Search Results (608)

Background/Objectives: Birooted mandibular canines are a rare but clinically significant variation that is often underdiagnosed and may complicate dental treatment. The aim of this review was to conduct a comprehensive meta-analysis to estimate the prevalence of birooted and multirooted mandibular canines, and to address the research question of whether geographical region, sex, or side predilections significantly influence these anatomical variations. Methods: A systematic search was performed on 4 September 2025 across five databases: BASE, Scopus, PubMed, DOAJ, and Scielo. Studies on permanent mandibular canines with at least 10 cases, assessed radiologically or in vitro, were included. Reports without detailed root number data or based only on two-dimensional imaging were excluded. Meta-analysis estimated prevalence and odds ratios by sex and geographic region, with results shown in tables and graphs. Risk of bias was assessed using the Joanna Briggs Institute appraisal tools. Results: Eighteen studies met the inclusion criteria, of which seventeen were classified as population studies and one case as a series. The pooled prevalence of birooted mandibular canines was 2.71%. A female predilection was statistically significant in four modern cohorts. Only one case of a three-rooted mandibular canine was documented. No clinical outcome data were available regarding endodontic success or extraction complications. Conclusions: Birooted mandibular canines represent a relatively common anatomical variant, especially in females and on the right side of the jaw. However, clinical implications related to treatment outcomes remain underreported, emphasizing the need for future clinical and radiological investigations. Full article

Background/Objectives: Physical restraints and seclusion remain ethically contested interventions in psychiatric care, raising significant concerns regarding patient safety, dignity, and therapeutic impact. Despite growing international momentum towards restraint-reduction strategies, their use persists across the Eastern Mediterranean Region (EMR), an area that has been the subject of limited systematic attention. This review synthesises evidence on the knowledge, attitudes, and experiences of nurses and individuals with mental illness regarding these practices in EMR psychiatric settings. Methods: Following PRISMA 2020 guidelines (PROSPERO: CRD42023383751), we systematically searched nine electronic databases for studies published up to June 2023, supplemented by backward and forward citation searching. Multiple reviewers independently screened records against predefined eligibility criteria, with disagreements resolved through consensus. Methodological quality was assessed using Joanna Briggs Institute (JBI) Critical Appraisal tools, and reporting quality was evaluated using an adapted CROSS checklist; these two appraisal dimensions were conducted and reported independently. Findings were integrated through narrative synthesis. Results: From 4634 identified records, 19 studies conducted across 11 EMR countries met the inclusion criteria. Nursing knowledge deficits were identified across multiple settings, and attitudes towards restraint practices were predominantly negative. Individuals with mental illness consistently described restraint as humiliating, punitive, and physically distressing. Recurrent challenges identified across studies included inadequate staff training, chronic understaffing, and limited access to restraint-reduction alternatives. Conclusions: Substantial gaps in nursing knowledge and training persist across the EMR. The findings of this review, while derived predominantly from cross-sectional studies with convenience samples, suggest that evidence-based education programmes, standardised restraint-reduction policies, and patient-centred care frameworks warrant prioritisation to safeguard the rights, safety, and dignity of individuals with mental illness in this region. Longitudinal and experimental research is needed to confirm these directions and establish their effectiveness within EMR contexts. Full article

