Search Results (3,052)

Objectives: Despite the widespread availability of digital clinical information, timely access to relevant biomedical evidence during routine consultations remains limited in practice. Primary care clinicians, in particular, face significant time constraints that make it difficult to integrate comprehensive literature searches into everyday workflows. This study evaluates whether an ontology-based recommender system can support routine clinical workflows by reducing information retrieval time while preserving the clinically acceptable usefulness of retrieved evidence. We assessed the performance of the HOPE (Health Operation for Personalised Evidence) system compared with realistic manual PubMed searches conducted by physicians. Materials and Methods: We conducted an observational evaluation involving 50 primary care physicians, who independently assessed 30 anonymised, rewritten clinical cases representative of common primary care scenarios. HOPE automatically extracted biomedical concepts from case descriptions using natural language processing and mapped them to Unified Medical Language System (UMLS) ontologies to generate ranked PubMed recommendations. A subset of 10 physicians also conducted manual PubMed searches in line with their usual clinical practice. Article relevance was assessed using a predefined binary criterion, and a reference relevance set was established by consensus among three senior physicians using a pooled document set. Retrieval performance was evaluated using Precision@k, relative Recall@k, and Normalised Discounted Cumulative Gain (NDCG@k). Manual search time was measured using a standardised stopwatch protocol, whereas HOPE response time was logged automatically by the system. Results: Inter-physician agreement in relevance assessment was substantial (Fleiss’ κ = 0.66; 95% CI: 0.61–0.70). HOPE achieved moderate-to-high precision within the top-ranked results (Precision@3 = 0.72), with relative recall increasing as additional documents were considered. Ranking metrics indicated that relevant articles were generally positioned early in the result lists. The mean total retrieval time for manual PubMed searches was 13.3 ± 1.7 min per case, compared with 17.4 ± 2.1 s for HOPE-assisted retrieval (p < 0.001). Conclusions: In a controlled, workflow-oriented evaluation using synthetic clinical cases, HOPE substantially reduced information retrieval time while maintaining clinically acceptable relevance in the retrieved literature. These findings support the use of ontology-based, AI-assisted systems as workflow-support tools to facilitate timely access to biomedical evidence, without replacing clinical judgment. Full article

Aging populations have intensified the demand for thermally comfortable and energy-efficient housing, particularly for elderly residents whose diminished thermoregulatory capacity renders them disproportionately vulnerable to indoor temperature fluctuations. Existing senior apartments in cold-climate regions frequently fail to meet age-specific thermal comfort standards, yet systematic retrofit optimization frameworks explicitly tailored to elderly occupants remain scarce. This study presents a data-driven multi-objective optimization framework for building envelope retrofitting, which is validated using on-site temperature measurements from a representative 1980s brick–concrete senior apartment building in Beijing. The framework integrates Latin Hypercube Sampling (LHS) for design space exploration, a Long Short-Term Memory (LSTM) surrogate model for simultaneous prediction of three performance objectives, and Non-dominated Sorting Genetic Algorithm II (NSGA-II) for Pareto-optimal solution generation, with final selection performed via a weighted Mahalanobis distance-based Technique for Order Preference by Similarity to an Ideal Solution (TOPSIS). Optimization targets—annual energy consumption, indoor thermal discomfort hours, and retrofit cost—are parameterized using the age-sensitive comfort thresholds specified in GB 50340-2016. The LSTM surrogate achieved R² values of 0.91–0.93 across all objectives with training–testing differences below 0.02. The optimal retrofit package—Polyvinyl Chloride (PVC) Low Emissivity (Low-E) double-glazed windows (5 + 6A + 5), glass fiber roof insulation (65.25 mm), and Extruded Polystyrene (XPS) external wall insulation (65.39 mm)—reduces annual energy consumption by 47.1% (from 40,867 to 21,626 kWh) and annual thermal discomfort hours by 62.4% (from 2454 °C·h to 923 °C·h). SHapley Additive exPlanations (SHAP)-based sensitivity analysis further identifies wall U-value and roof thickness as the dominant performance drivers. A reproducible and computationally efficient pathway is provided by the proposed framework for evidence-based envelope retrofit decision-making in existing senior residential buildings. Full article

