Search Results (296)

The entrepreneurial ecosystem theory posits that regional development emerges from synergistic interactions among entrepreneurs, institutions, and markets. This study positions entrepreneurial vitality as the core catalyst synchronizing digital inclusive finance (DIF) with rural revitalization—two systems often advancing in isolation, leading to unbalanced rural development. Using a coupling coordination degree model and provincial panel data from China (2011–2020), we demonstrate that entrepreneurial vitality significantly strengthens DIF–rural revitalization coupling coordination, following a nonlinear threshold pattern. Coordination gains accelerate only after vitality passes empirically identified critical levels, explaining persistent regional disparities in coupling coordination. Furthermore, the vitality–coordination link is moderated by technological infrastructure, organizational electronic commerce (e-commerce) engagement, and regional economic development, as outlined by the Technology–Organization–Environment framework. Framing DIF as an e-commerce-related ICT input, this paper advances the entrepreneurial ecosystem, e-commerce, and ICT-for-development (ICT4D) literature by revealing the threshold-driven nature of resource coordination in rural contexts. The findings offer a contextualized framework for catalyzing balanced and inclusive rural development in emerging economies. Full article

Objective. The aim of this study was to define a structured competence model for nurses working in gastrointestinal endoscopy in Italy and to assess nurses’ perceptions of the number of procedural repetitions required to acquire and maintain competence across different endoscopic procedures. Methods. A cross-sectional online survey targeted registered nurses working in Italian gastrointestinal endoscopy units. The questionnaire, developed from guidelines and expert consensus, covered demographics, organizational context, and perceived repetition thresholds for 30 procedures. Partial Credit Models (PCMs) estimated acquisition and maintenance thresholds; Differential Item Functioning (DIF) tested differences by self-reported experience level. Results. A total of 332 nurses participated (68.4% female; mean age 47.1 years; mean endoscopy experience 10.1 years). For competence acquisition, most procedures were placed in the 11–30 or 31–50 repetition range, with higher values for complex techniques. Competence maintenance generally required fewer repetitions, but thresholds varied by procedure. Advanced or infrequently performed techniques were perceived as more demanding. More experienced nurses reported higher thresholds, reflecting stricter internal standards. Conclusions. Acquisition and maintenance of gastrointestinal endoscopy competences differ in intensity and frequency requirements, supporting the need for tailored, modular training pathways. Findings highlight the importance of national competence standards, adaptive learning technologies, and structured mentorship to enhance skill development, reduce variability, and promote consistent, high-quality patient care across Italy. Full article

Background: Emerging evidence suggests that COVID-19 may influence obstructive sleep apnea (OSA) pathophysiology by affecting upper airway collapsibility, ventilatory control, and arousal responses, raising the possibility of a bidirectional relationship. This study examined whether individuals with a history of COVID-19 show altered OSA-related physiological traits compared with those without prior infection. Methods: In a case–control study, 60 participants with a history of COVID-19 were compared to 60 matched controls who underwent overnight in-hospital polysomnography before the pandemic. The matching criteria included age (±5 years), gender, body mass index (BMI) (±5 kg/m²), and OSA presence. Key pathophysiological traits (collapsibility, loop gain, arousal threshold, muscle compensation) estimated from polysomnographic signals were compared, with adjustment for age, sex, BMI, and apnea–hypopnea index. Results: The participants (78% male, mean age 55 ± 12 years, BMI 29.4 ± 5.0 kg/m²) exhibited no meaningful differences in their average levels of collapsibility (Adj dif [95% CI]; V_passive: −1 [−4, 2] %_eupnea, p = 0.7), loop gain (LG₁: 0.01 [−0.04, 0.06], p = 0.7), or arousal threshold levels (−1 [−7, 4] %_eupnea) and showed similar levels of muscle compensation (V_comp: 5 [−1, 11], p = 0.12). However, a greater ventilatory response to arousal (7 [1, 12] %_eupnea) was associated with COVID-19 history. Conclusions: COVID-19 history is not associated with differences in key OSA pathophysiological traits, suggesting it is unlikely to explain observed differences in OSA presentation. The increased ventilatory response to arousal may have implications for treatment responses and outcomes. Full article

Robust mean–geometric mean (MGM) linking is a method for comparing the performance of two groups on a test involving dichotomous items and is particularly suited to settings with fixed and sparse differential item functioning (DIF). However, robust MGM linking has been shown to yield biased estimates in finite samples because the estimated item parameters are affected by sampling error, which in turn induces bias in the estimated linking parameters. To address this issue, the simulation extrapolation (SIMEX) method is applied to robust MGM linking to reduce bias in the linking parameter estimates. Results from a simulation study demonstrate that SIMEX reduces bias in robust MGM linking. Moreover, SIMEX with a linear extrapolation function also reduces the variance of the parameter estimates in the absence of DIF effects. These findings indicate that the application of SIMEX in robust MGM linking methods can be generally recommended for empirical research aimed at removing DIF items from group comparisons. Full article

