Search Results (308)

The bridge deck is more vulnerable to deterioration than other structural components. This is due to its direct exposure to environmental factors such as vehicular loads, chloride ingress, and freeze–thaw cycles. The resulting accelerated degradation often results in a serviceability life that is shorter than the intended design life. However, the absence of standardized condition assessment methods coupled with clear definitions of remaining service life has limited the establishment of rational guidelines for repair and strengthening. In a bid to address this lack, this study focuses on PSC-I type bridges in South Korea, utilizing long-term field inspection data to analyze environmental, structural, and material factors—including reinforcement corrosion, chloride diffusion, and freeze–thaw actions. Environmental zoning was applied based on regional conditions, while structural zoning was performed according to load characteristics, thereby allowing the classification of deck regions into moment zones and cantilever sections. Machine learning models were employed to identify dominant deterioration mechanisms, with the validity of the zoning classification being evaluated via model accuracy and SHAP value analysis. Additionally, a regression-based approach was proposed to estimate the remaining service life of the bridge deck for each corrosion phase, thereby providing a quantitative framework for durability assessment and maintenance planning. Full article

Background/Objectives: Cannabinoid use is rising among patients undergoing spinal fusion, yet its influence on bone healing is poorly defined. The endocannabinoid system (ECS)—through cannabinoid receptors 1 (CB1) and 2 (CB2)—modulates skeletal metabolism. We reviewed preclinical, mechanistic and clinical evidence to clarify how individual cannabinoids affect fracture repair and spinal arthrodesis. Methods: PubMed, Web of Science and Scopus were searched from inception to 31 May 2025 with the terms “cannabinoid”, “CB1”, “CB2”, “spinal fusion”, “fracture”, “osteoblast” and “osteoclast”. Animal studies, in vitro experiments and clinical reports that reported bone outcomes were eligible. Results: CB2 signaling was uniformly osteogenic. CB2-knockout mice developed high-turnover osteoporosis, whereas CB2 agonists (HU-308, JWH-133, HU-433, JWH-015) restored trabecular volume, enhanced osteoblast activity and strengthened fracture callus. Cannabidiol (CBD), a non-psychoactive phytocannabinoid with CB2 bias, accelerated early posterolateral fusion in rats and reduced the RANKL/OPG ratio without compromising final union. In contrast, sustained or high-dose Δ⁹-tetrahydrocannabinol (THC) activation of CB1 slowed chondrocyte hypertrophy, decreased mesenchymal-stromal-cell mineralization and correlated clinically with 6–10% lower bone-mineral density and a 1.8–3.6-fold higher pseudarthrosis or revision risk. Short-course or low-dose THC appeared skeletal neutral. Responses varied with sex, age and genetic background; no prospective trials defined safe perioperative dosing thresholds. Conclusions: CB2 activation and CBD consistently favor bone repair, whereas chronic high-THC exposure poses a modifiable risk for nonunion in spine surgery. Prospective, receptor-specific trials stratified by THC/CBD ratio, patient sex and ECS genotype are needed to establish evidence-based cannabinoid use in spinal fusion. Full article

Asphalt pavement cracking is an important factor affecting its service life. Under certain conditions, the self-healing behavior of asphalt itself can repair pavement cracks. However, the self-healing ability of asphalt itself is limited. In order to strengthen the self-healing ability of asphalt, the microcapsule wrapped with a repair agent is pre-mixed into the asphalt mixture. When the crack occurs and spreads to the surface of the microcapsule, the microcapsule ruptures and the healing agent flows out to realize the self-healing of the crack. Current microcapsules are mostly prepared with healing agents and bio-oil as core materials, and their high-temperature resistance to rutting is poor. While the epoxy resin contains a three-membered cyclic ether, it can undergo ring-opening polymerization to bond and repair the asphalt matrix. In addition, research on microcapsules mainly focuses on the self-healing properties of microcapsule-modified asphalt. In fact, before adding microcapsules to asphalt to improve its self-healing performance, it is necessary to ensure that the asphalt has a good road performance. On this basis, the self-healing performance of asphalt is improved, thereby extending the service life of asphalt pavement. Therefore, two-component epoxy self-healing microcapsules (E-mic and G-mic) were first prepared in this paper. Then, a temperature scanning test, rheological test of bending beams, and linear amplitude scanning test were, respectively, conducted for the microcapsule/asphalt to evaluate its road performance, including the high-temperature performance, low-temperature crack resistance, and fatigue performance. Finally, the self-healing performance of microcapsules/asphalt was tested. The results showed that the self-developed epoxy self-healing microcapsules were well encapsulated and presented as spherical micron-sized particles. The average particle size of the E-mic was approximately 23.582 μm, while the average particle size of the G-mic was approximately 22.440 μm, exhibiting a good normal distribution. In addition, they can remain intact and unbroken under high-temperature conditions. The results of road performance tests indicated that the microcapsule/asphalt mixture exhibits an excellent high-temperature resistance to permanent deformation, low-temperature crack resistance, and fatigue resistance. The self-healing test demonstrated that the microcapsule/asphalt exhibited an excellent self-healing performance. When the microcapsule content was 4%, the self-healing rate reached its optimal level of 67.8%, which was 149.2% higher than that of the base asphalt. Full article

