Search Results (27,640)

Accurate assessment of gingival thickness is essential for clinical decision-making in implant dentistry, periodontology, and orthodontics. Qualitative phenotype assessment using color-coded periodontal probes is commonly applied as a rapid screening tool, whereas ultrasonography provides quantitative, non-invasive measurements expressed in millimeters. The relationship between these two approaches, however, remains insufficiently defined. The aim of this study was to evaluate the correspondence between qualitative gingival phenotype classification using a color-coded probe and quantitative soft tissue thickness measured with an ultrasound-based system. In this observational diagnostic substudy, the gingival phenotype was categorized as thin, medium, thick, or very thick based on probe translucency and compared with ultrasound-derived thickness values obtained at standardized sites. Qualitative phenotype categories showed a consistent association with quantitative measurements, supporting the role of color-coded probes as screening tools within a complementary diagnostic framework. Ultrasonography provided objective data suitable for detailed assessment and monitoring. These findings support a complementary diagnostic approach combining qualitative screening with quantitative measurement. Full article

Background/Objectives: Coping with death is an essential yet challenging aspect of nursing. In Ecuador, limited training and cultural factors may influence how nurses face the process of death and dying. This study aimed to explore nurses’ perspectives and highlight the degree of congruence between the numerical and discursive data provided by participants. Methods: A sequential explanatory mixed-methods design (QUAN → qual) using questionnaires and qualitative interviews was employed. The quantitative phase included 497 nurses who completed the Bugen Coping with Death Scale and the qualitative phase involved semi-structured interviews with 18 nurses. Quantitative data were analysed descriptively, while qualitative data underwent thematic analysis. Integration occurred at the methodological level—through the building of the qualitative data collection instrument—and at the levels of analysis and interpretation. Results: Nurses demonstrated moderate coping levels on the Bugen Coping with Death Scale. Although many reported being comfortable discussing death, qualitative data revealed substantial emotional distress and limited preparedness—particularly when facing their own mortality or the death of loved ones. Nurses expressed fear of suffering, sadness, and helplessness, especially when caring for dying children or young mothers. Communication with patients and families at the end of life emerged as a major challenge. Spirituality was identified as a key coping resource. Conclusions: Coping with death remains a complex and emotionally demanding process for nurses in Ecuador. Continuous education, emotional support, and training in spiritual and psychological dimensions of care are essential to strengthen nurses’ resilience and enhance the quality of care. Full article

Groundwater modeling in semi-arid regions presents significant challenges due to complex aquifer dynamics, limited data availability, and heterogeneous hydrogeological conditions. This study presents a comprehensive comparative analysis of three fuzzy expert system strategies for monthly groundwater level forecasting in the Al-Hsain Basin, Syria: localized models based on hydrogeographical grouping, a unified basin-wide approach, and an innovative behavioral clustering methodology. Using synchronized rainfall and temperature data from 35 monitoring wells over four years (2020–2024), we developed and evaluated fuzzy inference systems’ directional classification accuracy as the primary performance metric, categorizing groundwater level changes into rise, stable, and decline states rather than predicting continuous values. This choice reflects the qualitative nature of fuzzy expert systems and their suitability for groundwater management under data-limited conditions. The behavioral clustering approach achieved excellent overall performance with a mean accuracy of 0.74, outperforming localized models (0.71) and unified models (0.67). Behavioral clustering demonstrated effectiveness in 66% of wells, with individual accuracy improvements reaching up to 0.23, while reducing model complexity from five group-specific systems to three behaviorally coherent clusters. Localized models achieved optimal performance in 29% of wells where hydrogeological conditions aligned with spatial assumptions, whereas unified models provided consistent moderate performance across 89% of locations. The incorporation of lagged variables and seasonal indices in behavioral clustering models proved essential for capturing temporal complexity in semi-arid groundwater responses. Statistical analysis revealed lower intra-group variability in behavioral clusters (standard deviation 0.06–0.09) than in geographical groupings (0.08–0.14), confirming improved functional homogeneity through response-based organization. These findings indicate that fuzzy modeling strategy selection should be context-dependent, with behavioral clustering offering an effective balance between accuracy, interpretability, and generalization for regional groundwater management applications. The novelty of this work lies in isolating the effect of fuzzy system organization logic (localized, unified, and behavioral) on forecasting performance, robustness, and transferability, evaluated under an identical inference and time-series validation framework. Full article

