Search Results (59)

Background/Objectives: Childhood cancer leads to significant physical, cognitive, and psychosocial consequences that adversely affect the development and quality of life. Occupational Therapy (OT) has the potential to mitigate these effects. However, its integration into pediatric oncology care in Spain remains limited and underexplored. This study aims to examine the availability, characteristics, and perceived impact of OT services within pediatric oncology units across Spain and to identify key barriers to their implementation. Methods: A descriptive, cross-sectional study using a mixed-methods approach was conducted. An online questionnaire was distributed to healthcare professionals working in pediatric oncology units nationwide. Quantitative data were analyzed using descriptive statistics, Fisher’s exact test, and odds ratios with 95% confidence intervals to explore associations. Effect sizes were calculated using Cramér’s V where applicable. Qualitative responses underwent inductive thematic analysis. Results: A total of 42 hospital centers from 12 autonomous communities participated. Only 16 reported having OT services in pediatric oncology, with notable regional disparities. A significant proportion of respondents were unaware of the integration of OT in their institutions. Identified barriers included lack of resources, insufficient specialized training, and limited institutional recognition of OT. Nonetheless, professionals familiar with OT interventions reported positive outcomes, particularly in improving patients’ functional autonomy, emotional well-being, and social participation. Conclusions: OT remains insufficiently integrated into pediatric oncology care in Spain. To optimize the quality of care, it is essential to address educational, structural, and institutional challenges and promote OT as a key component of multidisciplinary teams. Full article

Background/Objectives: Extraction and replacement of hopeless teeth is a common practice in dentistry. Tooth autotransplantation (TA) offers several advantages as a viable and biological treatment option. However, its utilization in Saudi Arabia appears limited. Understanding dentists’ knowledge and attitudes toward TA is crucial for promoting its adoption in clinical practice. Therefore, the aim of this study is to assess the knowledge and attitudes of dentists in Saudi Arabia toward tooth autotransplantation. Methods: A cross-sectional study was conducted using a web-based questionnaire distributed to dentists across Saudi Arabia. The questionnaire included 19 questions assessing demographic characteristics, knowledge of TA, and attitudes toward its clinical application. Data were analyzed using SPSS v23 with chi-square and Cramér’s V tests to explore associations between variables (p < 0.05). Results: 253 dentists participated in this study. All participants had heard of TA, while only 26.5% reported moderate-to-high familiarity. Female dentists showed significantly greater interest in adopting TA than males (p = 0.038, Cramér’s V = 0.183). Specialists expressed higher familiarity than general dentists and underscored the importance of clinical guidelines, evidence-based outcomes, confidence in their capacity to engage in a TA team, the total number of required appointments, and malpractice concerns (p < 0.05) in their decision-making process. Nevertheless, general dentists demonstrated significantly more interest in implementing TA (p = 0.025, Cramér’s V = 0.192). Participants with more than 5 years of clinical dental experience were significantly more familiar with TA (p = 0.015, Cramér’s V = 0.204) and were more influenced by appointment numbers in decision-making (p = 0.012, Cramér’s V = 0.225). Conclusions: The study reveals limited familiarity but notable interest among dentists in Saudi Arabia toward TA. Addressing educational gaps by integrating TA training into dental curricula and offering clinical exposure opportunities to students, along with providing evidence-based clinical guidelines, and improving access to advanced imaging technologies, may enhance the adoption of TA as a viable treatment modality for tooth replacement. Full article

The increasing integration of large language models (LLMs) into healthcare presents significant opportunities, but also critical risks related to patient safety, accuracy, and ethical alignment. Despite these concerns, no standardized framework exists for systematically evaluating and stress testing LLM behavior in clinical decision-making. The PIEE cycle—Planning and Preparation, Information Gathering and Prompt Generation, Execution, and Evaluation—is a structured red-teaming framework developed specifically to address artificial intelligence (AI) safety risks in healthcare decision-making. PIEE enables clinicians and informatics teams to simulate adversarial prompts, including jailbreaking, social engineering, and distractor attacks, to stress-test language models in real-world clinical scenarios. Model performance is evaluated using specific metrics such as true positive and false positive rates for detecting harmful content, hallucination rates measured through adapted TruthfulQA scoring, safety and reliability assessments, bias detection via adapted BBQ benchmarks, and ethical evaluation using structured Likert-based scoring rubrics. The framework is illustrated using examples from plastic surgery, but is adaptable across specialties, and is intended for use by all medical providers, regardless of their backgrounds or familiarity with artificial intelligence. While the framework is currently conceptual and validation is ongoing, PIEE provides a practical foundation for assessing the clinical reliability and ethical robustness of LLMs in medicine. Full article