Background/Objectives: Development of Patient-Reported Outcome Measures (PROMs) in ophthalmology is limited by high patient burden during early validation. We propose an In Silico Pre-validation Framework using Large Language Models (LLMs) to stress-test instruments before clinical deployment. Methods: The LLM generated a PROM questionnaire and a synthetic cohort of 500 distinct patient profiles via a Python-based pipeline. Profiles were instantiated as structured JSON objects with detailed attributes for demographics, lifestyle, and health background, including specific clinical parameters like IOL type (Monofocal, Multifocal, EDOF) and dysphotopsia severity. To eliminate memory bias, a stateless simulation approach was used for test–retest reliability; AI agents were re-instantiated without access to prior conversation history. Psychometric validation included Confirmatory Factor Analysis (CFA) using WLSMV estimation and Differential Item Functioning (DIF). Results: The model demonstrated excellent fit (CFI = 0.962, TLI = 0.951, RMSEA = 0.048, SRMR = 0.063), confirming structural validity. DIF analysis detected no significant bias based on age, sex, or IOL type (0/20 items flagged). Internal consistency was robust (Cronbach’s alpha > 0.80) and stateless test–retest reliability was high (ICC > 0.90), indicating stability independent of algorithmic memory. Convergent validity was established via significant correlations with NEI-VFQ-25 scores (Spearman’s: −0.425 to −0.652,). While responsive to change, known-groups validity reflected realistic clinical overlap. Conclusions: LLM-based pre-validation effectively mirrors complex human response patterns through “algorithmic fidelity.” By identifying structural failure points in silico, this framework ensures PROMs are robust and unbiased before clinical trials, reducing the ethical and logistical burden on real-world populations. Full article

Abductive reasoning, or abduction, is a key process in scientific discovery and medical diagnosis. In everyday dermatology and dermatopathology, however, it functions as the practical engine behind differential diagnosis, clinicopathologic correlation, and disciplined pattern recognition. In this paper, we retain the epistemological foundation of abduction but translate it into usable steps for clinicians and dermatopathologists. We distinguish abduction from deduction and induction; separate creative abduction (which generates new concepts) from selective abduction (daily diagnostic choice); and show how both operate within a simple Select-and-Test (ST) Model: select a hypothesis, deduce what else should be true, test against data, and then update. We then reinterpret Ackerman’s algorithmic method of pattern analysis as an operationalization of the ST-Model. Through a couple of concise case vignettes, we illustrate visual and manipulative abduction, nonmonotonic updates, and the role of artifacts (dermoscopy, DIF, stains) as so-called epistemic mediators. Finally, we map contemporary AI tools to selective abduction and propose practical guardrails for fairness, transparency, and accountability. The result is a pragmatic framework that preserves philosophical depth while addressing the daily needs of dermatologists and dermatopathologists in the clinic and at the microscope. Full article

Background and Objectives: Pemphigus vulgaris (PV) is a rare autoimmune blistering disease caused by IgG au-toantibodies against desmoglein 1 and/or desmoglein 3, leading to flaccid blisters on the skin and mucous membranes. The course of PV during pregnancy represents a special clinical challenge due to immunological changes accompanying physiological immunosuppression and the need to protect the developing fetus. Materials and Methods: To analyze the current state of knowledge, a literature review was performed covering the years 2015–2025. Publications describing PV diagnosed during pregnancy or in neonates were screened, and nine case reports discussing ten patients meeting the inclusion criteria were selected for detailed analysis. In this study, we also present our own clinical case of PV in pregnancy to complement the literature review and provide practical insight into disease management. Results: In most cases, the disease was diagnosed in the first trimester of pregnancy, and the most common symptoms were flaccid blisters and erosions of the oral mucosa. The diagnosis was confirmed by direct immunofluorescence (DIF) and ELISA testing. The first-line treatment remained systemic glucocorticosteroids (GCS), mainly prednisolone, which is considered the safest. In resistant cases, intravenous immunoglobulins (IVIg) were used, which were considered effective and safe, though their use may limit the transplacental transfer of autoantibodies to the fetus. In newborns, the symptoms rarely occurred, were mild, and resolved spontaneously. Drugs with proven teratogenic effects, such as methotrexate, cyclophosphamide, and mycophenolate mofetil, are contraindicated during pregnancy. In the case of rituximab therapy, it is recommended to postpone pregnancy for at least 12 months after the completion of treatment to minimize the potential risk of immunosuppression in the newborn. Conclusions: The treatment of PV during pregnancy requires close interdisciplinary cooperation. Therapy should be carefully individualized, taking into account both therapeutic efficacy and fetal safety. Perhaps then, pregnancy-related pemphigus diseases, given their peculiarities, should be classified as a distinct variety within the desmosomal type of autoimmune blistering diseases. Full article

