Search Results (2,784)

Deep learning models for tabular data often behave unpredictably during training, and these internal dynamics directly influence the reliability of post hoc interpretability methods. Static techniques such as SHapley Additive exPlanations (SHAP) and Integrated Gradients offer useful but incomplete snapshots of model behaviour, while tabular models frequently undergo noise-driven fluctuations, structural reorganisations, and collapse phases that these methods cannot detect. This study introduces a temporally aligned, multimodal diagnostic framework that observes and interprets model behaviour as it evolves. The framework integrates fractal complexity, spectral energy, persistent homology, gradient-noise statistics, reflex responsiveness, attribution instability, and exploratory sonification into a single phase-aligned system. The framework is evaluated on Multilayer Perceptron (MLP) and Gated Recurrent Unit (GRU) models across benchmark and real-world datasets using a reproducible protocol with consistent configurations and autocorrelation-robust analysis. An ablation study confirms the distinct diagnostic value of each modality, with reflex-aware metrics validated against optimiser behaviour and sonification assessed through event detection. The multimodal diagnostics reveal instability regimes, fragmentation events, attribution drift, and optimiser–noise coupling failures that static Explainable Artificial Intelligence (XAI) methods cannot detect. GRU models show repeated structural transitions, whereas MLPs exhibit simpler but noisier optimisation dynamics. These behaviour-aware, temporally aligned diagnostics provide a more reliable foundation for interpreting tabular deep learning models. Full article

Cervical cancer is one of the most preventable malignancies, yet disparities in survival remain a significant public health burden across Eastern Europe and the Balkans. Bulgaria illustrates this paradox: HPV vaccination coverage is very low, and prevention continues to rely substantially on opportunistic screening, although recent national initiatives have introduced HPV-based testing and self-sampling. This article argues that the primary barrier to cervical cancer control in Bulgaria is not the lack of medical technology, but the absence of a structured, organized screening system. A modern national cervical cancer screening program should be recognized as a structured clinical and organizational pathway rather than a single diagnostic test. Such a programme requires population identification, active invitation and recall, reg-istry-based tracking, standardized referral and follow-up pathways, and continuous quality assurance. Primary high-risk HPV (hrHPV) testing provides high sensitivity and excellent negative predictive value, supporting longer screening intervals; however, screening for HPV positivity alone is insufficient as a sole referral criterion because many infections are transient and clinically insignificant. We propose a rational framework for cervical cancer screening in Bulgaria and comparable health systems: invitation-based screening for women aged 25–65 years built on primary hrHPV testing with genotyping, reflex cytology, and selective use of p16/Ki-67 dual staining. Drawing on a regional comparison of HPV vaccination and screening programs and on Bulgarian cost-of-illness data, we argue that transitioning from opportunistic testing to an integrated, registry-based screening cascade is essential for effective and equitable cervical cancer prevention in the region. Full article