Objective: Adolescence is a high-risk period for problematic eating behaviours, including overeating. However, few studies have explored adolescent perceptions of these eating behaviours and whether there is a shared understanding between adolescents and parents. This study aimed to investigate perceptions of eating behaviours, focusing on overeating, in Australian adolescents and parents. Method: Adolescents aged 13–19 years, and parents of adolescents, participated in two interviews for exploration and thematic deepening of participant perceptions, underpinned by Integrated Knowledge Translation Framework principles. Interviews explored perceptions of overeating and other eating behaviours, including help-seeking and stigma. Data were analysed thematically. Results: Twelve adolescents (59% female) and seven parents (100% female) participated in the interviews, with three major themes emerging. In theme 1, “perceptions of overeating”, interpretations of overeating varied; however, both adolescents and parents associated problematic overeating with increased frequency and impacts on functioning. Discrepancies between adolescent and parent perceptions of overeating terms such as binge eating were present. In theme 2, “beliefs about overeating”, adolescents felt that broaching the topic of overeating and help-seeking for overeating to be more challenging than restrictive eating disorders due to stigma. In theme 3, “perceptions of other eating behaviours”, there were differences between how adolescents perceived healthy eating and dieting compared to parents. Discussion: Differences in adolescent and parent understanding of eating behaviour terminology highlights a need for a shared language to support appropriate detection of problematic eating behaviours. There is a need for prevention and early intervention approaches that promote awareness and accessible support pathways for overeating to prevent progression to an eating disorder. Full article

Backgrounds/Objectives: Fatty infiltration (FI) of rotator cuff (RC) muscles is a critical prognostic factor after surgical repair. While the Goutallier–Fuchs grading system is widely used, its reproducibility is often debated. This study aimed to validate a previously reported three-dimensional (3D) magnetic resonance imaging (MRI)-based volumetric quantification method by comparing it with histologic findings in a chronic rotator cuff tear (RCT) rabbit model. Methods: Eighteen shoulders from nine rabbits were randomly assigned to three groups (n = 6 each): repair (A), chronic tear (B), and control (C). In groups A and B, a chronic RCT model was established by detaching the supraspinatus tendon, with group A receiving repair after six weeks. At 12 weeks after repair, 7.0T MRI was performed, and volumetric quantification of intra-muscular fat was performed using semi-automated 3D Slicer software. Histologic fat proportion was measured via Oil Red O staining and ImageJ analysis. Results: The muscle weight and MRI-based muscle volume were significantly lower in group B than group C (p < 0.05). The radiologically measured fat proportion was significantly higher in groups A (1.8 ± 0.8) and B (2.8 ± 0.7) compared to group C (0.5 ± 0.4, p < 0.001). Histologic analysis showed a corresponding pattern (3.0 ± 1.2%, 5.2 ± 1.0%, 1.7 ± 1.0% for groups A, B, and C, respectively; p < 0.001). A strong positive correlation was identified between the radiologic and histologic measurements of FI (r = 0.784, p < 0.001). Conclusions: Direct histologic comparison validates the reliability of 3D MRI-based volumetric quantification for evaluating FI of the RC muscle in a chronic RCT rabbit model. This objective approach may address the inherent limitations of the conventional qualitative grading system. Full article