Photobiomodulation (PBM) has been widely studied for its regenerative and anti-inflammatory properties. Its application, combined with biomaterials, is emerging as a promising strategy for promoting tissue regeneration. Considering the diversity of available evidence, this study conducted an integrative literature review, aiming to critically analyze and synthesize the effects of PBM on bone tissue, particularly its potential role as an adjunct in guided bone regeneration (GBR) procedures. To ensure an integrative approach, studies with different methodological designs were included, encompassing both preclinical and clinical research. The article search was performed in the digital databases PubMed/MEDLINE, Scopus, and Web of Science, using the following search terms: “Photobiomodulation therapy” AND “guided bone regeneration”. The search was conducted from November 2024 to January 2025. A total of 85 articles were found using the presented terms; after checking the results, 11 articles were selected for this study. The remaining articles were excluded because they did not fit the proposed inclusion and exclusion criteria. Studies to date have shown preclinical models that demonstrated increased bone-volume fraction and accelerating healing. Although it has exciting potential in bone regeneration, offering a non-invasive and promising approach to promote healing and repair of damaged bone tissue, the clinical application of PBM faces challenges, such as the lack of consensus on the ideal treatment parameters. Calcium phosphate ceramics were one of the most used biomaterials in the studied associations. Further well-designed studies are necessary to clarify the effectiveness, optimal parameters, and clinical relevance of PBM in bone regeneration, in order to strengthen the current evidence base and guide its potential future use in clinical practice. Full article

The use of both structural steel and reinforced concrete is common in civil and military infrastructure projects. Anchorage plays a crucial role in these systems, serving as the key element that connects structural components and secures attachments within complex composite structures. This research focuses on evaluating the performance of steel–concrete column connections under the combined effects of lateral loading and fire exposure. Additionally, the study investigates the use of carbon fiber-reinforced polymers (CFRP) for strengthening and repairing these connections. The research methodology combines experimental testing and finite-element modeling to achieve its objectives. First, experimental investigation was carried out to test two groups of steel-reinforced concrete column specimens, each group made of three specimens. The first group specimens were designed based on special moment frame (SMF) detailing, and the other group specimens were designed based on intermediate moment frame (IMF) detailing. These two types of design were selected based on seismic demands, with SMFs offering high ductility and resilience for severe earthquakes and IMFs providing a cost-effective solution for moderate seismic zones, both benefiting from ongoing innovations in connection detailing and design approaches. Then, finite-element analysis was conducted to model the test specimens. High-fidelity finite-element modeling was conducted using ANSYS program, which included three-dimensional coupled thermal-stress analyses for the six tested specimens and incorporated nonlinear temperature-dependent materials characteristics of each component and the interfaces. Both the experimental and numerical results of this study show that fire has a more noticeable effect on displacement compared to the peak capacities of both types of specimens. Fire exposure results in a larger reduction in the initial residual lateral stiffness of the SMF specimens when compared to IMF specimens. While the effect of CFRP wraps on initial residual lateral stiffness was consistent for all specimens, it caused more improvement for the IMF specimen in terms of post-fire ductility when compared to SMF specimens. This exploratory study confirms the need for further research on the effect of fire on the concrete–steel anchorage zones. Full article

