Search Results (1,983)

Objective: This study aimed to explore the emotional, social, and ethical dimensions of early or presymptomatic diagnosis in individuals with Autosomal Dominant Polycystic Kidney Disease (ADPKD). Methods: A total of 118 participants diagnosed with ADPKD were recruited from a tertiary nephrology center in Türkiye. Data were collected via a 22-item structured and open-ended questionnaire. Chi-square and non-parametric statistical tests were used to assess associations between awareness, attitudes, and demographic variables. Results: Although only 10% of participants reported direct disadvantages from their diagnosis, such as difficulties in employment, insurance, or relationships, many voiced concerns about stigma and long-term uncertainties. Genetic awareness was significantly associated with increased likelihood of recommending family screening (p = 0.022), and higher educational attainment correlated with greater disease knowledge (p < 0.01). Despite emotional burden, 71.2% of participants reported adopting lifestyle modifications, and 79.6% expressed willingness to screen their children, though often with ethical hesitation. Conclusions: While early diagnosis of ADPKD may offer clinical benefits, it also introduces complex psychosocial and ethical dilemmas. These findings highlight the importance of integrating patient-centered counseling, clear communication strategies, and supportive policies to ensure informed decision making and mitigate potential harms. Full article

Background: Despite the significant global disease burden associated with HPV infection, the vaccination coverage among female college students in China remains suboptimal. This study aimed to examine HPV vaccination coverage, knowledge levels, and determinants influencing vaccination behavior among female college students in northern China, utilizing the Health Belief Model (HBM) as a theoretical framework. Methods: A cross-sectional online survey was conducted from December 2024 to January 2025, involving 4076 female students from six universities in Jinan, China. The participants were categorized into three groups: vaccinated (VG), willing-to-vaccinate (WTG), and unwilling-to-vaccinate (UTG). Data on sociodemographic characteristics, HPV knowledge, health beliefs, and vaccination behavior were analyzed using ANOVA, chi-square tests, correlation analysis, and multivariate logistic regression. Results: The vaccination rate was 18.11%, with 40.19% expressing willingness to vaccinate and 41.71% expressing unwillingness. Vaccinated students demonstrated higher levels of HPV knowledge (6.66 ± 2.67 compared to 4.76 ± 3.10 in the UTG, p < 0.001) and were predominantly from urban areas (OR = 0.64, p < 0.001). The key determinants of vaccination uptake included perceived benefits (OR = 1.54, p < 0.001), perceived barriers (OR = 3.34, p < 0.001), self-decision-making ability (OR = 1.80, p < 0.001), and social motivation (OR = 0.21, p < 0.001). Notably, increased knowledge was associated with vaccine hesitancy in the WTG group (OR = 0.45, p < 0.001), indicating that information overload may adversely affect decision-making processes. Structural barriers, such as cost (42.63%), safety concerns (46.59%), and misconceptions (e.g., 57.76% cited “no sexual activity” as a reason for refusal), significantly impeded vaccine uptake. Conclusions: The low coverage of HPV vaccination is indicative of deficiencies in knowledge, socioeconomic disparities, and cultural perceptions. Tailored interventions should focus on educational efforts to correct misconceptions, provide subsidized access to vaccines, and implement empowerment strategies that enhance self-efficacy and informed decision-making. Policymakers should incorporate these findings into national cervical cancer prevention programs to address the gap between vaccination intention and behavior among young women in China. Full article

This study explores graduate students’ perceptions of and experiences with digital governance in higher education, using data from semi-structured interviews with thirty participants. A qualitative research design guided the investigation, addressing six research questions related to the definition, roles, effectiveness, required skills, challenges, and opportunities of digital governance. The findings reveal varying levels of familiarity with digital governance, often linked to concepts of e-government and efficient decision-making. However, many participants lacked a deep understanding of the term. Key roles of digital governance identified include improved data management, enhanced transparency, and increased inclusivity in decision-making processes. The study also highlights significant challenges, such as inadequate infrastructure, inconsistent implementation, and a lack of formal training in digital governance. Despite these barriers, digital governance offers practical benefits, including streamlined administrative processes, better accessibility, and improved research outcomes. Participants emphasized the importance of digital skills education but noted that weak infrastructure and limited curricular integration hinder skill development. Opportunities identified include greater efficiency, expanded access to education, and better support for marginalized groups. The study concludes with recommendations for a holistic approach, combining education reform, infrastructure improvement, and stakeholder collaboration to optimize the benefits of digital governance in higher education. These insights provide valuable guidance for policymakers and educators seeking to enhance digital governance in academic institutions. Full article

