Search Results (14)

Introduction: Cutaneous leishmaniasis (CL) poses a number of challenges when it comes to diagnosis and treatment, due to the variety of clinical presentations that mimic other conditions and hinder the choice of the most appropriate therapeutic approach, especially in the context of immunodepression. Case presentation: We present the case of a 63-year-old woman on anti-tumor necrosis factor (TNF) therapy, who underwent surgical excision for the diagnostic purposes of a chronic non-healing lesion located on her right arm. The histopathological examination revealed the presence of Leishmania amastigotes. CL relapsed in the following months, with new lesions appearing both close to the excision scar and at a different body site. At this point, in order to avoid another surgical intervention, cutaneous swabs for Leishmania Polymerase Chain Reaction (PCR) were performed on both lesions. Both samples yielded positive results, and the patient was treated with a 4-week course of miltefosine. Conclusions: These results support the use of cutaneous swabs as a highly sensitive and less invasive tool for the diagnostic workup of CL. In addition, our case prompts a reflection on the management of immunosuppressed patients with CL, with particular emphasis on the risk of reactivation or simultaneous involvement of multiple anatomical sites, thus suggesting the need for specific considerations and personalized management for this group of subjects. Full article

Background/Objectives: Chat Generative Pretrained Transformer (ChatGPT) is a useful resource for individuals working in the healthcare field. This paper will include descriptions of several ways in which ChatGPT-4 can achieve greater accuracy in its diagnosis and treatment plans for ulcerative colitis (UC) and Crohn’s disease (CD) by following the guidelines set out by the European Crohn’s and Colitis Organization (ECCO). Methods: The survey, which comprised 102 questions, was developed to assess the precision and consistency of respondents’ responses regarding the UC and CD. The questionnaire incorporated true/false and multiple-choice questions, with the objective of simulating real-life scenarios and adhering to the ECCO guidelines. We employed Likert scales to assess the responses. The inquiries were put to ChatGPT-4 on the initial day, the 15th day, and the 180th day. Results: The 51 true or false items demonstrated stability over a six-month period, with an initial accuracy of 92.8% at baseline, 92.8% on the 15th day, and peaked to 98.0% on the 180th day. This finding suggests a negligible effect size. The accuracy of the multiple-choice questions was initially 90.2% on Day 1, reached its highest point at 92.2% on Day 15, and then decreased to 84.3% on Day 180. However, the reliability of the data was found to be suboptimal, and the impact was deemed negligible. A modest, transient increase in performance was observed at 15 days, which subsequently diminished by 180 days, resulting in negligible effect sizes. Conclusions: ChatGPT-4 demonstrates potential as a clinical decision support system for UC and CD, but its assessment is marked by temporal variability and the inconsistent execution of various tasks. Essential initiatives that should be carried out before involving artificial intelligence (AI) technology in IBD trials are routine revalidation, multi-rater comparisons, prompt standardization, and the cultivation of a comprehensive understanding of the model’s limitations. Full article

Background: Investment decisions in stocks are one of the most complex tasks due to the uncertainty of which stocks will increase or decrease in their values. A diversified portfolio statistically reduces the risk; however, stock choice still substantially influences the profitability. Methods: This work proposes a methodology to automate investment decision recommendations with clear explanations. It utilizes generative AI, guided by prompt engineering, to interpret price predictions derived from neural networks. The methodology also includes the Artificial Intelligence Trust, Risk, and Security Management (AI TRiSM) model to provide robust security recommendations for the system. The proposed system provides long-term investment recommendations based on the financial fundamentals of companies, such as the price-to-earnings ratio (PER) and the net margin of profits over the total revenue. The proposed explainable artificial intelligence (XAI) system uses DeepSeek for describing recommendations and suggested companies, as well as several charts based on Shapley additive explanation (SHAP) values and local-interpretable model-agnostic explanations (LIMEs) for showing feature importance. Results: In the experiments, we compared the profitability of the proposed portfolios, ranging from 8 to 28 stock values, with the maximum expected price increases for 4 years in the NASDAQ-100 and S&P-500, where both bull and bear markets were, respectively, considered before and after the custom duties increases in international trade by the USA in April 2025. The proposed system achieved an average profitability of 56.62% while considering 120 different portfolio recommendations. Conclusions: A t-Student test confirmed that the difference in profitability compared to the index was statistically significant. A user study revealed that the participants agreed that the portfolio explanations were useful for trusting the system, with an average score of 6.14 in a 7-point Likert scale. Full article

