Search Results (1,120)

Set in the vocational education and training sector in England, this article draws attention to how top-down, centre–periphery approaches to curriculum design and development in vocational education fail for at least three reasons. First, they misconstrue the nature of knowledge. Second, they lead to perfunctory and fragmented approaches to curriculum design, coupled with mechanistic measures of quality and achievement, which often require little more than “one-off” and superficially assessed demonstrations of performance. Finally, they underplay the role and importance of the teacher as researcher and artist in putting the cultural resources of society to work in creative curriculum design and pedagogy. Teacher artistry is pivotal in animating and heightening the vitality of vocational curricula. It is through this artistry that teachers make theories, ideas and concepts in vocational subjects and disciplines accessible and meaningful to all learners in coherent ways in the contexts of their learning and their lives. The consequences of the epistemic faux pas underpinning centre-to-periphery models of curriculum design and development are highlighted in this article in vocational tutors’ accounts of experiences of problems and issues in curriculum design, development and assessment encountered in their practice. Participants in the research teach in a variety of vocational education settings, including Apprenticeships and Higher-Level Technical Education; English Language at General Certificate of Secondary Education (GCSE) level; Health and Social Care; Information and Communications Technology; Construction (Plumbing); Digital Production, Design and Development and High-Tech Precision Engineering. Data are analysed and reported through systematic, thematic analysis This article draws upon qualitative data derived from a study funded by the Education and Training Foundation (ETF) in England over a two-year period from 2021 to 2023. The research population consists of a group of eight practitioner–researchers working in three colleges of Further Education (FE) and one Industry Training Centre (ITC) in England. All of the teachers of vocational education reported here volunteered to participate in the study. Research methods include semi-structured interviews, analysis of critical incidents and case studies produced by practitioner–researchers from across the FE and Skills sector in England. Full article

Background: Malnutrition is common among older adults with cognitive impairment and contributes to frailty and poorer health outcomes. Many individuals with dementia require mealtime assistance, yet differences in caregiving practices across hospital and nursing home settings remain underexplored. Aim: The aim of this study was to compare eating encouragement practices, feeding skills, feeding difficulties, and nutritional status between family caregivers in hospitals and professional caregivers in nursing homes. Methods: A cross-sectional observational study was conducted between June 2020 and December 2023 in New South Wales, Australia. The study included 82 older adults (≥65 years) with cognitive impairment: 31 hospital patients supported by family caregivers and 51 nursing home residents supported by assistant nurses. Eating encouragement, feeding skills, and feeding difficulties were assessed using structured observation tools, and nutritional status was evaluated using the Mini Nutritional Assessment–Short Form (MNA-SF). Group differences were analysed using chi-square tests and independent t-tests (p < 0.05). Results: Family caregivers in hospitals demonstrated stronger relational and engagement-based practices, including consistent handwashing (χ² = 31.945, p < 0.001), encouraging self-feeding (χ² = 21.678, p < 0.001), verbal cueing (χ² = 12.083, p = 0.002), touch prompting (χ² = 51.817, p < 0.001), and sitting face to face (χ² = 38.697, p < 0.001). Nursing home caregivers showed more advanced technical skills, such as task simplification (χ² = 54.135, p < 0.001), mirroring (χ² = 78.456, p < 0.001), hand-over-hand guidance (χ² = 73.076, p < 0.001), mouth- and lip-opening techniques (both χ² = 81.000, p < 0.001), and stronger choking management (p < 0.001). Feeding difficulties also differed: refusal behaviours were more common in nursing homes, while distraction and oral–motor issues were more frequent in hospitals. Overall, nursing home residents had significantly poorer nutritional status (t = −12.592, p < 0.001). Conclusions: Family caregivers provide stronger relational support, whereas professional caregivers demonstrate superior technical competence. Integrating these complementary strengths may enhance mealtime care and reduce malnutrition among cognitively impaired older adults. Full article

