Search Results (181)

A pervasive trend across academia, social cognition, and general communication contexts is the interchangeable use of “information” and “knowledge”, particularly with reference to their forms—explicit knowledge, testimony, and expertise—conveyed by external sources. This raises a fundamental question: is the source perceived, considered, and validated as a reliable knowledge provider or merely as an information carrier? This study investigates seven academic and popular science sources by modelling their constructs of knowledge provision based on epistemological criteria and sociopsychological value, as manifested through the perspectives of university academics. The external sources examined include scientific journal articles, knowledge shared by university lecturers, scholarly monographs, textbooks and handbooks, popular science books and magazines, academic social networks and social media platforms. A quantitative investigation, supplemented by qualitative content analysis, collected assessments from sixty-six university academics in Latvia using the Epistemological Attitude Questionnaire towards Knowledge Sources. Statistical analysis, coupled with an examination and interpretation of academics’ perceptions, comprehension, use, and personal valuation of these sources, elucidated their profiles. The findings provide a holistic picture of these sources, detailing the value, qualities, functionality, and contributions of each type. Interpretations reveal that the designation of a form of “knowledge source” predominantly aligns with scientific and educational sources, whereas “information carriers” or socially functional sources primarily pertain to popular science and social media. Academic social networks, notably, occupy an intermediary position. This study offers critical academic insights into ongoing issues regarding these means of cognition. It prompts a scrutiny of both established traditional sources and contemporary mediums, both academic and popular, encouraging readers to evaluate these compiled images according to the delineated criteria of the theoretical framework. Full article

Background: Simultaneous pancreas–kidney transplantation (SPK) is the standard treatment for selected patients with type 1 diabetes mellitus and end-stage renal disease. Textbook Outcome (TO), a composite of perioperative and long-term quality indicators, provides a benchmark for optimal results. This study analyzed factors associated with failure to achieve TO after SPK. Methods: We retrospectively analyzed 119 SPK recipients (1980–2022). TO was defined according to IQTIG criteria: (i) patient survival ≥ 3 years, (ii) insulin independence at discharge, (iii) kidney function at discharge (GFR ≥ 20 mL/min), (iv) insulin-free survival ≥ 3 years, and (v) sustained kidney function ≥ 3 years. Predictors of TO failure were identified by logistic regression. Long-term survival was assessed by Kaplan–Meier analysis. Results: Ninety-two patients were eligible for TO assessment; 52% achieved TO. Compared with TO patients, non-TO patients had older donors (median 30 vs. 25.5 years, p = 0.017), older recipients (44 vs. 39 years, p = 0.012), longer kidney cold ischemia time (CIT; 13.0 vs. 9.7 h, p = 0.005), and more pancreatic complications (p = 0.009). In multivariate analysis, donor age (OR 1.050, p = 0.030) and kidney CIT (OR 1.180, p = 0.029) independently predicted TO failure. Cut-offs were donor age ≤ 37 years and kidney CIT ≤ 11.5 h. Patients achieving TO had significantly better long-term survival (15 years, p = 0.0077). Conclusions: Younger donor age and shorter kidney CIT independently predict TO achievement, which is associated with superior long-term survival. Optimized donor selection and perioperative management may improve SPK outcomes. Full article

Graphs are used in school, many occupations, and daily life, yet many people struggle to interpret them accurately. To help identify sources of difficulty in graph comprehension, we propose the Pictorial–Semantic–Task Framework. In it, we argue that accurate interpretation of graphs requires integrating pictorial variables (e.g., slope direction, graph format, data points) with semantic variables (e.g., titles, labels, scales, variable types) to determine what the graph represents. Many errors arise because readers fail to coordinate these two sources of information, often basing interpretations solely on pictorial variables. The present theoretical synthesis presents the basic analysis underlying the Pictorial–Semantic–Task Framework and an integrative review of relevant findings from graph encoding, extrapolation, and comparison tasks. The findings show that people encode and recall pictorial information far more accurately than semantic information, and often base interpretations solely on visual patterns even when semantic features call for a different conclusion. Analyses of U.S. textbooks and mass media reveal potential sources of these biased interpretations: systematic imbalances in the types of semantic information provided in textbooks and media seem likely to contribute to biases, emphasizing visual over semantic cues. By describing how perceptual and conceptual processes interact during graph comprehension, we aim to advance theories of cognitive processing in the context of graph comprehension and to derive educational implications for helping children interpret graphs more accurately. Full article