Modern businesses increasingly rely on chatbots to enhance customer communication and automate routine tasks. The research aimed to determine the optimal configurations of a telecommunications chatbot on the Rasa Pro platform, including the selection of large language models (LLMs), prompt formats, and command structures. The impact of various LLMs, prompt formats, and command precision on response quality was analyzed. Smaller models, like Gemini-1.5-Flash-8B and Gemma2-9B-IT, can achieve results comparable to larger models, offering a cost-effective solution. Specifically, the Gemini-1.5-Flash-8B model achieved an accuracy improvement of 21.62 points when using the JSON prompt format. This emphasizes the importance of prompt engineering techniques, like using structured formats (YAML, JSON) and precise commands. The study utilized a dataset of 400 sample test phrases created based on real customer service conversations with a mobile phone operator’s customers. Results suggest optimizing chatbot performance does not always require the most powerful models. Proper prompt preparation and data format choice are crucial. The theoretical framework focuses on the interaction between model size, prompt format, and command precision. Findings provide insights for chatbot designers to optimize performance through LLM selection and prompt construction. These findings have practical implications for businesses seeking cost-effective and efficient chatbot solutions. Full article

Diet-related diseases impact populations across the globe. While intertemporal preferences—a fundamental preference for the distribution of benefits across time—have been used to explain low-quality food choices, the recent literature proposes another cause: inattention to the future implications (or opportunity costs) of the options faced. Food choices tend to become habitual to conserve cognitive resources, rather than carefully modeling future health impacts. Both low discount rates for future benefits and attention to future health impacts predict healthier decisions. While intertemporal preferences are stable, attention may provide an opportunity to intervene in the decision process to promote healthier decisions. In this study, we test the impact of a simple message that highlights health during food choice on the healthiness of the foods chosen and on health consideration and intertemporal preferences. Our results show that actively considering health outcomes and lower discount rates lead to healthier food choices. We find that messaging increases the consideration of health outcomes during food choice but does not affect intertemporal preferences, suggesting that simple prompts may be an effective way to promote decisions balancing short- and long-term benefits by drawing attention to the overlooked opportunity costs of choices. Full article

Unstable and symptomatic complete atrioventricular block represents a potentially fatal condition that requires prompt therapy while waiting for definitive pacemaker implantation. Although transcutaneous pacing is included in acute management, it could be a difficult approach due to its painfulness and the occasional failure of mechanical capture. Drug therapy is a feasible choice, and current guidelines encompass the use of atropine, dopamine, or epinephrine. Isoprenaline has never been investigated in this setting, and no specific indication of its use has been provided despite its potentially more favorable pharmacological profile. The study population included a consecutive series of patients who presented to the emergency department because of unstable third-degree atrioventricular block and were treated with either isoprenaline or dopamine infusion while waiting for definitive pacemaker implantation. Asymptomatic patients or those with reversible causes of complete atrioventricular block were excluded. The clinical response to the drug was deemed poor if, despite achieving a full drug dose, patients remained symptomatic and/or with hemodynamic instability, ventricular rate and rhythm did not improve or worsened, including if ventricular arrhythmias or asystolic pauses and/or irrepressible nausea/vomiting occurred. Isoprenaline infusion has proved to be safe and tolerated with no arrhythmia induction or hypotensive issues. Isoprenaline has also proven to be more satisfactory in achieving an effective clinical response in 84% of patients rather than dopamine (31%, p < 0.001), reducing the need for temporary artificial pacing. Our data point out the efficacy and safety of isoprenaline infusion and its greater tolerability over dopamine in the acute management of unstable third-degree AV block while waiting for definitive pacemaker implantation. Full article

The COVID-19 pandemic has led to problems and upheaval throughout the higher-education sector, with university campuses ceasing face-to-face instruction and with assessments shifting to an online model for a few years. As a result, the pandemic prompted educators to teach online, utilizing online lectures, narrated power points, audio snippets, podcasts, instant messaging, and interactive videos, whereas traditional universities had primarily relied on in-person courses. Evaluations, which included assignments and multiple-choice questions, were conducted online, forcing lecturers to reconsider how deliverables were set up to prevent students from having easy access to the answers in a textbook or online. Learning from college students’ experiences throughout this time period will assist higher-education stakeholders (administration, faculty, and students) in adapting future online course delivery selections for higher education. In this study, we investigated the experiences of students learning from a distance, as well as aspects of their learning. We provide recommendations for higher education. The COVID-19 pandemic has clearly resulted in the largest distance-learning experiment in history. Full article

