Search Results (989)

This study aims to provide a comprehensive overview of psychological distress among medical students in Spain, a growing concern given the high prevalence rates of anxiety, depression, and burnout reported across multiple medical schools and universities. To assess the scope and key characteristics of this phenomenon, a thorough literature search was conducted in the PubMed, ProQuest, and Web of Science (WoS) databases. Studies published between 2010 and 2024 in peer-reviewed scientific journals, written in English or Spanish, and specifically focused on medical students enrolled in Spanish universities were considered for inclusion. A total of 14 studies were analysed. The findings indicate that psychological distress often emerges early in medical training and tends to intensify as students progress academically. Female medical students are consistently more affected, as most of the studies reviewed indicate that they exhibit higher levels of depressive symptoms, trait anxiety, and perceived stress. Some research also suggests greater levels of burnout among female students compared to their male peers. Key contributing factors include academic overload and dissatisfaction, sleep deprivation, and the use of maladaptive coping strategies. Although awareness of the issue is increasing, available evidence suggests that institutional responses remain limited, and that only a small number of universities have implemented structured mental health programmes. Overall, the results underscore the urgent need for institutional reforms in Spanish medical education to safeguard students’ mental wellbeing. Key priorities include revising curricula, implementing structured emotional support programmes, and ensuring accessible services—requiring coordinated, long-term commitment across academic, healthcare, and policy sectors. Future research should explore longitudinal trends and the effectiveness of targeted interventions. Full article

Background/Objectives: The integration of AI chatbots in nursing education, particularly in simulation-based learning, is advancing rapidly. However, there is a lack of structured evaluation models, especially to assess AI-generated simulations. This article introduces the AI-Integrated Method for Simulation (AIMS) evaluation framework, a dual-phase evaluation framework adapted from the FAITA model, designed to evaluate both prompt design and chatbot performance in the context of nursing education. Methods: This simulation-based study explored the application of an AI chatbot in an emergency planning course. The AIMS framework was developed and applied, consisting of six prompt-level domains (Phase 1) and eight performance criteria (Phase 2). These domains were selected based on current best practices in instructional design, simulation fidelity, and emerging AI evaluation literature. To assess the chatbots educational utility, the study employed a scoring rubric for each phase and incorporated a structured feedback loop to refine both prompt design and chatbox interaction. To demonstrate the framework’s practical application, the researchers configured an AI tool referred to in this study as “Eval-Bot v1”, built using OpenAI’s GPT-4.0, to apply Phase 1 scoring criteria to a real simulation prompt. Insights from this analysis were then used to anticipate Phase 2 performance and identify areas for improvement. Participants (three individuals)—all experienced healthcare educators and advanced practice nurses with expertise in clinical decision-making and simulation-based teaching—reviewed the prompt and Eval-Bot’s score to triangulate findings. Results: Simulated evaluations revealed clear strengths in the prompt alignment with course objectives and its capacity to foster interactive learning. Participants noted that the AI chatbot supported engagement and maintained appropriate pacing, particularly in scenarios involving emergency planning decision-making. However, challenges emerged in areas related to personalization and inclusivity. While the chatbot responded consistently to general queries, it struggled to adapt tone, complexity and content to reflect diverse learner needs or cultural nuances. To support replication and refinement, a sample scoring rubric and simulation prompt template are provided. When evaluated using the Eval-Bot tool, moderate concerns were flagged regarding safety prompts and inclusive language, particularly in how the chatbot navigated sensitive decision points. These gaps were linked to predicted performance issues in Phase 2 domains such as dialog control, equity, and user reassurance. Based on these findings, revised prompt strategies were developed to improve contextual sensitivity, promote inclusivity, and strengthen ethical guidance within chatbot-led simulations. Conclusions: The AIMS evaluation framework provides a practical and replicable approach for evaluating the use of AI chatbots in simulation-based education. By offering structured criteria for both prompt design and chatbot performance, the model supports instructional designers, simulation specialists, and developers in identifying areas of strength and improvement. The findings underscore the importance of intentional design, safety monitoring, and inclusive language when integrating AI into nursing and health education. As AI tools become more embedded in learning environments, this framework offers a thoughtful starting point for ensuring they are applied ethically, effectively, and with learner diversity in mind. Full article

