Search Results (451)

Understanding the migratory strategies of plateau-endemic species is essential for informing effective conservation, especially under climate change. The Black-necked Crane (Grus nigricollis), a high-altitude specialist, has shown notable population growth in recent years. We analysed satellite tracking data from 16 individuals of a western subpopulation in the lake basin region of northern Tibet (2021–2024), focusing on migration patterns, stopover use, and habitat selection. This subpopulation exhibited short-distance (mean: 284.21 km), intra-Tibet migrations with low reliance on stopover sites. Autumn migration was shorter, more direct, higher in altitude, and slower in speed than spring migration. Juveniles used smaller, more fragmented habitats than subadults, and their spatial range expanded over time. Given these patterns, we infer that the short-distance migration strategy may reduce energetic demands and mortality risks while increasing route flexibility—characteristics that may benefit population growth. We refer to this as a low-energy, high-efficiency migration strategy, which we hypothesise could support faster population growth and enhance resilience to environmental change. We recommend prioritizing the conservation of short-distance migration corridors, such as the typical lake basin area in northern Tibet–Yarlung Tsangpo River system, which may help sustain plateau-endemic migratory populations under future climate scenarios. Full article

Smart living is strongly promoted to enhance the quality of life via the application of innovative solutions, and this is driven by domain specialists and policymakers, including designers, urban planners, computer engineers, and property developers. Nonetheless, the actual user, whose views ought to be considered during the design and development of smart living systems, has received little attention. Thus, this study aims to identify and examine the critical smart functions to achieve smart living in smart buildings based on occupants’ perceptions. The aim is achieved using a sequential quantitative research method involving a literature review and 221 valid survey data gathered from a case of a smart student residence in Hong Kong. The method is further integrated with descriptive statistics, the Kruskal–Walli’s test, and the criticality test. The results were validated via a post-survey with related experts. Twenty-six critical smart functions for smart living were revealed, with the top three including the ability to protect personal data and information privacy, provide real-time safety and security, and the ability to be responsive to users’ needs. A need was discovered to consider the context of buildings during the design of smart living systems, and the recommendation is for professionals to understand the kind of digital technology to be integrated into a building by strongly considering the context of the building and how smart living will be achieved within it based on users’ perceptions. The study provides valuable insights into the occupants’ perceptions of critical smart features/functions for policymakers and practitioners to consider in the construction of smart living systems, specifically students’ smart buildings. This study contributes to knowledge by identifying the critical smart functions to achieve smart living based on occupants’ perceptions of smart living by considering the specific context of a smart student building facility constructed in Hong Kong. Full article

Background: Treatment compliant with the Global Initiative for Asthma (GINA) can promote more effective disease control. Single-inhaler triple therapy (SITT) is one method that is used to optimize therapy in this context, but TRIPLE therapy is still employed by physicians to a limited extent. Objective: This study aimed to describe the factors influencing challenges in optimizing asthma therapy. Methods: A 19-question survey, created via the CATI system, was distributed among pulmonologists, allergologists, general practitioners, and internal medicine specialists in Poland, Greece, Sweden, Slovenia, and Austria. Results: Statistically significant percentage differences in the use of TRIPLE therapy in the context of asthma management were observed among countries as well as between pulmonologists, allergists, and other specialists. Overuse of oral corticosteroids (OCSs) to treat nonsevere and severe asthma in the absence of an approach that focuses on optimizing inhalation therapy among asthma patients receiving TRIPLE therapy was observed in different countries as well as among physicians with different specialties. Twenty elements associated with the challenges involved in diagnosing and managing difficult-to-treat and severe asthma were identified. Six clinical categories for the optimization of asthma therapy via SITT were highlighted. The degree of therapeutic underestimation observed among severe asthma patients was assessed by comparing actual treatment with the recommendations of the GINA 2023 guidelines. Conclusions: Physicians of various specialties in Europe are subject to therapeutic inertia in terms of their compliance with the GINA 2023 guidelines. Full article