Background/Objectives: Trauma management in emergency departments (EDs) requires rapid and reliable diagnostic tools. The Focused Assessment with Sonography in Trauma (FAST) is a bedside ultrasound examination used for the early detection of free fluid in the intraperitoneal cavity, pericardium, and pleural spaces. Expanding FAST use to trained emergency nurses may support timely bedside evaluation in high-demand settings. However, data on agreement with physicians remains limited. This study aimed to evaluate the inter-rater agreement between a trained emergency nurse and physicians in performing FAST and to explore the diagnostic accuracy of nurse-performed FAST compared with computed tomography (CT). Methods: A prospective pilot observational agreement study was conducted between October and December 2023 in the ED of a general hospital in Cyprus. FAST examinations were independently performed by a nurse trained in FAST and by physicians from the radiology department. Four anatomical areas were assessed: right upper quadrant (RUQ), left upper quadrant (LUQ), subxiphoid-pericardial area (SUPH), and suprapubic area (BLADDER). Findings were recorded independently to promote blinding. Diagnostic performance of nurse-performed FAST was explored in a subset of patients undergoing CT. Results: The sample included 68 trauma patients, of whom 58 underwent FAST by both the nurse and the radiologists and were included in the inter-rater agreement analysis. Fluid was detected in four patients (6.9%) in the RUQ area and in one patient (1.7%) in both the LUQ and SUPH regions, while no positive findings were recorded in the BLADDER area. Agreement in the RUQ area was 98.3% (Cohen’s kappa = 0.85, p < 0.001) while agreement was observed in all cases in the SUPH region (100%, Cohen’s kappa = 1.00, p < 0.001), although this finding was based on a single positive case. High observed agreement was also noted in LUQ (98.3%) and BLADDER regions; however, Cohen’s kappa could not be reliably estimated in these regions due to limited variability and the very small number of positive cases. In a subgroup of patients who underwent CT (n = 23), as well as in an additional Trauma Team subgroup (n = 10), diagnostic accuracy estimates were 100% for sensitivity and specificity; however, these estimates were based on a very small number of positive cases (only two positive cases in each subgroup) and were associated with wide confidence intervals. Conclusions: This pilot study suggests that, under specific training conditions, a trained emergency nurse may achieve a high level of agreement with physician assessments when performing FAST. The findings regarding diagnostic accuracy are preliminary and should be interpreted with caution due to the small sample size and low number of positive cases. Further studies with larger samples and multiple operators are required to confirm these findings and to evaluate their clinical implications. Future research is also needed to determine whether nurse-performed FAST may contribute to improved patient safety and emergency department workflow. Full article

Background: Preterm birth, the leading cause of neonatal mortality, is associated with reduced nephron endowment and an increased risk of kidney disease in later life. In preterm infants, the interruption of nephrogenesis leads to a lower nephron number and structural abnormalities. Prenatal factors such as intrauterine growth restriction, and postnatal factors including nephrotoxic medications, patent ductus arteriosus, perinatal asphyxia, and infections contribute to this deficit. Ultrasound is a key tool for assessing renal volume at birth and can, when indexed to body weight, be used to estimate nephron endowment, which is known to vary widely among individuals. Methods: This study analyzed 52 preterm infants with birth weight < 1000 g, assessing combined renal volume (sum of right and left kidney volumes) indexed to body weight. Results: The mean combined kidney volume-to-body weight ratio was 12.12 (SD = 2.03). Values below the 10th percentile (9.46) or more than one standard deviation below the mean (10.11) may indicate nephron deficiency at birth. Conclusions: Standardized ultrasound-based parameters enable the early identification of neonates at risk for nephron deficit, supporting targeted preventive strategies. Long-term follow-up is essential to detect early renal functional impairment and reduce the risk of chronic kidney disease. Full article