Objectives: The objective of this manuscript is to translate, adapt, and validate an Arabic version of the Diabetes Eating Problem Survey—Revised (DEPS-R) questionnaire to assess disordered eating behaviors (DEBs) in adolescents with T1D in Saudi Arabia. Additionally, the study sought to estimate the prevalence of DEBs and analyze its associations with glycemic control and diabetes-related complications. Methods: A cross-cultural validation study was conducted following the COSMIN guidelines. The DEPS-R questionnaire was translated into Arabic through forward and backward translation involving expert panels, including psychiatrists, diabetologists, and linguists. A sample of 409 people with type 1 diabetes (PwT1D) (58.4% females) aged 12–20 years was recruited from outpatient diabetes clinics in the five main regions of Saudi Arabia. Participants completed the Arabic DEPS-R and the validated Arabic version of the SCOFF questionnaire. Sociodemographic, anthropometric, and biochemical data were collected, and statistical analyses, including confirmatory factor analysis (CFA) and internal consistency tests, were conducted. Results: The Arabic DEPS-R exhibits strong internal consistency (Cronbach’s alpha = 0.829) and high test–retest reliability (ICC = 0.861), with a CFA supporting a three-factor structure, namely body weight perception, disordered eating behaviors (DEBs), and bulimic tendencies. Notably, higher DEPS-R scores are significantly linked to elevated HbA1c levels, increased BMI, and more frequent insulin use. Alarmingly, 52.8% of participants show high-risk DEB, which is directly associated with poor glycemic control (HbA1c ≥ 8.1%) and a heightened risk of diabetic ketoacidosis (DKA). Conclusions: The Arabic DEPS-R is a valid and reliable tool for screening DEBs among Saudi adolescents with T1D. Findings underscore the necessity for early identification and intervention to mitigate the impact of EDs on diabetes management and overall health outcomes. Full article

Hernia is a physiological condition that significantly impacts patients’ quality of life. Surgical treatment for hernias often involves the use of specialized meshes to support the abdominal wall. While this method is highly effective, it frequently leads to complications such as pain, infections, inflammation, adhesions, and even the need for revision surgeries. According to the Food and Drug Administration (FDA), hernia recurrence rates can reach up to 11%, surgical site infections occur in up to 21% of cases, and chronic pain incidence ranges from 0.3% to 68%. These statistics highlight the urgent need to improve mesh technologies to minimize such complications. The design and material composition of meshes are critical in reducing postoperative complications. Moreover, integrating drug-eluting properties into the meshes could address issues like infections and inflammation by enabling localized delivery of antibiotics and anti-inflammatory agents. Mesh design is equally important, with innovative structures like auxetic designs offering enhanced mechanical properties, flexibility, and tissue integration. These advanced designs can distribute stress more evenly, reduce fatigue, and improve performance in areas subjected to high pressures, such as during intense coughing, sneezing, or heavy lifting. Technological advancements, such as 3D printing, enable the precise fabrication of meshes with tailored designs and properties, providing new opportunities for innovation. By addressing these challenges, the development of next-generation mesh implants has the potential to reduce complications, improve patient outcomes, and significantly enhance quality of life for individuals undergoing hernia repair. Full article