Background/Objectives:Breast reconstruction (BR) following mastectomy plays a critical role in post-cancer care by offering both physical and psychological benefits. Despite advancements in techniques and shared decision-making (SDM), BR uptake remains inconsistent. This systematic review aims to synthesize evidence on objective (medical and socioeconomic) and subjective (psychological and personal) factors influencing BR decision-making among women undergoing mastectomy for breast cancer. Methods: A systematic search was conducted across PubMed, ScienceDirect, OVID, and Google Scholar, identifying peer-reviewed studies published between January 2013 and 25 July 2024. Eligible studies examined determinants of BR decisions in women undergoing therapeutic mastectomy, excluding perspectives of non-patient stakeholders and post-decision outcomes. The risk of bias and study quality were assessed using the Quality Appraisal for Diverse Studies (QuADS) tool. This review was registered in PROSPERO (CRD42023456198) and followed PRISMA guidelines. Results: Twenty-seven studies comprising 994,528 participants across 16 countries met the inclusion criteria. The objective factors included age, comorbidities, insurance coverage, physician recommendations, and healthcare access. The subjective factors encompassed body image concerns, self-esteem, fear of recurrence, and emotional readiness. Younger age, private insurance, and active physician counseling were associated with increased BR uptake, while older age, lack of information, and financial or logistical barriers reduced uptake. Regional disparities were noted across healthcare systems. Conclusions: BR decisions are influenced by complex, interrelated clinical, psychological, and systemic factors. Integrating SDM tools, enhancing patient education, and addressing healthcare inequities are essential for supporting informed and equitable BR decision-making. Future research should prioritize longitudinal studies and policy interventions to improve access to and patient satisfaction with BR outcomes. Full article

Abstract: This paper explores the evolving relationship between Digital Twins (DT) and the Metaverse, two foundational yet often conflated digital paradigms in digital architecture. While DTs function as mirrored models of real-world systems—integrating IoT, BIM, and real-time analytics to support decision-making—Metaverses are typically fictional, immersive, multi-user environments shaped by social, cultural, and speculative narratives. Through several research projects, the team investigate the divergence between DTs and Metaverses through the lens of their purpose, data structure, immersion, and interactivity, while highlighting areas of convergence driven by emerging technologies in Artificial Intelligence (AI) and Extended Reality (XR).This study aims to investigate the convergence of DTs and the Metaverse in digital architecture, examining how emerging technologies—such as AI, XR, and Large Language Models (LLMs)—are blurring their traditional boundaries. By analyzing their divergent purposes, data structures, and interactivity modes, as well as hybrid applications (e.g., data-integrated virtual environments and AI-driven collaboration), this study seeks to define the opportunities and challenges of this integration for architectural design, decision-making, and immersive user experiences. Our research spans multiple projects utilizing XR and AI to develop DT and the Metaverse. The team assess the capabilities of AI in DT environments, such as reality capture and smart building management. Concurrently, the team evaluates metaverse platforms for online collaboration and architectural education, focusing on features facilitating multi-user engagement. The paper presents evaluations of various virtual environment development pipelines, comparing traditional BIM+IoT workflows with novel approaches such as Gaussian Splatting and generative AI for content creation. The team further explores the integration of Large Language Models (LLMs) in both domains, such as virtual agents or LLM-powered Non-Player-Controlled Characters (NPC), enabling autonomous interaction and enhancing user engagement within spatial environments. Finally, the paper argues that DTs and Metaverse’s once-distinct boundaries are becoming increasingly porous. Hybrid digital spaces—such as virtual buildings with data-integrated twins and immersive, social metaverses—demonstrate this convergence. As digital environments mature, architects are uniquely positioned to shape these dual-purpose ecosystems, leveraging AI, XR, and spatial computing to fuse data-driven models with immersive and user-centered experiences. Full article