Background/Objectives: Although the safety and feasibility of robot-assisted pancreatoduodenectomy (RPD) compared to open pancreatoduodenectomy (OPD) have been reported, studies investigating the advantages of RPD remain limited. Moreover, only a few studies have investigated the effects of robotic surgery on textbook outcomes (TO). Methods: This single-center retrospective study included 400 patients who underwent RPD and OPD at our institution between January 2017 and December 2025. Outcomes were compared between the RPD (n = 162) and OPD (n = 238) groups using propensity score-matching (PSM) analysis. The factors associated with TO were examined. Results: Before PSM, significant differences were observed between the groups. PSM yielded RPD (n = 117) and OPD (n = 117) with equal preoperative factors. The RPD group demonstrated a significantly shorter operative time (402 vs. 444 min, p < 0.001), lesser blood loss (75 vs. 270 mL, p < 0.001), shorter postoperative hospital stays (13 vs. 22 days, p < 0.001), and fewer major complications (17.1 vs. 44.4%, p < 0.001), resulting in a higher TO achievement rate (76.9 vs. 52.1%, p = 0.001). Adjusted multivariate analyses identified robotic surgery (odds ratio 3.04, p < 0.001) as an independent predictor of TO. Conclusions: This study demonstrated that RPD was potentially superior to OPD in terms of short-term outcomes. Robotic surgery was significantly associated with TO after pancreatoduodenectomy at the expert’s hand. Full article

Background: Early childhood is a key period for the development of health literacy, and school textbooks play an important role in shaping early health-related understandings. Objectives: This study examines how health is represented in Grade 1 primary school textbooks in Greece and how children are positioned in relation to health within the curriculum. Methods: Multimodal critical discourse analysis was conducted on thirteen state-approved Grade 1 textbooks (n = 1.271 pages) published by the Ministry of Education and distributed free-of-charge to all public primary schools in Greece. The dataset covers seven subject areas: Language, English Language, Environmental Studies, Physical Education, Visual Arts, Music and Literature. Analysis was informed by Nutbeam’s typology of functional, interactive and critical health literacy. Results: Health-related content appeared across all subject areas but was unevenly framed. Language textbooks and workbooks emphasized prescriptive routines and functional health literacy. Environmental Studies and Literature offered more opportunities for reflective and relational engagement with health. Physical Education and Visual Arts supported well-being through activity and creativity but included limited explicit reflection. Across the curriculum, critical health literacy was minimally represented. Conclusions: Grade 1 textbooks in Greece promote basic health behaviors but provide limited support for the development of critical health literacy in early primary education. Full article

This review summarizes the existing literature to investigate the role of excessive dynamic genu valgum (DGV) upon landing on subsequent movement performance in athletes. General systems theory and kinetic chain theory comprise the underlying theoretical frameworks, with an emphasis on regional interdependency in the context of lower-limb kinematics. Using a snowballing methodology, information was obtained from PubMed, CINAHL, Wiley Online Library, ProQuest, and Scopus databases, as well as through the utilization of Google Scholar and relevant biomechanics and movement analysis textbooks. Limitations include a paucity of research in the absence of injury and on DGV and subsequent performance post landing. Numerous factors, such as strength deficits of the predominant stabilizers of the knee in the frontal plane, fatigue, presence of dual tasks, and ingrained motor control, may influence medial knee excursion upon landing. Increased medial knee excursion during the transition from force attenuation to control is theorized to reduce the mechanical advantage of the quadriceps, impairing the efficiency of the stretch–shortening cycle for subsequent athletic movement performance. Mechanical and cognitive factors may influence knee biomechanics during landing and subsequent movement efficiency; however, the existing literature would benefit from further exploration of the differences in movement mechanics (e.g., acceleration) post landing in excessive DGV and the role of the trunk and subtalar joint on knee kinematics through the context of regional interdependency. This review is novel in investigating DGV from the perspective of movement performance rather than injury. Full article

