Search Results (196,422)

Providing regulation-compliant, high-fidelity training in aircraft maintenance remains challenging for institutions of education, where access to real aircraft, specialist tools, and operational environments is limited by cost, safety, and resource factors. This paper presents the design, in-house development, and pilot deployment of a virtual reality (VR) training system for an operationally critical maintenance procedure—Airbus A320 nose landing gear (NLG) wheel removal, strictly following the official Airbus Aircraft Maintenance Manual (AMM). Managed by an Agile-based methodology, the application, programmed with the Unity engine, uses full-size 3D CAD models and domain-expert input iteratively for quality-assured and rapid deployment. The system was piloted with aeronautical engineering students at the Vietnam Aviation Academy (VAA), achieving significant engagement and perceived gains for procedure knowledge and skill development. Positive comments emphasized the realistic, interactive, and repeatable quality of the simulation. Usability issues related to controller handling, cybersickness, and the absence of haptic feedback, however, suggest opportunities for refinement. This paper reports an early published case study of VR use in commercial aircraft maintenance training that is practically replicable and scalable, and developed in alignment with applicable civil aviation procedural requirements. It suggests that such a high-fidelity VR training platform can provide an accessible solution for aviation stakeholders to help bridge classroom training and real-world application in safety-critical training contexts. Full article

With the in-depth advancement of the “Digital China” initiative, policies and research discourses related to the digital economy have continued evolved, making it necessary to systematically examine their stage-specific characteristics and underlying logic from a long-term perspective. Accordingly, this study adopts information society theory as the analytical framework and selects the annual series of reports on China’s digital economy development published by the China Academy of Information and Communications Technology (CAICT) from 2015 to 2024 as the research corpus. Using text mining techniques and Latent Dirichlet Allocation (LDA) topic modeling, this paper conducts a longitudinal examination of the stage-wise systemic evolution of key topics in China’s digital economy development. The findings indicate that over the past decade, the topic structure of China’s digital economy has followed a clear evolutionary trajectory, progressing from “informatization-driven development” to “platform expansion,” and subsequently to “data factors and institutional governance.” In the early stage, the focus was on information infrastructure development and industrial integration; the middle stage shifted toward the platform economy and enterprise growth; more recently, the emphasis has increasingly been placed on the construction of data factor markets and the improvement of governance frameworks. This process of topic evolution not only reflects changes in the practical forms of the digital economy but also reveals the ongoing adjustment of the state’s cognitive framework and governance logic regarding digital economy development. These findings provide empirical evidence for understanding the systemic evolution of China’s digital economy over time. By identifying the stage-specific pathways of China’s digital economy, this study extends the application of information society theory within this context and provides new empirical evidence for understanding the evolutionary logic underlying high-quality digital economy development. Full article

This study empirically examines the joint effect of financial anomaly risk and ESG performance on accounting conservatism using accrual models, market models, and earnings time-series models. Financial anomaly scores are obtained using unsupervised machine learning to identify reporting anomalies for firms. Our findings suggest that higher financial anomaly risk is negatively related to accounting conservatism through delayed or reduced loss recognition. ESG engagement serves as a moderating variable to mitigate conditional conservatism losses partially for both accrual- and earnings-based models, conditional on financial anomaly risk; otherwise, ESG engagement has a weak or insignificant effect on market-based models. ESG practice is therefore a state-dependent conditional governor to complement traditional governance structures, depending on both levels of anomaly risk as well as accounting models used to derive conservatism measures. Our findings have practical implications for investors and government regulators, as well as managers, which emphasize that ESG practice is not universally beneficial to conservatism but can further improve reporting quality, conditional on certain risk levels. Full article