The 2025 Ebola outbreak that ravaged the Bulape Health District (HD) in Kasai, Democratic Republic of Congo (DRC), was tackled using the incident management system (IMS) model. The Bulape HD is located in the Mweka territory, which has experienced two Ebola epidemics: one in 2007 and another in 2008. The IMS comprises seven strategies recommended for an effective response to an Ebola outbreak: (i) thorough investigation, (ii) strengthening infection prevention and control measures in the community, (iii) ensuring that medical care is provided by experienced professionals, (iv) strengthening risk communication and community engagement (RCCE), (v) ring vaccination, (vi) operational research, and (vii) anchoring interventions in the existing health system. We share our experience implementing these seven strategies and compare them with those utilized during three previous Ebola outbreaks. This paper describes our achievements, the resulting benefits, and the factors that facilitated the implementation of the aforementioned strategies. A literature review and interviews were conducted. The atlas.ti 22 software was used for data analysis. Implementing these seven strategies contributed to an effective response, largely due to the experience and expertise of those involved but also thanks to the support of technical and financial partners (TFPs) and the engagement of the local community. Challenges such as geographical accessibility, the fragile health system, the community’s strong attachment to traditional practices, and negative reactions to healthcare—which was widely discredited, with many of those involved expressing a lack of faith in its effectiveness—were major obstacles. To overcome these challenges, an integrated approach was utilized, combining a rapid comprehensive response with deep and respectful community engagement. The support and alignment of TFPs were invaluable during this process. The RCCE pillar proved key to successful IMS implementation. Our experiences will be useful during the next Ebola outbreak in the DRC; additionally, they may also help to inform the response to similar outbreaks in other countries. Full article

This article provides a narrative review of the technical, computational and clinical aspects of transcranial brain stimulation (TBS), with an emphasis on transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS). The review addresses three central questions: which physical, engineering, and biological principles determine the generation, propagation, and focality of electromagnetic fields in the human head. The second question asks how modeling approaches, stimulation parameters, and hardware design influence the accuracy, safety, and individual variability of brain stimulation. And, finally, how these technical factors translate into current clinical applications, therapeutic efficacy, and practical limitations. The key take-home messages are as follows: for engineers, realistic anatomical head models, precise coil/electrode placement, and reliable numerical solvers remain essential for predicting field distribution and optimizing stimulation protocols; for clinicians, stimulation outcomes are strongly dependent on anatomy-specific field patterns, safety constraints, and device-related parameters that require careful adjustment; and for both groups, despite significant technological progress, effective and reproducible stimulation still demands systematic protocol refinement and individualized planning. Overall, this review integrates contemporary technical knowledge with clinical perspectives to support evidence-based use and future development of TMS and tDCS. Full article

Background and Objectives: Robot-assisted procedures represent a significant advancement in minimally invasive liver resection techniques. Nonetheless, the introduction of a novel surgical technique in a new environment necessitates meticulous planning and a gradual, stepwise approach. This study describes the adoption of a robotic surgical platform for liver resection at a high-volume tertiary care center. Materials and Methods: We retrospectively analyzed data that had been prospectively collected from fifty robot-assisted liver resections. Descriptive statistics, including frequencies, percentages, means/medians, and standard deviations, were employed for description and summary. Results: The median operative duration was 166 min (range: 85–400 min), with an average intraoperative blood loss of 200 mL (range: 50–1000 milliliters). Intraoperative or postoperative blood transfusion was required in 8% of patients. Conversion to open resection was necessary in one patient (2%). The mean duration of hospitalization was 5 days (range: 3–20 days), with a 30-day readmission rate of 6% and no mortality within 90 days. Postoperative complications classified as Clavien-Dindo grade 3 or higher were observed in five patients (10%). The mean tumor size varied according to pathology: 58.5 mm (range: 30–120 mm) in the hepatocellular carcinoma group; 27.4 mm (range: 10–32 mm) in the secondary malignancy group; and 42.6 mm (range: 24–60 mm) in the intrahepatic cholangiocarcinoma group. The median number of lymph nodes harvested during lymphadenectomy (IHHCA/GBCA) was 5.4, ranging from 1 to 11. The R0 resection rate for malignant tumors was 88.2% (of 30/34). Conclusions: This study validates the safe integration of robot-assisted surgery into liver disease treatment, supported by our initial experience. Despite its technical advantages, robotic-assisted liver surgery remains complex and demanding. Structured robotic training within established programs, meticulous patient selection, and a stepwise implementation approach are critical during the early phases to optimize the outcomes. Full article

