Search Results (2,289)

Increasing healthcare demands and physician shortages have prompted many countries to expand clinical responsibilities of pharmacists. Although Canada, the UK, and the US have implemented pharmacist prescribing, other nations lag behind. This review compares international roles, identifies inferred competencies, and explores implications for role expansion. A systematic search of MEDLINE, CINAHL, and the Cochrane Library was conducted using the PICO framework; studies were appraised with Critical Appraisal Skills Programme (CASP) checklists, and interrater reliability assessed via Cohen’s Kappa. Data from 23 studies were thematically synthesized following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Four themes emerged: (1) expanding clinical and public health roles and pharmacists’ self-perceived readiness; (2) regulatory frameworks defining legal authority, qualifications, and temporary pandemic exemptions; (3) inferred competencies, including micro-skills (patient assessment, guideline application) and macro-capabilities (clinical judgment, accountability, reflective practice); and (4) contextual barriers such as training gaps, limited funding, unclear legal provisions, and workflow challenges. Implementation implications were synthesized and included training, funding, acceptance, and integration. Evidence indicates pharmacist prescribing is safe and patient-centered when supported by regulation, structured training, and systemic integration. Insights from established models can guide incremental implementation, optimizing medication management, enhancing healthcare access, and promoting equitable care. Full article

This study proposes a Transformer–NSGA-III multi-objective optimization framework for high-rise residential buildings in Haikou, a coastal city characterized by a hot summer and warm winter climate. The framework addresses four conflicting objectives: Annual Energy Demand (AED), Predicted Percentage of Dissatisfied (PPD), Global Cost (GC), and Life Cycle Carbon (LCC) emissions. A localized database of 11 design variables was constructed by incorporating envelope parameters and climate data from 79 surveyed buildings. A total of 5000 training samples were generated through EnergyPlus simulations, employing jEPlus and Latin Hypercube Sampling (LHS). A Transformer model was employed as a surrogate predictor, leveraging its self-attention mechanism to capture complex, long-range dependencies and achieving superior predictive accuracy (R² ≥ 0.998, MAPE ≤ 0.26%) over the benchmark CNN and MLP models. The NSGA-III algorithm subsequently conducted a global optimization of the four-objective space, with the Pareto-optimal solution identified using the TOPSIS multi-criteria decision-making method. The optimization resulted in significant reductions of 28.5% in the AED, 24.1% in the PPD, 20.6% in the GC, and 18.0% in the LCC compared to the base case. The synergistic control of the window solar heat gain coefficient and external sunshade length was identified as the central strategy for simultaneously reducing energy consumption, thermal discomfort, cost, and carbon emissions in this hot and humid climate. The TOPSIS-optimal solution (C = 0.647) effectively balanced low energy use, high thermal comfort, low cost, and low carbon emissions. By integrating the Energy Performance of Buildings Directive (EPBD) Global Cost methodology with Life Cycle Carbon accounting, this study provides a robust framework for dynamic economic–environmental trade-off analyses of ultra-low-energy buildings in humid regions. The work advances the synergy between the NSGA-III and Transformer models for high-dimensional building performance optimization. Full article

Multidimensional approaches to understanding the daily lived experiences and well-being among spousal dyads, where one partner has diagnosed mild cognitive impairment (MCI) and the other serves as an informal caregiver, is a relatively unexplored area of research. This study examined contextual day-to-day patterns of spousal dyads’ caregiver burden, depressive affect, stress, relationship mutuality, sleep, and cognition from the perspective of both dyad members. For 14 consecutive nights, 27 dyads (n = 54 individuals) completed online daily diary forms. The forms included self and informant reports about daily caregiver burden, depressive affect, stress, dyadic interactions, memory, and sleep quality. Exploratory multilevel modeling was performed to understand how daily fluctuations among these aspects of everyday living for both dyad members were associated. Mutuality emerged as an important moderator for caregiver burden and depressive affect outcomes, underscoring the significance of the relationship between care recipients with MCI and their caregivers. Sleep debt was also associated with contagion effects among partners’ depressive affect, stress, mutuality, and cognition. The present study demonstrates the value of multifaceted investigations that account for contextually relevant factors using daily repeated measures with both dyad members to better understand the MCI caregiver experience. Larger, more diverse samples are needed for generalizability of findings. Full article