Background/Objectives: Benign paroxysmal positional vertigo (BPPV) is the most prevalent vestibular disorder encountered in clinical settings and is highly responsive to evidence-based diagnostic and therapeutic interventions. However, variations in practice patterns among physician specialties can compromise timely diagnosis and effective treatment. Understanding these variations is essential for improving clinical outcomes and standardizing care. This study aimed to assess the diagnostic and treatment practices for BPPV among Ear, Nose, and Throat (ENT) specialists, neurologists, general practitioners, and family physicians in Saudi Arabia and to examine how these practices are influenced by clinical experience and patient case exposure. Methods: A cross-sectional, questionnaire-based study was conducted between April 2023 and March 2024 at King Khalid University, Abha, Saudi Arabia. A total of 413 physicians were recruited using purposive sampling. Data were analyzed using IBM SPSS version 24.0. Parametric tests, including one-way ANOVA and chi-square tests, were used to assess differences across groups. A p-value of <0.05 was considered statistically significant. Results: Overall, all physician groups exhibited limited adherence to guideline-recommended positional diagnostic and therapeutic maneuvers. However, ENT specialists and neurologists demonstrated relatively higher compliance, particularly in performing the Dix–Hallpike test, with 46.97% and 26.79% reporting “always” using the maneuver, respectively (p < 0.001, Cramér’s V = 0.22). Neurologists were the most consistent in conducting oculomotor examinations, with 73.68% reporting routine performance (p < 0.001, Cramér’s V = 0.35). Epley maneuver usage was highest among neurologists (86.36%) and ENT specialists (77.14%) compared to family physicians (50.60%) and GPs (67.50%) (p = 0.044). Physicians with 11–15 years of experience and >50 BPPV case exposures consistently showed a greater use of diagnostic maneuvers, repositioning techniques, and guideline-concordant medication use (betahistine 76.67%; p < 0.001). Continuing medical education (CME) participation and the avoidance of unnecessary imaging were also highest in this group (46.67% and 3.33%, respectively; p < 0.001). Conclusions: Significant inter-specialty differences exist in the management of BPPV in Saudi Arabia. Greater clinical experience and higher case exposure are associated with improved adherence to evidence-based practices. Targeted educational interventions are needed, particularly in primary care, to enhance guideline implementation. Full article

Background/Objective: Dry eye syndrome affects 16 million Americans with USD 52 billion in annual healthcare costs. With large language models (LLMs) increasingly used for healthcare information, understanding their performance in delivering equitable dry eye guidance across diverse populations is critical. This study aims to evaluate and compare five major LLMs (Grok, ChatGPT, Gemini, Claude.ai, and Meta AI) regarding dry eye syndrome information delivery across different demographic groups. Methods: LLMs were queried using standardized prompts simulating a 62-year-old patient with dry eye symptoms across four demographic categories (White, Black, East Asian, and Hispanic males and females). Responses were analyzed for word count, readability, cultural sensitivity scores (0–3 scale), keyword coverage, and response times. Results: Significant variations existed across LLMs. Word counts ranged from 32 to 346 words, with Gemini being the most comprehensive (653.8 ± 96.2 words) and Claude.ai being the most concise (207.6 ± 10.8 words). Cultural sensitivity scores revealed Grok demonstrated highest awareness for minority populations (scoring 3 for Black and Hispanic demographics), while Meta AI showed minimal cultural tailoring (0.5 ± 0.5). All models recommended specialist consultation, but medical term coverage varied significantly. Response times ranged from 7.41 s (Meta AI) to 25.32 s (Gemini). Conclusions: While all LLMs provided appropriate referral recommendations, substantial disparities exist in cultural sensitivity, content depth, and information delivery across demographic groups. No LLM consistently addressed the full spectrum of dry eye causes across all demographics. These findings underscore the importance for physician oversight and standardization in AI-generated healthcare information to ensure equitable access and prevent care delays. Full article