Coupling microbial catalysis with electrochemical stimulation offers a promising strategy for heavy metal remediation. This study investigates how potentiostatic control influences the bioreduction of hexavalent chromium (Cr(VI)) by Bacillus cereus strain DIF1 in a bioelectrochemical system. Cr(VI) reduction was evaluated under various applied cathodic potentials, and the highest reduction efficiency (91.45%) was achieved at +0.04 V after 24 h. This performance significantly surpassed that of the abiotic control (82.55%) and the open-circuit biotic control (9.25%), indicating that the applied potential enhances microbial Cr(VI) reduction beyond contributions from abiotic processes alone. Cyclic voltammetry (CV) revealed a distinct redox feature at +0.04 V with no corresponding reverse peak, indicating kinetically favored electron transfer during Cr(VI) reduction under this condition. Microscopic imaging confirmed that, under the applied potential, Bacillus cereus DIF1 formed filamentous connections, exhibited higher chromium accumulation on bacterial cells than on the surrounding carbon paper electrode, and developed a robust biofilm on the cathode surface. The system maintained consistent Cr(VI) reduction performance over three consecutive cycles, demonstrating good short-term operational reproducibility. These findings highlight the critical role of precise electrochemical control in modulating microbial Cr(VI) reduction and provide mechanistic insights into the interplay between electrode potential and bacterial activity. Full article

Background: The Psychache Scale (PS) is the most widely used scale to measure psychological pain due to its ease of application, favorable evidence of predictive validity, and adequate psychometric properties from the CTT (Classical Test Theory) approach. This paper aims to contribute to the improvement of the Spanish version of the PS by analyzing its psychometric properties using a Rasch model. Methods: Using quota sampling, 905 young adults completed an online questionnaire with the PS. Results: The items and response categories showed an acceptable fit to the model and good performance. The separation index indicated three strata for persons. The item-person map showed that persons were placed lower on the psychological pain continuum than item, and some item pairs presented small difference in their severity. The study of men-women DIF (differential item functioning) showed a slight differential functioning only for item 6. Conclusions: This study provides new evidence that supports the use of the PS to measure psychological pain. Full article

Coupled high temperature and dynamic loading often leads to the complicated degradation of performance in industrial kilns, enclosures, or other concrete structures, which constitutes a serious hazard to the safety of concrete structure. To bridge this research gap, this study investigates not only the mechanical response but also the damage mechanisms of normal concrete (NC), basalt fiber-reinforced concrete (BFRC), and steel fiber-reinforced concrete (SFRC) under the coupled effects of high temperature and dynamic loading. Test specimens were conditioned for ambient conditions, 200 °C, 400 °C, and 600 °C, and underwent quasi-static and dynamic splitting tensile tests using the Split Hopkinson Pressure Bar (SHPB) with strain rates varying between 24 and 91 s⁻¹. Significantly, the high-temperature-induced degradation of all types of concrete is remarkably suppressed by fibers, especially steel fibers. The best thermal degradability resistance was displayed by the SFRC with the highest remaining residual dynamic strength, peak strain, and energy dissipation, especially in the most severe (600 °C, 0.15 MPa) circumstances among these three types of materials. All materials revealed a clear strain rate strengthening effect. An empirical model, integrating the coupling effect of strain rate, temperature, and fiber type in DIF, was also developed, yielding better prediction capability than those already available. This reveals that the comprehensive performance of SFRC can meet structure requests, so it is suitable for applications involving steel fiber in environments characterized by high temperature and high strain rates. Full article

The root mean square deviation (RMSD) is a widely used item fit statistic in item response models. However, the sample RMSD is known to exhibit positive bias in small samples. To address this, seven alternative bias-corrected RMSD estimators are proposed and evaluated in a simulation study involving items with uniform differential item functioning (DIF). The results demonstrate that the proposed estimators effectively reduce the bias of the original RMSD statistic. Their performance is compared, and the most favorable estimators are highlighted for empirical research. Finally, the application of the various RMSD statistics is illustrated using PISA 2006 reading data. Full article