Amid Europe’s demographic decline and the intensifying global “war for talent,” migration is increasingly viewed as a critical source of human capital capable of sustaining economic growth and welfare systems. Nevertheless, the literature on Macro-Talent Management (MTM) has primarily focused on the attraction of highly skilled expatriates, paying limited attention to how national integration systems shape the broader capacity of countries to attract and retain migrant talent. Addressing this gap, the present study conceptualizes migrant integration as a strategic component of macro-level talent management and evaluates the “talent attractiveness” of different European welfare and migration regimes. Methodologically, the study develops a multi-criteria evaluation framework based on the PROMETHEE II (Preference Ranking Organization Method for Enrichment of Evaluations) outranking method, enabling the simultaneous assessment of institutional, socio-economic, and administrative dimensions of migration governance. The model integrates nine indicators combining policy inclusiveness (e.g., Migrant Integration Policy Index—MIPEX (Migrant Integration Policy Index), citizenship accessibility), labor market outcomes (employment and gender gaps), and systemic pressures on migration management (asylum applications). By integrating policy indicators with real-world labor market performance and administrative capacity, the proposed framework offers a novel analytical tool for comparative migration policy evaluation and decision support. The empirical application covers six European countries representing distinct migration regimes: Portugal, Sweden, France, Poland, Greece, and Germany. The results challenge the conventional assumption that economic strength alone determines migrant attractiveness. Portugal emerges as the most attractive destination, demonstrating that inclusive rights-based integration policies can offset lower GDP levels. In contrast, Germany ranks last in the sample, revealing signs of systemic overextension due to extreme administrative pressure, while Greece occupies the fifth position characterized by structural integration deficits. The study contributes to the literature by linking migration governance, integration policy effectiveness, and macro-level talent management and by introducing a multi-criteria decision-analytic approach for evaluating national migration systems in Europe. The study offers a reassessment of the ‘talent attractiveness’ of European welfare models in a post-pandemic context (2023). Full article

Carotid artery disease, including atherosclerotic stenosis and non-atherosclerotic abnormalities, substantially increases ischemic stroke risk and motivates accessible tools for early screening. Current diagnostic pathways rely on clinic-based imaging and skilled operators, creating barriers to frequent monitoring and scalable deployment. We present a non-invasive diagnostic approach using a wearable MEMS accelerometer patch to capture mechano-acoustic vibrations generated by carotid blood flow at the neck. The miniature device integrates a hermetically sealed wideband accelerometer with out-of-plane sensitivity and micro-g resolution to detect subtle flow-induced vibrations. We validated the approach in a carotid flow phantom and a clinical study of 74 patients. Time–frequency representations were computed using the continuous wavelet transform (CWT), from which interpretable spectral and scalogram-derived candidate biomarkers were extracted. Six non-redundant features were then selected for multivariate classification, distinguishing pathology, defined as 50% or greater stenosis or a non-atherosclerotic abnormality, from non-pathology, defined as less than 50% stenosis. Finally, model interpretability was assessed using SHapley Additive exPlanations (SHAP) to quantify the contribution of each biomarker to predicted disease probability. These findings resulted in an AUROC of 0.97 and AUPR of 0.947, with 81.7% sensitivity and 93.6% specificity at the prespecified threshold (precision 85.4%, F1 83.5%, accuracy 89.8%), highlighting the potential of wearable seismic sensing combined with interpretable machine learning for fast screening and longitudinal monitoring of the right and left carotid arteries. Full article

The incorporation of digital technologies has transformed Social Work, generating new demands in terms of professional competencies. It is worth questioning whether, in contexts as sensitive as social services, the mere acquisition of instrumental mastery of these tools is sufficient to ensure safe practice. Considering that the level of proficiency with these tools is influenced by age, the aim of this study is to conduct a comparative analysis of the digital competence levels of social work professionals and students in order to contrast the skills and shortcomings of both groups. To achieve this, a quantitative methodological design was employed using questionnaires based on the European DigComp 2.2 framework. The sample included 451 professionals from Spain and 171 students from the University of Huelva, whose data were processed using statistical software (SPSS 27). The results show that students display a higher overall level of digital competence, particularly in the creation of digital content and the use of artificial intelligence tools. Professionals, on the other hand, demonstrate stronger competencies in digital security and data literacy. The findings reveal a clear complementarity between the two groups, highlighting an opportunity for mutual feedback and learning that can help combine technological efficiency with ethical responsibility and respect for human rights. Full article