Colorectal cancer (CRC) remains one of the most frequently diagnosed malignancies worldwide and a leading indication for major abdominal surgery, with a rising incidence among younger adults. Because CRC resection is a physiologically demanding procedure performed in a frequently comorbid, often anemic and malnourished population, the preoperative period represents a decisive window in which laboratory and diagnostic testing shapes staging, risk stratification, and optimization. This narrative review is deliberately confined to the preoperative window—from histological diagnosis to the day of elective, curative-intent colon or rectal resection—and synthesizes evidence retrieved from PubMed/MEDLINE, Scopus, and ScienceDirect together with current society guidelines. It is organized around four themes: (i) the core laboratory workup, including the complete blood count and preoperative anemia, iron studies, metabolic and hepatic panels, coagulation testing, and carcinoembryonic antigen (CEA); (ii) the diagnostic and staging workup, encompassing complete colonic evaluation, contrast-enhanced computed tomography, pelvic magnetic resonance imaging for rectal cancer, and the selective role of positron emission tomography; (iii) risk stratification and preoperative optimization, spanning patient blood management, nutritional assessment and albumin, computed-tomography-defined low skeletal muscle mass, frailty, functional capacity, prehabilitation, and glycemic control; and (iv) molecular characterization, distinguishing mismatch-repair/microsatellite-instability (MMR/MSI) testing—an established, widely recommended component of CRC evaluation—from genuinely emerging biomarkers such as circulating tumor DNA (ctDNA) and systemic inflammatory and prognostic nutritional indices. Differences between colon and rectal cancer, elective and emergency presentation, and upfront versus post-neoadjuvant surgery are signposted throughout. We further integrate these elements within contemporary guideline and Enhanced Recovery After Surgery (ERAS) frameworks, including the 2025 ERAS Society recommendations for elective colorectal surgery, and distill them into a practical, evidence-based preoperative checklist specifying thresholds, timing, interventions, and strength of supporting evidence. We emphasize that the prognostic power of postoperative ctDNA does not yet translate into ctDNA-guided treatment decisions outside clinical trials. The central message is that preoperative testing in CRC should be purposeful and stage- and risk-adapted rather than reflexive: each investigation should refine staging, modify perioperative management, or enable measurable optimization. Each risk domain is paired with the intervention it should trigger, the criteria identifying candidates for extended thromboprophylaxis are specified, and the systemic inflammatory indices are framed as a trigger for optimization rather than as prognostic commentary. Full article

Twice-exceptional students with ADHD may experience educational challenges related to both their giftedness and their ADHD diagnosis. This article presents a case study with two twice-exceptional students (7. Grade and 10. Grade) and explores their experiences within the educational systems of the United States and Norway. The data for the two cases were collected using different methods: observation with case 1 (Theo) and interview with case 2 (Adam). The data were originally collected for different studies and re-analyzed using reflexive thematic analysis for this case study. The thematic analysis revealed four main themes: student-led participation, self-confidence, strengths and interests, and ADHD diagnosis. The themes reveal similar patterns of disengagement, boredom, underachievement, and unmet educational needs across both contexts. Drawing on the Schoolwide Enrichment Model, the findings suggest that schools can better meet the needs of twice-exceptional students by building on their strengths and interests, fostering intrinsic motivation through student-led participation, and targeting issues like self-regulation through planning, persistence and strategic learning. Full article

Black neurodiverse women with postsecondary education occupy an underexamined intersection of race, gender, and neurodiversity, yet little research has examined their access to affirming community support. This survey study (N = 53) examines community access and mental health among Black neurodiverse women with postsecondary education. Findings reveal a 54.7 percentage-point gap between how many participants rated community support as important (96.2%) and how many had found it (41.5%). Participants also reported high rates of anxiety (90.6%), depression (79.2%), and masking (77.4%). Using qualitative reflexive thematic analysis, the following four themes were developed, defined, and named: (1) living at the intersection of race, gender, and neurodiversity; (2) structural barriers to access; (3) finding and building community; and (4) community as emotional validation and intersectional recognition. Framed through Black Feminist Disability Theory and intersectionality, these findings position access to affirming community as a structural health need and a health equity issue. Implications are drawn for campus mental health services, community organizations, and future research. Full article

Sustainability is increasingly recognised as a key priority in tourism development. Based on stakeholder theory, sustainable tourism implicates the involvement of diverse destination stakeholders. However, the roles of local residents and tourism providers as stakeholders who play an important role in achieving sustainability have largely been examined separately. This study addressed the dual role of local resident tourism providers operating in rural areas by exploring their perceptions, implementation, and recommendations related to sustainable tourism practices (STPs). By integrating stakeholder theory with systems theory, the study considered local resident tourism providers as embedded within a complex destination system. Data were collected through an online and offline survey of local resident tourism providers in the rural area of Istria County, Croatia, with 82 valid responses obtained. A qualitative approach based on an interpretive research paradigm was applied, and reflexive thematic analysis (RTA) was used to analyse the data. The findings indicate that respondents have an understanding of the concept of STPs and implement them, mainly in an environmental context, in their tourism activities. A focus on the quality of tourism services, presentation of local identity and heritage, and relationships and communication with guests emerged as important to respondents, while stakeholder cooperation between providers was limited in their responses. These findings suggest that resident tourism providers may be unaware of the importance of stakeholder collaboration, including their own role, in achieving sustainable tourism development. However, the findings also highlight the importance of adopting a systems approach: respondents’ identification of STPs and recommendations for improving their implementation point to the need for appropriate enabling conditions at destination system level. The findings are intended to be of interest to researchers, destination management organisations, local authorities, and tourism policymakers working in the field of sustainable tourism. Full article