The implementation of Building Information Modelling (BIM) in public design processes enhances efficiency, transparency, and sustainability. However, public agencies often encounter significant barriers, particularly regarding organisational and managerial readiness. This study develops a BIM implementation framework tailored to the specific needs of an Italian public agency. The research adopts a qualitative approach, combining 15 semi-structured interviews with process mapping Using (Business Process Modeling Notation) BPMN. The current as-is workflows were analysed and validated by internal stakeholders. Based on this analysis, strategic objectives were defined, relevant (Building Information Modelling) BIM uses were selected, and revised to-be processes were proposed, integrating new roles and responsibilities according to the standards. The framework addresses both technical and organisational dimensions of BIM adoption, highlighting the need for training, coordination, and stakeholder engagement. The main outcomes include a structured process model, a priority-based selection of BIM uses, and a role matrix supporting organisational transformation. The added value for researchers lies in the replicable methodology that combines empirical process mapping with implementation planning. For practitioners, especially consultants in sustainable design, the study offers a practical roadmap for aligning BIM adoption with project goals, regulatory compliance, and environmental performance targets in complex public sector contexts. Full article

Despite progress in inclusive education, students with Special Educational Needs (SEN) often lack valid, tailored tools for career assessment, limiting equitable transitions to adulthood and employment. Closing this gap is crucial for Sustainable Development Goal 4 (SDG 4), which calls for quality and inclusive educational opportunities. This study addresses this need by adapting and validating a 16-item Career Maturity Inventory-Form C (CMI-C) for Chinese post-secondary SEN students (n = 34) in vocational training in higher education. Rasch modeling, supported by exploratory factor analysis, indicated that a two-factor structure—‘career choice readiness’ and ‘intention to seek career consultation’—provided the best fit to the data, rather than the originally hypothesized four-factor model. The results were more consistent with a two-dimensional structure than with prior four-factor frameworks, though both were explored. Two poorly performing items were removed, resulting in a fourteen-item scale with acceptable item fit and reliability indices in this hard-to-reach group. This restructuring suggests constructs such as concern, confidence, and curiosity are closely linked in SEN populations, underscoring the value of context-sensitive assessment. The revised instrument demonstrated satisfactory model fit and internal consistency; however, convergent validity and practical utility should be interpreted cautiously given the modest sample size. While further validation in larger and more diverse samples is warranted, this study offers preliminary evidence for an adapted, inclusive assessment tool that aligns with SDG 4’s aim to promote equity and empower SEN students in educational and career pathways. Full article

Background: Antenatal depression and anxiety contribute significantly to maternal morbidity and adverse pregnancy outcomes. However, structured screening and targeted interventions are largely absent from standard prenatal care in many Eastern European countries, including Bulgaria. This study examines the prevalence and psychosocial predictors of antenatal psychosocial risk using the validated Antenatal Risk Questionnaire–Revised (ANRQ-R) in a nationally underrepresented population. Methods: A cross-sectional survey was conducted among 216 third-trimester pregnant women in Bulgaria. Data on sociodemographic characteristics, health behaviours, and reproductive history were collected. Multivariate logistic regression identified predictors of elevated psychosocial risk. Results: A total of 65.7% of participants met the criteria for elevated psychosocial risk. Significant risk factors included passive smoking exposure during pregnancy (OR = 5.03, p < 0.001), physical activity prior to pregnancy (OR = 1.81, p = 0.004), and a family history of hereditary disease (OR = 42.67, p < 0.001). Protective factors were better self-rated current health (OR = 0.37, p = 0.004), the presence of chronic illness (OR = 0.42, p = 0.049), previous childbirth experience (OR = 0.11, p = 0.032), and residence in Northwestern Bulgaria (OR = 0.31, p = 0.028). Despite the high prevalence of psychosocial vulnerability, only 9.5% of affected women sought professional help. Conclusions: While our findings point to important unmet needs in antenatal mental health, further research is required before national screening policies can be implemented. Pilot programs, cultural validation of tools, and system-level readiness assessments should precede broad adoption. Full article

