Search Results (5,999)

Adopting advanced e-commerce practices is essential for enhancing user engagement and business performance, particularly in tourism. This study evaluates the e-commerce adoption of Kazakhstan’s tourism websites using an innovative Integrated Multi-Criteria Decision Analysis (IMCDA) methodology. Traditional evaluation methods overlook the interplay between website functionality, user experience, and strategic objectives. To address this gap, the IMCDA framework integrates qualitative and quantitative approaches by combining advanced Multi-Criteria Decision-Making (MCDM) techniques, including SPOTIS, ESP-COMET, RANCOM, and SITW, with content analysis and logistic regression. The study assessed 77 tourism websites, categorized into Online Travel Agencies (OTAs), Official Tourism Websites (OTWs), and Attraction Websites (AWs), based on 34 e-commerce features grouped into dimensions such as product information, functionality, reservations, payment systems, and customer relationship management (CRM). The findings reveal that OTAs significantly outperform OTWs and AWs in most dimensions, especially in online booking and CRM functionalities. At the same time, AWs lag in key e-commerce features like reservations and payment systems. This research highlights critical gaps in Kazakhstan’s tourism e-commerce ecosystem. It provides actionable recommendations, including enhancing CRM tools, integrating advanced booking systems, and leveraging collaborations with local financial technology providers like Kaspi Pay. The IMCDA framework offers a robust, adaptable evaluation model with practical implications for digital transformation and competitiveness in the tourism industry. This study contributes to advancing digital maturity in Kazakhstan’s tourism sector by addressing these gaps. It sets the foundation for future research to explore innovative strategies in e-commerce adoption across various regions and industries. Full article

Background: Lymphadenectomy in the operative management of hepatocellular carcinoma (HCC) remains controversial, with no recommendation for routine practice. Our study aimed to assess the effects of lymphadenectomy in addition to hepatic resection (HR) compared to HR alone for adults with HCC. Methods: This systematic review was conducted according to PRISMA guidelines until March 2023, searching and selecting the relevant literature comparing lymph node dissection or sampling, combined with HR, and with no lymph node removal. Critical appraisal of the included studies was performed using the ROBINS-I tool. Fixed- or random-effect meta-analysis models were carried out, and inter-studies were assessed for heterogeneity. Results: Fourteen studies were selected during the screening process. Data from eight studies containing 32,041 HCC patients were included in the quantitative synthesis. In total, 12,694 patients underwent lymph node dissection (LND), either selectively for preoperatively diagnosed or intraoperatively suspected lymph node metastasis (LNM) or unselectively (i.e., regardless of suspected LNM). According to LN status, 1-, 3- and 5-year mortality rates were higher in the LNM group with respect to both clinically negative LN (OR 3.25, 95% CI 2.52–4.21; p < 0.001; OR 3.79, 95% CI 2.74–5.24; p< 0.001; OR 3.92, 95% CI 2.61–5.88; p < 0.001) and proven LN0 (OR 1.75, 95% CI 1.0–3.04; p = 0.05; OR 2.88, 95% CI 1.79–4.63; p < 0.001; OR 2.54, 95% CI 1.33–4.84; p < 0.001). Moreover, the summary estimates of two controlled trials showed no significant difference in overall survival between LND groups and those without LND for negative LN patients. Conclusions: Lymph node dissection does not appear to improve overall survival, according to the available literature; thus, this does not support its routine adoption as part of standard liver resection for HCC. A case-by-case decision remains advisable. Full article

Congenital heart defects (CHDs) are the most common congenital defect, occurring in approximately 1 in 100 live births and being a leading cause of perinatal morbidity and mortality. Of note, approximately 25% of these defects are classified as critical, requiring immediate postnatal care by pediatric cardiology and neonatal cardiac surgery teams. Consequently, early and accurate diagnosis of CHD is key to proper prenatal and postnatal monitoring in a tertiary care setting. In this scenario, fetal echocardiography is considered the gold standard imaging ultrasound method for the diagnosis of CHD. However, the availability of this examination in clinical practice remains limited due to the need for a qualified specialist in pediatric cardiology. Moreover, in light of the relatively low prevalence of CHD among at-risk populations (approximately 10%), ultrasound cardiac screening for potential cardiac anomalies during routine second-trimester obstetric ultrasound scans represents a pivotal aspect of diagnosing CHD. In order to maximize the accuracy of CHD diagnoses, the views of the ventricular outflow tract and the superior mediastinum were added to the four-chamber view of the fetal heart for routine ultrasound screening according to international guidelines. In this context, four-dimensional spatio-temporal image correlation software (STIC) was developed in the early 2000s. Some of the advantages of STIC in fetal cardiac evaluation include the enrichment of anatomical details of fetal cardiac images in the absence of the pregnant woman and the ability to send volumes for analysis by an expert in fetal cardiology by an internet link. Sequentially, new technologies have been developed, such as fetal intelligent navigation echocardiography (FINE), also known as “5D heart”, in which the nine fetal cardiac views recommended during a fetal echocardiogram are automatically generated from the acquisition of a cardiac volume. Furthermore, artificial intelligence (AI) has recently emerged as a promising technological innovation, offering the potential to warn of possible cardiac anomalies and thus increase the ability of non-cardiology specialists to diagnose CHD. In the early 2010s, the advent of 3D reconstruction software combined with high-definition printers enabled the virtual and 3D physical reconstruction of the fetal heart. The 3D physical models may improve parental counseling of fetal CHD, maternal–fetal interaction in cases of blind pregnant women, and interactive discussions among multidisciplinary health teams. In addition, the 3D physical and virtual models can be an useful tool for teaching cardiovascular anatomy and to optimize surgical planning, enabling simulation rooms for surgical procedures. Therefore, in this review, the authors discuss advanced image technologies that may optimize prenatal diagnoses of CHDs. Full article