Multilingual students’ repertoires are often framed either as resources for participation or as possible sources of difficulty, yet their situated use in special education remains underexamined. This study investigated how students in German special schools for social, emotional and behavioral development (SEBD) mobilized migration-related multilingual repertoires to address practical interactional problems and how situational conditions shaped the functions and consequences of these practices. A multi-sited ethnography was conducted in six SEBD special schools in the Rhine-Ruhr metropolitan region (North Rhine-Westphalia) between April 2024 and March 2025. Data comprised participant observation, written and talking fieldnotes, and informal ethnographic conversations. They were analyzed through a constant-comparative approach informed by reflexive grounded theory. Six recurring practice types were grouped into four result domains: Participation and Meaning-Making, Relational Positioning and Communicative Accessibility, Affective Mobilization and Counter-Positioning, and Navigation of Institutional Language Orders. Repertoire use had no fixed inclusive, disruptive, or resistant function. Its meaning emerged within interaction and changed with participation structures, public visibility, adult comprehension, and peer responses. In SEBD settings, migration-related linguistic marking and behavioral interpretation could reinforce one another. Multilingual practices should therefore be analyzed sequentially and situationally rather than treated as direct indicators of competence or disturbance. Full article

Generative AI (genAI) is increasingly being integrated into critical appraisal and knowledge synthesis of research, with growing discourse on its value for qualitative research. Moreover, ChatGPT covers a major portion of the market share and is widely used by researchers and academics. However, a major gap remains in genAI’s ability to assess the reporting quality of qualitative research studies. This pilot study aimed to determine whether GPT-5 could reliably assess the reporting quality of health-related qualitative research studies. The Standards for Reporting Qualitative Research (SRQR) checklist was used as a framework for completing both human and AI chatbot assessments. The SRQR is a widely used validated checklist for enhancing the reporting of qualitative research. Overall, 68 peer-reviewed studies were selected for testing, comparing human SRQR assessments with GPT-5 assessments. Findings revealed a wide variability in agreement between human and GPT-5 assessments, with crude agreement ranging between 60 and 100% and interrater reliability ranging between 0 and 0.85 across checklist items. Simpler, objective checklist items such as study purpose were often correctly identified and had stronger agreement compared to nuanced items. The model struggled with the following SRQR items leading to an “Unclear” response: research design/paradigm (41%), researcher reflexivity (41%), data processing (27%), and trustworthiness (46%). These preliminary results suggest that GPT-5 may struggle with tasks requiring nuance and interpretation of qualitative research, which is rich in complex methods and differing worldviews. Currently, GPT-5 and other AI chatbots should be used with caution and alongside human oversight when assessing the reporting quality of qualitative research within public health and healthcare. Full article

Background/Objectives: Nurses may use digital communication channels alongside formal rostering systems to negotiate shift swaps. How these practices are organized, governed, and experienced in Saudi hospitals remains insufficiently understood. This study explored how nurses in one tertiary hospital coordinated shift swaps through digital communication and navigated reciprocity, professional accountability, and access to scheduling flexibility. Methods: A qualitative descriptive study was conducted in a tertiary hospital in the Riyadh region, Saudi Arabia. Twenty-four registered nurses, recruited by purposive maximum-variation sampling from medical–surgical, intensive care, emergency, and specialty units, completed individual semi-structured interviews incorporating digital journey-mapping prompts. Interviews were audio-recorded, transcribed, de-identified, and analyzed using reflexive thematic analysis, reported with reference to the Reflexive Thematic Analysis Reporting Guidelines. Results: Four interrelated themes were developed: (1) digital pathways of negotiation; (2) reciprocity as social currency; (3) managing risk and responsibility; and (4) collective coping and unequal flexibility. Private and group messaging supported initial negotiation, whereas managerial approval and formal roster documentation established legitimacy and accountability. Reciprocal assistance increased flexibility but could also generate obligation and reproduce inequalities associated with seniority, trust, and social integration. Conclusions: In this hospital, digital shift-swap coordination operated alongside, rather than in place of, formal scheduling governance. Transparent procedures connecting peer communication with managerial approval may support flexibility while protecting fairness, documentation, professional boundaries, and appropriate staffing. These findings describe one purposively recruited sample in a single hospital and require evaluation in multi-center research. Full article