Despite increasing investments in digital transformation and sustainability initiatives, many organizations struggle to translate these efforts into measurable sustainable organizational performance, particularly in emerging economies, where resource constraints and institutional pressures persist. This study examines how digital capability and environmental strategy orientation contribute to sustainable organizational performance through the sequential mediating roles of environmental management accounting (EMA) integration and managerial decision quality. Drawing on dynamic capability theory and the natural resource-based view, this study proposes a moderated mediation model incorporating technology readiness and environmental regulatory pressure. Data were collected from 479 middle- and senior-level managers of ISO 14001-certified manufacturing firms in Pakistan and analyzed using partial least squares structural equation modeling (PLS-SEM). The results indicate that both digital capability and environmental strategy orientation significantly enhance EMA integration, which in turn improves managerial decision quality and ultimately drives sustainable organizational performance. The findings confirm the presence of sequential mediation through EMA integration and decision quality. Furthermore, technology readiness strengthens the relationship between digital capability and EMA integration, whereas environmental regulatory pressure does not significantly moderate the relationship between environmental strategy orientation and EMA integration. This study contributes to the sustainability literature by introducing a novel sequential mediation mechanism linking digital and strategic capabilities to sustainability outcomes through accounting-based processes. It also provides empirical evidence offering practical insights for managers and policymakers aiming to enhance sustainability performance. The findings provide context-specific insights from an emerging economy and contribute to advancing organizational sustainability in line with SDGs 8, 12, and 13. Full article

Electrocardiogram (ECG)-gated contrast-enhanced computed tomography angiography (CTA) is the reference method for follow-up of ascending aortic aneurysms but delivers substantially higher radiation doses than ECG-gated non-contrast CT (NCCT). NCCT can be acquired at a lower dose while enabling measurements of the aortic outer diameter. This study aimed to quantify the radiation dose of both techniques and determine whether a significant difference exists in ascending thoracic aorta diameter measurements between NCCT and CTA. Eighty patients who underwent ECG-gated cardiac CT for suspected coronary artery disease were retrospectively analyzed. Three observers measured the ascending aortic diameter at the level of the pulmonary artery in a plane perpendicular to the aorta on both NCCT and CTA images. Inter-rater reliability was assessed using intraclass correlation coefficients, and paired samples t-tests were used to evaluate measurement differences. Dose-length products (DLP) were collected. Median DLP values were 16.1 mGy·cm (interquartile range 11.8–25.1) for NCCT and 190.3 mGy·cm (interquartile range 120.5–298.9) for CTA. NCCT measurements were consistently larger than CTA measurements, with mean differences of 2.1 ± 0.8 mm, 2.6 ± 0.96 mm, and 2.9 ± 1.09 mm for the senior radiologist, junior radiologist, and resident, respectively (all p < 0.001). Inter-observer agreement was excellent (ICC = 0.99, p < 0.001). NCCT delivered an 11.8-fold lower radiation dose than CTA. NCCT may replace CTA for ascending aortic diameter follow-up if measurements are adjusted by approximately 2–3 mm relative to CTA-derived inner-diameter thresholds. Full article

This study explored individual differences among senior high school students in detecting and correcting logical errors in mathematical reasoning. Eight participants with high and average mathematical abilities each were recruited from a key high school in Shanghai to solve three error-detecting tasks by thinking aloud; they were then interviewed. Results showed that high ability students performed better in answering time, validation judgment, detection, explanation, and correction of logical errors. The cognitive processes for detecting and correcting logical errors were a combination of five types of cognitive behaviors—read, analyze, check, judge and correct. Although their specific combination methods were different, the two groups exhibited two different detecting styles. Error detection of high ability students was more active and effective, and their thinking processes were smooth and concise. The average ability group was more passive in error detection, more dependent on mathematical texts, and more stuck in the thinking process. Both groups agreed on the value of logical error-detecting tasks, although the high ability group had a more positive attitude toward them. Full article