Background: Nuclear Magnetic Resonance (NMR) spectroscopy is a powerful analytical tool in metabolomics, but it is often hindered by the high cost and technical complexity of the machines, limiting its clinical and point-of-care applications. Recent advances in benchtop NMR technology have sought to overcome these barriers by providing more compact, affordable, and user-friendly instruments. This systematic review aims to assess the potential of benchtop NMR in clinical metabolomics, highlighting its practical advantages, current applications, and technological challenges relative to high-field systems. Methods: For this systematic review we searched Web of Science and PubMed databases to identify studies employing benchtop NMR spectroscopy in clinical and biomedical applications. The review focuses on works that evaluated metabolic profiling in human and animal disease contexts, compared benchtop and high-field performance, and utilized advanced data analysis methods, including multivariate and machine learning approaches. Results: Among the 74 records identified, 15 research articles were eligible, including 11 studies involving human biospecimens and 4 studies concerning animal samples. The selected works were published between 2018 and 2025. These studies demonstrated the potential clinical utility of low-field NMR in differentiating disease states such as tuberculosis, type 2 diabetes, neonatal sepsis, and chronic kidney disease, achieving diagnostic accuracies comparable to high-field instruments. Conclusions: Although limited by lower sensitivity and spectral resolution, benchtop NMR represents a significant step toward the democratization of NMR-based metabolomics. Continued hardware development, improved pulse sequences, and the integration of artificial intelligence for spectral processing and modeling are expected to enhance its analytical power and accelerate its clinical adoption. Full article

Digital twins (DTs) powered by artificial intelligence (AI) are becoming important transformational tools in healthcare, enabling real-time simulation and personalized decision support at the patient level. The aim of this review is to critically examine the evolution, current applications, and future potential of AI-based DTs in healthcare, with a particular focus on their role in enabling real-time simulation and personalized patient-level decision support. Specifically, the review aims to provide a comprehensive overview of how AI-based DTs are being developed and implemented in various clinical domains, identifying existing scientific and technical gaps and highlighting methodological, regulatory, and ethical issues. Taking a “local to global” perspective, the review aims to explore how individual patient-level models can be scaled and integrated to inform population health strategies, global data networks, and collaborative research ecosystems. This will provide a structured foundation for future research, clinical applications, and policy development in this rapidly evolving field. Locally, DTs allow medical professionals to model individual patient physiology, predict disease progression, and optimize treatment strategies. Hospitals are implementing AI-based DT platforms to simulate workflows, efficiently allocate resources, and improve patient safety. Generative AI further enhances these applications by creating synthetic patient data for training, filling gaps in incomplete records, and enabling privacy-respecting research. On a broader scale, regional health systems can use connected DTs to model population health trends and predict responses to public health interventions. On a national scale, governments and policymakers can use these insights for strategic planning, resource allocation, and increasing resilience to health crises. Internationally and globally, AI-based DTs can integrate diverse datasets across borders to support research collaboration and improve early pandemic detection. Generative AI contributes to global efforts by harmonizing heterogeneous data, creating standardized virtual patient cohorts, and supporting cross-cultural medical education. Combining local precision with global insights highlights DTs’ role as a bridge between personalized and global health. Despite the efforts of medical and technical specialists, ethical, regulatory, and data governance challenges remain crucial to ensuring responsible and equitable implementation worldwide. In conclusion, AI-based DTs represent a transformative paradigm, combining individual patient care with systemic and global health management. These perspectives highlight the potential of AI-based DTs to bridge precision medicine and public health, provided ethical, regulatory, and governance challenges are addressed responsibly. Full article