Polyethylene storage tanks are widely used for storing water and chemicals due to their lightweight and corrosion-resistant properties. Despite these advantages, their structural performance under seismic conditions remains a concern, mainly because of their low mechanical strength and weak bonding characteristics. In this study, a method of external strengthening using fiber-reinforced polymer (FRP) laminates is proposed and explored. The research involves a combination of laboratory testing on carbon fiber-reinforced polymer (CFRP)-strengthened polyethylene strips and finite element simulations aimed at assessing bond strength, anchorage length, and structural behavior. Results from tensile tests indicate that slippage tends to occur unless the anchorage length exceeds approximately 450 mm. To evaluate surface preparation, grayscale image analysis was used, showing that mechanical sanding increased intensity variation by over 127%, pointing to better bonding potential. Simulation results show that unreinforced tanks under seismic loads display stress levels beyond their elastic limit, along with signs of elephant foot buckling—common in thin-walled cylindrical structures. Applying CFRPs in a full-wrap setup notably reduced these effects. This approach offers a viable alternative to full tank replacement, especially in regions where cost, access, or operational constraints make replacement impractical. The applicability is particularly valuable in seismically active and densely populated areas, where rapid, non-invasive retrofitting is essential. Based on the experimental findings, a simple formula is proposed to estimate the anchorage length required for effective crack repair. Overall, the study demonstrates that CFRP retrofitting, paired with proper surface treatment, can significantly enhance the seismic performance of polyethylene tanks while avoiding costly and disruptive replacement strategies. Full article

In B-cell chronic lymphocytic leukemia (B-CLL), hypodiploidy is a rare but aggressive subtype of the disease with a very bad prognosis. Hypodiploidy, in contrast to normal B-CLL chromosomal aberrations, is marked by widespread genomic instability, which promotes treatment resistance and quick illness development. Its persistence after treatment implies that chromosomal loss gives cancerous clones a selection edge, which is made worse by telomere malfunction and epigenetic changes. Since thorough genetic profiling has a major impact on patient outcomes, advanced diagnostic methods are crucial for early detection. Treatment approaches must advance beyond accepted practices because of its resistance to traditional medicines. Hematopoietic stem cell transplantation (HSCT) and chimeric antigen receptor (CAR) T-cell therapy are two potential new therapeutic modalities. Relapse and treatment-related morbidity continue to be limiting concerns, despite the noteworthy improvements in outcomes in high-risk CLL patients receiving HSCT. Although more research is required, CAR T-cell treatment is effective in treating recurrent B-ALL and may also be used to treat B-CLL with hypodiploidy. Novel approaches are essential for enhancing patient outcomes and redefining therapeutic success when hypodiploidy challenges established treatment paradigms. Hypodiploidy is an uncommon yet aggressive form of B-CLL that has a very bad prognosis. Hypodiploidy represents significant chromosomal loss and structural imbalance, which contributes to a disordered genomic environment, in contrast to more prevalent cytogenetic changes. This instability promotes resistance to certain new drugs as well as chemoimmunotherapy and speeds up clonal evolution. Its persistence after treatment implies that hypodiploid clones have benefits in survival, which are probably strengthened by chromosomal segregation issues and damaged DNA repair pathways. Malignant progression and treatment failure are further exacerbated by telomere erosion and epigenetic dysregulation. The need for more sensitive molecular diagnostics is highlighted by the fact that standard karyotyping frequently overlooks hypodiploid clones, particularly those concealed by endoreduplication, despite the fact that these complications make early and correct diagnosis crucial. Hypodiploidy requires a move toward individualized treatment because of their link to high-risk genetic traits and resistance to conventional regimens. Although treatments like hematopoietic stem cell transplantation and CAR T-cells show promise, long-term management is still elusive. To improve long-term results and avoid early relapse, addressing this cytogenetic population necessitates combining high-resolution genomic technologies with changing therapy approaches. Full article