Background/Objectives: Anxiety and depression are prevalent global health concerns, especially prominent in vulnerable groups such as older adults, individuals with chronic health conditions (e.g., neurodegeneration and cancer), and those from low socioeconomic backgrounds. Digital interventions, including computerized cognitive training (CCT), show promise in addressing emotional dysfunctions in a more accessible and cost-effective manner. The CREATE platform aims to enhance Emotion Regulation (ER) through targeted Working Memory (WM) training, aesthetic engagement, and creativity, while accounting for dopamine activity via spontaneous Eye Blink Rate (sEBR). The purpose of the present study is to evaluate the platform’s feasibility and validity through a single pilot trial. Methods: The study enrolled twenty-seven healthy adults (aged 21–44) who completed standardized self-report questionnaires on sleep quality and ER. They were also enrolled in sEBR recordings and performed a CCT-adapted Corsi block-tapping task and an aesthetic art evaluation. Affective textual narratives and valence/arousal ratings were also collected. Participants were divided into “Good Sleepers” and “Poor Sleepers”. The platform evaluation enrolled a multi-modal pipeline including correlations and regression analysis of intervention metrics, sentiment analysis, and group comparisons. Results: WM task performance correlated positively with global ER and Cognitive Reappraisal scores. Post-training sEBR was significantly associated with ER, and lower sleep efficiency negatively impacted changes in dopamine activity (sEBR Diff). Dopamine activity of “Good Sleepers”, as indicated by sEBR, reached the high levels of the “Poor Sleepers” group after the training, suggesting a dopamine boost caused by the CREATE platform for those with quality sleep. Creativity and emotional expression, as indicated by sentiment analysis, were related to sleep quality. Conclusions: The CREATE platform shows promise in enhancing ER through multi-modal digital engagement, integrating cognitive training, art, and creativity. The findings support the inclusion of sleep and dopamine markers in intervention evaluation. Further studies with larger samples and clinical cohorts are warranted to establish efficacy and generalizability, as the present one was not powered to test the effectiveness of our training platform but was designed to assess its feasibility and validity instead. Full article

The stages of change have been identified as a valuable framework for understanding the transition toward a healthy lifestyle. It is also important to recognize change through other psychosocial variables, such as motivation and self-efficacy. The objective of this study was to explore weight control over the course of an academic year (nine months) through three behaviors: the stage of change toward weight control (pre-contemplation, contemplation, preparation, action, maintenance), healthy and unhealthy eating behaviors for weight control, and the frequency of physical activity (PA). Furthermore, we wanted to ascertain whether the three distinct types of motivation (autonomous, controlled, and amotivation) and self-efficacy could account for fluctuations in weight control over time. The sample consisted of 303 adolescents (205 female and 98 male) between the ages of 15 and 23 (M = 17.26; SD = 1.65). Chi-square, t-test, and multiple linear stepwise regression analysis were employed. The results indicated that a higher proportion of adolescents were in the precontemplation and action stages at Time 2. Concurrently, an increase in the frequency of moderate-to-vigorous PA and an increase in healthy and unhealthy behaviors were observed during the school period. The present study posits that autonomous motivation, controlled motivation, and self-efficacy can explain healthy eating behaviors for weight control and the frequency of moderate-to-vigorous PA, while only controlled motivation explains unhealthy eating behaviors for weight control. The conclusion of the study points out that healthy behaviors can change over time due to individual regulation of motivation and increased self-perception of efficacy in one’s own abilities to perform a specific action to control weight. Full article

The rising cost of traditional energy sources is forcing us to seek alternatives that enable energy self-sufficiency. At the Madrid Zoo Aquarium (Spain), the production of biomethane through the anaerobic digestion of organic waste is being considered, improving environmental management and achieving a competitive advantage in the energy management process. This opportunity also carries with it the possibility of explosions, fires or polluting environments, which requires the establishment of preventive measures to minimize these risks. To respond to this type of contingency, this study develops both empirical equation and charts that allow the establishment of dangerous distances that must be considered due to the presence of flammable gases escaping into the atmosphere and the duration of the danger, taking into account the influence of environmental conditions and dilution. Different risk situations are considered, both during the operation of the facility and during the cleaning and maintenance of tanks and equipment, as well as in the management of waste generated at the end of treatment. Full article