Marine renewable energy could support Costa Rica’s decarbonization pathway, but its offshore resource base and enabling conditions remain poorly characterized in the body of knowledge. This study provides the first integrated assessment of marine energy resources, grid integration opportunities, and governance challenges in Costa Rica. A meta-analysis of 76 technical, legal, and policy sources is combined with qualitative doctrinal analysis, GIS-based multi-criteria evaluation for Ocean Thermal Energy Conversion (OTEC), and satellite and reanalysis data for winds, waves, currents, and sea surface temperature to estimate power densities and extractable energy. Results show a contrast between the Pacific and Caribbean coasts. For instance, on the Northern Pacific coast, there are strong Papagayo winds, and persistent swells yield high offshore wind and wave energy potentials, with technical offshore wind resources of around 14.4 GW and Pacific wave power frequently exceeding 20–25 kW/m with relatively low seasonal variability. Furthermore, twelve OTEC-suitable zones are identified with two priority areas in the southern Pacific that combine steep bathymetry and strong thermal gradients with limited environmental conflicts, but they overlap with sensitive conservation and Indigenous territories. Current energy potential is more localized and modest in the Caribbean coast. The analysis highlights major infrastructural, legal, and social barriers but concludes that marine energy can play a pivotal role in diversifying Costa Rica’s renewable-dominated electricity market. Full article

Firefighters and correctional workers are highly exposed to potentially traumatic events, but research shows that resiliency training may help support their mental health. Both occupations remain men-dominated and highly masculinized, creating challenges for women public safety personnel (PSP) and reinforcing stigma about mental health as a feminized topic. This exploratory qualitative study examines the gender dynamics of peer resiliency training for firefighters and correctional officers in Canada. Based on interviews with 10 trainers from three provinces, we developed three key themes. First, mental health is constructed as a “feminine” topic, which may create access barriers for men, but also for women who wish to avoid marginalization. Second, gendered beliefs shape perceptions of trainers’ credibility and skills. Men trainers are respected for performing masculinity, while respect for women trainers stems from stereotypes about their maternal “nature”. Such beliefs may increase respect for mental health topics while further entrenching gendered stereotypes. Third, a gender stereotyping paradox exists regarding the roles of women in these occupations. That is, mental health training may provide a leadership pathway for women PSP while simultaneously “pigeonholing” them into emotional-labour roles. We conclude that peer resiliency training is best positioned as the responsibility of both men and women. Full article

The Background: monoclonal antibody therapies represent high-efficacy treatment options for relapsing forms of multiple sclerosis (MS). However, the absence of direct head-to-head randomized trials and the use of heterogeneous comparators across pivotal studies complicate comparative effectiveness assessments. While network meta-analysis (NMA) offers a framework to integrate evidence, the fragmented structure of the available evidence base precludes a conventional NMA with global indirect comparisons and treatment ranking. Methods: A systematic review with qualitative assessment of treatment effects of randomized controlled trials evaluating monoclonal antibody therapies in relapsing forms of multiple sclerosis was conducted. Annualized relapse rate (ARR) was analyzed as the primary outcome, and six-month confirmed disability progression (CDP) as the key secondary outcome. Network geometry and connectivity were explicitly assessed for each outcome prior to quantitative synthesis. Analyses were restricted to comparator-defined connected components of the evidence base, and indirect comparisons across disconnected components were not performed. Sensitivity analyses, including descriptive analyses in progressive multiple sclerosis, were conducted where appropriate. Results: nine randomized controlled trials involving 6762 patients were included. For ARR, the evidence network was fragmented into three disconnected components defined by placebo-, interferon beta-1a-, and teriflunomide-controlled trials. Within connected sub-networks, monoclonal antibody therapies consistently demonstrated substantial reductions in ARR relative to their respective comparators, with overlapping confidence intervals suggesting broadly comparable relapse suppression among high-efficacy agents. For CDP, network connectivity was more limited, and treatment effects were more heterogeneous. Significant reductions in disability progression were observed for some agents within comparator-specific networks, while uncertainty remained for others. Due to network disconnection, no global treatment ranking was performed. Conclusions: this study provides a transparent synthesis of randomized evidence on monoclonal antibody therapies in relapsing MS. By explicitly accounting for network connectivity and comparator heterogeneity, the analysis avoids unsupported indirect comparisons and global treatment hierarchies. The findings support robust relapse suppression across monoclonal antibody therapies within comparable trial frameworks, while highlighting heterogeneity in disability outcomes. These results illustrate the importance of contextual interpretation in comparative effectiveness research in MS. Full article