Background and Objectives: this pilot study aimed to evaluate the diagnostic accuracy of ChatGPT-4o in analyzing oral mucosal lesions from clinical images. Materials and Methods: a total of 110 clinical images, including 100 pathological lesions and 10 healthy mucosal images, were retrieved from Google Images and analyzed by ChatGPT-4o using a standardized prompt. An expert panel of five clinicians established a reference diagnosis, categorizing lesions as benign or malignant. The AI-generated diagnoses were classified as correct or incorrect and further categorized as plausible or not plausible. The accuracy, sensitivity, specificity, and agreement with the expert panel were analyzed. The Artificial Intelligence Performance Instrument (AIPI) was used to assess the quality of AI-generated recommendations. Results: ChatGPT-4o correctly diagnosed 85% of cases. Among the 15 incorrect diagnoses, 10 were deemed plausible by the expert panel. The AI misclassified three malignant lesions as benign but did not categorize any benign lesions as malignant. Sensitivity and specificity were 91.7% and 100%, respectively. The AIPI score averaged 17.6 ± 1.73, indicating strong diagnostic reasoning. The McNemar test showed no significant differences between AI and expert diagnoses (p = 0.084). Conclusions: In this proof-of-concept pilot study, ChatGPT-4o demonstrated high diagnostic accuracy and strong descriptive capabilities in oral mucosal lesion analysis. A residual 8.3% false-negative rate for malignant lesions underscores the need for specialist oversight; however, the model shows promise as an AI-powered triage aid in settings with limited access to specialized care. Full article

Background: Bulgaria carries a high burden of colorectal cancer (CRC) but, at the start of this study, lacked a nationwide organized screening program. Understanding specialist views (particularly on mail-based fecal testing) is essential for effective policy development. Objective: The objective is to assess the attitudes towards, practices of, and perceived barriers to CRC screening among Bulgarian gastroenterologists, with a focus on the feasibility of mail-based fecal occult blood testing (FOBT). Methods: A cross-sectional survey of 38 gastroenterologists examined clinical use of FOBT, screening method preferences, and perceived systemic and patient-level barriers to CRC screening. Results: Among respondents, 57.89% reported using FOBT in clinical practice, and 71.05% indicated they would undergo the test themselves and recommend it to relatives. Colonoscopy was the preferred diagnostic tool for 84.21% of participants; however, the existing literature raises concerns about its feasibility for large-scale population screening. Key systemic barriers, rated on a 5-point Likert scale, included financial constraints (mean = 3.08), inadequate infrastructure (2.89), and healthcare workforce shortages (2.71). Patient-level barriers were led by low health literacy (4.13), lack of motivation (3.95), and procedural fears (3.26). A majority (84.38%) believed that mail-based FOBT would increase screening uptake, and 57.89% supported annual distribution of test kits. Nearly all respondents (97.37%) favored initiating screening at age 50. Conclusions: This study highlights strong support among Bulgarian gastroenterologists for a national CRC screening program, with particular endorsement of mail-based FOBT. Despite acknowledged systemic and population-level barriers, the findings suggest that such an approach could increase screening coverage, promote early detection, and support the strategic rollout of Bulgaria’s emerging cancer control initiatives. Full article