In this segment of the Palliative Care Unit case series, we introduce a patient with a long history of oncological treatments for recurrent breast cancer. After active treatments and a global control of the neoplasm, disease progression made the patient access different lines of chemotherapies, even asking for them in anticipation of a few advantages in the balance between benefits and risks. When the patient decided to permanently discontinue chemotherapy, she felt she had disrupted her values. Also, as a reaction to breaking bad news without estimating alternative paths, she considered her deteriorating condition as the sole criterion for assisted dying in another country. Could this be a self-consistent choice for this patient, so determined to find and pursue possibilities in treatment previously? Should this clue respond precisely to the patient’s needs? This contribution’s objective is to debate possibilities of patient self-determination and dignity at the end of life by integrating psychological support, palliative care, and legal–ethical awareness. This case study presents multidisciplinary team work through some key turning points. This team work was carried out in a national context that is currently inconclusive regarding assisted suicide, since active euthanasia is illegal. At the same time, the national Constitutional Court (242/2019) recently opened the possibility of eventual medically assisted suicide under certain circumstances. In this case, health professionals considered this context and tried to delve deeply into respecting the patient’s identity in order to determine when and if the exceptional circumstances were met. This case highlights the ethical sense of end-of-life accompaniment, which when conducted by physicians, nurses, and psychologists together can lead to effective support and allow patients to maintain their identity and to express themselves respecting not only their fears but also their vision of themselves as human beings. A first key turning point was, for instance, taking into account the patient’s history and values, and a subsequent one was supporting the patient in exploring healthcare services and related end-of-life support. In a further key turning point, the patient was helped in engaging with physicians in order to understand types of continuous care, as well as the timing and expected results of sedation. Finally, she chose a healthcare service where she could spend the end of her life in fulfillment of her values. Overall, this case report illustrates how integrating psychological support, palliative care, and legal–ethical awareness can promote patient self-determination and dignity at the end of life. Full article

Background/Objectives: Breast cancer incidence is increasing in younger Ghanaian women. However, few epidemiological studies have evaluated the modifiable risk factors in this population. Additionally, these studies have classified breast cancer in Ghanaian women based on the global menopausal case classification. This study reclassified premenopausal and postmenopausal breast cancer in a Ghanaian cohort, assessing the risk factors using the observed menopausal age in Ghanaian women of 48 years, rather than the global standard of 50 years. Methods: Women diagnosed with breast cancer and scheduled for surgery from December 2018 to March 2023 were recruited across four hospitals in Ghana for the Ghana Breast Cancer Omics Project (BCOPGh), and data were collected using a questionnaire. Cross-tabulation and linear regression were used to evaluate the relationships between categorical variables and age at diagnosis. Results: Out of a total of 262 women recruited, 34.4% were classified as having premenopausal breast cancer, while early-onset breast cancer (EOBC) accounted for 14.9% of all cases. The molecular subtypes were predominantly hormone receptor (HR)-positive (61%) while triple-negative breast cancer (TNBC) accounted for 16%. The tumours were predominantly at stage II (62%) and grade 2 (51%), with invasive carcinoma NST (56%) being the most common subtype. Within this cohort, nulliparity increased the odds of EOBC by 13.5-fold, while having a first birth after the age of 23 doubled the odds of premenopausal breast cancer. Reproductive factors (menarche and menopause) and lifestyle (alcohol intake, smoking, contraceptive use, and breastfeeding duration) were not associated with premenopausal breast cancer in this cohort. About 13% of participants reported a family history of breast cancer, and 79% had prior knowledge of the disease. Conclusion: This study supports previous reports of the relatively higher incidence of aggressive disease in young Ghanaian women and the protective effect of early age at first birth. It further underscores the need to investigate its genetic underpinnings, whilst highlighting the importance of public education on self-examination techniques to reduce advanced disease presentation in Ghanaian women. Full article