Despite reaching intermediate English proficiency, many bilingual secondary students in Colombia struggle with academic writing due to difficulties in organizing ideas and expressing arguments coherently. To address this issue, this study explores the integration of AI-powered tools—Grammarly and ChatGPT—within the Writing Workshop Instructional Model (WWIM) to enhance students’ writing skills. Conducted at a bilingual secondary school, the intervention targeted 10th grade ESL learners and focused on improving grammar accuracy, textual coherence, and organizational structure. Drawing on Galbraith’s model of writing as content generation, the study adopted a design-based research methodology, incorporating iterations of implementation, feedback, and refinement. The results indicate that combining WWIM with AI feedback significantly improved students’ academic writing performance. Learners reported greater confidence and engagement when revising drafts using automated suggestions. These findings highlight the pedagogical potential of integrating AI tools into writing instructions and offer practical implications for enhancing academic writing curricula in secondary ESL contexts. Full article

Field foundation pile loading tests were conducted in the context of an actual bridge pile foundation project. The test data were analyzed to determine the reasons for the variation in the complex geological conditions of the seashore. Moreover, finite element analysis was conducted to evaluate the influence of pile length and diameter on the settlement of coastal friction foundation piles. Increasing the pile length from 65 m to 75 m reduced the settlement by 25.7%, while increasing the diameter from 1.5 m to 2.0 m led to a 35.9% reduction. Increasing the pile spacing reduced the amount of structural settlement. Group pile foundation pile spacings should be 2.5–3.0 D. Pile group superposition reduced the most obvious effects and the settlement reduction rate was the fastest. Under seismic conditions, the pile group foundation exhibited 5.60 times greater horizontal displacement, 3.57 times higher bending moment, and 5.30 times increased shear force relative to static loading. The formula for predicting the settlement of oversized friction pile group foundations was modified based on settlement values calculated using finite elements. The revised formula is suitable for calculating the settlement of friction pile group foundations in coastal areas. Full article

Background: Proximal tibial fractures can lead to post-traumatic osteoarthritis (PTOA), and subsequent total knee arthroplasty (TKA) in such patients is associated with elevated complication rates. A two-stage approach, involving the elective removal of osteosynthetic hardware prior to TKA, is recommended. The utility of microbiological sampling from macroscopically unremarkable tissue during TKA implantation remains controversial. Objective: To retrospectively evaluate the rate of periprosthetic joint infection (PJI) following TKA after PTOA and to assess the potential benefit of intraoperative microbiological sampling. The secondary objective was to evaluate the presence of prior colonization in osteosynthetic hardware among the affected cases. Patients and Methods: A retrospective screening of the hospital database was conducted between 2008 and 2022, including only AO/OTA type 41-B and 41-C fractures. Patients were assigned to a sampling group (with microbiological sampling during TKA) or a control group (without sampling). All patients received structured follow-up to assess postoperative complications. Results: A total of 40 patients met the screening criteria. In the sampling group (n = 29), 17.24% required surgical revision, and the rate of PJI was 3.45%. In the control group (n = 11), 18.14% underwent revision surgery, with a PJI rate of 9.09%. The average follow-up period was 4.35 years (range 2–11.6 years). Discussion: TKA in patients with PTOA is associated with a heightened risk of complications. A noteworthy possible correlation between systematic microbiological sampling and reduced PJI incidence was observed. While the small sample size limits definitive conclusions regarding causality, the findings support the potential value of consistent intraoperative sampling. Full article

This study investigates the effect of accelerated aging on the microstructure and surface properties of synthetic sports surfaces, with the goal of developing a more representative laboratory simulation method. Three common types of polyurethane-based sports surfaces were examined: (1) a dual-layer SBR base with a thin EPDM spray topcoat; (2) a single-layer EPDM surface with a smooth finish; and (3) a dual-layer “sandwich” structure with a rough EPDM upper layer. Samples were tested for slip resistance (PTV), abrasion resistance, and surface morphology using SEM, as well as surface roughness and tensile properties before and after aging. Method combining UV radiation and water spray was introduced and evaluated. Microstructural analysis with roughness measurements revealed surface degradation in all materials, with more extensive damage observed in the UV + spray cycle. Slip resistance results showed reduced performance in dry conditions and improved values in wet conditions post-aging. The single-layer EPDM surface demonstrated the highest initial dry PTV, while the dual-layer with spray had the lowest. After aging, all surfaces exhibited smaller differences between dry and wet performance but no longer met dry condition standards. These results may guide future revisions of performance testing standards and contribute to the development of safer, longer-lasting synthetic sports surfaces. Full article