Background and Objectives: Negative-pressure wound therapy (NPWT) expedites tissue repair, yet functional recovery depends on adjunct rehabilitation. Evidence from high-resource settings is difficult to translate to Romanian county hospitals, where advanced devices are scarce. The objective of this study is to determine whether two tiers of low-technology, therapist-delivered exercise improve mobility, oedema resolution, pain and quality-of-life (QoL) beyond NPWT alone in adults with acute lower-limb wounds. Methods: A single-centre, prospective observational study (January 2021–June 2024) enrolled 92 patients and randomised them unevenly into: Group A, NPWT only (n = 39); Group B, NPWT + routine physiotherapy (n = 33); Group C, NPWT + enhanced manual programme (n = 20). All received −125 mmHg continuous suction; rehabilitation started 48 h post-operation. Primary outcomes were ankle dorsiflexion and knee flexion at 12 weeks. Secondary outcomes included calf circumference, ultrasound oedema depth, Manual Muscle Testing (MMT), pain (VAS), analgesic use and SF-36 domains through 24 weeks. Results: Baseline characteristics were similar (p > 0.40). At 12 weeks dorsiflexion reached 20.1 ± 1.8° in Group C, surpassing Group B (18.4 ± 2.1°; p = 0.004) and Group A (16.0 ± 2.3°; p < 0.001). Knee flexion followed the same gradient (140.8 ± 3.2°, 137.6 ± 3.4°, 133.4 ± 3.8° respectively). Oedema depth fell fastest in Group C (0.4 ± 0.2 mm by day 42) versus B (0.6 ± 0.2 mm) and A (0.8 ± 0.3 mm). Week-12 MMT grade ≥ 4.5 was attained by 95% of Group C, 85% of B and 72% of A (χ² = 10.9, p = 0.004). VAS pain fell more steeply with each rehabilitation layer, paralleled by a stepwise decline in daily tramadol. All SF-36 domains were highest in Group C at 24 weeks (Physical Function 88.7 ± 4.8 vs. 85.1 ± 5.4 vs. 78.2 ± 5.9; p < 0.001). Mobility correlated positively with QoL (r = 0.66) and inversely with pain and oedema. Conclusions: In a resource-constrained Romanian setting, adding structured manual physiotherapy to NPWT produced meaningful functional and patient-centred gains, while an “enhanced” programme incorporating daily PNF and elastic-band strengthening delivered the largest observed benefit. These findings justify prioritising therapist-led interventions even where sophisticated equipment is unavailable. Full article

The church of Saint Felix in Girona (Spain) is crowned by an octagonal bell tower with a stone pinnacle at each corner. It was built using dry-joint stone masonry, a technique that involves laying stones in a precise pattern to create a solid and durable structure. In order to strengthen the connection between the stone blocks of the pinnacles, a wooden bar was placed through a central hole carved in the stone structure. Today, the inner structure has completely disappeared. During maintenance and repair work, it was decided to restore the functionality of the disappeared reinforcement by installing a titanium bar in its place. Due to the uncertainty associated with the pinnacle’s behaviour and the lack of both, a proper numerical model of the monument, and an extensive characterization of the materials, a strategy based on multiple approaches was designed. The proposed strategy was based on combining numerical and experimental models, the final objective being to determine the length and mechanical properties of the metallic inclusion, considering the effects of gravity, wind, and seismic forces. A scale model of the pinnacle was evaluated in laboratory conditions. The results were used to calibrate a numerical model representing the scale specimen. After calibration, the results were extrapolated to a full-scale numerical model. The experimental and numerical results showed that the pinnacles needed to be reinforced along their entire height. The tensile stresses cause by wind and seismic forces at different levels, could not be compensated without the contribution of the titanium bar inserted into the pinnacle. Full article

Under the background of intensified global economic fluctuations, to prevent the systemic risk of real estate (e.g., the U.S. subprime crisis), this study constructs a linkage network of the real estate industry in the U.S. based on the complex network method, reveals the fluctuation diffusion mechanism, identifies the key pivotal industries through the network characteristic indicators, and analyses the characteristics of the fluctuation conduction paths by applying the industrial fundamental association trees. The study found that (1) the U.S. real estate industry is a ‘supply hub’ industry, with first-order and second-order weighted degrees of mean 6.78, 3.98, and significant asymmetry in the supply structure of the industrial network; (2) industries like architectural, engineering, and related services (541300), nonresidential maintenance and repair (230301), and electric power generation, transmission, and distribution (221100) show high degree centrality and betweenness centrality. Their strong propagation and control capabilities form real estate fluctuations’ core transmission mechanisms; (3) foundational association trees reveal long, broad propagation paths where financial investment and energy-supply sectors act as “traffic hubs,” decisively influencing risk diffusion depth and breadth. Targeted policy recommendations address four dimensions: optimizing industrial chain structures, strengthening financial risk isolation, improving housing supply systems, and enhancing policy coordination. This aims to help China avoid U.S.-style real-estate-bubble risks and achieve coordinated real estate macroeconomy development. Full article