Background: The deployment of large language models (LLMs) in mental health therapy presents a compelling yet deeply fraught opportunity to address widespread disparities in access to psychological care. Recent empirical evidence reveals that these AI systems exhibit substantial shortcomings when confronted with complex clinical contexts. Methods: This paper synthesizes key findings from a critical analysis of LLMs operating in therapeutic roles and argues for the urgent establishment of comprehensive risk management frameworks, policy interventions, and ethical protocols governing their use. Results: LLMs tested in simulated therapeutic settings frequently exhibited stigmatizing attitudes toward mental health conditions and responded inappropriately to acute clinical symptoms such as suicidal ideation, psychosis, and delusions. Real-world evaluations reinforce these concerns. Some studies found that therapy and companion bots endorsed unsafe or harmful suggestions in adolescent crisis vignettes, while others reported inadequate chatbot responses to self-harm and sexual assault queries, prompting concern from clinicians, disappointment from patients, and calls for stronger oversight from policymakers. These failures contravene fundamental principles of safe clinical practice, including non-maleficence, therapeutic alliance, and evidence-based care. Moreover, LLMs lack the emotional intelligence, contextual grounding, and ethical accountability that underpin the professional responsibilities of human therapists. Their propensity for sycophantic or non-directive responses, driven by alignment objectives rather than clinical efficacy, further undermines their therapeutic utility. Conclusions: This analysis highlights barriers to the replacement of human therapists with autonomous AI systems. It also calls attention to the regulatory vacuum surrounding LLM-based wellness and therapy applications, many of which are widely accessible and unvetted. Recommendations include professional standards, transparency in training and deployment, robust privacy protections, and clinician oversight. The findings underscore the need to redefine AI as supportive, not substitutive. Full article

This study assesses De Lone and McLean’s Information System (D&M IS) Success Model concerning DAS throughout small and medium enterprises (SMEs) in Saudi Arabia (SA). The present work mainly sought to evaluate the impact of information quality (IQ), system quality (SysQ), service quality (SrvQ) serving, system utilization, and user satisfaction (Usat) on the usage of the Digital Accounting System (DAS), which is posited to ultimately improve the quality of sustainable decision-making. The research utilized a quantitative methodology, employing a self-administered questionnaire to collect data from 328 decision-makers who are knowledgeable about actual DAS usage by SMEs in SA. Subsequent to gathering data, validation was conducted via Structural Equation Modeling (SEM) by utilizing smart-PLS software. The findings indicate that SysQ and IQ significantly influenced system utilization, although SrvQ did not. DAS was determined to significantly influence user happiness. Moreover, system utilization and user satisfaction positively influenced DAS, thereby affecting the sustainability of decision-making and reflecting the overall benefits of DAS. This work enhances the current IS literature by identifying the characteristics that affect the net advantages of DAS, with the suggested model evaluated in SMEs in SA utilizing DAS. This study serves as a reference to elucidate the significance of DAS and offers consequences, limitations, and prospects for further research. Full article

Background: Nursing research has evolved through different historical stages, from the initial development of theoretical models to today’s challenges involving advanced practice and emerging technologies. Within this context, Middle-Range Nursing Theories (MRNTs) play a crucial role as a bridge between abstract conceptual frameworks and clinical practice. However, their recent production appears limited. Aims: To identify MRNTs published in the last five years, determine the main thematic fields addressed, and analyze current trends in their development. Methods: A scoping review was conducted in accordance with PRISMA-ScR guidelines. Databases searched included MEDLINE, CINAHL, PsycINFO, EMBASE, and Education Research Complete (August 2025). Eligible studies were published within the last five years in journals indexed in the Journal Citation Reports and explicitly proposed an MRNT. Exclusion criteria encompassed non-nursing theories, secondary applications of existing models, and purely methodological studies. Results: From 1230 initial records, 18 articles met the inclusion criteria. The Revista Brasileira de Enfermagem accounted for the highest number of publications. The identified MRNTs predominantly addressed clinical diagnoses and phenomena such as heart failure self-care, overweight, occupational stress, peripheral tissue perfusion, and social support networks. Most theories were derived from established nursing models (Orem, Roy, Levine, Neuman, Watson). Despite thematic diversity, few MRNTs had undergone methodological validation. Conclusions: Recent MRNT development remains limited and geographically concentrated, with Brazil emerging as a leading contributor. Strengthening methodological validation, clinical integration, and international dissemination is essential, as MRNTs continue to be pivotal tools for advancing nursing science, reinforcing disciplinary identity, and reducing the persistent gap between theory and practice. Full article