To date, various species of Erigeron genus have been used both in the ethnopharmacology of numerous nations across the world and in contemporary herbal practices. The objective of this study is to revise the phytochemical data on the essential oils (EOs) of various fleabanes species and to evaluate the variability of their biological activities. Up to June 2025, this review provides an updated overview of 105 literature sources (published during last 25 years) related to 14 Erigeron sp. (native, naturalized, or invasive) which have been investigated extensively and are of the greatest significance. It summarizes the compositional variability of the EOs and their pharmacological and toxic effects, such as anti-inflammatory, anticancer, antiproliferative, skin regeneration, antioxidant, antifungal, antibacterial, insecticidal, larvicidal, repellent, and allelopathic activity. The EOs of each Erigeron species were characterized, and a chemical structure of 43 major constituents is presented herein. The most characteristic and prevalent compounds were found to be limonene, δ-3-carene, matricaria ester, lachnophyllum ester, germacrene D, β-caryophyllene, β-farnesene, α-bergamotene, allo-aromadendrene, etc., in the EOs from the E. acris, E. annuus, E. bonariensis, E. canadensis, E. floribundus E. mucronatus, and E. speciosus plants. Major constituents, such as borneol, bornyl acetate, modhephen-8-β-ol, cis-arteannuic alcohol, β-caryophyllene, and τ-cadinol, were found in the oils of E. graveolens (Inula graveolens). A paucity of data concerning E. incanus EOs was revealed, with the prevalence of 3-hydroxy-4-methoxy cinammic acid and thymol acetate noted in the oils. The EOs from E. multiradiatus and E. sublyratus were comprised mainly of matricaria and lachnophyllum esters. The available data on EOs of E. ramosus is limited, but the main constituents are known to be α-humulene, 1,8-cineole, eugenol, and globulol. The EOs containing appreciable amounts of matricaria and lachnophyllum esters exhibited strong anticancer, anti-inflammatory, antimicrobial, larvicidal, and repellent activities. Repellence is also related to borneol, bornyl acetate, caryophyllene derivatives, τ-cadinol, modhephen-8-β-ol, and cis-arteannuic alcohol. Cytotoxicity was determined due to the presence of limonene, δ-3-carene, α- and β-farnesene, (E)-β-ocimene, ledene oxide, sesquiphellandrene, and dendrolasin in the fleabanes EOs. Skin regeneration and antifungal properties were related to germacrene D; and anti-inflammatory effects were determined due to high amounts of limonene (E)-β-ocimene, lachnophyllum ester, and germacrene D. The antimicrobial properties of the oils were conditioned by appreciable quantities of limonene, β-pinene, 1,8-cineole, carvacrol, thymol acetae, β-eudesmol, 2,6,7,7α-tetrahydro-1,5-dimethyl-1H-indene-3-carboxaldehyde, caryophyllene and its oxide, allo-aromadendrene, α-humulene, farnesene, carvacrol, and eugenol. This review provides a foundation for further studies on volatile secondary metabolites to explore the potential sources of new biologically active compounds in Erigeron sp. Full article