Background/Objectives: The SENTIREC-endo study identified a safe sentinel lymph node mapping algorithm combined with PET-positive node dissection, matching radical pelvic and paraaortic lymphadenectomy in high-risk endometrial cancer. The present study evaluated the diagnostic accuracy of FDG-PET/CT for lymph node metastases in the same population based on location, size, and Standardised Uptake Value (SUV), in addition to assessing interrater agreement across three Danish centres. Methods: This prospective multicentre study included women with high-risk endometrial cancer from the Danish SENTIREC study database (2017–2023). All patients underwent preoperative FDG-PET/CT. Diagnostic accuracy was evaluated against a pathology-confirmed reference standard. Interrater agreement was evaluated between trained specialists in Nuclear Medicine. Results: Among 227 patients, 52 patients (23%) had lymph node metastases. FDG-PET/CT identified lymph node metastases with 56% sensitivity (95% CI: 42–68) and 91% specificity (95% CI: 86–94). Positive and negative predictive values were 64% and 87%, respectively. Specificity for paraaortic nodes was high (97%), though sensitivity remained limited (56%). Lymph node size and SUVmax had moderate diagnostic value (AUC-ROC ~0.7). Interrater proportion of agreement was 95% and Cohen’s Kappa κ = 0.84 (95% CI: 0.73–0.94), the latter of which was ‘almost perfect’. Conclusions: FDG-PET/CT had limited sensitivity in lymph node staging in high-risk EC, and the diagnostic accuracy of FDG-PET/CT remains complementary to the sentinel node procedure. Due to its high specificity and strong interrater reliability, FDG-PET/CT is recommended for clinical implementation in combination with the sensitive sentinel node biopsy for the targeted dissection of PET-positive lymph nodes, particularly in paraaortic regions. Full article

Background and aim: Low-density lipoprotein cholesterol (LDL-C) is an important and well-established modifiable risk factor for cardiovascular disease, including peripheral artery disease (PAD). We aimed at evaluating the lipid profile at admission in PAD patients with an indication for invasive treatment. Methods: Among patients with PAD diagnosis admitted to the vascular surgery department, those receiving statins and those with LDL-C values in the recommended target (<55 mg/dL) were identified. The correlation of LDL-C values with different clinical variables was investigated. Results: Of the 399 patients, 259 (65%) were on statin therapy. According to multivariate linear regression analysis, diabetes (p = 0.004), previous CAD history (p < 0.001), and statin therapy (p < 0.001) were independently associated with LDL-C levels. Patients with LDL-C < 55 mg/dL at admission were 89 (22% of the overall cohort). Among these patients, diabetes (48.3% versus 35.8%, p = 0.036), CAD history (52.8% versus 30%, p < 0.001), and statin use (91% versus 57.4%, p < 0.001) were more frequent as compared with patients not at target. Conclusion: Despite the very high cardiovascular risk of our group, the rate of statin prescription was very low and far from ideal. Only a small percentage of patients achieved target LDL-C values. Patients with coexistent diabetes and CAD had lower LDL-C values, suggesting management by specialists with greater attention to lipid profile and pointing out an urgent need for information on cardiovascular disease management. Full article

Background/Objectives: Access to specialized care for patients with cognitive impairment in remote areas is often limited. Despite the increasing adoption of telemedicine, standardized guidelines have not yet been specified. This study aimed to develop a comprehensive protocol for the specialized neurological, neuropsychological, and neuropsychiatric assessment of patients with cognitive disorders in remote areas through telemedicine. Methods: We analyzed data from (i) a comprehensive literature review of the existing recommendations, reliability studies, and telemedicine models for cognitive disorders, (ii) insights from a three-year experience of a specialized telemedicine outpatient clinic for cognitive movement disorders in Greece, and (iii) suggestions coming from dementia specialists experienced in telemedicine (neurologists, neuropsychologists, psychiatrists) who took part in three focus groups. A critical synthesis of the findings was performed in the end. Results: The final protocol included: technical and organizational requirements (e.g., a high-resolution screen and a camera with zoom, room dimensions adequate for gait assessment, a noise-canceling microphone); medical history; neurological, neuropsychiatric, and neuropsychological assessment adapted to videoconferencing; ethical–legal aspects (e.g., data security, privacy, informed consent); clinician–patient interaction (e.g., empathy, eye contact); diagnostic work-up; linkage to other services (e.g., tele-psychoeducation, caregiver support); and instructions for treatment and follow-up. Conclusions: This protocol is expected to serve as an example of good clinical practice and a source for official telemedicine guidelines for cognitive disorders. Ultimate outcomes include the potential enhanced access to specialized care, minimized financial and logistical costs, and the provision of a standardized, effective model for the remote diagnosis, treatment, and follow-up. This model could be applied not only in Greece, but also in other countries with similar healthcare systems and populations living in remote, difficult-to-access areas. Full article

