Search Results (1,836)

Background/Objectives: Communication training in undergraduate nursing skills courses is often overshadowed by procedural skill acquisition, leaving limited opportunities for students to develop patient-centered communication skills and engage in reflective learning. This study evaluated a reflection-integrated CICARE communication program embedded in a Fundamentals of Nursing skills course and explored students’ learning experiences. Methods: A quasi-experimental study with an embedded qualitative component was conducted among second-year undergraduate nursing students in China. The quantitative component used a non-equivalent control group design, while reflective journals from the Intervention Group provided qualitative data on students’ learning experiences. Two intact classes were assigned to the Intervention Group (n = 65), and two intact classes were assigned to the Control Group (n = 66). The Intervention Group received an 18-week CICARE-based communication program integrated into skills training, including scenario-based role-play, emotional cue recognition, demonstration videos, feedback, and reflective journals. The Control Group received conventional skills training. Outcomes included communication competence, empathy, professional identity, clinical judgment, and course performance. Analysis of covariance was used to compare post-intervention outcomes after adjustment for baseline scores. Reflective journals from the Intervention Group were analyzed thematically. Results: After adjustment for baseline scores, the Intervention Group showed significantly higher communication competence than the Control Group (adjusted mean difference = 2.699, 95% CI: 0.108–5.291, p = 0.041). Empathy was also higher in the Intervention Group (adjusted mean difference = 3.796, 95% CI: 0.538–7.053, p = 0.023). The between-group difference in professional identity was not statistically significant (p = 0.073). The Intervention Group achieved higher total clinical judgment scores than the Control Group (31.52 ± 5.50 vs. 27.20 ± 6.45, p < 0.001), with significant differences in noticing, interpreting, and reflecting. Course performance was also higher in the Intervention Group. In their reflective journals, students described greater patient-centered awareness, attention to patients’ emotional needs, professional reflection, and motivation for self-directed learning. Conclusions: Integrating CICARE-based communication training with reflective learning may strengthen communication competence, empathy, clinical judgment, and course performance in undergraduate nursing skills education. Further studies with longer follow-up are needed to determine whether the observed differences persist over time and whether professional identity and action-oriented clinical responses improve with longer educational exposure. Registration: This study was not registered. Full article

Background/Objectives: Telerehabilitation is increasingly used globally to deliver physiotherapy services remotely, yet its adoption in Jordan remains limited. This quantitative cross-sectional study aimed to explore the awareness, perceptions, and willingness of Jordanian physiotherapists regarding telerehabilitation, and to identify barriers and facilitators to its adoption. Methods: An online self-administered questionnaire was completed by a convenience sample of 200 physiotherapists (111 males, 89 females; age range 23–62 years). Descriptive statistics and chi-square tests were used for analysis. Results: Results revealed that 116 participants (58.0% of the total sample) were aware of telerehabilitation. Among those aware, 79 (68.1%) had used it, with online video (27.0% of total sample; 46.6% of users) being the most common modality. A significant association was found between higher education level (Master’s/Ph.D.) and greater awareness (p < 0.001). Key barriers included lack of reimbursement (33.0% of total sample; 56.9% of aware respondents), technical difficulties (47.0%), infrastructure issues (39.0%), and lack of training (34.0%). Among aware participants who responded to attitude items, the majority agreed that telerehabilitation enhances patient access (85/116, 73.3% of aware respondents) and is a valuable addition to practice (102/116, 87.9% of aware respondents), while 43.0% of the total sample (86/200) believed it can never fully replace in-person consultation. Conclusions: Awareness of telerehabilitation among Jordanian physiotherapists is moderate, and actual clinical use remains low. Higher education level was significantly associated with greater awareness, highlighting a key demographic correlate. However, significant educational, financial, and infrastructural barriers hinder the transition from awareness to adoption. Policy reforms and structured training programs are urgently needed to support the integration of telerehabilitation into routine physiotherapy practice in Jordan. Full article