Background and Aims: Colon capsule endoscopy (CCE) provides a non-invasive alternative to traditional colonoscopy. This study evaluated the feasibility, safety, diagnostic yield (DY), and patient satisfaction of the OMOM CC100 CCE system, with special focus on fully remote (n = 30) and partially remote (n = 89) administration across four centres to advance decentralised models. Methods: This prospective, investigator-initiated, international multicentre feasibility study enrolled 119 patients aged 18–75 years at centres in Denmark, Sweden, Portugal, and Poland from July 2024 to May 2025. Indications included rectal bleeding, iron-deficiency anaemia, a positive faecal immunochemical test, changes in bowel habit, suspected inflammatory bowel disease (IBD), post-polypectomy or colorectal cancer (CRC) surgery surveillance, and a family history of CRC. The OMOM CC100 capsule was employed with a standardised bowel preparation regimen. Administration was fully remote in Denmark using the IntelliGI™ platform and partially remote (clinic ingestion, home completion) at the other sites. Primary outcomes encompassed procedure feasibility, completion rate (capsule excretion or anal verge visualisation), bowel cleanliness (Leighton-Rex scale ≥ 3), diagnostic yield, and patient satisfaction. Secondary measures included transit times, adverse events, and technical failures. Results: Median age was 55.7 years (65 males, 54 females). Overall completion rate was 79%, varying by centre: Sweden (90%), Portugal (81%), Denmark (80%), and Poland (63%). Adequate bowel cleanliness was achieved in 71% of cases. Diagnostic findings included polyps (25 patients), angioectasia (20), diverticulosis (17), and mucosal inflammation (17); 42% were normal. Fully remote administration yielded 80% completion and 89.7% satisfaction. No serious adverse events occurred; overall satisfaction was 81%, with 87% preferring home-based procedures. Conclusions: The OMOM CC100 CCE system is feasible, safe, with DY comparable to established systems. IntelliGI™-enabled remote administration promotes decentralised care, enhancing accessibility. Full article

Background: Population aging has led to a rise in dementia prevalence, increasing the demand for innovative care models. Telemedicine offers an opportunity to improve access, continuity, and caregiver support for older adults with cognitive impairment. Methods: This qualitative descriptive study was conducted at the Geriatrics and Gerontology Service of Cassiano Antônio de Moraes University Hospital (HUCAM-UFES), Brazil. Semi-structured interviews were carried out with 11 caregivers of older adults living with dementia who participated in telemedicine consultations. Data was analyzed thematically using a reflexive thematic analysis approach. Results: Caregivers considered telemedicine useful, accessible, and safe, facilitating the continuity of care and strengthening the caregiver–professional relationship. The main limitations were the absence of physical examination and occasional technical difficulties. Most caregivers favored a hybrid care model, combining remote and in-person visits. Conclusions: Telemedicine proved to be a feasible and well-accepted strategy for the care of older adults with dementia, improving caregiver support and communication with healthcare teams. Public policies should foster digital inclusion and training for both caregivers and professionals, consolidating hybrid, person-centered models of care. Full article

Background: Recent trials, including JCOG0802/WJOG4607L and CALGB140503, have confirmed the oncological adequacy of segmentectomy for early-stage non-small-cell lung cancer (NSCLC). This shift emphasizes the preservation of pulmonary function and minimal invasiveness. Robot-assisted thoracic surgery (RATS) offers enhanced anatomical precision and potentially improves segmentectomy outcomes. Methods: We reviewed the current evidence comparing sublobar resection and lobectomy for early-stage NSCLC, focusing on RATS segmentectomy. Clinical trials, perioperative and long-term outcomes, technical innovations, and patient selection criteria were analyzed. Comparative data among RATS, video-assisted thoracoscopic surgery (VATS), and open approaches were synthesized, including the emerging roles of AI and 3D imaging. Results: Segmentectomy yields survival outcomes equivalent or superior to lobectomy for stage IA peripheral NSCLC ≤2 cm, with better pulmonary function despite higher locoregional recurrence. RATS enhances visualization, dexterity, and ergonomics, thereby enabling precise dissection and lymph node assessment. Compared to VATS and open surgery, RATS shows lower conversion rates, reduced pain, and comparable oncological control. Innovations, such as indocyanine green imaging, 3D modeling, and AI-guided navigation, support margin accuracy and personalized care. Conclusions: Segmentectomy has redefined the surgical standards for early-stage NSCLC. RATS maximizes the minimally invasive benefits by combining oncological safety and functional preservation. Its technical precision facilitates complex resections and integration with digital planning tools to advance personalized thoracic surgery. RATS represents the next evolution of minimally invasive thoracic surgery, redefining the balance between oncological safety and functional preservation in early-stage NSCLC. Full article