The increasing prevalence of cardiovascular diseases highlights the need to develop vascular grafts that match the mechanics of native vascular tissue and offer functional adaptability. This study reports the development and systematic optimization of a shape-memory polyurethane acrylate (PUA)-based photocurable resin for digital light processing (DLP)-based four-dimensional printing (4DP) applications. Resin formulations were designed by controlling hard/soft segment ratios, reactive diluent content, and crosslink density to position the glass transition temperature (T_g) within the physiological range (25–40 °C). Thermomechanical characterization was performed via dynamic mechanical analysis (DMA) and tensile testing, while a full-factorial Design of Experiments (DoE) approach was applied to optimize DLP process parameters—namely layer thickness, exposure time, and post-curing time. The developed resin formulation yielded a T_g of 38 °C as determined by DMA. Following process optimization, regression models showed high statistical fit (R² > 99%), and experimental validation under optimal conditions (layer thickness: 82.83 µm, exposure time: 11 s, post-curing: 2 min) resulted in an elongation at break of 64.0 ± 3.4%, a Young’s modulus of 10.9 ± 0.1 MPa, and a tensile strength of 6.2 ± 0.3 MPa. The optimized system exhibited thermally triggerable shape memory behavior at near-body temperature, with mechanical properties consistent with natural arterial tissue benchmarks. These findings demonstrate a promising material design strategy for DLP-based 4D-printed vascular structures. Full article

There is a well-documented gap between the prescription of adrenaline auto-injectors (AAIs) and their real-world use during anaphylaxis. Although several aspects of AAI underuse have been investigated, the potential role of shelf life in influencing patient adherence has not been quantified. This study assessed the real-world remaining shelf life of AAIs available at pharmacies in Denmark, Finland, Sweden, and Norway, using pharmacy-level stock data and pharmacy employee-reported perceptions. Across Denmark, Finland, and Sweden, the average remaining shelf life was 9.6 months, and in Norway it was 10.5 months at the point of dispensing. In Denmark, Finland and Sweden, 100%, 91%, and 94% of employees, respectively, considered shelf life an important or very important factor when dispensing AAIs to patients. Our findings suggest that patients and caregivers filling prescriptions for AAIs frequently receive devices with limited remaining shelf life, which may necessitate multiple renewals per year. This has potential implications in terms of adherence to clinical guidelines, dependence of expired devices during emergencies, patient cost, caregiver burden, and overall societal expenditure. These results highlight an unmet need for emergency treatment options with longer shelf life to better support continuous access to life-saving medicine during anaphylaxis. Full article

Climate change is increasingly recognized as a source of psychological distress, yet the prevalence, predictors, and behavioral implications of climate anxiety remain unevenly understood. This study examines climate anxiety, its key drivers, and associated behavioral responses in a multi-country sample of adults. A cross-sectional online survey was conducted across 21 countries using the Climate Change Anxiety Scale (CCAS), alongside measures of awareness, coping strategies, social support, and food-related behaviors, including food waste reduction, increased plant-based food consumption, and home or community gardening. Analyses included descriptive statistics, exploratory factor analysis (EFA), and multivariable regression. Given the uneven country-level representation, results are reported as pooled patterns with a few exploratory cross-country comparisons. Climate anxiety was widely reported, with over 60% of participants indicating that climate challenges were emotionally overwhelming. Regression analyses showed that climate awareness and frequency of climate-related thinking were positively associated with higher anxiety, although the effect sizes were small and explanatory power was limited (R² = 0.055). EFA identified two related dimensions: cognitive concern about future impacts and affective distress. Climate anxiety across countries showed modest variation (2.44–3.23) and no statistically significant differences, despite variation in awareness. A gap between concern and climate action was evident: only 39.1% reported environmentally motivated dietary changes. Cost, limited availability, and lack of information were the main barriers to climate action, and only 24.4% reported frequent social support. These findings indicate that climate anxiety is shaped by both psychological and structural factors, and that reducing it requires not only increasing awareness but also enabling conditions that support meaningful climate action. Full article