Background/Objectives: The high sensitivity of paediatric nurses directly influences the quality of nursing care provided to patients. The purpose of this study is to present the most frequent issues faced by paediatric nurses in their everyday work and their responses to difficult situations at work, define the actions applied when a difficult situation occurs, and assess the level of stress and other factors influencing the level of stress experienced by paediatric nurses. Methods: This study was conducted using an original survey form and a standardised psychological questionnaire based on the Perceived Stress Scale (PSS-10) for paediatric nurses. Results: The study involved 416 paediatric nurses and indicated a medium level of stress among the nurses. The median stress level, calculated as the sum of answers to questions based on the PSS-10, was 18 (16.0 ÷ 20.0), and the mean was 17.9 (min–max = 1–30). The median Sten score was 6 (5.0 ÷ 7.0), and the mean Sten score was 5.94 (min–max = 2–9). Nurses aged 21–30 years, who live in a city, have a Bachelor of Science in Nursing or a Master of Science in Nursing, and work ≥ 61 h a week and 161–250 h a month experience a higher level of stress. Factors such as choosing which child to help first, spending a great deal of time filling out medical documentation, obtaining a sick child’s consent to perform nursing procedures which the child does not understand, involving the minor in decision-making, impolite or offensive behaviour from a sick child or their parents, ineffective nursing and treatment methods, providing care against the opinion/views of a sick child or their parents, difficulties in or a lack of understanding of the situation of a sick child and their family, performing nursing procedures that can cause the child pain, and the inability to fulfil a sick child’s request increase the level of stress experienced by paediatric nurses. When a difficult situation occurs at work occurs, the nurses usually meet and talk about the situation with someone close (72.4%) or engage in other activities to avoid thinking about the situation (66.6%). They consult a psychologist/psychotherapist very rarely (9.6%) and a psychiatrist extremely rarely (4.6%). Conclusions: Polish paediatric nurses were found to experience a medium level of stress. Since paediatric nurses are exposed to stress, providing them with psychological care is important. The level of perceived stress is dependent on the nurse’s age, place of residence, and education, as well as weekly and monthly working durations. Paediatric nurses experience many difficult situations in their everyday work that influence their stress levels. Management should pay special attention to difficult workplace situations faced by paediatric nurses and implement regular actions to reduce the levels of stress experienced. Full article

Artificial intelligence (AI) is transforming dentomaxillofacial radiology education by enabling adaptive, personalized, and data-driven learning experiences. This review critically examines the pedagogical potential of AI within dental curricula, focusing on its ability to enhance student engagement, improve diagnostic competencies, and streamline clinical decision-making processes. Key innovations include real-time feedback systems, AI-guided simulations, automated assessments, and clinical decision support tools. Through these resources, AI transforms static learning into dynamic, interactive, and competency-based education. Additionally, this review discusses the integration of AI into formative assessment frameworks, such as OSCEs and mini-CEX, and its impact on student confidence, performance tracking, and educational scalability. Although primarily narrative in structure, this review synthesizes the current literature on dentomaxillofacial radiology education, supported by selected insights from medical radiology, to provide a comprehensive and up-to-date perspective on the educational applications of AI. Challenges (including ethical implications and other practical considerations) are addressed, alongside future directions for research and curriculum development. Overall, AI has the potential to significantly enhance radiology education by fostering clinically competent, ethically grounded, and technologically literate dental professionals. Full article

Background/Objectives:As dementia progresses, patients often lose decision-making capacity, leaving family members responsible for making critical end-of-life (EOL) care decisions. This cross-sectional descriptive study explored the factors associated with the intention to complete an advance directive (AD) among family caregivers of older adults with dementia in South Korea. Methods: This study surveyed 140 caregivers aged 20 years or older to assess their knowledge of advance directives (ADs), preferences for EOL care, and attitudes toward withdrawing life-sustaining treatment (LST). Data were collected from 1 August to 14 August 2024, and analyzed using descriptive statistics, the Chi-squared test, Fisher’s exact test, Spearman’s correlation, and logistic regression, with SPSS/WIN 28.0. Results: The intention to complete an AD significantly differed by religion (p = 0.004) and the functional status of the patient with dementia (p = 0.012). There was a positive correlation between intention to complete an AD and knowledge of ADs (r = 0.23, p = 0.007). Factors associated with intention to complete an AD included religion (OR = 4.36, p = 0.028) and knowledge of ADs (OR = 1.16, p = 0.033), explaining 22.2% of the variance, which is considered meaningful in studies dealing with complex psychosocial and behavioral variables. Conclusions: These findings suggest that religious affiliation and knowledge of ADs may contribute to greater emphasis on EOL preparedness and self-determination. To promote informed decision making, it is essential to implement targeted educational interventions—such as community-based workshops, telehealth counseling, and in-clinic guidance—that enhance caregivers’ understanding of ADs and empower them in their caregiving roles. Full article