PA is an important determinant of health and well-being; however, many university students, including healthcare students, do not achieve recommended activity levels despite their future role in health promotion. This study aimed to explore healthcare students’ perspectives on physical activity, including their habits, perceived barriers and facilitators, the relationship between physical activity and academic self-efficacy, and its role in their future professional identity. A qualitative descriptive design was applied using semi-structured individual interviews with 15 healthcare students. Data were analyzed using Braun and Clarke’s six-phase reflexive thematic analysis approach. Five interrelated themes were identified: physical activity as a resource for health, well-being, and academic functioning; academic demands shaping physical activity behavior; physical activity strengthening academic self-efficacy; physical activity as part of professional identity; and the university environment as a facilitator of physical activity. Students perceived physical activity as supporting physical and mental well-being, stress management, concentration, and daily functioning. Academic workload, limited time, fatigue, financial constraints, and motivational challenges were identified as barriers, whereas institutional support and flexible opportunities facilitated participation. Students also viewed physical activity as contributing to confidence, discipline, and their perceived credibility as future healthcare professionals. Supportive university environments may help healthcare students maintain active lifestyles and support the development of their role as health-promoting professionals. Full article

Background/Objectives: Supporting families during end-of-life care in intensive care units is clinically, emotionally, and ethically demanding, and nurses’ experiences of this work in Saudi Arabian intensive care settings remain underexplored. This study explored nurses’ experiences of providing psychosocial and emotional support to families during end-of-life care, including their role in treatment-limitation and goals-of-care discussions. Methods: A qualitative descriptive study, analyzed using reflexive thematic analysis from a contextualist position, was conducted with 15 intensive care nurses across three healthcare facilities in Riyadh. Ten were Saudi nationals and five internationally recruited; eleven had Arabic as a first language. Semi-structured interviews were conducted in Arabic (n = 11) or English (n = 4) between December 2025 and February 2026 and coded in the language of collection. Results: Three themes were developed: doing relational work inside a system organized for clinical throughput; carrying what the work leaves behind; and standing between, brokering understanding for families. Nurses described having no formal decision-making authority while shaping what families understood and what the clinical team heard. Conclusions: Nurses positioned themselves as intermediaries between families and clinical teams. This relational work was shaped by staffing, formal preparation, access to palliative care, and physician recognition of the nursing role. Strengthening these organizational conditions may support more consistent family care. Full article

The need for efficiency in radiology has been made clear and augmented reality (AR) has the potential to address this by aiding with issues around irregular lighting conditions impacting the accuracy of reports, while also speeding up the process with improved interactions. However, some interaction questions are still very much open, and interactions for radiological applications deserve more attention. This short-term exposure study involved a series of seven interviews with practising radiologists and radiology registrars, most of whom were AR-novices. Participants engaged in AR tasks using the Microsoft HoloLens 2 and Meta Quest 3, running software provided by GigXR, as a basis for rich dialogue around the interaction value of AR for radiological tasks. Reflexive thematic analysis was used to analyse the resulting data, generating five themes, with the NASA-TLX providing additional context. The themes were mapped to three design considerations that stand as the contribution of this work and highlight how radiological AR requires interaction design distinguishing intended from unintended movement, standardised hardware requirements for clinical-grade HMDs, and versatile, workflow-integrated deployment to overcome resistance to clinical adoption. These are embodied in the speculation of an AR-First world that illustrates key requirements. Full article