Application Tracking Systems (ATSs) have evolved significantly since their inception in 1996, transitioning from simple resumérepositories to AI-driven tools with advanced capabilities. While these developments have improved recruitment efficiency, they have also raised important ethical, organizational, and human-rights-related concerns. Bias in machine learning (ML) training data, opaque decision criteria, and excessive reliance on automated judgment may contribute to unfair treatment, reduced transparency, and limited human oversight in hiring processes. This study addresses these challenges by proposing a human-centered approach to ATS-supported recruitment based on a set of Humanization Services. Using a Design Science Research approach, three main artifacts were developed: a Job Requirements Validation Module, a Bias Trigger Removal Module, and a blockchain-supported dual-authorization mechanism for vacancy approval, which requires digital signatures from qualified professionals to approve job postings, ensuring that there are humans that assume responsibility. These components are intended to improve job posting quality, reduce bias-conducive information in applicant data, and strengthen accountability in recruitment workflows. The evaluation provides initial empirical support for the operational feasibility of the proposed approach under the tested conditions. The study therefore contributes a practical and theoretically grounded step toward more transparent, accountable, and human-centered AI-supported recruitment. Full article

Acute pulmonary embolism (PE) is increasingly managed as a dynamic risk continuum in which imaging findings guide therapeutic escalation rather than merely confirm diagnosis. The principal challenge still remains normotensive patients with intermediate–high-risk features, where early right ventricular (RV) dysfunction may precede overt hemodynamic collapse. New trends focus on a trajectory-based model by integrating clinical, laboratory, and standardized imaging parameters into severity categorization. This review critically examines how imaging-derived markers influence risk stratification, escalation timing, and endovascular decision pathways in contemporary PE management. A structured narrative review was conducted focusing on the literature published between January 2020 and January 2026. PubMed/MEDLINE, Scopus, and Web of Science were searched for studies addressing imaging-based risk assessment, catheter-based reperfusion strategies, randomized trials, prospective registries, and guideline documents. Contemporary data consistently demonstrate that catheter directed therapies (CDTs) lead to rapid improvement in RV imaging surrogates and hemodynamic parameters. However, short-term mortality differences are uncommon in predominantly normotensive cohorts. Clinically meaningful signals instead emerge in the reduction in early clinical deterioration, the need for rescue escalation, bleeding optimization, and healthcare resource utilization. Imaging, as standardized reporting of RV strain on computed tomography pulmonary angiography and echocardiography, should be further embedded into escalation algorithms. In modern PE care, imaging functions as a trigger for escalation within multidisciplinary pathways rather than as a passive prognostic marker. CDTs should be interpreted as tools for trajectory modulation in selected intermediate-risk patients rather than mortality-reduction strategies. Future research should integrate imaging phenotyping, dynamic reassessment models, and organizational variables to refine patient selection and optimize outcome-relevant endpoints. Full article

This article formulates guidelines for the transactional regulation of surrogacy in Colombia, based on a comparative analysis with the Mexican regulatory model, especially in the states of Tabasco and Sinaloa. To this end, a qualitative methodology was adopted by applying the technique of comparative law to simultaneously analyze the regulations of the focused Mexican states and the most recent (now shelved) initiative in Colombian law, identifying significant contributions to national progress in surrogacy through the theory of legal transactions, the principle of solidarity, and the right to found a family. The results show that, although Colombia had tried to progress in recognizing procreative will as the basis for filiation and has attempted regulatory adjustments to the civil registry, serious regulatory gaps persisted in the design of post-contractual mechanisms, especially regarding the prevention of human trafficking, the well-being of gestational carriers, institutional monitoring, and the guarantee of breastfeeding. The conclusions show that effective regulation should not focus exclusively on formalizing agreements between adults but should also guarantee the fundamental rights of the child from birth. In contrast, the Mexican model offers valuable tools to enrich the Colombian debate, but it also has some shortcomings that warrant revision. Therefore, this study contributes to the Colombian legislative discussion by calling for comprehensive regulation guided by the dignity of all the involved subjects and based on comparative experiences. Full article