The impact mechanical properties of coral aggregate seawater concrete (CASC) are crucial for its application in island construction. This study examines how the dynamic compressive mechanical properties of CASC degrade in a marine setting. Laboratory tests were conducted to simulate the corrosion of CASC under three different immersion scenarios: full immersion (FI), semi-immersion (SI), and salt spray (SS). Dynamic compressive mechanical property tests were performed using a split Hopkinson pressure bar (SHPB). The study analyzed the effects of immersion condition and duration on key dynamic properties, including strength, elasticity, dynamic increase factor (DIF, defined as the ratio of dynamic strength to static strength), and energy dissipation. The experimental stress–strain data were fitted using the Guo model. Results show that the dynamic strength and energy dissipation in FI and SI conditions first increased, peaking at 30 days of corrosion, before decreasing. The DIF of CASC was linearly related to the strain rate and was largest in the SS zone, followed by the SI zone, and smallest in the FI zone. The experimental stress–strain data were well fitted by the Guo model, validating its effectiveness and offering insights into CASC use in island-reef engineering. Full article

In educational large-scale assessment studies, uniform differential item functioning (DIF) across countries often challenges the application of a common item response model, such as the two-parameter logistic (2PL) model, to all participating countries. DIF occurs when certain items provide systematic advantages or disadvantages to specific groups, potentially biasing ability estimates and secondary analyses. Identifying misfitting items caused by DIF is therefore essential, and several item fit statistics have been proposed in the literature for this purpose. This article investigates the performance of four commonly used item fit statistics under uniform DIF: the weighted root mean square deviation (RMSD), the weighted mean deviation (MD), the infit, and the outfit statistics. Analytical approximations were derived to relate the uniform DIF effect size to these item fit statistics, and the theoretical findings were confirmed through a comprehensive simulation study. The results indicate that distribution-weighted RMSD and MD statistics are less sensitive to DIF in very easy or very difficult items, whereas difficulty-weighted RMSD and MD exhibit consistent detection performance across all item difficulty levels. However, the sampling variance of the difficulty-weighted statistics is notably higher for items with extreme difficulty. Infit and outfit statistics were largely ineffective in detecting DIF in items of moderate difficulty, with sensitivity limited to very easy or very difficult items. To illustrate the practical application of these statistics, they were computed for the PISA 2006 reading study, and the distribution of the statistics across participating countries was descriptively examined. The findings guide selecting appropriate item fit statistics in large-scale assessments and highlight the strengths and limitations of different approaches under uniform DIF conditions. Full article

This study investigated the occurrence, dissipation, and dietary risks of four pesticides (difenoconazole (DIF), prochloraz (PRO), spinosad (SPI), dinotefuran (DIN)) and their metabolites in pomegranates through nationwide field trials across six Chinese production regions. Results indicated that SPI and DIN dissipated within 7–14 days, while DIF and PRO had longer half-lives (4.91–12.90 days). All pesticide residues remained confined to peels without penetrating arils. Terminal residues were below China’s MRLs. While deterministic and probabilistic risk assessments confirmed acceptable acute and chronic risks from pomegranate consumption alone (%ARfD: 0.09–17.66%; %ADI: 0.21–17.65%), comprehensive multi-crop dietary assessment revealed unacceptable chronic exposure risks for children aged under 11 years (%ADI: 56.1–155%). The non-carcinogenic risk (%HQ) for PRO from pomegranate consumption was 2.1–21.0%, indicating acceptable safety. The study provides data for safe pesticide use while highlighting the urgent need to protect vulnerable pediatric populations from cumulative pesticide exposure across multiple food sources. Full article

Background/Objectives: Chronic pain in women arises from a complex interplay of biological, psychological, and social factors. Despite its impact, validated screens for these bio-psycho-social risk factors are lacking. This study aimed to develop and validate a new screening and assessment tool to prevent chronic pain onset and detect hidden experiences of violence or trauma in women, also supporting individualized treatment. Methods: Conducted from December 2023 to June 2024 as part of a larger project, the original instrument comprised 36 bio-psycho-social risk factors. Rasch analysis was used for validation, assessing Infit, Outfit, DIF, ROC curves, and reliability indexes. Results: The sample included 239 women (100 victims), with 103 experiencing chronic pain, and 136 pain-free. Seven items were excluded due to poor fit, resulting in a 29-item version that met Rasch model criteria. Conclusions: The validated 29-item checklist, available in Italian, supports the bio-psycho-social model by identifying risk factors for chronic pain onset and detecting violence-related variables in diagnosed individuals. It offers clinicians and operators a practical tool to guide prevention and tailor personalized treatments. In addition, the RFCP-CK holds forensic relevance by offering measurable indicators that can support medico-legal evaluations, especially in cases where chronic pain is claimed to be a consequence of violence. Full article