Regional cartography has traditionally supported the representation and organization of territorial space; however, its role within contemporary spatial planning and governance systems has evolved alongside the growing emphasis on evidence-based and multi-level governance. This paper examines how regional cartographic frameworks are integrated into spatial planning processes and how they contribute to coordination, monitoring, and implementation capacity. The study adopts a qualitative research design based on systematic document analysis of key European and national planning and policy documents, using an analytical framework that conceptualizes cartography as a structural component of planning and governance systems. The findings indicate that, although cartographic tools, spatial indicators, and territorial monitoring instruments are widely employed, particularly within European analytical initiatives, their institutional integration within planning frameworks remains limited and uneven. Cartography is primarily positioned as an analytical or communicative resource rather than as a binding element of planning architecture. Drawing on the Greek planning experience within a broader European context, the paper concludes that strengthening the institutional embedding of regional cartography as a planning infrastructure may contribute to improved monitoring, multi-level coordination, and a more coherent translation of strategic objectives into spatial policy frameworks. Full article

Finite element analysis (FEA) is increasingly used in conservative and restorative dentistry to investigate the mechanical behavior of adhesive direct and indirect polymer-based restorations. Despite the growing number of FEA-based studies, the literature currently lacks a dedicated critical synthesis specifically addressing the methodological validity and clinical interpretability of FEA in adhesive restorative dentistry. This narrative review critically examines the current literature on the application of FEA in adhesive restorative dentistry, with particular attention to class I to class V cavities in anterior and posterior teeth restored with direct or indirect polymeric materials, including inlays, onlays, overlays, and tabletop restorations. A structured, non-systematic search of major databases was conducted, and selected studies were qualitatively appraised with emphasis on modeling assumptions, stress distribution, and clinical meaning. Unlike previous broad overviews of dental biomechanics, this review provides a clinically oriented framework for interpreting FEA findings across restorative strategies. FEA consistently identifies trends related to cavity configuration, cuspal support, restoration design, material stiffness, polymerization shrinkage, and adhesive interface behavior, helping to explain clinically observed failure patterns and supporting minimally invasive approaches. However, simplified material models, idealized bonding conditions, and static loading protocols limit prediction of long-term performance. When interpreted within these constraints and integrated with experimental and clinical evidence, FEA remains a valuable complementary tool for rational restorative decision-making. Full article

This study assesses the effectiveness of social media advertising campaigns in the supermarket sector by combining managerial insights with multi-criteria decision analysis (MCDA) to support informed, sustainable decision-making. Considering the ever-increasing complexity of digital communication and the growing need for sustainable marketing resources, supermarkets require effective methods to evaluate social media platforms beyond isolated metrics. The study employs the Visual PROMETHEE program, an MCDA that incorporates qualitative insights from 27 supermarket managers in Northern Greece, along with the PROMETHEE II multi-criteria decision analysis method. At the outset, managers evaluated the importance of thirty-four social media performance factors with a five-point scale. Seven core evaluation criteria are identified by aggregating importance ratings and qualitative analysis: return on investment, revenue contribution, lead generation, engagement, cost efficiency, feedback, electronic word of mouth (eWoM), and reach. The use of these criteria later led to the evaluation of seven major social media platforms. A transparent ranking of platforms is presented, based on the results. The ranking highlights significant performance differences across financial, engagement, and reputational dimensions. The findings demonstrate the importance of integrating managerial guidance with multi-criteria analysis to inform long-lasting and evidence-based marketing decisions in retail. Full article

Rural higher education in Latin America plays a crucial role in advancing both human and sustainable development. However, it continues to face persistent barriers related to access, equity, and systemic inequality. This scoping review investigates how rural higher education contributes to integral human development in the region, focusing on its theoretical underpinnings, contextual specificities, and methodological approaches. Following the PRISMA-ScR protocol, we analyzed qualitative and quantitative studies published between 2015 and 2024, drawing from Scopus, EBSCOhost, ERIC, Redalyc, and SciELO. The review protocol was registered in PROSPERO (CRD420251075119). After applying rigorous inclusion and exclusion criteria, seven peer-reviewed articles were selected. These studies address key issues such as educational access, territorial rurality, and human development, and highlight innovative strategies including community-based pedagogy, values-oriented curricula, and student support during crises. Our findings underscore the transformative capacity of rural universities in fostering students’ analytical, emotional, and civic competencies. To ensure inclusive and meaningful impacts, rural higher education must perform context-sensitive, integrative strategies aligned with local realities and broader sustainable development goals. Full article