Background/Objectives: Artificial intelligence (AI) shows promise in supporting mammography interpretation and triaging referrals, potentially enhancing breast screening. However, successful AI integration depends on patient acceptance and trust. This study explores patient and public perceptions of AI in breast imaging and clinical decision-making to identify knowledge gaps and guide communication strategies. Methods: Paper surveys were distributed to women attending the Breast Care Unit at Queen’s Hospital, Burton, and the London Breast Institute between August and December 2025. Demographic data, levels of trust and comfort with AI, and concerns about AI were collected. Responses were analysed using descriptive statistics, Pearson’s Chi-square tests with Cramér’s V and thematic analysis. Results: One hundred and twenty participants completed the survey. Fifty percent would accept AI alongside clinicians for interpretation of mammograms or ultrasound scans, significantly associated with no previous breast cancer diagnosis (p = 0.02; Cramér’s V = 0.22, 2 degrees of freedom (df)) and technological comfort (p < 0.001; Cramér’s V = 0.42, 1 df). Lower acceptance was found among those with prior diagnosis and low comfort with technology. Acceptance of AI-assisted triage (44.5%) was also significantly associated with technological comfort (p = 0.008; Cramér’s V = 0.30, 1 df). Eighty percent reported no knowledge of AI use in breast clinics, and only 37% would trust AI findings. Qualitative analysis identified three themes: (1) clinician oversight as indispensable, (2) the knowledge gap as a barrier to acceptance, and (3) concerns about operational risks and accountability. Conclusions: Although patients were generally receptive to AI, acceptance was conditional on clinician supervision. Limited awareness and concerns about diagnostic accuracy remain barriers to implementation. Educational initiatives should precede widespread adoption to support informed and confident patient acceptance of AI-assisted imaging and decision-making. Full article

Universal adhesives (UAs) exhibit considerable versatility; however, no single commercial product has attained recognition as a clinical gold standard. This study evaluated the functional performance, retention, and marginal integrity of various UA brands in non-carious cervical lesion (NCCL) restorations and examined the effects of different adhesion strategies. A search of electronic databases was conducted for randomized clinical trials (RCTs) published between 2015 and 2025. Only RCTs that assessed the retention and marginal integrity of UAs with follow-ups of 18–48 months, using the USPHS/FDI criteria, were included. This review was registered with PROSPERO (CRD420251026490) and adhered to PRISMA 2020 and PICOS guidelines. Risk of bias was evaluated using the RoB 2 tool; statistical significance was defined as p < 0.05. Of 251 records screened, 23 met the eligibility criteria, resulting in the inclusion of 21 RCTs. Sixteen UA brands exhibited no clear differences in performance outcomes. Etch-and-rinse (ER) and selective enamel-etching (SEE) strategies achieved higher retention rates (median up to 100%; USPHS, p < 0.001), while the self-etch (SE) approach demonstrated lower and more variable retention (median 87.0%). Marginal integrity remained consistently high across all strategies (median 100%; p > 0.05). Although ER and SEE strategies significantly enhance long-term retention, no UA brand showed consistent superiority to be considered a gold standard. Full article

Community disaster resilience is increasingly guiding risk-reduction investments, but in many Southeast European settings, comparable subnational data remain scarce. This study assesses perceived community disaster resilience across Serbia by combining BRIC–DROP dimensions into a single index and analyzing differences across hazard types and sociodemographic factors. A cross-sectional household survey was conducted using multistage random sampling and the “next birthday” method for respondent selection. The final sample included 1200 adults from 22 local government units across four regions: Belgrade, Vojvodina, Šumadija & Western Serbia, and Southern & Eastern Serbia. Participants evaluated preventive measures and societal resilience for ten hazard types and considered five social dimensions: social structure, social capital, social mechanisms, social equity/diversity, and social beliefs. Descriptive statistics, bivariate analyses (including Pearson correlations, t-tests, and ANOVA), and multiple linear regression identified key predictors of preventive behavior and perceived resilience. Composite scores highlighted spatial resilience differences. Overall perceptions were generally low, mostly falling below the midpoint of the scale. Furthermore, the highest ratings for implemented preventive measures were recorded for pandemics/epidemics, storms/hail, and floods, whereas the lowest were observed for environmental pollution and droughts. Perceived resilience was highest for snowstorms, storms/hail, and pandemics/epidemics, and lowest for environmental pollution and droughts. Also, respondents reported relatively strong family ties and favorable perceptions of communication and access to basic supplies, but weak institutional capacity, particularly in budget allocation, early warning and public notification, rapid decision-making, and evacuation and shelter readiness. Regression results were statistically significant but explained only a small portion of the variance. Age and public-sector employment positively predicted perceived resilience; fear, income, and, to a lesser extent, education were negatively associated. These findings highlight the structural and psychosocial factors that shape perceptions of resilience. The BRIC–DROP composite indicates generally low perceived preparedness and resilience, especially in risk communication, evacuation and shelter readiness, and financing—the key bottlenecks in strengthening local resilience. The results recommend combining institutional reform with targeted risk communication to reduce fear and build trust, especially focusing on hazard areas with the lowest confidence, such as environmental pollution and drought. Full article