Background/Objectives: This study aimed to compare AI-generated educational material with faculty-authored content in Dental Prostheses Technology, evaluating perceived clarity, accuracy, structure, usefulness, and overall instructional quality across different age and professional groups. Methods: An analytical cross-sectional study was conducted using two versions of the first three chapters of a prosthodontics textbook: the original faculty-authored text and a reformulated version generated by ChatGPT 5.2 (OpenAI). Images were removed and formatting standardized to ensure a text-only comparison. An anonymized online questionnaire based on a five-point Likert scale assessed clarity, accuracy, readability, usefulness and structure. To reduce potential bias, participants were unaware of the authorship of the evaluated materials (human-authored vs. AI-generated). A total of 130 participants independently reviewed both documents. Data were analyzed using Wilcoxon signed-rank, Mann–Whitney U, and Friedman tests. Results: Both materials received favorable evaluations across all dimensions. The AI-generated version demonstrated a statistically significant advantage in clarity (Z = −2.107, p = 0.035; r = 0.19), while no significant differences were observed for structure, accuracy, readability, or usefulness. Generational differences emerged: younger participants valued improved clarity but reported reduced usefulness, mid-career participants showed the greatest improvement in perceived accuracy, and senior professionals reported substantial gains in usefulness and readability. Conclusions: AI-generated educational material demonstrates pedagogical equivalence to faculty-authored content, with clarity representing its principal advantage. Large language models may serve as effective complementary tools in dental education, particularly for restructuring complex content. Full article

The COVID-19 pandemic intensified communication challenges for community college leaders navigating prolonged uncertainty and organizational disruption. This qualitative study examines how community college administrators described and interpreted their communication practices during the pandemic. Guided by the Elaboration Likelihood Model (ELM), this study explores how leaders made sense of message design, audience responsiveness, and trust under conditions of information overload and emotional strain. Semi-structured interviews were conducted with twelve administrators from community colleges across the United States, including presidents, vice presidents, and senior-level directors. Data were analyzed using reflexive thematic analysis. Five themes emerged: communication breakdowns between employee groups; tailored messaging for specific constituencies; preferences for in-person and interactive communication; trust-building through transparency; and reliance on collaborative communication structures. Participants described communication as an ongoing relational and organizational practice rather than a one-time transmission of information. Administrators reported adapting strategies by combining repetition, audience-specific framing, interactive formats, and structural supports to manage uncertainty and sustain institutional trust. Findings are not intended to be generalizable but provide contextually grounded insight into leadership communication during an extended crisis. This study contributes to scholarship on higher education leadership and crisis communication by illustrating how persuasion, sensemaking, and relational cues intersected in administrators’ communication practices. Full article

Many business schools have set strategic objectives to integrate sustainability in their curricula; however, there is limited evidence of effective curriculum change initiatives, including organizational change approaches that could inform effective strategy design and implementation. This paper examines how a business school sought to embed sustainability content in undergraduate business education, and how it navigated contested understandings of sustainability and multiple orientations to teaching sustainability, including ESG, Corporate Social Responsibility (CSR), Sustainable Development Goals (SDGs), Social-ecological Systems, and Social Innovation. Using qualitative documentary curriculum data, a curriculum mapping methodology is presented to quantitatively assess year-on-year changes in sustainability content at curriculum, discipline, and orientation levels. Findings show that sustainability integration increased over the period studied, albeit unevenly across the curriculum, with integration driven by educators of various instructor types and sustainability orientations. The discussion highlights factors that likely supported progress, including the School’s approach to change and the strategy’s explicit recognition of multiple sustainability orientations. The study presents a practical methodology that senior managers seeking to integrate sustainability in higher education can use to track curriculum change progress, drivers, and orientations. It also offers guidance on how to advance sustainability integration in organizational contexts characterized by different sustainability orientations. Full article