The integration of artificial intelligence (AI) into medical practice is a paradigmatic transformation that compels a reconsideration of the very conceptual structure of bioethics. We argue that this transformation is the local symptom of a wider mutation we designate the anthropological singularity: the threshold at which humanity withdraws from natural evolution and enters an artificial, self-directed one, along three converging vectors—the virtualisation of social space, the cognitive and relational reconfiguration of the human agent through interaction with AI, and the modification of the biological substratum through synthetic biology and gene editing. This approach must be seen as a conceptual study, and not as a systematic literature review, since the study does not aggregate empirical findings but constructs them by defending a theoretical framework and drawing on medical sociology, medical anthropology and biolaw, in order to examine the recurrent tensions between transparency vs. performance, justice vs. efficacy, precaution vs. innovation. We argue that algorithmic bias is part of socio-technical ecosystems, being a systemic property of these. We also argue that responsibility must migrate towards distributed frameworks between human and non-human agents, and that the digital revolution could produce an algorithmic stratification of populations, now prolonged through gene editing into the very biology of future generations. An augmented bioethics is required—not mere delegation of moral judgement to algorithms, but a reflexive framework that revises the ontological presuppositions of principlism, sustained by multi-stakeholder governance and deliberate public policies. Full article

Background/Objectives: Supporting everyday self-management is a central component of person-centered neurological nursing for young adults living with epilepsy. However, little is known about how young adults experience and negotiate everyday life with epilepsy during a developmental stage characterized by increasing independence and major life transitions. This study aimed to explore how young adults experience and negotiate everyday life with epilepsy. Methods: A qualitative exploratory study informed by a hermeneutic approach was conducted to explore participants’ experiences. Twelve young adults aged 18–29 years participated in individual virtual interviews. Interviews followed a semi-structured guide and were analyzed using reflexive thematic analysis to identify patterns across participants’ experiences. The study was reported according to the Standards for Reporting Qualitative Research (SRQR). Results: The analysis identified a main theme, Keeping balance on a moving platform, which captured how young adults experienced living with epilepsy as a continuous balancing act within an unpredictable condition. Participants described continuously balancing independence with vulnerability while managing seizures, cognitive challenges, and concerns related to safety and social participation. Familiar digital and non-digital tools supported everyday self-management by helping participants structure daily routines, compensate for cognitive difficulties, and maintain a sense of normality. Conclusions: Living with epilepsy in young adulthood requires continuous adaptation to cognitive, emotional, and practical challenges that extend beyond seizure control. This study extends current knowledge by showing that self-management involves continuous negotiation between independence, vulnerability, and everyday participation rather than symptom control alone. The findings provide insights into person-centered neurological nursing by highlighting the importance of individualized support for managing cognitive challenges, everyday self-management, and transitions into education, employment, and family life. Full article

Next-generation sequencing (NGS) is integral to colorectal cancer (CRC) care, but its value depends on results being available when treatment decisions are made. We conducted a qualitative study to identify quality gaps in CRC NGS pathways and assess perspectives on digital and artificial intelligence (AI)-enabled workflow support. Semi-structured interviews were conducted with 22 medical oncologists and pathologists from 14 Ontario hospitals, and transcripts were analyzed thematically. Five themes emerged: (1) clinical indications and test ordering, where initiation was inconsistent because of unclear reflex-testing criteria, reliance on upstream clinicians, staging uncertainty, evolving indications, and funding constraints; (2) tissue, pathology, and laboratory workflow, where participants attributed bottlenecks and turnaround variability to send-out testing, staffing, infrastructure, and capacity; (3) interdisciplinary communication and tracking, where informal communication, unclear ownership, and manual tracking highlighted the need for closed-loop confirmation and alerts; (4) reporting and clinical integration, where report clarity, interpretability, and timing affected use; and (5) electronic health record integration and AI integration, where fragmented systems and limited interoperability delayed result access. Participants supported clinician-supervised digital or AI-enabled tools for case identification, triage, tracking, and overdue-result alerts. CRC NGS optimization requires standardized reflex criteria, clearer ownership, closed-loop tracking, reliable routing, structured reporting, and interoperable infrastructure. Full article