The Brazilian Araucaria Forest (AF) now covers only 1% of its original extent due to significant degradation, making conservation a challenge. The AF occurs in a mosaic alongside grassland and Atlantic Forest ecosystems, influencing bird species’ distribution through ecological processes. We compared the composition and functional diversity of the bird community along a gradient of AF cover in a protected area (Pró-Mata Private Natural Heritage Reserve) in southern Brazil. Bird sampling was conducted using MacKinnon lists along five trails with different histories of vegetation suppression, based on forest cover estimates from landscape imagery. Birds were functionally classified based on morphological and ecological traits. We recorded 191 bird species in total. We found higher bird richness in trails with less forest cover, while functional diversity responded inversely to vegetation cover. Bird species composition shifted from more open-habitat specialists to more forest specialists with the increasing forest cover and vegetation structural complexity. These findings highlight the ecological importance of maintaining vegetation heterogeneity, as vegetation mosaics enhance avian species richness and support a broader range of functional traits and ecosystem processes. We recommend the conservation of Araucaria Forest–grassland mosaics as a strategic approach to support multidimensional biodiversity and sustain key ecological functions in southern Brazil. Full article

Upper extremity amputations significantly impact an individual’s physical capabilities, psychosocial well-being, and overall quality of life. The level at which an amputation is performed influences residual limb function, prosthetic compatibility, and long-term patient satisfaction. While surgical guidelines traditionally emphasize maximal limb preservation, prosthetists often advocate for amputation sites that optimize prosthetic fit and function, highlighting the need for a collaborative approach. This review examines the discrepancies between surgical and prosthetic recommendations for optimal amputation levels, from digit amputations to shoulder disarticulations, and explores their implications for prosthetic design, functionality, and patient outcomes. Various prosthetic options, including passive functional, body-powered, myoelectric, and hybrid devices, offer distinct advantages and limitations based on the level of amputation. Prosthetists emphasize the importance of residual limb length, not only for mechanical efficiency but also for achieving symmetry with the contralateral limb, minimizing discomfort, and enhancing control. Additionally, emerging technologies such as targeted muscle reinnervation (TMR) and advanced myoelectric prostheses are reshaping rehabilitation strategies, further underscoring the need for precise amputation planning. By integrating insights from both surgical and prosthetic perspectives, this review highlights the necessity of a multidisciplinary approach involving surgeons, prosthetists, rehabilitation specialists, and patients in the decision-making process. A greater emphasis on preoperative planning and interprofessional collaboration can improve prosthetic outcomes, reduce device rejection rates, and ultimately enhance the functional independence and well-being of individuals with upper extremity amputations. Full article

The 26th annual Western Canadian Gastrointestinal Cancer Consensus Conference (WCGCCC) was held in Saskatoon, Saskatchewan, on 17–18 October 2024. The WCGCCC is an interactive multidisciplinary conference that was attended by healthcare professionals from across Western Canada (British Columbia, Alberta, Saskatchewan, and Manitoba) who are involved in the care of patients with hepatocellular and biliary tract cancers. Specialists from the fields of medical and radiation oncology, interventional radiology, pathology and laboratory medicine, and general and hepatobiliary surgery participated in presentations and discussions for the purpose of developing the recommendations presented here. This consensus statement addresses current issues in the management of hepatocellular and biliary tract cancers. Full article