Background/Objectives: Hearing aids are essential for managing hearing loss, yet their accessibility, consistent use, and maintenance remain challenging in public healthcare systems, particularly in low- and middle-income countries (LMICs) such as South Africa. Despite the availability of these services, many patients struggle with device utilization, resulting in suboptimal rehabilitation outcomes. This study explores patient experiences with hearing aids in South Africa’s public healthcare sector. This study aimed to (1) assess patients’ experiences with hearing aid access, including waiting times and service delivery; (2) identify challenges related to hearing aid maintenance and repairs in the public sector; (3) explore factors influencing consistent hearing aid use, including social, psychological, and practical barriers; and (4) propose strategies to enhance hearing aid provision and aftercare services in South Africa. Methods: This descriptive qualitative study was conducted at two public healthcare facilities in Johannesburg. Purposive sampling was used to recruit 15 adult hearing aid users who had received government-funded hearing aids within the past 12 months. Semi-structured interviews were conducted, transcribed verbatim, and analyzed using thematic analysis. Results: Participants reported long waiting periods (up to a year) for hearing aids, with poor communication regarding timelines. Challenges included difficulties adjusting to amplification, discomfort, and battery shortages, leading to inconsistent use or device abandonment. Social stigma and lack of family support further discouraged consistent use. Repair services were slow, with waiting times exceeding three months. Participants recommended decentralized battery distribution, structured follow-up appointments, improved aftercare, awareness campaigns, and mobile audiology services to improve accessibility and usability. Conclusions: While public hearing aid provision is essential for hearing rehabilitation, systemic inefficiencies, maintenance issues, and social barriers limit its impact. Strengthening aftercare services, decentralizing hearing aid distribution, and increasing public awareness could significantly improve hearing aid accessibility and adherence. Furthermore, policy interventions that incorporate tele-audiology, community-based maintenance programs, and integrated healthcare approaches are crucial in ensuring sustainable hearing healthcare outcomes. Full article

The monolithic composite action of structures relies on the interface bond strength between concrete and the repair material. This study uses explainable deep learning techniques to evaluate the ultimate strength capacity (Us) of U-shaped normal concrete (NC) strengthened with polyurethane grouting (PUG) materials. Machine learning algorithms (ML) such as Long Short-Term Memory (LSTM), Random Forest (RF), and Wide Neural Network (WNN) models were developed to estimate Us by considering five input parameters: the initial crack strength (Cs), thickness of the grouting materials (T), mid-span deflection (λ), and peak applied load (P). The results indicated that LSTM models, particularly LSTM-M2 and LSTM-M3, demonstrated superior predictive accuracy and consistency in both the calibration and verification phases, as evidenced by high Pearson’s correlation coefficients (PCC = 0.9156 for LSTM-M2) and Willmott indices (WI = 0.7713 for LSTM-M2), and low error metrics (MSE = 0.0017, RMSE = 0.0418). The SHAP (SHapley Additive exPlanations) analysis showed that the thickness of the grouting materials and maximum load were the most significant parameters affecting the ultimate capacity of the composite U-shaped specimen. The RF model showed moderate improvements, with RF-M3 performing better than RF-M1 and RF-M2. The WNN models displayed varied performance, with WNN-M2 performing poorly due to significant scatter and deviation. The findings highlight the potential of LSTM models for the accurate and reliable prediction of the ultimate strength of composite U-shaped specimens. Full article