Background: In rehabilitation medicine, efficient gait analysis is crucial for evaluating postoperative recovery and frailty, especially given the increasing burden on clinicians due to an aging population. Objectives: This study aims to conduct preliminary validation of an automated linear walking evaluation system using 2D AI posture tracking. By evaluating the basic accuracy of the system on healthy individuals, we aim to establish a technical foundation for future introduction into clinical rehabilitation settings. Methods: In this observational study, we utilized a standard visible light camera for practical use. To evaluate accuracy, we compared 2D AI tracking against a gold-standard three-dimensional (3D) motion capture system during normal walking trials with 10 healthy participants. Specifically, we employed Dynamic Time Warping (DTW) to temporally align the asynchronous data streams from the 2D and 3D systems, ensuring precise comparison of joint angles. Results: Following the DTW-based alignment, the similarity with the 3D system was 0.806 ± 0.094 overall (Left: 0.797 ± 0.101, Right: 0.814 ± 0.086). Conclusions: In this preliminary validation, the proposed 2D AI posture tracking showed good agreement with the gold standard 3D motion capture for gait in healthy individuals. While the average systematic bias was within clinically acceptable limits, the observed limits of agreement suggest that this system is currently optimal as a foundational tool for gait screening. These results establish a technical foundation for the clinical application of this system. Full article

Introduction: Nerve-sparing (NS) during robot-assisted radical prostatectomy (RARP) plays a critical role in postoperative functional recovery, particularly urinary continence and erectile function. Despite the importance of precise neurovascular bundle (NVB) preservation, intraoperative assessment of NS quality remains largely subjective and lacks standardized evaluation tools. The aim of this study was to develop and preliminarily evaluate a structured intraoperative scoring system designed specifically for assessing NS quality during RARP. Methods: A novel 10-point intraoperative NS scoring system (NSQ Score) based on five domains was developed: dissection plane, bleeding control, bundle manipulation, continuity of dissection, and symmetry. Each parameter was rated on a 0–2 scale. Thirty robot-assisted radical prostatectomy (RARP) procedures performed in 2024 were randomly selected from a prospectively maintained institutional surgical video archive. Cases were not pre-filtered based on tumor stage, surgical difficulty, or intraoperative complexity. High-definition video recordings of the nerve-sparing phase were anonymized and independently evaluated by three experienced observers blinded to patient outcomes and to each other’s assessments. Inter-rater agreement was analyzed using weighted Cohen’s kappa statistics with quadratic weights, complemented by exact and near-agreement proportions. Cluster bootstrap resampling was applied to account for bilateral observations. Results: A total of 48 evaluable observations were analyzed. The overall inter-rater agreement demonstrated a weighted kappa of 0.41 (95% CI 0.36–0.48), indicating fair-to-moderate agreement among reviewers. Exact agreement occurred in 43% of observations, while near-agreement (allowing one ordinal level difference) reached 98%. Among individual parameters, symmetry demonstrated the highest reliability with substantial agreement (κ = 0.70; 95% CI 0.58–0.81). Other domains showed fair agreement, including intraoperative bleeding (κ = 0.36), continuity of dissection (κ = 0.39), bundle manipulation (κ = 0.34), and dissection plane (κ = 0.27). Agreement levels were comparable between left- and right-sided dissections. Conclusions: We propose a novel structured intraoperative scoring system for evaluating nerve-sparing quality during RARP. The scale is simple, procedure-specific, and feasible for structured postoperative or video-based assessment. Preliminary results demonstrate fair-to-moderate inter-rater reliability with very high near-agreement, supporting the feasibility of this tool for clinical use. The proposed scoring system may facilitate standardized training, objective performance assessment, and future studies correlating intraoperative NS quality with functional outcomes. Full article

Forest Rights Mortgage Loans (FRMLs) have grown quickly in China’s collective forest areas, even though the basic conditions for this type of lending remain far from ideal. In many places, forest holdings are small and scattered, property rights are complex and not fully consolidated, and channels for disposing of collateral are limited. Under these circumstances, the Fulin Loan Model (FLM) in Fujian provides a useful case for understanding how forest-rights lending can still function in practice. Drawing on fieldwork, semi-structured interviews, and process tracing, this study explores both how the model was established and how it has been sustained over time. The analysis suggests that the FLM is neither a straightforward market-based lending tool nor merely a top-down policy arrangement. Rather, it relies on a more mixed form of governance in which local government support, banking procedures, and village-level social relations are brought together through specific organizational arrangements. These arrangements help lower the costs of early institutional experimentation, distribute and manage lending risks, and translate locally rooted trust into a form of credit support that formal financial institutions can recognize. As a single-case study, the FLM points to one possible way in which rural finance can be made workable under conditions of incomplete markets and strong social embeddedness. Full article