Background/Objectives: The development of hypophosphatemia has been associated with intravenous iron products, with the rate of hypophosphatemia found to be higher with ferric carboxymaltose. This consensus statement provides clinical guidance on the risk of hypophosphatemia development with ferric carboxymaltose and the approaches for management. To develop consensus recommendations regarding the clinical implications of hypophosphatemia after the administration of ferric carboxymaltose, the assessment of patient risk profile, and recommended approaches for risk reduction. Methods: Consensus statements were developed from an in-person meeting of specialists with expertise in iron pathophysiology and iron therapy and further supplemented with literature review. The multidisciplinary expert panel comprised global iron specialists spanning anesthesiology, cardiology, gastroenterology, obstetrics/gynecology, hematology, nephrology, and iron molecular biology. Structured discussions were held in an in-person meeting to gather expert opinion on the evidence base regarding intravenous iron and hypophosphatemia. Consolidated summary opinions underwent further iterations of panel review to form consensus recommendation statements. Results: The expert panel developed the following consensus statements: (1) Routine serum phosphate level measurement is not recommended for low-risk patients before or after treatment with ferric carboxymaltose, as most cases of hypophosphatemia that occur following the administration of ferric carboxymaltose are asymptomatic and transient; (2) patients receiving ferric carboxymaltose should be assessed for the degree of risk for developing symptomatic or severe hypophosphatemia prior to administration; (3) monitoring serum phosphate is recommended for patients at an increased risk for developing low serum phosphate or who require repeated courses of ferric carboxymaltose treatment at higher doses; (4) prophylactic oral phosphorus after ferric carboxymaltose is unlikely to effectively elevate phosphate and is not recommended for routine clinical practice; and (5) hypophosphatemic osteomalacia is rare and the risk of development after the administration of ferric carboxymaltose, in particular single infusion, is low. Conclusions: Hypophosphatemia following ferric carboxymaltose is predominantly asymptomatic and transient. Individuals at higher risk for developing hypophosphatemia with ferric carboxymaltose treatment include those who receive multiple infusions, higher cumulative doses, or long-term iron treatment or who have underlying clinical risk factors. These consensus statements provide structured guidance on the risk of hypophosphatemia with ferric carboxymaltose and the approaches to clinical management. Full article

Purpose: The objective of this study was to evaluate the implementation of a Multidisciplinary Tumor Board (MDTB) strategy in the treatment of patients with uveal melanoma. Methods: A retrospective analysis was conducted on the implementation of MDTB meetings over a 24-month period. During this time, 72 intraocular tumors were discussed, including 59 confirmed cases of uveal melanoma. The MDTB involved a core group of specialists (e.g., ophthalmologists, oncologists, and radiologists), with other experts included when clinically appropriate. To assess patient satisfaction with the MDTB approach, a structured questionnaire was administered, including items on clarity of communication, perceived quality of care, and overall satisfaction, which were ranked on a 5-point scale. Results: A total of 319 patients with ocular, periocular, or orbital tumors were discussed during the study period, of which, 72 had intraocular tumors. A total of 13 (18%) were diagnosed to have choroidal metastases, whereas 59 (82%) had uveal melanomas. The average time between patient care and MDTB discussion was 15.9 days (IQR: 7.5–16.5). The mean time between the case discussion and the implementation of recommendations (diagnostic, therapeutic, or referral decisions) was 14.8 days (IQR: 6.0–23.75). Overall, 4 (7%) patients were classified as Stage I, 16 (27%) as Stage IIa, 18 (31%) as Stage IIb, 7 (12%) as Stage IIIa, 2 (3%) as Stage IIIb, and 12 (20%) as Stage IV. Regarding the satisfaction questionnaire, all patients (100%) agreed to have the clinical case discussed at the TB even though this could result in a delay in diagnostic/therapeutic implementation. However, only 60% of patients perceived they had been directly involved in the decision-making process. Conclusions: In selected cases of uveal melanoma and other types of cancer, MDTBs should be recognized as a gold standard in cancer care, allowing for comprehensive decision-making that draws on a wide range of highly specialized expertise. Full article