Proton exchange membrane fuel cell (PEMFC) parameter identification is a nonlinear computational modeling problem involving strongly coupled electrochemical parameters and partially unobservable polarization processes. Its experimental teaching is further constrained by the cost of fuel cell stacks and the safety requirements associated with hydrogen operation. To address these challenges, this study develops a computational modeling and intelligent simulation framework for a virtual teaching experiment on PEMFC parameter identification. A semi-empirical output-voltage model is established, and the sum of squared errors (SSE) between measured and simulated voltages is formulated as the optimization objective. An enhanced Logistic–Tent reverse snow ablation optimizer (LRSAO), termed RLFDB-LRSAO, is introduced by integrating roulette-wheel-selection-enhanced fitness-distance balance and Lévy flight perturbation. Its methodological novelty lies in the stage-wise coordination of population-diversity enhancement, candidate-selection guidance, and search perturbation within the LRSAO framework, rather than in the individual component strategies themselves. The framework organizes the identification process into mechanism interpretation, model construction, algorithm implementation, parameter configuration, visualization, comparative evaluation, and reflective analysis. Case studies using the NedStack PS6 and Modular SR-12 stacks yield best SSE values of 1.2173340 and 6.13503904, respectively. A small-scale qualitative teaching evaluation involving 20 postgraduate students indicated that the framework supported programming practice, strengthened conceptual understanding of PEMFC parameter identification and intelligent optimization, and provided useful support for research-oriented skills such as engineering problem analysis, technical writing, and innovation-oriented project development. These results provide preliminary evidence of technical and educational feasibility while supporting a cautious, problem-dependent interpretation of the optimizer. Full article

Background/Objectives: Older adults residing in long-term care facilities (LTCFs) are at increased risk of poor oral health because of functional dependence and limited access to professional oral healthcare. Although oral healthcare education programs for care workers improve knowledge and performance, evidence of their effects on residents’ biological oral health outcomes remains limited. This study evaluated the effects of a care worker-centered oral healthcare program on oral inflammatory status in LTCF residents using salivary interleukin-1 beta (IL-1β) as an objective biomarker. Methods: A single-group pretest–posttest quasi-experimental study was conducted in two LTCFs in the Republic of Korea. Forty care workers completed a structured oral healthcare education program and provided daily oral healthcare to residents for 4 weeks. Saliva samples were collected before and after the intervention, and salivary IL-1β concentrations were measured using enzyme-linked immunosorbent assay. Changes in IL-1β concentrations were analyzed using the Wilcoxon signed-rank, Mann–Whitney U, and Kruskal–Wallis tests. Results: Thirty-seven residents completed the study. Median salivary IL-1β concentrations significantly decreased from 19.33 pg/mL (interquartile range [IQR], 11.49–34.66) at baseline to 10.78 pg/mL (IQR, 0.65–33.64) after the intervention (Z = −3.764, p = 0.001). Greater reductions were observed among residents with greater functional dependence, whereas limited communication ability or oral care refusal was associated with minimal improvement. Conclusions: A care worker-centered oral healthcare program significantly reduced salivary IL-1β concentrations among older adults residing in LTCFs. Findings support care worker training and highlight the use of salivary IL-1β as an objective biomarker for evaluating oral healthcare interventions. Full article

Background: Worldwide, around 400,000 children are diagnosed with cancer every year. Understanding survivors’ social and stigma-related experiences may help address their needs and improve their outcomes. Objectives: To explore the social and stigma-related experiences, coping strategies, and support needs of pediatric cancer survivors in Newfoundland and Labrador, a province of Canada. Methods: This is a qualitative, cross-sectional study focusing on retrospective participant experiences. Eligibility criteria included being diagnosed with cancer before the age of 18 and being diagnosed or treated in the province. Extensive recruitment activities were employed. Data collection occurred through semi-structured virtual interviews and completion of a sociodemographic survey. Participant interviews were transcribed verbatim, and themes were identified iteratively through inductive thematic analysis. Descriptive statistics were used to define the participants’ sociodemographic characteristics. Results: Seven participants were recruited. Thematic analysis identified five major themes: (i) isolation and being treated differently; (ii) support received, coping mechanisms, and support needs; (iii) resilience and interest to give back; (iv) workplace and disability related experiences; and (v) additional impacts of cancer. Our results showed that participants received substantial social support in various ways but inadequate professional mental health support. School was a significant setting for cancer-related stigmatization. Discrimination in the workplace was rare and was disability-related rather than cancer-related. Conclusions: Our results show that there are significant issues to address, such as stigma and isolation experienced by pediatric cancer survivors as well as the need to improve the psychosocial support programs offered to them. Our results also show that the participants had distinct lived experiences compared to adult-onset cancer populations. Overall, the findings presented are expected to inform further studies and healthcare-education policies to help address these issues and improve the experiences of pediatric cancer survivors. Full article