Background: Lumbar Interbody Fusion (LIF) is a surgical procedure aimed at addressing a range of pathological conditions affecting the structure and function of the spine. Patient-Specific Interbody Cages (PSICs) are an emerging technology that are used in LIF; however, there is a lack of clinical outcome data, making it difficult to assess the potential risks, benefits, and value of PSICs. The purpose of this present study is to contribute data to the field on this new emerging technology. The aims were to investigate Quality of Life (QoL), pain, and the complications of PSICs in LIF. To provide a comparative cohort, we performed a systematic review of patient-reported outcomes of conventional fusion techniques. Methods: This study reports on a multi-surgeon, multi-centre clinical trial of patients with lumbar degenerative disc disease, necessitating discectomy and fusion. All patients underwent LIF procedures with 3D-printed PSICs. Pain Visual Analogue Scale (VAS) and QoL (EQ-5D) scores were collected pre-operatively and at 6m, 12m, and 24m post-operatively. For comparative purposes, we performed a systematic review of the VAS scores from traditional LIF cages and analysed the Australian Spine Registry QoL data. Results: The literature search yielded 4272 publications. The studies were subdivided into four groups based on the interbody device type. All the groups demonstrated improvements in the VAS (for back pain) scores post-operatively. In total, 78 patients (109 instrumented levels) underwent LIF procedures with 3DP PSICs. There were three reoperations (3.8%) and no revisions of any PSIC. The mean VAS scores improved significantly (p < 0.01) from 7.85 (1.50 SD) pre-operatively to 2.03 (2.13 SD) at 24 months post-operatively. The mean QoL index scores improved significantly (p < 0.01) from a pre-operative 0.257 (0.332 SD) to 0.815 (0.208 SD) at 24 months. Conclusions: The systematic review indicated that device fixation to the interbody space was associated with lower VAS scores. The results from the investigational cohort suggest that PSICs may represent a new progression in implant design for spinal fusion, with an associated clinical benefit for LIF. Full article

A syntaxonomical revision of the plant communities of the Isoëto-Nanojuncetea class occurring in Sardinia is provided. Within this class, the ephemeral herbaceous hygrophilous associations linked to temporarily submerged surfaces occur, which are widespread in the European, Mediterranean, and Macaronesian countries. It groups plant communities floristically characterized by a rich set of annual hygrophytes or more rarely hemicryptophytes and geophytes, which are also physiognomically, ecologically, and structurally well differentiated. Within this class, two orders are recognized in Sardinia, such as Isoëtetalia and Nanocyperetalia, which are represented by several alliances. In particular, four alliances can be referred to as Isoëtetalia (Isoëtion, Menthion cervinae, Cicendio-Solenopsion laurentiae, and Agrostion pourretii), while a single alliance (Verbenion supinae) belonging to Nanocyperetalia has been identified. Within these alliances, several associations already described have been surveyed, while several other unpublished ones, are here proposed as new to science. Overall, 35 associations are recognized, 18 of which are described for the first time. Each higher-rank syntaxa and related associations are examined from a nomenclatural, floristic, ecological, and chorological point of view. In particular, the more significant phytosociological relevés regarding the examined associations were processed using cluster analysis, DCA ordination, optimclass diagram in order to highlight the correlations between them. As regards the floristic aspects, a checklist of the species occurring in the phytosociological relevés is provided. Full article

This study presents a bibliographic review of the genus Menegazzia in Chile, the first in over two decades, updating new records, the taxonomic placement of the genus, and the synonymization of species. Up to twenty species have been cited in the country, considering that M. albida, M. hollermayeri, and M. norstictca are synonyms of the valid species M. wilsonii, M. dispora, and M sanguinascens. A fully revised dichotomous key and color photographs are included to facilitate accurate identification, especially given the genus’s morphological convergence and sparse reproductive structures. For the first time, the divergence times of Menegazzia lineages are discussed in relation to major Southern Hemisphere geologic events, suggesting a dispersal-driven distribution with a crown age of approximately 21.2 Ma. This review consolidates fragmented data, integrates recent molecular findings, and emphasizes the genus’s value as an ecological and biogeographic indicator in Chilean temperate forests. Full article