Adult Clergy Sexual Abuse (ACSA) is a profound betrayal of trust and power that produces complex psychological, spiritual, and relational injuries for survivors. While much of the literature has focused on the abuse itself and its consequences, less attention has been given to recovery and resilience. This qualitative study draws on in-depth interviews with 27 female survivors of ACSA to explore how they heal and recover. Using artificial intelligence to support thematic analysis, nine key recovery processes were identified: 1. therapy, 2. supportive relationships and community, 3. faith and spirituality, 4. survivor organizations, 5. education and understanding, 6. justice and accountability, 7. sharing their stories, 8. time and patience, and 9. practical support and advocacy. Across experiences, the most potent factor undergirding recovery was being believed and validated, which addressed survivors’ core wounds of self-blame and isolation. Findings highlight survivors’ capacity for healing and underscore the critical role of supportive, informed communities. Full article

Recent work on theological reflection on the phenomenon of human grief has called for an apophatic posture, one that resists speaking positively about what grief is, what grief does, or where it is situated with respect to the economy of God’s works. Grief, on this account, is viewed as inaccessible to theological inquiry and illogical in nature. This essay references recent work in psychological science to offer “theological fragments” on the nature of grief with the respect to the generational self’s journey in the “time of weeping.” In so doing, it argues that an integration of theological and psychological science provides a framework for describing grief in a way that resists the temptation to ascribe positive meaning or value to it in the reconciling work of God. Full article

Background: AMR causes a large global health burden, with approximately 4.95 million deaths linked to bacterial AMR in 2019, 1.27 million due to AMR directly. Although Brazil mandated prescriptions for systemic antibiotics in 2010/2011, self-medication and access without prescriptions continue, with community pharmacists playing a vital part in antimicrobial stewardship (AMS). This study examined antibiotic misuse and AMR in Brazil through community pharmacists’ perspectives, emphasising their dual role as professional actors and frontline observers of public behaviour. Methods: We conducted 20 semi-structured interviews with community pharmacists and performed reflexive thematic analysis of their accounts, repeating five independent analytic cycles to confirm thematic robustness. Results: Six themes were consistently identified as recounted by pharmacists in their practice contexts: Access and Self-Medication; Relationships with Healthcare Professionals; Knowledge and Beliefs about Antibiotics; Use and Adherence; Healthcare System Barriers; and Regulation and Enforcement. Pharmacists mentioned regular requests for antibiotics without prescriptions, drug reuse, and significant impact from community, i.e., from relatives, and peers. The common misunderstanding was that antibiotics treat viral illnesses. Structural issues, for instance GP appointment costs and long waits, made patients seek help from pharmacies. Due to regulation being applied inconsistently, pharmacies struggled to refuse unsuitable requests. Conclusions: Framed through pharmacists’ dual vantage as professionals and frontline observers, the findings highlight intertwined factors underpinning inappropriate antibiotic use in Brazil and support a multi-pronged intervention spanning health system strengthening, professional education, economic considerations, and community engagement. Full article

Smart manufacturing demands adaptive, scalable, and human-centric solutions for predictive maintenance. This paper introduces the concept of Agentic AI, a paradigm that extends beyond traditional multi-agent systems and collaborative AI by emphasizing agency: the ability of AI entities to act autonomously, coordinate proactively, and remain accountable under human oversight. Through federated learning, edge computing, and distributed intelligence, the proposed framework enables intentional, goal-oriented monitoring agents to form self-organizing predictive maintenance ecosystems. Validated in a ceramic manufacturing facility, the system achieved 94% predictive accuracy, a 67% reduction in false positives, and a 43% decrease in unplanned downtime. Economic analysis confirmed financial viability with a 1.6-year payback period and a €447,300 NPV over five years. The framework also embeds explainable AI and trust calibration mechanisms, ensuring transparency and safe human–machine collaboration. These results demonstrate that Agentic AI provides both conceptual and practical pathways for transitioning from reactive monitoring to resilient, autonomous, and human-centered industrial intelligence. Full article