Background/Objectives: Regular participation in physical activity is essential for maintaining health and well-being and plays a key role in disease prevention and quality of life, both in the general population and among people with disabilities, who represent approximately 16% of the global population. Martial arts-based physical activity programs incorporating safe-falling techniques may contribute to improving physical fitness, reducing fall-related injuries, and supporting adherence to the World Health Organization physical activity recommendations. This systematic review primarily aimed to identify martial arts-based fall-training programs, particularly judo-based interventions, and examine their effects on health and well-being in individuals with intellectual disability. As a secondary objective, evidence from other populations and martial arts disciplines was considered to identify relevant fall-training protocols and transferability. Methods: The research question was formulated using the PEO framework. Eligibility criteria included: people with intellectual and developmental disabilities or special educational needs; exposure to exercise programs involving martial arts, combat sports, or judo; and outcomes related to safe falling, falls, balance, motor skills, and physical condition. A systematic literature search was conducted between December 2025 and April 2026 on the Web of Science Core Collection, Scopus, PubMed, and SPORTDiscus in accordance with PRISMA guidelines. Results: From a total of 658 records identified, 27 studies met the inclusion criteria, encompassing 1892 participants with various disabilities, including intellectual disability, autism spectrum disorder, visual impairment, and deafness. The interventions involved different martial arts modalities, such as judo, taekwondo, karate, tai chi, and capoeira. Overall, the available evidence suggests beneficial effects on physical fitness, motor abilities, balance, psychosocial outcomes, and safe-falling skills across different populations; however, substantial clinical and methodological heterogeneity was observed among the included studies. Conclusions: No studies investigating structured martial arts-based fall-training programs in individuals with intellectual disability were identified. Although evidence from other populations is promising, it remains heterogeneous. Further high-quality studies are needed to evaluate these interventions in individuals with intellectual disabilities. Full article

Background/Objectives: Maternal nutrition is an important exogenous factor which, together with other factors, may play a fundamental role in ensuring the well-being of the pregnant woman and in the development of the offspring, with long-term effects on health. Therefore, this narrative review aims to synthesize current evidence on how maternal dietary patterns and nutrient intake during pregnancy affect maternal well-being, pregnancy outcomes, fetal growth, and the short- and long-term health of the child, while addressing research gaps, and implications for antenatal nutrition guidance. Literature Search Strategy and Study Selection: A comprehensive literature search was performed using the electronic databases PubMed and Google Scholar. The selection and curation of articles were guided by the central research question: “How does maternal diet during pregnancy influence maternal health and offspring outcomes?” Results: The analysis of the literature reveals that the overall maternal dietary pattern is more important than the isolated intake of nutrients in determining the course of pregnancy and the long-term health of the offspring. Conclusions: The present review pointed out that maternal nutrition is not merely energy support for pregnancy, but a factor in fetal programming with a long-term impact on the child, in line with the Developmental Origins of Health and Disease (DOHaD) concept, and may act as an epigenetic and metabolic influence with potential transgenerational effects. Optimizing the diet in the periconceptional period and during pregnancy represents an accessible and effective form of preventive intervention, but it requires personalized recommendations and structured nutritional education begun as early as the preconception period. Full article

Background/Objectives: Positive psychological constructs such as psychological well-being, resilience, subjective vitality, and mental toughness are fundamental to students’ emotional adjustment and overall development. Physical activity (PA) is a modifiable factor known to enhance these variables; however, the influence of its timing throughout the day remains underexplored. This systematic review aimed to examine the effects of PA on psychological well-being, resilience, subjective vitality, and mental toughness in children and adolescents, considering the timing of implementation—before, during, or after school hours—and the specific characteristics of the activities performed. Methods: Following the PRISMA guidelines, a comprehensive search was conducted in Scopus, PubMed, ERIC, and Web of Science, identifying 29 studies published between 2014 and 2026, comprising 12 cross-sectional and 17 longitudinal studies. Results: Overall, PA was positively associated with all four psychological variables across different times of the day. PA before school, such as active commuting and active starts, was primarily associated with higher in well-being and vitality. During-school interventions, particularly structured programs such as active breaks and cooperative games, were associated with better resilience, emotional self-regulation, and prosocial behavior. After-school PA, especially organized and voluntary activities, was associated with higher resilience and mental toughness. The effects varied according to the intensity, structure, social context, and student role, with moderate-to-vigorous intensities and cooperative formats producing the most consistent benefits. Conclusions: In conclusion, PA appears to exert a beneficial influence on positive psychological development, with variations depending on the time and mode of practice. Schools, particularly through Physical Education programs, constitute a key context for promoting students’ emotional, motivational, and behavioral health. Full article