Background: Green logistics requires decision-support approaches that jointly address cost efficiency, emissions reduction, service reliability, and reporting transparency under dynamic operating conditions. Existing studies often treat optimization, predictive updating, stakeholder coordination, and emissions traceability separately, limiting integration. Methods: This study develops a simulation-based integrated decision-support framework that combines multi-objective mixed-integer linear programming (MILP), machine learning-based travel-time prediction in a rolling-horizon setting, cooperative allocation using a Shapley value mechanism, and ISO 14083:2023-aligned emissions accounting. A permissioned blockchain layer is included as a post-decision governance mechanism to support traceability. The framework is evaluated using industry-calibrated synthetic scenarios over a 30-day planning horizon with 50 independent simulation runs. Results: Under the tested scenarios, the integrated configuration reduced average CO₂ emissions per route by 27.6% (±2.4%), improved the cost index by 17.3% relative to the baseline, and increased on-time delivery to 96.8%. Robustness analyses showed average key performance indicator (KPI) deviations below 5%. Component-level analysis suggests that the main operational gains arise from the interaction between predictive updating and prescriptive optimization, while the blockchain layer mainly improves auditability. Conclusions: The framework improves environmental and operational performance under the tested simulation scenarios, although real-world validation remains necessary before deployment-level conclusions can be drawn. Full article

Background/Objectives: A non-surgical orthodontic treatment strategy for transverse maxillary deficiencies, especially in late adolescents and young adults, is microscrew-assisted rapid palatal expansion (MARPE). The literature indicates several concerns regarding its long-term efficacy and potential complications. Recent studies have provided valuable insights into the MARPE technique, particularly focusing on its efficacy, potential complications, and treatment failures. The present scoping review aims to synthesize and critically appraise clinical evidence on MARPE in post-pubertal patients, with a specific focus on treatment outcomes, mechanisms of failure, and local and systemic adverse effects to inform risk–benefit assessment and clinical decision-making. Methods: A systematic search was conducted across four electronic databases (PubMed, EMBASE, Scopus, and Cochrane Library) to identify English-language clinical trials, observational studies, and systematic reviews published between January 2015 and December 2025. The search strategy employed controlled vocabulary (MeSH terms) and Boolean operators targeting MARPE, treatment failure, and adverse effects in patients aged ≥ 16 years. After title/abstract screening and full-text assessment using predetermined inclusion criteria, 15 studies (3 systematic reviews with meta-analysis, 2 umbrella reviews, 4 systematic/scoping reviews, 2 randomized controlled trials, and 4 observational studies) were selected for qualitative synthesis. Results: Fifteen studies were finally included, which demonstrated significant heterogeneity in methodological design, sample characteristics, outcome measurement protocols, and MARPE device specifications. Mean success rates of 92.5% for maxillary transverse expansion were reported, with mean expansion duration ranging between 20 and 126 days. Key adverse effects comprised dentoalveolar tipping (buccal inclination of maxillary molars and premolars), periodontal complications (buccal bone resorption of 0.6–0.9 mm, gingival recession, papilla recession in 18% of cases), root resorption, miniscrew loosening, midpalatine/circummaxillary sutures, and potential but minimally documented intracranial effects. Conclusions: MARPE appears to be a valid non-surgical option for selected post-pubertal patients, but its success depends on careful case selection and monitoring for dentoalveolar, periodontal, sutural, and rare intracranial adverse effects. Full article