Water security is a basic requirement of a region’s residents and also an important point of discussion worldwide. The middle route of the south-to-north water diversion project (MR-SNWDP) represents the most extensive inter-basin water allocation scheme globally. It is the major water resource for the Beijing–Tianjin–Hebei region, and its security is of great significance. In this study, 28 indicators including society, nature, and economy were selected from the water sources of the MR-SNWDP from 2000 to 2017. According to the Drivers-Pressures-States-Impact-Response (DPSIR) framework principle, the entropy weight method was used for weight calculation, and the comprehensive evaluation method was used for evaluating the water security of the water sources of the MR-SNWDP. This study showed that the total loss of nonpoint source pollution (NPSP) in the water source showed a trend of slow growth, except in 2007. Over the past 18 years, the proportion of pollution from three NPSP sources, livestock, and poultry (LP) breeding industry, planting industry, and living sources, were 44.56%, 40.33%, and 15.11%, respectively. The main driving force of water security in all the areas of the water source was the total net income per capita of farmers. The main pressure was the amount of LP breeding and the amount of fertilizer application. The largest impact indicators were NPSP gray water footprint and soil erosion area, and water conservancy investment was the most effective response measure. Overall, the state of the water source safety was relatively stable, showing an overall upward trend, and it had remained at Grade III except for in 2005, 2006, and 2011. The state of water safety in all areas except Shiyan City was relatively stable, where the state of water safety had fluctuated greatly. Based on the assessment findings, implications for policy and decision-making suggestions for sustainable management of the water sources of the MR-SNWDP resources are put forward. Agricultural cultivation in water source areas should reduce the application of chemical fertilizers and accelerate the promotion of agricultural intensification. Water source areas should minimize retail livestock and poultry farming and promote ecological agriculture. The government should increase investment in water conservancy and return farmland to forests and grasslands, and at the same time strengthen the education of farmers’ awareness of environmental protection. The evaluation system of this study combined indicators such as the impact of agricultural nonpoint source pollution on water bodies, which is innovative and provides a reference for the water safety evaluation system. Full article

The integration of artificial intelligence (AI) into the biological sciences marks a transformative era, reshaping research methodologies, data analysis, and hypothesis generation. This technological advancement accelerates discoveries and enhances our understanding of complex biological systems. As AI increasingly influences decision-making processes, the necessity for students and scientists to critically assess AI-generated outputs becomes paramount. The current narrative review explores the evolving role of critical thinking in biological sciences amidst the rise of AI, emphasizing the importance of skepticism, contextual understanding, and ethical considerations. It argues that while AI provides powerful tools for data interpretation and pattern recognition, human oversight and critical analysis remain indispensable to validate findings and prevent biases inherent in automated systems. Higher education institutions play a crucial role in fostering a culture of critical thinking, equipping biological scientists to effectively harness AI technologies while ensuring the integrity of their research and upholding scientific and ethical standards. Furthermore, AI tools, including chatbots, could be strategically employed in active learning methodologies, such as problem-based learning, flipped classrooms, and online learning. These methodologies enhance the ability of students to effectively utilize AI technologies while ensuring the rigor of scientific research. In conclusion, the current review underscores the benefits, challenges, and educational implications of AI integration, offering actionable insights for educators and learners seeking to adapt effectively to this rapidly evolving technological landscape. Full article

Climate adaptation in urban environments is often constrained by rigid institutional rules and fragmented governance, which limit inclusive and context-specific planning of public spaces such as schoolyards. This study addresses this challenge by examining how collaborative planning can transform schoolyards, from asphalt-dominated, monofunctional spaces into green, climate-resilient community assets. The research employed the Institutional Analysis and Development framework within a qualitative case study design. Two public schools in the San Cristóbal de los Ángeles neighbourhood of Madrid served as case studies, with data collected through document analysis, participant observation, and interviews with municipal officials, urban planners, educators, and community members. Results indicate that the collaborative planning process reshaped rules in use, expanded the network of actors, and transformed decision-making processes. Existing rules were flexibly reinterpreted to allow new uses of space. Children, teachers, and residents became co-producers of the public space, expanding the governance network, where new deliberative practices emerged that improved coordination across people and organisations. These institutional changes occurred without formal regulatory reform, but with the reinterpretation of the game’s rules by each organisation. Thus, schoolyards can serve as laboratories for institutional innovation and participatory climate adaptation, demonstrating how urban experiments have the potential to catalyse not only physical transformations but also transformations in urban management. Full article