Sensitive detection of biomarkers is very critical in the diagnosis, management, and monitoring of diseases. Recent efforts have suggested that bioassays using surface-enhanced Raman scattering as a signal read-out strategy possess certain unique beneficial features in terms of sensitivity and low limits of detection which set this method apart from its counterparts such as fluorescence, phosphorescence, and radiolabeling. Surface-enhanced Raman scattering (SERS) has also emerged as an ideal choice for the development of multiplexed bioassays. Such promising features have prompted the need for the development of SERS-based tools suitable for point-of-care applications. These tools must be easy to use, portable, and automated for the screening of many samples in clinical settings if diagnostic applications are considered. The availability of such tools will result in faster and more reliable detection of disease biomarkers, improving the accessibility of point-of-care diagnostics. In this paper, we describe a modular Raman reader instrument designed to create such a portable device suitable for screening a large number of samples with minimal operator assistance. The device’s hardware is mostly built with commercially available components using our unique design. Dedicated software was created to automatically run sample screening and analyze the data measured. The mRR is an imaging system specifically created to automate measurements, eliminating human bias while enhancing the rate of data collection and analysis ~2000 times. This paper presents both the design and capabilities of the custom-built modular Raman reader system (mRR) capable of automated and fast measurements of sandwich immunoassay samples on gold substrates using modified gold nanoparticles as Raman tags. The limit of detection (LOD) of the tested MUC4-specific iSERS assay was measured to be 0.41 µg/mL. Full article

The power system is changing towards a decarbonized one. The Kyoto protocol and the Paris climate agreement have prompted many nations to approve energy policies based on volatile renewable energy sources (RESs). However, the integration into the grid of the power generated by RESs as well as the electrification of the heating, gas and transportation sectors is becoming a huge challenge. Planning industrial and tertiary sites as net-zero energy systems (NZESs) might contribute to advance the solutions of fully integrating volatile RESs into the power system. This study aims to point out the importance of planning large energy consumer sites such as NZESs, and to depict a holistic modeling approach for this. The methodology is based on a multi-layer approach, which focuses on on-site power generation by RESs, on the improvement of energy efficiency, and on the increase of system flexibility. A qualitative case study has been conducted. It considers the planning of a Net-Zero Energy Data Center located in Germany. Results point out that new interdisciplinary and in particular social analysis methods are necessary. They might be used for accelerating the decision making process during the planning of RES-based on-site power generation systems. Besides, for computation and cooling systems, new technologies that are continuously emerging in the market should be taken into account. If well designed, they contribute to significantly decrease the whole energy demand of data center. Finally, optimal sizing of energy storage systems (electric and thermal) as well as an expedient choice of performance indicators to evaluate technology options are identified as the key factor for decreasing the external energy demand of tertiary sites, such as data center. Full article

Only 5% of Americans consume the recommended amount of dietary fiber. In an online simulated shopping experiment, we examined whether a fiber-focused point-of-decision prompt (PDP) would influence consumers to choose food products that were higher in this important nutrient. We hypothesized that participants exposed to the dietary fiber PDP would choose products with more dietary fiber/serving than those who were not exposed to the PDP. The experiment was completed by 753 participants. Participants were randomly assigned to a condition in which they were not exposed to a PDP (the no-PDP condition), a personalized PDP, or PDP without personalization. Choices in the two PDP conditions were not significantly different. Therefore, the PDP conditions were pooled together into one condition and compared with control participants that did not receive the fiber-focused PDP. Across the three product categories, participants in the PDP condition chose products that had a greater amount of dietary fiber/serving (cereal: 22% increase; bread: 22% increase; crackers: 26% increase; p < 0.01) and products that had a greater healthiness rating (cereals (odds ratio (OR): 1.45, 95% confidence interval (95% CI): (1.10, 1.92)), bread (OR: 1.44, 95% CI: (1.09, 1.91)), and crackers (OR: 1.66, 95% CI: (1.25, 2.21)). Overall, the fiber PDP influenced participants to choose healthier products that contained greater amounts of dietary fiber. Full article

Mitigating climate change and improving urban livability is prompting cities to improve sustainability of urban transportation and logistics. Cargo bikes, in combination with urban transshipment points, are gaining momentum as a green last mile alternative. Although a wide body of research proves their viability in dense urban areas, knowledge about planning urban transshipment points is very limited. This also entails the siting of such facilities and the assessment of effects on emissions. This study therefore presents a first quantitative scenario-based model that assesses the impacts on a district. It examines different strategies for siting urban transshipment points in a single district and its effect on traffic, the carbon footprint, and air quality to give strategic insights where to create candidate locations for such facilities. Our result contributes to knowledge of planning urban transshipment facilities and assessing the impact of different configurations. The findings demonstrated that the use of cargo bikes to make courier, express, and parcel (CEP) deliveries in urban districts could reduce greenhouse gas (GHG), particulate matter (PM10), and nitrogen oxides (NOx) emissions significantly. However, the choice of vehicles completing inbound and outbound processes and the strategies for siting urban transshipment points display widely differing and even conflicting potential to reduce emissions. Full article