Non-operating room anesthesia (NORA) is a rapidly growing domain for anesthesia professionals due to advances in procedural technology and increased emphasis on patient comfort. The majority of these procedures are conducted under monitored anesthesia care (MAC) where patients receive varying levels of sedation. Analysis of the Anesthesia Closed Claims database suggests that adverse respiratory events continue to be the main cause of morbidity and mortality in patients undergoing NORA procedures. Most NORA claims occurred under MAC, with oversedation leading to respiratory depression coupled with inadequate monitoring making up the majority of claims. The American Society of Anesthesiologists (ASA) has released standards of pre-anesthesia, intraoperative monitoring, and post-anesthesia care, which apply to all anesthetizing locations including NORA. The ASA has also made recommendations in a statement on NORA to promote patient safety. Evidence suggests that patient characteristics, monitoring tools, physical constraints, and team familiarity play a role in the risk for adverse respiratory events. Future studies are required to further understand the challenges specific to NORA locations. Full article

The paper explores virtual worlds as an innovative training platform for upskilling and reskilling smart city professionals, comprising technicians and engineers. Focusing on developing soft skills, the study presents findings from the pilot of a virtual training which was part of a comprehensive tech skills program that also included transversal skills, namely soft, entrepreneurial and green skills. Moreover, the paper describes the methodological approach adapted for the design and the use of the soft skills’ virtual world during the online multi-user sessions, and depicts the technical infrastructure used for its implementation. The virtual world was assessed with a mixed-methods approach, combining a specially designed evaluation questionnaire completed by 27 trainees with semi-structured interviews conducted with instructors. Quantitative data were analyzed to assess satisfaction, perceived effectiveness, and the relationship between curriculum design, support, and instructional quality. Qualitative feedback provided complementary insights into learner experiences and implementation challenges. Findings indicate high levels of learner satisfaction, particularly regarding instructor expertise, curriculum organization, and overall engagement. Statistical analysis revealed strong correlations between course structure and perceived training quality, while prior familiarity with virtual environments showed no significant impact on outcomes. Participants appreciated the flexibility, interactivity, and team-based nature of the training, despite minor technical issues. This research demonstrates the viability of VWs for soft skills development in technical professions, highlighting their value as an inclusive, scalable, and experiential training solution. Its novelty lies in applying immersive technology specifically to smart city training, a field where such applications remain underexplored. The findings support the integration of virtual environments into professional development strategies and inform best practices for future implementations. Full article

It is imperative that (preservice) teachers engage in continuous reflection on their pedagogical practice to foster their continuous professional development. Teaching videos are therefore used in teacher education programmes to stimulate reflection. The authentic presentation of teaching through videos enables (preservice) teachers to reflect on certain aspects of teaching. To enhance the reflection quality of (preservice) teachers, it is essential that they receive structured support throughout the reflection process. The following article examines the reflection processes of preservice teachers who took part in the FLECTT project (Collegial video-based reflection on teaching in Reflecting Teams) at the University of Duisburg-Essen. During their practical semester, preservice teachers had the opportunity to reflect on videotapes of their own teaching in a collegial reflection setting. As only a few studies have investigated processes of collegial video-based reflection of preservice teachers, the following study addresses this research desideratum and investigates the reflection processes by means of an explorative, qualitative study. The findings suggest that preservice teachers engage intensively with the teaching video. They reflect on their personal experiences and develop new alternative courses of action. However, it seems to be crucial that the participants are familiar with the specific setting in order to be able to participate effectively in the reflection process. In addition, the high level of engagement with the teaching video seems to have an effect on the concentration or fatigue of the preservice teachers. Full article