Data from community-based research offer crucial insights into community needs, challenges, and strengths, informing effective decision making for development strategies. To ensure efficient analysis, accessible and user-friendly tools are necessary for quick and accurate results. While successful tools and programming languages exist, many social science researchers struggle with complex analytical tools due to limited exposure during their education, as such tools are often not required. Developing an automated, user-friendly tool for community research can support students, researchers, and data centers by bridging gaps in analysis capabilities and enhancing the accessibility of valuable insights. We developed a new automated tool using the Shiny framework in R designed primarily for analyzing data in community research, which often involves pre- and post-analysis tests. While the tool is specifically tailored for pre- and post-survey data, it can also be easily adapted to provide other statistical information. The findings presented in this paper highlight the efficiency of using this tool for community-based research and emphasize the need for further development to address its shortcomings. Furthermore, this paper is considered the groundwork for developing more accessible, user-friendly, and free tools in the future, especially in an era of advanced and complex technologies. Full article

Distance learning offers enhanced flexibility and reduced access restrictions, making it increasingly popular among non-traditional students and those juggling academic studies with professional and family obligations. This study explored the associations between study demands and resources (decision latitude and social support from lecturers and peers) and different study outcomes by applying the Job Demands-Resources Model in a distance learning context. Based on the model’s assumptions, we hypothesized that academic demands negatively predict study success in distance learning, while decision latitude and social support from lecturers and peers positively affect it. These associations were expected to be mediated by emotional exhaustion and different dimensions of engagement. The cross-sectional online study involved 286 psychology students from a German distance university. The multivariate path model revealed an association of demands and decision latitude with perceptions of competence and study satisfaction. While demands were significantly correlated with the grade point average, decision latitude was not. Consistent with the model’s assumptions, these effects were partially mediated by exhaustion and engagement. We did not find significant incremental associations of social support with the outcomes. The findings concerning measures to support students in distance education were discussed. Full article

This paper explores Gen Z’s understanding of science and pseudoscience, assessing, at the same time, their media literacy skills. Drawing on the relevant literature and elaborating on the findings from five focus groups studies in remote areas of Greece and Portugal, it sheds light on how young people perceive science. Through a synthesis of the insights garnered from the participants’ personal experiences, this study endeavors to offer valuable advice and recommendations for designing education material that is tailor-made to address the needs of generation Z. By adopting these suggestions, policymakers and educational experts can advance scientific literacy, cultivate critical thinking, and nurture an environment of evidence-based decision-making for young people. Full article

Despite ongoing efforts to reduce maternal mortality in Nigeria, the uptake of skilled birth attendance remains persistently low, especially in rural areas. While structural and socio–demographic barriers have been widely studied, less attention has been paid to psychological determinants of maternal healthcare-seeking behavior in low-resource settings. This study explores how the locus of control influences the use of skilled birth care among postpartum women in rural Edo State, Nigeria, and whether neuroticism serves as a mediating factor in this relationship. We draw on data from a cross-sectional survey involving 1411 women aged 15–45 who had given birth within the two years preceding the study. Participants were recruited from 20 randomly selected communities across two rural Local Government Areas. Data were collected using structured interviews that included validated measures of locus of control, neuroticism, and self-reported use of skilled birth care. We applied the Baron and Kenny mediation framework using linear and logistic regression models with standardized coefficients, adjusting for education, household wealth, and women’s decision-making autonomy. The findings show that women with a more external locus of control were significantly less likely to utilize skilled birth care (p < 0.01), and that neuroticism partially mediated this effect. Higher levels of neuroticism were associated with a reduced likelihood of engaging with skilled maternity care services. These results highlight the importance of psychological traits in shaping maternal health behaviors. Integrating psychosocial interventions, such as emotional support, cognitive reframing, and community health education, into maternal healthcare programs may improve service uptake in marginalized rural populations. Full article