Background/Objectives: Drowning among children younger than five years remains a major public health problem in Thailand, particularly in residential water environments. Caregivers’ supervision and home safety practices play an important role in preventing childhood drowning. This study evaluated the association between participation in the Be SAFE Program, a community-based educational intervention developed using the Health Belief Model (HBM), and changes in caregivers’ health beliefs and self-reported drowning prevention behaviors. Methods: A quasi-experimental pretest–posttest control group study was conducted among 60 caregivers of children younger than five years recruited from two community settings in Ubon Ratchathani Province, Thailand. Participants were assigned to either an intervention group (n = 30) or a control group (n = 30). The intervention group participated in the HBM-based Be SAFE Program, whereas the control group received routine care. Outcomes included HBM constructs and self-reported drowning prevention behaviors. Baseline-adjusted analyses of covariance (ANCOVA) were performed to compare post-intervention outcomes between groups. Holm adjustment was applied to account for multiple comparisons. Results: After adjustment for baseline scores, caregivers in the intervention group demonstrated significantly greater improvements than those in the control group in perceived susceptibility, perceived severity, perceived benefits, cues to action, self-efficacy, and self-reported drowning prevention behaviors, together with significantly lower perceived barriers (all Holm-adjusted p < 0.05). Large effect sizes were observed across all measured outcomes. Conclusions: The findings suggest that the HBM-based Be SAFE Program was associated with greater short-term improvements in caregivers’ health beliefs and self-reported drowning prevention behaviors than routine care. These findings support the potential value of theory-based community educational programs for childhood drowning prevention while highlighting the need for larger multi-site studies with longer follow-up to confirm the program’s effectiveness and broader applicability. Full article

Large language model-enabled virtual patients may expand access to clinical skills practice by supporting explicitly defined practice tasks. This program evaluation examined medical students’ awareness, use, and perceptions of the McMaster Virtual SP Tool, a custom generative artificial intelligence tool developed to supplement clinical skills practice. We conducted an anonymous, single-institution cross-sectional survey of students across three cohorts at McMaster University. Quantitative responses were summarized descriptively, and free-text responses were analyzed using qualitative content analysis informed by task-aligned fidelity, deliberate practice, learner-centred feedback, and simulation instructional design. Thirty-five students responded; 23 (65.7%) were aware of the tool and 16 (45.7%) had used it. Among the 16 users, 15/16 (93.8%) found the tool at least somewhat easy to navigate; 13 (81.3%) would use it again; and 13 (81.3%) would recommend it. Across all respondents, 14/35 (40.0%) reported using AI-enabled virtual patients for OSCE preparation. Users valued its accessibility, independent low-stakes rehearsal, and usefulness for focused history-taking, question wording, and clinical reasoning. Perceived limitations included reduced human connection, nonverbal and emotional realism, physical examination practice, and feedback specificity. AI-enabled virtual patients may therefore be considered as adjuncts for selected cognitive and structural rehearsal tasks. Objective educational outcomes were not assessed. Full article