Intake of New Zealand blackcurrant (NZBC) extract for 7 days has been shown to improve high-intensity intermittent running (HIIR) performance. Objectives: We examined the repeat response of NZBC extract on HIIR performance. Methods: Sixteen active males (age: 23 ± 3 yrs, height: 179 ± 5 cm, mass: 79 ± 11 kg, $\dot{V}$O_2max: 55.3 ± 5 mL∙kg⁻¹∙min⁻¹, velocity at $\dot{V}$O_2max: 17.2 ± 0.8 km∙h⁻¹, mean ± SD) participated. Familiarized subjects completed the HIIR test at individualized exercise intensities with stages consisting of six 19 s high-intensity running bouts interspersed by 15 s of low-intensity running and 1 min of inter-stage rest. The test was repeated at increasing speeds until exhaustion, under four conditions; two with a daily dose of 600 mg of NZBC extract (CurraNZ™, providing 210 mg anthocyanins) and two with a placebo, each over 7 days. The study used a double-blind, randomized, cross-over design with a wash-out period of at least 14 days. Results: For the cohort, there were no differences between the placebo and NZBC conditions for mean heart rate (p = 0.071), mean oxygen uptake (p = 0.713), and mean lactate (p = 0.121) at exhaustion for the HIIR. The NZBC extract increased the mean total running distance and mean high-intensity running distance by 7.9% and 8.0% compared to the placebo. With NZBC extract, 8 of the 16 participants (50%) enhanced in both trials beyond the smallest worthwhile change for total running distance (≥173 m) and high-intensity running distance (≥111 m). For repeated responders, total running distance and high-intensity running distance was increased by 16.7% (95% CI [11.0, 22.4%] and 16.6% (95% CI [11.0, 22.2%]. Three participants had enhanced running performance in one trial beyond the SWC, and five participants were considered non-responders. Conclusions: This is the first study on the repeated response by an anthocyanin-rich supplement on high-intensity running performance. New Zealand blackcurrant extract can substantially enhance intermittent high-intensity running performance in consistent responders. Future work should examine dosing strategies of New Zealand blackcurrant, and whether a repeated response rate exceeding 50% can be attained. These findings suggest that NZBC extract could be beneficial for athletes participating in high-intensity team sports. Full article

As AI coding tools become more prevalent in programming, it is essential to understand how they influence programming education. This study, conducted in a first-semester Introduction to Programming course, aimed to determine the positive and negative effects of these tools on students’ learning experiences and their ability to develop essential programming skills. Using a mixed-methods approach, we collected data from 73 teams of engineering students over a 12-week period. Students completed surveys and reported on their AI tool usage. We analyzed this data quantitatively to identify trends in tool familiarity, usage, and student satisfaction. Additionally, qualitative analysis of student reports provided insights into the specific ways AI tools were used and their perceived benefits and drawbacks. The findings revealed a significant increase in AI tool familiarity (from 28% to 100%) and usage among students. Students’ satisfaction with AI tools improved over time. The most prevalent tasks for which novice programmers used AI tools included creating comments (91.7%), identifying and correcting bugs (80.2%), and seeking information (68.5%), while other tasks were less common. While these tools offered benefits like assisting in learning and enhancing real-world relevance, they also raised concerns about cheating, over-reliance on AI tools, and a limited understanding of core programming concepts. Full article

Background and Objectives: Resuscitation is one of the most stressful tasks in emergency medicine. The participation of nurses in this procedure can have specific effects on them. In this research, we wanted to find out what these effects are. Materials and Methods: A qualitative approach by conducting semi-structured interviews was used, and a thematic data analysis of the recorded interviews was carried out. The collected data were transcribed verbatim, with no corrections to the audio recordings. The computer program ATLAS.ti 22 was used for the qualitative data analysis. Results: Eleven male registered nurses were interviewed, with an average of 18.5 years of experience working in a prehospital environment (max. 32/min. 9). A total of 404 min of recordings were analyzed, and 789 codes were found, which were combined into 36 patterns and 11 themes. As the most stressful situations, the interviewees pointed out the resuscitation of a child, familiar persons, conflicts with the environment, conflicts within the resuscitation team, nonfunctioning or insufficient equipment, complications during resuscitation, and resuscitating a person only for training. As positive effects, the interviewees cited successful resuscitations or their awareness that, despite an unsuccessful resuscitation, they did everything they could. Conclusions: Participation in these interventions has a specific positive or negative impact on the performers. The interviewees shared the opinion that they can cope effectively with the adverse or stressful effects of resuscitation. Yet, despite everything, they allow the possibility of subconscious influences of this intervention on themselves. Full article