Introduction: Operative time is commonly used as a surrogate marker for operative difficulty in liver resection, but the contribution of other intraoperative factors is less understood. This study aimed to develop an objective, composite score to assess operative difficulty and evaluate its association with postoperative and oncological outcomes in liver surgery. Methods: A retrospective cohort study was conducted on patients who underwent liver resection for malignant disease between 1999 and 2023 at an Australian tertiary hospital, using a prospectively maintained database. Principal component analysis (PCA) was applied to operative time, estimated blood loss, total time of hepatic inflow occlusion and the number of packed red bloods transfused intraoperatively to derive a composite operative difficulty score. Patients were then stratified into low, moderate and high difficult groups using Gaussian mixture models (GMM). Comparison of textbook oncological outcomes (TOO) achievement and futile resection rates were assessed using Chi-squared analysis. Kaplan-Meier analysis was used to assess recurrence-free and overall survival in subgroup analysis. Results: Of 729 patients, 699 met the inclusion criteria. GMM identified three distinct operative difficulty groups: low (n = 540), moderate (n = 143), and high (n = 16). TOO and non-futile resection rates declined with increasing difficulty: 77% and 58% (low), 47% and 52% (moderate), and 6% and 19% (high), respectively (p < 0.001, p = 0.004 respectively). Among patients with cholangiocarcinoma, median overall survival was inversely correlated with operative difficulty (40 months low, 16 months moderate, 7 months high, p = 0.004). In patients with colorectal liver metastases, there was a trend towards worse overall survival and disease-free survival with increasing operative difficulty, however, this did not reach statistical significance. Conclusions: An objective intraoperative difficulty score was developed and demonstrated a significant inverse association with both quality and oncological outcomes. While external validation is required, these findings support the potential of operative difficulty assessment to enhance perioperative decision-making, inform patient counselling, and optimise postoperative care planning. Full article

This study analyses the variety of the language used in textbooks for teaching Italian as a second/foreign language. These books use a language much closer to written than to spoken Italian and do not consider its varieties, providing examples and exercises with a “neutral” standard that speakers rarely use in everyday speech. The aim of this study is to provide a critical review of pronunciation sections in current L2 Italian textbooks, in the light of a renewed and growing interest in the study of the Italian language, not only by students with a migrant background in Italy, but also by second and third-generation emigrants who want to learn Italian to recover their roots. Thirty-two Italian textbooks were examined, considering some geolinguistic variables. The general tendency seems to be the introduction of some neo-standard Italian features. As far as the phonetic–phonological level is concerned, this is probably still insufficient because of the complexity of the Italian linguistic repertoire. Our analysis further suggests the inadequacy of notions such as (neo-)standard Italian for teaching purposes in the linguistic space of global Italian. Full article

Background and Aim: Large language models (LLMs) demonstrate significant potential in assisting with medical image interpretation. However, the diagnostic accuracy of general-purpose LLMs on image-based internal medicine cases and the added value of brief clinical history remain unclear. This study evaluated three general-purpose LLMs (ChatGPT, Gemini, and DeepSeek) on expert-curated cases to quantify diagnostic accuracy with image-only input versus image plus brief clinical context. Methods: We conducted a comparative evaluation using 138 expert-curated cases from Harrison’s Visual Case Challenge. Each case was presented to the models in two distinct phases: Phase 1 (image only) and Phase 2 (image plus a brief clinical history). The primary endpoint was top-1 diagnostic accuracy for the textbook diagnosis, comparing performance with versus without a brief clinical history. Secondary/Exploratory analyses compared models and assessed agreement between model-generated differential lists and the textbook differential. Statistical analysis included Wilson 95% confidence intervals, McNemar’s tests, Cochran’s Q with Benjamini–Hochberg correction, and Wilcoxon signed-rank tests. Results: The inclusion of clinical history substantially improved diagnostic accuracy for all models. ChatGPT’s accuracy increased from 50.7% in Phase 1 to 80.4% in Phase 2. Gemini’s accuracy improved from 39.9% to 72.5%, and DeepSeek’s accuracy rose from 30.4% to 75.4%. In Phase 2, diagnostic accuracy reached at least 65% across most disease nature and organ system categories. However, agreement with the reference differential diagnoses remained modest, with average overlap rates of 6.99% for ChatGPT, 36.39% for Gemini, and 32.74% for DeepSeek. Conclusions: The provision of brief clinical history significantly enhances the diagnostic accuracy of large language models on visual internal medicine cases. In this benchmark, performance differences between models were smaller in Phase 2 than in Phase 1. While diagnostic precision improves markedly, the models’ ability to generate comprehensive differential diagnoses that align with expert consensus is still limited. These findings underscore the utility of context-aware, multimodal LLMs for educational support and structured diagnostic practice in supervised settings while also highlighting the need for more sophisticated, semantics-sensitive benchmarks for evaluating diagnostic reasoning. Full article