Background/Objectives: Strengthening management competencies are essential to ensure effective and equitable Primary Health Care (PHC) systems. Emerging perspectives suggest that effective leadership in PHC could benefit from integrating cognitive, emotional, and social competencies. Although there is existing evidence on the required competencies worldwide and the characterization of PHC managers in Chile, no study has yet developed or validated a specific competency profile for these positions. This study developed and validated a competency profile for PHC managers to provide an evidence-based and context-specific tool for leadership, training, and evaluation. Methods: A mixed-method observational study based on expert judgment was conducted across three Chilean macrozones (northern, central, and southern), involving 36 professionals with recognized experience in PHC management identified through direct contact and snowball sampling. Quantitative validation through the Content Validity Index (CVI) confirmed high expert agreement (CVI ≥ 0.90), while thematic analysis of qualitative responses led to the inclusion of new areas. Results: The final profile comprises 47 competencies organized into knowledge, skills, and attitudes, emphasizing executive functions and social cognition and incorporating emerging domains such as emotional intelligence and institutional support. Beyond managerial relevance, the profile offers a structured framework for designing, implementing, and evaluating competency-based education and training in health sciences. Conclusions: These results also support leadership development and performance assessment, providing an evidence-based reference for professional training initiatives in PHC. This profile emphasizes that leadership development should not be limited to technical competencies, but also encompasses emotional, cognitive, and social dimensions essential for effective performance. Full article

Background/Objectives: Artificial intelligence (AI)-based chatbots present a viable approach to overcoming several challenges associated with conventional psychotherapy, such as high financial costs, limited access to mental health professionals, and geographical or logistical barriers. Thus, these chatbots are increasingly employed as complementary tools to traditional therapeutic practices in mental health care. Our aim was to develop and validate a scale to measure attitudes toward the use of AI-based chatbots for mental health support, i.e., the Artificial Intelligence in Mental Health Scale (AIMHS). Methods: A multidisciplinary panel of experts assessed the content validity. To confirm face validity, we carried out cognitive interviews and calculated the item-level face validity index. We applied factor analysis to verify the construct structure. We assessed measurement invariance across demographic subgroups. Concurrent validity was evaluated using three valid instruments. Reliability was tested through Cronbach’s alpha, Cohen’s kappa, and the intraclass correlation coefficient. Results: Factor analysis supported a two-factor five-item model. The two factors were technical and personal advantages, and explained 81.28% of the variance. The AIMHS demonstrated adequate concurrent validity, evidenced by statistically significant correlations with Artificial Intelligence Attitude Scale (r = 0.405, p-value < 0.001), Attitudes Towards Artificial Intelligence Scale (acceptance subscale; r = 0.401, p-value < 0.001, fear subscale; r = −0.151, p-value = 0.002), and Short Trust in Automation Scale (r = 0.450, p-value < 0.001). Configural, metric and scalar invariance were supported by our findings. Cronbach’s alpha was 0.798, and intraclass correlation coefficient was 0.938. Cohen’s kappa for the five items ranged from 0.760 to 0.848. Conclusions: The AIMHS is a five-item psychometrically sound and user-friendly instrument capturing two dimensions; technical and personal advantages. Future research should be undertaken to further evaluate the psychometric properties of the AIMHS across diverse populations and contexts. Full article