This research critically explores deficiencies in the palliative care system, focusing on evaluation and treatment aspects for both adult and paediatric patients. Using a qualitative methodology, the study engages healthcare professionals and family caregivers to uncover perspectives on the existing state of palliative care. Conducted through three focus groups and a semi-structured in-depth interview with participants recruited from Virgen de la Arrixaca University Clinical Hospital, this research illustrates critical issues, highlighting the insufficient healthcare workforce and resources to meet the comprehensive needs of patients and their families. Recommendations include holistic care addressing social, emotional, psychological, socio-familiar, and economic dimensions, supported by embedded support groups and the enforcement of relationships with palliative associations. This study also advocates for improved health institutional coordination, social worker support, and ongoing health professional satisfaction monitoring. In paediatric care, specific demands involve specialised units, medical team continuity, 24 h paediatrician care, and a more professional paediatric approach. Beyond problem identification, this study offers valuable insights for shaping health policies and tools, incorporating new indicators and introducing grief bereavement support in clinical reports, contributing to the advancement of patient evaluation in palliative care. Full article

The purpose of this study was to examine competing hypotheses (positive vs. negative) on how organizational members’ familiarity with multiple stakeholders differentially relates to members’ social identity and perception of leadership styles grounded in relational and emotional factors. Specifically, we developed and tested a conceptual model wherein employees’ familiarity with leaders, colleagues, and externals plays a differential role in predicting the extent to which they identify with their workgroup (i.e., group member prototypicality—GMP) and perceive transformational, authentic, leader–member exchange and servant leadership styles. Moreover, we examined the moderating effect of combat experience. We tested this nomological network using structural equation modeling and invariance analyses on a sample of 435 military personnel from the Italian Army (228 combat, 207 non-combat). Results indicated an invariant pattern of relationships among variables for combat and non-combat sub-samples. Specifically, familiarity with leaders positively predicted all leadership styles and GMP. Familiarity with colleagues positively predicted only GMP, whereas familiarity with externals did not predict GMP or leadership factors. Moreover, post hoc quadratic regressions showed a curvilinear inverted-U-shaped relationship between familiarity with colleagues and GMP. Militaries with low or high levels of familiarity with colleagues reported lower levels of GMP compared to militaries with moderate levels of familiarity with colleagues. Hence, at very high levels of familiarity with colleagues, GMP begins to decrease. Theoretical and practical implications of results are discussed in light of the increasing relevance of relational and emotional factors for military leadership, and the current pandemic and geopolitical turmoil. Full article

This study, framed by the GRPI (Goal, Role, Process, and Interaction) teamwork model, explores team dynamics among nursing students in performing group assignments, utilizing a qualitative research design. Twenty-three nursing students from Year 1 to Year 4 at a nursing school in Macau were invited. Semi-structured personal interviews were carried out. In addition, three teachers who were involved in instructing and assessing group assignments of nursing students were also interviewed. Data were analyzed using inductive and deductive approaches. The study found that although the barriers to accomplishing effective teamwork were embedded into the four dimensions of the DRPI model, they were interplayed. Communication was fundamental for teamwork, thus leading to a modified DRPI model. Teammates did not equally share the workload. Despite interpersonal conflicts among teammates, nursing students managed to stay in superficial harmony with their peers. They became more familiar with teamwork while advancing into their senior years but with decreased group communications. This study highlights various factors preventing students from transferring individualism to team players. Teaming is not an equal learning opportunity for teammates. Culturally upheld value of harmony prevails in the interpersonal relationships of the team members, which may compromise the teamwork spirit cultivation expectations from the teachers. Full article