The degradation of ‘black soil beach’ (BSB) ecosystems in the Three-River-Source region, characterized by widespread bald patches and severe soil erosion, poses a critical threat to regional ecological security and sustainable pastoralism. This study aims to elucidate the spatial distribution patterns and driving factors of bald patches in BSB degraded grasslands within the Guoluo Tibetan Autonomous Prefecture, providing a scientific basis for targeted restoration strategies. Utilizing multi-source remote sensing data (Landsat 8–9 OLI, UAV imagery, and Google Earth), we employed the Multiple Endmember Spectral Mixture Analysis (MESMA) method to identify bald patches, combined with the landscape pattern index and spatial autocorrelation to quantify their spatial heterogeneity. Geographical detector analysis was applied to assess the influence of natural and anthropogenic factors. The results indicate the following: (1) The patches are bounded by the Yellow River, showing a distribution pattern of ‘high in the west and low in the east’. The total area of patches reached 32,222.11 km², accounting for 43.43% of the total area of Guoluo Prefecture, among which Maduo County and Dari County had the highest degradation rate. (2) With the aggravation of degradation, the patch density of each county increased first and then decreased, while the aggregation index and landscape shape index continued to decrease. (3) Spatial autocorrelation of bare patches strengthens with degradation severity (Moran’s I index 0.6543→0.7999). LISA identified two clusters: the high–high agglomeration area in the north of Maduo–Dari and the low–low agglomeration area in the southeast of Jiuzhi–Banma, revealing the spatial heterogeneity of the degradation process. (4) The spatial distribution pattern of bare patches was mainly affected by the annual average precipitation and actual stocking capacity, and the synergistic effect was significantly higher than that of a single factor. The combination of a 4491–4708 m high altitude area, 0–5° gentle slope zone, and soil texture (clay 27–31%, silt 43–100%) has the highest degradation risk. This multi-factor coupling effect explains the limitations of traditional single factor analysis and provides a new perspective for accurate repair. Full article

Introduction: Hair damage from chemical treatments, mechanical stress, and environmental factors can lead to significant degradation in hair quality, necessitating effective solutions for restoration. The aim of this study was to develop and evaluate novel compounds for repairing hair damage through the chemical regeneration of disulfide bridges. Materials and Methods: Three novel thiol-reactive cross-linking agents (APA, STA, SAA) were synthesized and characterized. Their efficacy in repairing hair damage was evaluated through in vitro tensile strength tests on human hair fibers, comparing treated and untreated samples. Cysteine reactivity tests were also performed to assess the capability of these agents to restore disulfide bridges in hair keratin. Results: The tensile strength tests revealed significant improvements in the mechanical properties of treated hair fibers compared to untreated samples. APA demonstrated the highest efficacy in restoring tensile strength and elasticity, showing higher performance in mechanical strengthening. The cysteine reactivity tests confirmed that APA could effectively re-establish disulfide bonds, particularly at higher temperatures. STA, while less effective than APA, showed substantial efficiency in restoring disulfide bonds. When compared to the reference agent, both APA and STA exhibited higher performance in tensile strength and cysteine reactivity, with APA showing the greatest improvement in mechanical properties. Conclusions: Our study successfully revealed the potential of the synthesized thiol-reactive cross-linking agents in repairing hair damage by chemically regenerating disulfide bridges. These findings offer a promising new direction for the development of advanced hair repair treatments in the cosmetic industry. Full article

Background: Advancements in pharmacogenomics, artificial intelligence (AI), and CRISPR gene-editing technology are revolutionizing precision medicine by enabling highly individualized therapeutic strategies. Artificial intelligence-driven computational techniques improve biomarker discovery and drug optimization while pharmacogenomics helps to identify genetic polymorphisms affecting medicine metabolism, efficacy, and toxicity. Genetically editing based on CRISPR presents a precise method for changing gene expression and repairing damaging mutations. This review explores the convergence of these three fields to enhance improved precision medicine. Method: A methodical study of the current literature was performed on the effects of pharmacogenomics on drug response variability, artificial intelligence, and CRISPR in predictive modeling and gene-editing applications. Results: Driven by artificial intelligence, pharmacogenomics allows clinicians to classify patients and select the appropriate medications depending on their DNA profiles. This reduces the side effect risk and increases the therapeutic efficacy. Precision genetic modifications made feasible by CRISPR technology improve therapy outcomes in oncology, metabolic illnesses, neurological diseases, and other fields. The integration of artificial intelligence streamlines genome-editing applications, lowers off-target effects, and increases CRISPR specificity. Notwithstanding these advances, issues including computational biases, moral dilemmas, and legal constraints still arise. Conclusions: The synergy of artificial intelligence, pharmacogenomics, and CRISPR alters precision medicine by letting customized therapeutic interventions. Clinically translating, however, hinges on resolving data privacy concerns, assuring equitable access, and strengthening legal systems. Future research should focus on refining CRISPR gene-editing technologies, enhancing AI-driven pharmacogenomics, and developing moral guidelines for applying these tools in individualized medicine going forward. Full article