This article presents the development and validation process of a qualitative data collection instrument aimed at analysing natural sciences teachers’ perceptions of practical work in lower secondary education (third cycle) in Portugal. The methodological approach combined a systematic literature review following PRISMA guidelines with an analysis of relevant curricular frameworks and legal documents. Based on the triangulation of these sources, a semi-structured interview guide was constructed, validated by a panel of five experts from four Portuguese public universities, and tested through a pilot interview. The final instrument comprised seven dimensions and fourteen subdimensions, totalling 44 items. It demonstrated methodological rigour and practical applicability for qualitative data collection and analysis. Findings indicate that the instrument enables a comprehensive exploration of teachers’ practices and perceptions regarding practical work, offering a valuable contribution to the research on didactics of science and to the professional development of teachers. Also, the application of this instrument will enable teachers and researchers to characterise the dynamics of practical work carried out with young students in natural sciences education across seven structuring dimensions: (1) Conceptual; (2) Limitations; (3) Advantages; (4) Evaluative; (5) Operationalisation; (6) Textbook; and (7) Curricular. Full article

The most widespread lesson preparation resource used by mathematics teachers is the textbook. Initial teacher training programmes should therefore develop the skill of curricular noticing, i.e., the ability to critically analyse and make decisions concerning an activity sequence from a textbook. This mix-method study focused on the interpretations and decisions adopted by 85 Spanish pre-service primary school teachers (PTs) in relation to a three-dimensional (3D) geometry activity sequence from a textbook. The PTs were assigned two tasks: the first was identifying the limitations of the activity sequence for supporting students’ geometrical understanding regarding three aspects—attributes, geometrical processes, and modes of representation—and the second was completing the sequence. Most PTs interpreted a number of activity sequence limitations. In terms of their decision-making, the PTs prioritised certain characteristics over others, such as introducing further attributes rather than changing representation modes, or adding geometrical processes to their activity sequence designs. Moreover, the analysis allowed determining how PTs completed the activity sequence to address limitations, thereby revealing relationships between their interpretations and decisions. The study findings help teacher educators to design courses aimed at supporting the PTs’ ability to make more informed and effective teaching choices that enhance student learning. Full article

Background: Digitalisation is transforming medical education, but its integration into ultrasound training remains limited. This study evaluates the needs of students and physicians regarding digitally supported ultrasound education. Materials and Methods: A multi-year cross-sectional study (2017–2022) employed two standardised questionnaires. The first assessed the perceived relevance of ultrasound in medical education, the desirability of compulsory teaching, and the integration of digital media and case-based learning. The second explored user-centred requirements for e-learning formats, including functionality, multimedia design, usability, interactivity, and financing, as well as current use of digital devices and reference materials. Data were collected using dichotomous and 7-point Likert scales (1 = high need/strong agreement, 7 = low need/weak agreement). Results: A total of 3479 responses were analysed (2821 students; 658 physicians). Both groups showed strong support for integrating ultrasound into curricula (1.3 ± 0.7) and mandatory education (1.4 ± 0.9), with students expressing significantly greater support (p < 0.001). There was broad agreement on the integration and development of digital media (1.7 ± 1.0), as well as the use of case studies (1.4 ± 0.8), with no significant differences between groups (p > 0.05). Case-based learning as a stand-alone format was less favoured (3.4 ± 1.9). In the user-centred needs analysis, both groups rated features like search functions (1.4 ± 0.8), usability (1.5 ± 0.9), and learning objective checks (2.7 ± 1.6) as important. High-quality media (1.5 ± 0.9) and pathology explanations (1.6 ± 1.1) were also highly valued. Students primarily relied on digital platforms, while physicians used a more varied mix of digital platforms, guidelines, and textbooks. Conclusions: The study highlights the need for more extensive, digitally supported ultrasound training, with a focus on functionality and usability. Standardisation through structured certification processes should be considered for future implementation. Full article