Background: Training programs on resuscitation have been developed using simulation-based learning to build skills, strengthen cognitive strategies, and improve team performance. This is especially important for residency programs where reduced working hours and high numbers of residents can reduce the educational opportunities during the residency, with lower exposure to practical procedures and prolonged length of training. Within this context, gamification has gained popularity in teaching and learning activities. This report describes the implementation of a competition format in the context of newborn resuscitation and participants’ perceptions of the educational experience. Methods: Thirty-one teams of three Italian pediatric residents participated in a 3-day simulation competition on neonatal resuscitation. The event included an introductory lecture, familiarization time, and competition time in a tournament-like structure using high-fidelity simulation stations. Each match was evaluated by experts in neonatal resuscitation and followed by a debriefing. The scenarios and debriefings of simulation station #1 were live broadcasted in the central auditorium where teams not currently competing could observe. At the end of the event, participants received an online survey regarding their perceptions of the educational experience. Results: 81/93 (87%) participants completed the survey. Training before the event mostly included reviewing protocols and textbooks. Low-fidelity manikins were the most available simulation tools at the residency programs. Overall, the participants were satisfied with the event and appreciated the live broadcast of scenarios and debriefings in the auditorium. Most participants felt that the event improved their knowledge and self-confidence and stimulated them to be more involved in high-fidelity simulations. Suggested areas of improvement included more time for familiarization and improved communication between judges and participants during the debriefing. Conclusions: Participants appreciated the simulation competition. They self-perceived the educational impact of the event and felt that it improved their knowledge and self-confidence. Our findings suggest areas of improvements for further editions and may serve as an educational model for other institutions. Full article

Despite the importance of sustainable highway construction projects in achieving sustainable development, unsustainable construction highway projects still prevail in Jordan. Therefore, this article aims to identify barriers affecting sustainability implementation in Jordan’s highway construction projects. These barriers were identified from the previous literature. Questionnaire surveys were developed and distributed to experts to rank the degree of importance of each barrier. Moreover, a case study was assessed to evaluate the sustainability level of highway projects in Jordan. The research found that the sustainability concept should be supported financially to protect the environment by using a legislative framework to implement sustainability principles. There are several barriers to implementing the concept, like the lack of sustainability education, improper communication amongst team members, and the lack of familiarity with the techniques and the necessary skills to employ them properly. The use of sustainability assessment tools is needed to evaluate the sustainability level for highway projects. For the case study, a sustainability assessment tool was applied to the most recent important highway project in Jordan, “Bus Rapid Transit project,” to determine its sustainability level and to show how the barriers affect the implementation of the sustainable highway project and lower the sustainability level in the project. Full article

With the exception of well-differentiated liposarcoma, dedifferentiated liposarcoma, leiomyosarcoma, solitary fibrous tumour, malignant peripheral nerve sheath tumour, and undifferentiated pleomorphic sarcoma, the majority of the ≈70 histologic subtypes of retroperitoneal sarcoma are defined as ‘ultra-rare’ sarcomas, with an incidence of ≤1–5/1,000,000 persons/year. For most of these ultra-rare RPS subtypes, diagnosis and treatment follows international guidelines for the management of more common RPS histologies, with en bloc surgical resection as the mainstay of curative treatment, and enrolment in clinical trials where possible. Because the treatment of RPS is heavily driven by histology, the surgeon must be familiar with specific issues related to the diagnosis and management of ultra-rare sarcoma subtypes. Expert radiological and surgeon reviews are required to differentiate similarly presenting tumours where surgery can be avoided (e.g., angiomyolipoma), or where upfront systemic therapy is indicated (e.g., extraosseous Ewing’s sarcoma). Thus, the management of all retroperitoneal sarcomas should occur at a sarcoma referral centre, with a multidisciplinary team of experts dedicated to the surgical and medical management of these rare tumours. In this focused review, we highlight how diagnosis and management of the ultra-rare primary RPS histologies of malignant perivascular epithelioid cell tumour (PEComa), extraosseous Ewing sarcoma (EES), extraosseous osteosarcoma (EOS), and rhabdomyosarcoma (RMS) critically diverge from the management of more common RPS subtypes. Full article