Background/Objectives: Basic sciences form the conceptual foundation of dentistry, yet their delivery in dental curricula varies worldwide. As demographic shifts, growing healthcare complexity and scientific advances continue to reshape the dental profession, renewed attention to how these subjects are taught has become essential. This comparative narrative review aims to examine different approaches to basic science education in dentistry, exploring variation in curricular structure, depth, timing and pedagogical strategies across diverse dental schools. Particular emphasis is placed on models of vertical, horizontal and spiral integration, the alignment of basic sciences with clinical training and the implications of instructional design for long-term knowledge retention and professional competence. Methods: PubMed and Google Scholar were searched from November 2025 to June 2026 using terms related to dental education, curriculum integration and geographic regions. Sources were selected based on predefined relevance criteria rather than through systematic screening. Published literature was supplemented by structured outreach to faculty representatives using a standardised set of questions. Of the 25 dental schools contacted, nine responded, and five were included. Results: Across the programs examined, a structure of approximately two preclinical years followed by clinical training remained the most common. Early clinical exposure appeared to strengthen student confidence and professional identity. Heavy workload and curricular overload were recurring challenges in the dental curricula examined. Conclusions: The findings suggest that although curriculum integration is widely recognised as essential, no single model appears to be universally superior. Its effectiveness likely depends on the quality of implementation and faculty coordination. However, the lack of independent evaluation studies limits the ability to draw conclusions about the long-term effectiveness of different educational approaches. The review highlights the need for independent and systematic evaluation of dental curricula. Full article

Introduction: Lifestyle interventions are a fundamental component of type 2 diabetes mellitus management; however, evidence from real-world clinical settings regarding multicomponent interventions that simultaneously evaluate behavioral, metabolic, and anthropometric outcomes remains limited. Objective: To evaluate the effect of a multicomponent lifestyle intervention program on dietary habits, biochemical parameters, physical activity, and anthropometric indicators in adults with type 2 diabetes mellitus in the Peruvian Amazon. Methods: A quasi-experimental study with a non-randomized control group and pre–post assessments was conducted among 144 adults with type 2 diabetes mellitus (72 in the intervention group and 72 in the control group) receiving care at a hospital in the Peruvian Amazon. The three-month intervention included nutrition education sessions, practical workshops, group-based physical activity sessions involving traditional dance and Zumba, home visits, and follow-up through telephone calls and WhatsApp. Dietary habits, fasting blood glucose (FBG), glycated hemoglobin (HbA1c), lipid profile, physical activity (PA), body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR) were assessed. Intervention effects were estimated using linear mixed-effects regression models adjusted for age, sex, and disease duration. Results: Compared with the control group, participants receiving the intervention experienced greater improvements in dietary habits (β = 17.85; 95% CI: 16.80 to 18.89; p < 0.001), together with greater reductions in FBG (β = −84.23 mg/dL; 95% CI: −100.45 to −68.01; p < 0.001) and HbA1c (β = −2.32 percentage points; 95% CI: −2.74 to −1.90; p < 0.001). Greater reductions were also observed in triglycerides (β = −53.68 mg/dL), total cholesterol (β = −31.73 mg/dL), BMI (β = −1.67 kg/m²), WC (β = −5.31 cm), and WHtR (β = −0.034) (all p < file0.001). PA increased to a greater extent among participants receiving the intervention (β = 3015.40 MET-min/week; 95% CI: 2769.81 to 3260.99; p < 0.001), whereas no significant between-group difference in change was observed for serum creatinine (p = 0.075). Conclusions: Participation in a three-month multicomponent lifestyle intervention was associated with greater improvements in dietary habits, physical activity, glycemic control, lipid profile, and anthropometric indicators compared with usual care among adults with type 2 diabetes mellitus in the Peruvian Amazon. Full article

Background/Objectives: Internet Gaming Disorder (IGD) is included in ICD-11 and poses a substantial risk to Saudi university students, yet no structured nursing intervention framework exists within Saudi higher education health services. This paper presents the Resilience-Based Nursing Intervention Framework (RBNIF), a three-tiered, theory-driven nursing architecture translating evidence on impulsivity, resilience, and IGD into practice specifications for this setting. Methods: Using secondary analysis of a dataset of 207 gaming students from four King Saud University colleges, framework development followed a four-phase Medical Research Council (MRC) process: theoretical identification (I-PACE, Dual Process Theory, COM-B), evidence synthesis, Behavior Change Wheel/Intervention Mapping, and cultural adaptation via Bernal et al.’s Ecological Validity Framework. Results: The sample (58.9% male; 20–25 years, 61.4%; bachelor’s level, 73.9%) yielded three tiers differentiated by a dual-domain screening rule (elevated impulsivity and/or low resilience, rather than a single combined score): Tier 1 (universal psychoeducation); Tier 2 (six-session group program, S-UPPS-P ≥ 52 and/or CD-RISC-10 ≤ 20; 63 of 207 participants [30.4%]); and Tier 3 (10-session RIRDH clinical program, IGDS9-SF ≥ 36, met by 38 of 207 participants [18.4%]). Fifty-two participants (25.1%) met the elevated-impulsivity criterion, and 51 (24.6%) met the low-resilience criterion. Each tier specifies nursing competencies and behavior change techniques, with cultural adaptation integrating Islamic values concepts (sabr, mizan, tawakkul), family protocols, and single-sex delivery. Conclusions: To our knowledge, the RBNIF is the first theory-driven, culturally adapted nursing intervention architecture for IGD in Saudi university health services; a focused, non-systematic search of PubMed, Scopus, and CINAHL identified no directly comparable published framework. It is pre-implementation and requires feasibility testing, pilot evaluation, and a cluster-randomized controlled trial (c-RCT). Full article