The global aging process has increased the number of older individuals providing care for relatives with severe mental disorders (SMD). This population faces unique health challenges. The present cross-sectional study examined the relationship between self-perceived health (SPH) and clinical, functional, and sociodemographic variables among 71 older caregivers (median age: 65 years) in Bogotá, Colombia. SPH was assessed by answering the question: “How would you describe your overall health status?” and dichotomized into good versus poor perception. Comorbidity was measured as the number of self-reported chronic conditions. Caregiver burden was evaluated using the Zarit Caregiver Burden Interview, and health-related quality of life (HRQoL) was assessed using the SF-36, including dimensions such as physical functioning, emotional well-being, bodily pain, and general health. Descriptive analyses, non-parametric comparisons, and logistic regression models were conducted. The results revealed a marked feminization of caregiving (92.96%) and a high prevalence of good SPH (70.42%), despite a substantial burden of physical comorbidities (mean: 3.21). Dimensions such as physical functioning, emotional well-being, and pain were significant in univariate analyses. However, the multivariate model identified general health as the only independent predictor of good SPH (adjusted odds ratio [OR]: 1.112; 95% confidence interval [CI]: 1.053–1.174; p < 0.001). These findings suggest that subjective health assessment may transcend objective disease counts for older caregivers. Public health policies could prioritize wellness-based interventions and emotional support over traditional disease-centered approaches to improve the quality of life of this growing, active, socially valuable, yet vulnerable population. Full article

Background: Test descriptions from major diagnostic manufacturers do not include ferritin reference intervals (RIs) for individuals aged 60 and older. The absence of older adults-specific RIs contrasts with the widespread use of serum ferritin testing in older adults. We aimed to establish and verify RIs using two common analytical methods. Methods: For this study, 1467 older adults were prospectively enrolled and monitored for morbidity and mortality, and exclusion criteria were applied. Ferritin was measured using chemiluminescent microparticle immunoassay (CMIA) and transferred to an electrochemiluminescence immunoassay (ECLIA) using method comparison. RIs were evaluated using a direct method with a prospective observational study based on healthy individuals according to the Clinical and Laboratory Standards Institute (CLSI) 28-A3c guideline and compared with RIs obtained using an indirect approach based on data obtained in clinical routine outpatients, where normal and abnormal values are supposed to be statistically differentiated to determine RIs. When applied within a countrywide population-based setting in Liechtenstein, the impact of novel RIs on the frequency of abnormal values was analyzed. Results: A total of 386 men and 532 women were included in the direct RI determination. Women (W) had significantly lower ferritin levels than men (M), while age over the age of 60 years had no significant association with ferritin in men and women. RIs were 23–241 ng/mL (W) and 19–396 ng/mL (M) for CMIA and 27–293 ng/mL (W) and 23–480 ng/mL (M) for ECLIA. These RIs are higher than those mentioned in the test descriptions in both tests. In comparison, the indirect method for both assays showed comparably lower reference limits, whereas upper reference limits were only approximately similar. The prevalence of high abnormal ferritin levels was considerably lower with this study’s RIs compared with manufacturer RIs. Conclusions: Employing older adults-specific RIs in clinical routine seems to be advisable. This reduces the frequency of abnormal high values in comparison with the widely applied practice of extrapolating RIs obtained from younger age groups to older adults and therefore leads to fewer follow-up investigations. Full article

Objectives: The transition from in-person to online formats for clinical case discussions has transformed the way medical professionals collaborate and share knowledge. The current pilot study investigates the potential impact of this shift by comparing the experiences of specialists and residents who had practiced both online and in-person pituitary tumor boards compared to the experiences of those who only experienced the online format. Methods: A cohort of 15 participants, including 10 specialists and 5 residents, provided insights through structured surveys and free-text responses. Results: The results indicate differences in the perception of the duration and participation dynamics in online pituitary tumor boards between both groups, with online boards facilitating the discussion of more cases. Overall participant engagement was mostly perceived as the same; a subset reported reduced perceived engagement, particularly among senior professionals. Conclusions: These findings highlight how prior experience can affect the perceived effectiveness, level of engagement and duration of online formats, providing valuable hypothesis-generating input for optimizing future medical board meetings. Full article

Background/Objectives: Forest therapy has demonstrated stress-reducing and immune-enhancing effects, yet its simultaneous impact on cognitive function, stress biomarkers, and oral microbiota in older adults remains unexplored. This study aimed to evaluate the effects of an 8-week community-based village forest experience program on cognitive function, salivary cortisol, and oral pathogenic bacteria in community-dwelling older adults. Methods: A total of 125 older adults (mean age 82.2 ± 5.3 years; 87.2% female) from 17 senior centers participated in a single-arm, pre–post intervention study. Cognitive function was assessed using the Cognitive Impairment Screening Test (CIST), salivary cortisol was measured by ELISA, and seven oral bacterial species were quantified by qPCR. Results: CIST scores improved significantly (p = 0.003, d = 0.27), with the suspected cognitive impairment subgroup showing greater improvement (d = 0.66) and 48.8% transitioning to normal classification. Salivary cortisol decreased significantly (p = 0.002), and total bacterial load, Porphyromonas gingivalis, and Tannerella forsythia were significantly reduced. The 80–84-year age group showed the greatest cognitive gain, whereas participants aged 85 and older showed no significant change. Conclusions: An accessible village forest program may simultaneously benefit cognitive function, stress, and oral health in older adults with early-stage cognitive decline. Controlled studies are needed to confirm causality and elucidate the underlying mechanisms. Full article