Background: Despite level-A evidence demonstrating superior long-term survival with bilateral internal mammary artery (BIMA) grafting, its global utilization remains dismally low (<10–15%), largely due to historical concerns over deep sternal wound infections (DSWI) and technical complexity. This underutilization persists even as multi-arterial grafting (MAG) adoption stagnates, with recent North American data showing only 16% of coronary artery bypass grafting CABG procedures utilize more than one arterial conduit. Objective: This review synthesizes contemporary evidence demonstrating that modern surgical refinements—particularly skeletonized “no-touch” harvesting—have effectively mitigated these concerns, enabling wider BIMA application. Methods & Results: Over two decades of institutional experience confirm that skeletonized harvesting preserves sternal perfusion and minimizes DSWI risk, even in high-risk patients. Propensity-matched analyses show significant survival benefits of BIMA grafting across age and comorbidity strata (8-year survival: 67.1% BIMA vs. 58.2% single internal mammary artery (SIMA), p < 0.05), rendering previous contraindications relative rather than absolute. Long-term outcomes demonstrate superior 10-year survival for in situ BIMA compared with SIMA (86.1% vs. 78.6%, p < 0.05). Advanced configurations such as sequential skeletonized grafting are safe and further enhance outcomes. In single-vessel left anterior descending artery (LAD) disease, skeletonized left internal mammary artery (LIMA) continues to outperform percutaneous coronary intervention (PCI), underscoring the unmatched durability of arterial conduits. Conclusions: The technical evolution of conduit harvesting has resolved the “BIMA paradox”. Contemporary evidence supports BIMA grafting as a standard of care for a broad CABG population, offering a durable, lifelong solution for coronary artery disease and warranting renewed guideline emphasis on multi-arterial revascularization. Full article

Healthcare delivery systems operate as complex socio-technical Systems-of-Systems (SoS), where autonomous entities—hospitals, insurers, laboratories, and technology vendors—must coordinate to achieve collective outcomes that exceed individual capabilities. Despite substantial investment in interoperability standards and regulatory frameworks, persistent fragmentation undermines care quality, operational efficiency, and systemic adaptability. This fragmentation stems from a fundamental governance paradox: how can independent systems retain operational autonomy while adhering to shared rules that ensure systemic resilience? This paper addresses this challenge by advancing a governance-oriented architecture grounded in Object-Oriented Programming (OOP) principles. We reinterpret core OOP constructs—encapsulation, modularity, inheritance, polymorphism, and interface definition—as governance mechanisms that enable autonomy through principled constraints while fostering structured coordination across heterogeneous systems. Central to this framework is the Confluence Interoperability Covenant (CIC), a socio-technical governance artifact that functions as an adaptive interface mechanism, codifying integrated legal, procedural, and technical standards without dictating internal system architectures. To validate this approach, we develop a functional proof-of-concept simulation using Petri Nets, modeling constituent healthcare systems as autonomous entities interacting through CIC-governed transitions. Comparative simulation results demonstrate that CIC-based governance significantly reduces fragmentation (from 0.8077 to 0.1538) while increasing successful interactions fivefold (from 68 to 339 over 400 steps). This work contributes foundational principles for SoS Engineering and offers practical guidance for designing scalable, interoperable governance architectures in mission-critical socio-technical domains. Full article

The rapid advancement of artificial intelligence (AI) in healthcare delivery has introduced innovative tools to improve patient care, streamline administrative processes, and bridge accessibility gaps. This study assesses how end-users perceive the practicality and usability of a proposed AI-enabled eGuide within Omani healthcare facilities, addressing cultural, linguistic, and regulatory requirements unique to the Sultanate. Through a mixed-methods framework combining stakeholder analysis, technological readiness assessment, and socio-cultural adaptation strategies, the research identifies the operational, economic, and ethical viability of the system. The current research results suggest that regulatory alignment, stakeholder engagement, and proper localization of AI-based eGuides will significantly enhance patient navigation after being tested on a wider dataset or real-world healthcare environments, reduce healthcare delivery bottlenecks, and increase patient satisfaction. Furthermore, digital literacy disparities, data privacy compliance, and infrastructure variability challenges need to be planned strategically and handled with care. This study offers a roadmap for policymakers and healthcare administrators to adopt AI-enabled eGuide systems that are both technically feasible and socially acceptable within the Omani healthcare ecosystem. Full article