation. However, engagement is a complex construct that requires diverse methodological approaches for accurate assessment. This study empirically examines a multi-method approach, combining questionnaires, log file analyses, and observations, in the context of a tablet-based educational program developed for an exhibition on mobility and traffic. A total of 307 tenth-grade students from 21 classes at twelve state high schools participated in self-regulated learning activities during the museum visit. Findings reveal that each method offers distinct insights: questionnaires capture students’ self-reported engagement, log files track behavioral patterns, and observations provide qualitative evidence of interaction quality. Each method provides valuable, specific insights into student engagement. Thus, integrating multiple approaches yields a more comprehensive understanding of engagement. These results underscore the importance of methodological pluralism and critical reflection when interpreting research findings from different methodological sources in informal learning environments. Full article

This paper examines how Pakistani popular cinema reproduces a cruelly optimistic attachment to gender identity and thinness, where weight loss is imagined as the key to love, success, and social acceptance. Rather than surveying the entire industry, this study focuses on two emblematic case studies—Jawani Phir Nahi Ani (2015) and Oye Motti (2021)—to show how Lollywood normalises fatphobia through comic ridicule, makeover tropes, and exclusionary casting practices. The analysis reveals how fatness is framed not as an identity but as a flaw to be corrected, rendering overweight characters undesirable despite their talents or personalities. Thus, fatness is usually treated as an obstacle to social acceptance, marriage, and personal happiness; the very hope of inclusion becomes an instrument of exclusion, exemplifying Berlant’s concept of cruel optimism. In Berlant’s terms, cruel optimists always struggle to achieve unattainable fantasies of a better life that promise upward mobility. Full article

Background/Objectives: People with mobility limitations face disproportionately high rates of chronic health conditions and demonstrate lower adherence to wellness interventions. Digital programs such as MENTOR offer accessible alternatives but often face high rates of attrition. This study applied machine learning (ML) methods to predict adherence to the eight-week MENTOR telewellness program and identify key predictors of participant attendance. Methods: Data were drawn from 1218 adults enrolled in MENTOR (2023–2024). Adherence was defined as the percentage of 40 sessions attended. Baseline demographic, socioeconomic, psychosocial, mindfulness, resilience, health status, and physical activity variables were included as predictors. Following preprocessing and imputation, 13 ML regression models were trained using an 80/20 train–test split. The best-performing model was identified using mean absolute error (MAE), followed by feature selection and SHAP interpretability analyses. Pairwise synergy analysis quantified interactions between top predictors. Results: Model performance was modest overall. Bayesian ridge regression achieved the best performance (MAE 20.98; RMSE 25.26; R² = 0.12). SHAP analyses revealed that education, race, emotional support, Area Deprivation Index, household size, mindfulness, life satisfaction, and disability onset were the strongest predictors of adherence. Higher emotional support, mindfulness, and life satisfaction were associated with greater adherence, while socioeconomic disadvantage predicted lower adherence. Synergy analyses showed the strongest predictive interactions between low education and psychosocial resources (emotional support and life satisfaction). Conclusions: Baseline characteristics alone modestly predicted adherence to a digital wellness program. However, psychosocial and socioeconomic factors emerged as meaningful predictors, underscoring the need for personalized support strategies to reduce dropout among participants with mobility limitations. Full article

This article introduces Memetic/Metaphorical Digital Twins (MDTs) as a novel extension of Digital Twin typologies by twinning conceptual schemes, complementing Industrial, Human, and Cognitive Digital Twins. MDTs embed cultural, organizational, and semiotic knowledge into digital frameworks, enabling the recombination and evolution of knowledge structures across disciplines. Drawing on Schlaile’s economic perspectives and Mavromatidis’s architectural lens of entropy and constructal thermodynamics, this study demonstrates how MDTs can address systemic challenges in communication, knowledge transfer, and design. A Digital Community Platform, under development for supporting decentralized Personal Knowledge Management Systems (PKMS), provides the operational foundation, integrating iterative KM cycles to support knowledge co-creation. Its logic and logistics substitute the traditional document paradigm with a memetic approach by utilizing memes as replicable, adaptive knowledge units, thereby mimicking biological evolution and ecosystem resilience in digital platform environments. It aims to offer distributed, decentralized, bottom-up, affordable, knowledge-worker-centric applications prioritizing personalization, mobility, generativity, and entropy reduction; its mission is to serve a knowledge-co-creating community characterized by highly diverse individual Abilities, Contexts, Means, and Ends (ACME) facing increasingly volatile, uncertain, complex, and ambiguous futures (VUCA). A Boundary Object Taxonomy to Omnify Memetic Storytelling (BOTTOMS) is proposed to further structure atomic units of meaning—such as memes, mythemes, narratemes, and reputemes—into a unified framework for authorship and dissemination. The article situates MDTs within a design science research paradigm, outlines current implementation progress, and identifies future developments, including AI-supported curation, personalized metrics, and expanded boundary objects. Together, these contributions position MDTs as a universal framework for adaptive, transdisciplinary knowledge co-creation. Full article