The ecological momentary assessment (EMA) of eating behaviors represents an innovative, detailed and valid approach to capture the complexity of food intake and to overcome limitations of traditional dietary assessment methods. Moreover, EMA studies might generate a large variety of data (e.g., dietary, behavioral, physical, sociopsychological, and contextual information), thereby enabling to examine concurrent exposures and events. Due to the increasing number of studies in this field of research, here we systematically reviewed EMA methods for the assessment of dietary intake in epidemiological studies, and discussed implications and perspectives for future research. Our study summarized several protocols and platforms that may be applied to assess diet in terms of eating frequency, choices, and habits. Nearly 38% of studies used an event-contingent strategy by asking participants to report foods and beverages consumed in real-time at each eating occasion. Instead, approximately 55% of studies used a signal-contingent prompting approach that notified the participants to record their dietary consumption. The remaining studies used a combination of event- and signal-contingent protocols to compare their accuracy or to improve the assessment of dietary data. Although both approaches might improve the accuracy and ecological validity of dietary assessment—also reducing the burden for participants—some limitations should nevertheless be considered. Despite these limitations, our systematic review pointed out that EMA can be applied in various fields of nutritional epidemiology, from the identification of determinants of dietary habits in healthy people to the management of patients with eating or metabolic disorders. However, more efforts should be encouraged to improve the validity and the reliability of EMA and to provide further technological innovations for public health research and interventions. Full article

Increased stair climbing reduces cardiovascular disease risk. While signage interventions for workplace stair climbing offer a low-cost tool to improve population health, inconsistent effects of intervention occur. Pedestrian movement within the built environment has major effects on stair use, independent of any health initiative. This paper used pooled data from UK and Spanish workplaces to test the effects of signage interventions when pedestrian movement was controlled for in analyses. Automated counters measured stair and elevator usage at the ground floor throughout the working day. Signage interventions employed previously successful campaigns. In the UK, minute-by-minute stair/elevator choices measured effects of momentary pedestrian traffic at the choice-point (n = 426,605). In Spain, aggregated pedestrian traffic every 30 min measured effects for ‘busyness’ of the building (n = 293,300). Intervention effects on stair descent (3 of 4 analyses) were more frequent than effects on stair climbing, the behavior with proven health benefits (1 of 4 analyses). Any intervention effects were of small magnitude relative to the influence of pedestrian movement. Failure to control for pedestrian movement compromises any estimate for signage effectiveness. These pooled data provide limited evidence that signage interventions for stair climbing at work will enhance population health. Full article

Objective: Prolonged office sitting time adversely affects neuromuscular and cardiovascular health parameters. As a consequence, the present study investigated the effects of prompting the use of height-adjustable working desk (HAWD) on occupational sitting and standing time, neuromuscular outcomes and concentration in office workers. Methods: A single-blinded randomized controlled trial (RCT) with parallel group design was conducted. Thirty-eight office workers were supplied with HAWDs and randomly assigned (Strata: physical activity (PA), BMI, gender, workload) to a prompt (INT) or non-prompt (CON) group. INT received three daily screen-based prompts within 12 weeks. CON was only instructed once concerning the benefits of using HAWDs prior to the start of the study. Sitting and standing times were objectively assessed as primary outcomes for one entire working week using the ActiGraph wGT3X-BT at baseline (pre), after 6 (mid) and 12 weeks (post). Concentration (d2-test), postural sway during upright stance (under single, dual and triple task) and lower limb strength endurance (heel-rise) were collected as secondary outcomes. Results: With large but not statistically significant within group effects from pre to post, INT increased weekly standing time at work by 9% (p = 0.22, d = 0.8) representing an increase from 7.2 h (4.8) to 9.7 (6.6) h (p = 0.07). Concentration and neuromuscular performance did not change from pre to post testing (0.23 < p < 0.95; 0.001 < η_p² < 0.05). Conclusion: Low-frequent and low cost screen-based point of choice prompts (3 per day within 12 weeks) already result in notable increases of occupational standing time of approx. daily 30 min. These stimuli, however, did not relevantly affect neuromuscular outcomes. Full article