Previous studies indicate that the main predictors of stress-related disorders in firefighters are pre- and post-trauma factors, rather than intensity or type of traumatic event. This study aimed to identify risk and protective factors contributing to the development of Post-Traumatic Stress Disorder (PTSD) and other stress-related conditions in Portuguese firefighters who battled the 2017 forest fires. To assess the prevalence of PTSD and related conditions, a set of self-report measures—including PHQ-15 (somatic symptoms), PCL-5 (PTSD), PSQI (sleep quality), and DASS-21 (depression, anxiety, stress)—was completed by 96 firefighters and 96 individuals from the general population, who served as a comparison group. In addition, semi-structured interviews were conducted with 79 firefighters, focusing on their perceptions of PTSD, exposure to duty-related traumatic events, and coping strategies employed to manage stress. Findings indicated that firefighters reported higher levels of somatic symptoms, sleep disturbance, and PTSD than the general population. Organizational support, working conditions, professional experience and training were identified as protective factors, while a sense of belongingness and peer relationship were considered resources for managing stress reactions. Firefighters also associated social and media pressures with the development or exacerbation of stress-related symptoms. Collectively, these results highlight the relevance of both subjective and contextual factors and may inform prevention, intervention, and treatment strategies for stress-related psychopathologies. Full article

Background: During the early years of the coronavirus disease 2019 (COVID-19) pandemic, many schools found their staff, specifically teachers, adapting their roles to address social and health challenges, such as food insecurity and health literacy. Given the challenges these school-based communities faced, and continue to face, a clear gap was exposed during these early years of the public health crisis: a lack of community-centered professionals who can assist with social health factors impacting health and well-being. Methods: In this descriptive report, we examine the process and implementation of training two teachers to become community-centered professionals, specifically community health workers (CHWs), to serve schools located in socioeconomically challenged neighborhoods of urban regions. We explore their training and how these CHW–teachers prescribed social health interventions across four major domains: (a) access to medical and environmental equipment, (b) mental health challenges, (c) food insecurity, and (d) health literacy. We describe the specific interventions they implemented and the potential economic value and practicality of the overall initiative. Outputs: In less than one year, two teachers were successfully trained as CHWs in and for underserved communities. These CHW–teachers conducted informal surveys based on objectives of health themes that aligned with absenteeism. Both the process and implementation of the CHW training and CHW-led school-based interventions proved cost-effective and practical. Conclusions: Having CHW–teachers in schools is practical, may offer economic value, and is likely to complement additional health initiatives at schools (e.g., school nurses). As a small-scale pilot initiative, further studies should evaluate CHW–teacher impact on school-based goals, such as attendance rates, while this report focuses on early implementation processes. Full article

Childhood absence epilepsy (CAE) is one of the most common epilepsy syndromes in childhood and has traditionally been regarded as a condition with a favorable neurological prognosis. However, increasing evidence suggests that CAE is associated with functional disturbances in neuronal networks that extend beyond seizure generation and may involve sleep and wakefulness regulation. Methods: This narrative mini-review summarizes and critically discusses current clinical and neurophysiological evidence regarding alterations in sleep architecture and sleep electroencephalographic (EEG) microstructures in children with CAE, based on a focused analysis of selected clinical and observational studies. Results: The available data suggest that children with CAE, particularly before treatment initiation, may exhibit sleep macrostructure abnormalities, including reduced total sleep time, prolonged rapid eye movement sleep latency, increased arousal frequency, and decreased sleep efficiency. In addition, changes in sleep microstructure have been reported, most notably reduced sleep spindle density during stage-N2 sleep, especially in patients with concomitant cognitive impairment. These findings may reflect alterations in thalamocortical network function, although current evidence remains limited and heterogeneous. Conclusions: Sleep disturbances appear to represent an important component of the clinical phenotype of childhood absence epilepsy. Assessing the sleep architecture and sleep EEG microstructure, particularly sleep spindles, may provide insights into network dysfunction and cognitive vulnerability; however, further studies are needed to clarify their clinical utility. Full article

Carbonic anhydrase VA (CA5A) deficiency (OMIM 615751) is an ultra-rare inborn error of metabolism, presenting in newborns, infants, and young children with a pentad of encephalopathy, hyperammonemia, lactic acidosis, ketonuria, and hypoglycemia. We present two cases: a case of a healthy Bedouin infant admitted with hyperammonemic encephalopathy that required urgent hemodialysis, and her younger sibling, who presented with a milder episode. Molecular analysis confirmed the diagnosis of CA5A deficiency due to a homozygous missense variant in the CA5A gene. Both patients had a favorable outcome with continued normal development. These were the first identified cases of CA5A deficiency in the Bedouin population, emphasizing the importance of a high index of suspicion, early genetic consultation and diagnosis, and prompt treatment at the earliest possible stage of a hyperammonemic crisis. Full article