Background: Owing to significant clinical heterogeneity, the achievement of accurate survival forecasting for individuals with colorectal cancer and peritoneal metastasis continues to be a complex undertaking. We aimed to transcend traditional prognostic limitations by evaluating machine learning boosting models against standard regression-based methods in terms of estimating overall survival (OS). Methods: Utilizing a multi-institutional registry of 150 patients diagnosed with synchronous peritoneal metastasis of colorectal cancer, we integrated 124 clinicopathological variables to refine our predictive models. Beyond standard preprocessing—including standardization and median imputation—we rigorously compared XGBoost and LightGBM against Ridge, Lasso, and linear regression via five-fold cross-validation. To specifically address right-censoring, an XGBoost Cox model was implemented and validated using Harrell’s C-index, with SHAP and LIME providing essential model interpretability. Results: Boosting models consistently outperformed linear alternatives, which struggled with high error rates and negative R2 values. Specifically, XGBoost achieved an MAE of 475 ± 60 and an RMSE of 585 ± 88. The XGBoost Cox model reached a C-index of 0.64 ± 0.06. SHAP analysis highlighted inflammatory markers and peritoneal disease extent as the most influential prognostic drivers. Conclusions: While boosting models offer a clear accuracy advantage over linear methods, their prognostic power remains moderate. These findings underscore the potential of ensemble learning in oncology, yet mandate external validation before these tools can be integrated into clinical decision-making. Full article

Background: Cardiac implantable electronic device (CIED) lead perforation is a rare but potentially catastrophic complication. As global device implantations increase, understanding the clinical spectrum and optimal management of this complication is essential. This study characterizes the clinical presentation, diagnostic strategies, and outcomes of lead perforation over a 25-year period. Methods: A retrospective analysis was conducted on 32 patients diagnosed with CIED lead perforation between 2000 and 2025 at a high-volume center. Perforations were classified by timing: acute (<24 h), subacute (1–30 days), and chronic (>30 days). Data included demographics, comorbidities, imaging modalities, and procedural interventions. Results: The mean patient age was 76.0 ± 11.7 years, with a mean body mass index (BMI) of 25.5 ± 3.4 kg/m². Subacute presentation was the most frequent (59.3%, n = 19), followed by acute (28.1%, n = 9) and chronic (12.5%, n = 4) cases. The right ventricle was the primary site of perforation (90.6%). While chest X-rays served as an initial screening tool in 62.5% of cases, diagnosis relied on multimodal imaging, with Computed Tomography (CT) providing definitive confirmation in 31.3% of the cohort, particularly when lead parameters remained stable. Management was risk-stratified based on hemodynamic status. The majority of patients (71.9%, n = 23) underwent successful transvenous lead removal via simple traction. However, 25% (n = 8) presented with hemodynamic instability, and 21.9% (n = 7) suffered from cardiac tamponade. These high-risk cases required surgical intervention, including sternotomy (n = 4), thoracotomy (n = 2), or pericardiotomy (n = 3). Notably, 62.5% of hemodynamically unstable patients were on oral anticoagulants. All patients survived to discharge, with no in-hospital mortality. The median length of hospital stay was 3 days. Conclusions: CIED lead perforation often presents subacutely with subtle clinical signs. CT imaging has emerged as the gold standard for definitive diagnosis. While percutaneous transvenous removal is safe and effective for stable patients, immediate surgical backup is vital, as patients—particularly those on anticoagulation—can deteriorate rapidly. Full article