The article discusses the challenges faced by primary and secondary school students in North Macedonia, focusing on the availability of textbooks for those receiving instruction in minority languages. Although some materials are available for download on the E-učebnici platform operated by the Ministry of Education and Science, this does not encompass all didactic resources required for instruction. Cataloging of the materials on the platform reveals that while electronic versions of many textbooks in Macedonian are freely accessible, students studying in Albanian (a co-official language) and minority languages such as Turkish, Bosnian, and Serbian have considerably fewer digital resources. The data indicate that disparities begin from the fifth grade and widen in higher grades, with Bosnian- and Serbian-speaking students particularly disadvantaged. In vocational education, Macedonian-speaking students have the broadest access to electronic materials, while Albanian and especially Turkish speakers have far fewer options, and no digital textbooks are available in Serbian. The analysis demonstrates that a semi-official hierarchy of languages persists within North Macedonia’s educational system, privileging Macedonian and, to a lesser extent, Albanian, while marginalizing other minority languages both institutionally and technologically. The article concludes by outlining the challenges and implications of implementing digital resources as a means to address linguistic inequality in education. Full article

Generative textbooks are AI-powered educational resources generated using generative AI tools to create a variety of content types. However, this is a relatively new notion, and it is still under exploration. The current study aims to explore how the concept of a generative textbook can be effectively integrated into higher education academic programs. Specifically, it examined the creation, integration, and usability of generative textbooks in a college course, an area previously unexplored in higher education settings. A design-based research approach is employed to conduct this study through three phases: analysis and exploration, design and development, and evaluation and reflection. The instruments and participants are varied throughout the phases. The iterative process of this approach demonstrated how the generative textbook was generated. The output of this design-based research is a generative textbook chatbot (OLAD), which is an LLM; a responsive platform where students can post their queries regarding online learning and receive instant responses. The findings showed that the speed, creativity, adaptability, and efficiency of the OLAD are the critical advantages of this tool. Regarding the disadvantages, the study revealed that AI-generated content lacks accuracy, depth of information, and human insights. In addition, it is identified that the usefulness and ease of use of the OLAD of the generative textbook were at a moderate level. Further investigation is needed to inform pedagogical designs of integrating LLM into a college course. Full article

Foundation models for agriculture often suffer from fragmented and stale knowledge, making it difficult to deliver stable, traceable answers. We present an evidence-grounded retrieval-augmented generation (RAG) system for Yunnan Arabica coffee cultivation. First, we curate a lightweight knowledge base (approximately 250k Chinese characters) from cultivation textbooks, technical guidelines, and reports. Second, we adopt a retrieve–rerank–generate workflow: semantic-aware chunking with stable identifiers [docid#cid]; hybrid retrieval fused by reciprocal rank fusion (RRF); cross-encoder reranking on top; and final answer generation by DeepSeek v3.1 with mandatory inline evidence tags. In addition, we use GPT-5 Thinking to synthesize 346 gold QA items on the corpus with document-/chunk-level citations, and we evaluate with citation-level per-sample macro precision/recall/F1. On this gold set, our optimized system attains a citation-level per-sample macro F1 of 0.813 (81.3%), significantly outperforming a Simple RAG baseline that reads only a vector store (0.573; 57.3%). Error analysis shows that residual errors are dominated by fragment mismatch and missing evidence; latency analysis indicates that end-to-end delay is primarily driven by generation, whereas retrieval, fusion, and reranking incur sub-0.1 s overhead. The workflow preserves traceability and verifiability, supports hot updates via index rebuilding rather than model fine-tuning, and we release scripts for corpus construction, ablation, and citation-based evaluation to facilitate reproducibility. Full article