The integration of Generative AI (GenAI) into non-STEM education introduces cognitive demands that challenge static interpretations of technology acceptance. Evidence on GenAI acceptance is drawn largely from cross-sectional designs applied to general-purpose academic tasks and for computing students who already hold prior technical knowledge, leaving unresolved how acceptance perceptions evolve when non-technical students confront sustained high-load programming work. To address this gap, a pre-test/post-test randomized field experiment with repeated measures was conducted with 117 Chilean Accounting and Auditing undergraduates assigned to a control group (instructional videos; n = 57) or an experimental group (Google Gemini 1.5; n = 60). Participants completed Java programming exercises that increased in cognitive complexity, ranging from basic conditionals to vector operations. The study did not assess objective learning outcomes; instead, it tracked changes in user perceptions through a hybrid motivational framework integrating Perceived Ease of Use and Behavioral Intention with Perceived Enjoyment and Value/Usefulness. Baseline results showed lower initial Perceived Ease of Use in the GenAI group, consistent with initial cognitive friction. Post-intervention analyses indicated that the control group showed a significant increase only in Behavioral Intention, whereas the experimental group showed statistically significant within-group gains across all measured dimensions. These findings suggest that, for non-STEM students, the perceived ease and value of GenAI are not necessarily immediate but may develop through sustained interaction with cognitively demanding tasks. The study contributes to technology acceptance research by framing ease of use as an acquired proficiency in high-friction GenAI learning environments. Full article

The progressive integration of Whole Slide Imaging (WSI) technology and Artificial Intelligence (AI) architectures is driving a structural transformation in pathology and precision oncology. This structured critical review analyzes and systematizes the impact of this technological transition along two fundamental operational dimensions of the modern biopharmaceutical industry: pre-registration Clinical Research and post-launch strategies governed by Medical Affairs. The first section explores how computational pathology is improving efficiency and reducing risk in drug development. Replacing analog visual assessment—intrinsically subject to inter-observer and intra-observer variability—with quantitative algorithms for cellular classification and segmentation enables optimization of patient recruitment in clinical trials, reducing screening failure rates. This review also examines the emerging role of Spatial Biology in extracting complex topological metrics from the Tumor Microenvironment (TME) and the use of AI for the objective and auditable quantification of critical surrogate endpoints, such as Pathological Complete Response (pCR), while acknowledging that algorithmic precision remains sensitive to pre-analytical variables and dataset biases. In the second section, the study investigates the strategic evolution of Medical Affairs, acting as a vital scientific communication and translational bridge between the complexity of Data Science and clinical hospital practice. Challenges related to AI adoption by clinicians are examined, emphasizing the importance of educational programs based on Explainable AI (XAI) to overcome the cognitive limitations of the black-box paradigm and the complex regulatory validation pathway for Software as a Medical Device (SaMD) under the stringent European IVDR framework—supported by an analysis of historical regulatory benchmarks such as the Paige Prostate case. The paper also explores the potential of AI in the large-scale generation of Real-World Evidence (RWE), applied to the creation of synthetic control arms in pharmacoeconomic settings. In conclusion, the study highlights that the diagnostic algorithm has ceased to be merely a laboratory support tool and has become a strategic asset and an integral adjunct to therapeutic decision-making. Overcoming current challenges related to data privacy through Federated Learning architectures, together with the imminent transition toward Foundation Models, foreshadows a fully data-driven healthcare ecosystem, making continuous skills development (digital upskilling) an essential requirement for professionals in the biopharmaceutical sector. Full article