Background: The mother’s bond with her newborn is important for the child’s development and their relationship. Midwives are well placed to witness first-hand the beginning of this relationship. Objectives: This study examined, based on mothers’ perceptions, the contribution of midwives to the development of the bond with their baby from pregnancy to the first postnatal months. Methods: We conducted a descriptive qualitative interpretative study in Quebec, Canada (from 2022 to 2025), with 10 primiparous mothers who were cared for by midwives in a model of continuity of care, and gave birth in a birth center, at home, or in a hospital. Semi-structured retrospective interviews were conducted between two and four months after childbirth, and were complemented by interviews with two midwives. Results: Most participants developed a bond with their baby during pregnancy. They discussed their midwifery care and what they felt were significant elements in the development of their bond with the baby. Midwives encouraged them to develop this bond through their approach and various means: letting them feel the fetus during palpation, talking to it, encouraging mothers to do the same, and reinforcing the bond throughout pregnancy. The birth and first moments after birth were also key moments for promoting contact between mother and baby. Midwives were also creative in promoting bonding in more difficult situations, such as when a transfer to the hospital for delivery was needed. Conclusions: Midwives play an important role in initiating and developing the mother–child bond during pregnancy, especially if they practice within a model of relational continuity. Full article

Background: Undernutrition among infants and young children in South Asia remains a major public health concern, contributing to high rates of morbidity and mortality. While quantitative systematic reviews have identified various risk factors for undernutrition, no review has focused on qualitative studies. This study aims to review published literature on family member and healthcare provider perceptions about influences on undernutrition among infants and young children in South Asia. Methods: We searched for qualitative research articles published from 2000 to 2026 in the PubMed, Scopus and CINAHL databases, and used the Critical Appraisal Skills Program (CASP) tool to assess the quality of selected articles. Selected articles were analyzed thematically. The PROSPERO registration number is CRD42022385382. Results: After screening 201 research articles, 19 articles were selected for inclusion in this review. Perceived influences of undernutrition among children were categorized into individual, socio-cultural, economic, environmental and system factors. Interconnected influences included maternal illness, single motherhood, mothers’ knowledge and awareness, convenience of providing low-quality ready-made and junk food, spiritual beliefs and superstition, violence against women, financial constraints in a context of rising food prices and seasonal impacts on food production, and physical accessibility of healthcare services. Conclusions: This review emphasizes the complex interplay of influences on undernutrition among young children in South Asia. Potential interventions must be culturally tailored and gender-sensitive, with key strategies including nutrition education, community-based support, maternal health improvements, and policies addressing food insecurity and healthcare accessibility. Full article

Generally portrayed as a neutral framework, the Common European Framework of Reference for Languages (CEFR) is implemented in various contexts through unequal policy transfers that favour Global North perspectives. The CEFR has become a key policy tool for curriculum internationalisation worldwide, particularly in higher education institutions in the Global South that seek international recognition. This qualitative study uses a critical policy transfer and policy enactment approach to examine how lecturer agency influences CEFR-based curriculum internationalisation in Indonesian postgraduate English programs, especially those aiming for the C1/C2 level. Informed by Priestley, Biesta, and Robinson’s ecological model of agency, the analysis reveals that lecturers employ interpretive, adaptive, and transformative agency to counter deficit narratives, integrate global standards with local pedagogical principles, and redefine CEFR C1/C2 as a construct of contextual significance. Rather than implementing the CEFR as a fixed benchmark, lecturers act as epistemic and cultural brokers who reclaim curriculum internationalisation as a locally grounded pedagogical project. The study advances debates on the CEFR, policy transfer, and Global South internationalisation by foregrounding lecturer agency as a critical site where global language policies are negotiated, contested, and reworked. Full article