Integrating artificial intelligence (AI) into design education is no longer optional; it has become an essential tool for enhancing innovative design and preparing students for data-driven practice and rapid technological acceleration. However, ignoring AI risks professional irrelevance; it introduces a range of concerns about students’ cognitive skills and comes with many drawbacks in the education process, as it threatens the attainment of learning outcomes, renders a fair assessment process unachievable, and places academic integrity in a vulnerable position. Using a qualitative case study approach, this research employs semi-structured interviews with 27 senior-year students in the interior design department to gain in-depth academic insights into how AI influenced their design process in their term project and its impact on their cognitive development and decision -making. Instructors’ observations on students’ skills, their pace in the project, and their end-products were documented. This study demonstrates that integrating AI into design education cannot be avoided, making a new paradigm for addressing design education inevitable. Based on the analysis, the paper proposes a conceptual framework outlining key dimensions in teaching and assessing strategies in design education adopting AI, focusing on analysis, critical thinking, reasoning, and process rather than on the end-product and its presentation. Full article

Background: Respiratory syncytial virus (RSV) is a leading cause of severe lower respiratory tract infections in infants, seniors, and immunocompromised individuals, contributing substantially to the global disease burden. Given the limited preventive options available, developing an effective and safe vaccine remains a public health priority. Methods: An mRNA vaccine encoding the RSV PreF protein was designed and prepared. Antigen properties were evaluated in silico, and the coding sequence was optimized using NLP algorithms. The stability and translational efficiency of the mRNA constructs were verified through in vitro and in vivo assays, followed by immunogenicity evaluation of the formulated mRNA vaccines in a BALB/c mouse model. Results: The optimized mRNA showed predicted improvements in structural stability and a lower free energy state, which were associated with increased translational efficacy in vitro. Correct antigen conformation and retention of key epitopes were confirmed by intracellular staining followed by flow cytometry. A balanced Th1-biased immune response was induced in mice, characterized by high levels of neutralizing antibodies and antigen-specific T-cell immunity, along with enhanced memory T-cell proliferation and differentiation, indicating long-term immunological memory. Conclusions: A novel RSV PreF mRNA vaccine was successfully developed via optimization of protein structure and mRNA sequence. Superior immunogenicity was demonstrated in the BALB/c mouse model, together with promising potential in terms of vaccine safety and immunological persistence. These findings represent a promising step forward in the pursuit of an effective RSV vaccine and suggest the potential of the developed mRNA vaccine to induce substantial immune responses that may correlate with protection in future challenge studies. Full article

The college access policy landscape across Alabama, U.S., has gained traction in K-12 schools and higher education institutions over the last few years. In Spring 2021, the Alabama State Board of Education approved a resolution to require all seniors to complete the Free Application for Federal Student Aid (FAFSA). In Fall 2025, the state began implementing its Alabama Direct Admission Initiative, a partnership between dozens of 2-year and 4-year in-state institutions to streamline college application processes for all seniors. Advocates of both anticipate an increase in college enrollment, particularly for students who have previously faced issues with financing postsecondary education. Despite such policies and initiatives, Black, rural students in Alabama still face unique challenges to college access. This paper addresses the following questions: How do Black, rural students access postsecondary education in Alabama? How do Black, rural students perceive and experience college access policies? What role does policy enactment play in Black, rural students’ college access experiences? Using a multi-site case study approach, we present insights gleaned from 16 virtual focus groups with students across five higher education institutions in Alabama. Findings from this study highlight how Black, rural students engage in three types of labor associated with college-going: assessment labor, simulation labor, and capacity-building labor. Full article