Pultruded glass fiber-reinforced polymer (GFRP) materials are increasingly recognized in civil engineering for their exceptional properties, including a high strength-to-weight ratio, corrosion resistance, and ease of fabrication, making them ideal for composite structural applications. The use of concrete infill enhances the structural integrity of thin-walled GFRP sections and compensates for the low elastic modulus of hollow profiles. Despite the widespread adoption of concrete-filled pultruded GFRP tubes in composite beams, critical gaps remain in understanding their flexural behavior and failure mechanisms, particularly concerning design optimization and manufacturing strategies to mitigate failure modes. This paper provides a comprehensive review of experimental and numerical studies that investigate the impact of key parameters, such as concrete infill types, reinforcement strategies, bonding levels, and GFRP tube geometries, on the flexural performance and failure behavior of concrete-filled pultruded GFRP tubular members in composite beam applications. The analysis includes full-scale GFRP beam studies, offering a thorough comparison of documented flexural responses, failure modes, and structural performance outcomes. The findings are synthesized to highlight current trends, identify research gaps, and propose strategies to advance the understanding and application of these composite systems. The paper concludes with actionable recommendations for future research, emphasizing the development of innovative material combinations, optimization of structural designs, and refinement of numerical modeling techniques. Full article

Good oral hygiene is crucial during treatment with fixed appliances, emphasising the need for additional or alternative oral health methods during orthodontic treatment. This study investigates the effect of essential oil (EO)-based preparations on biofilm adhesion to orthodontic archwires. Five identical-sized orthodontic archwires of different materials were tested using therapeutic and preventive applications of essential oils. This study also used molecular docking to explore how essential oil compounds interact with key proteins of common oral pathogens like Staphylococcus aureus and Streptococcus mutans. We found that the constituent materials heavily influence the antimicrobial effects of essential oils on different orthodontic archwires. Stainless steel-based orthodontic archwires demonstrated the highest efficacy in antimicrobial protection against S. mutans strains (maximum BIP = 28.82% on the epoxy-coated SS). Conversely, inhibition effects in preventive applications against S. aureus were observed exclusively with titanium–molybdenum alloy orthodontic archwires across all tested emulsions (maximum BIP = 29.44%). CuNiTi alloys showed ineffectiveness in preventive treatments, as none of the EO mixtures inhibited biofilm development on this material. After biofilm contamination with S. mutans and S. aureuss strains, the ternary emulsion was most effective for four out of five orthodontic archwires. Computational analysis revealed strong binding interactions between essential oil compounds and key proteins of S. aureus and S. mutans, highlighting specific amino acid residues that are critical for these interactions. Based on the results, stainless steel with epoxy coating or TMA archwires, combined with BEO/CEO/OEO ternary mixture, are recommended for optimal antibacterial protection against biofilm formation on orthodontic archwires. Full article

Background: Barrett’s Esophagus (BE) is the only known precursor for esophageal adenocarcinoma (EAC). Patients with multiple risk factors for BE/EAC are recommended for screening; however, few eligible patients undergo evaluation by endoscopy. EsoGuard^® (EG) is a commercially available biomarker assay used to analyze esophageal cells collected non-endoscopically with EsoCheck^® (EC) for the qualitative detection of BE/EAC. This study evaluates the real-world clinical utility of EG on cells collected with EC in patients defined by U.S. gastroenterology societies to be at-risk for BE and EAC. Methods: This multi-center, observational CLinical Utility of EsoGuard (CLUE) study enrolled screening-eligible patients as defined by the American College of Gastroenterology (ACG) and the American Gastroenterological Association (AGA). Clinical utility was evaluated by the provider decision impact of EG and additionally by assessing patient compliance outcomes with recommended follow-up testing. Results: There were 551 patients enrolled, with a mean age of 62.0 ± 12.4 years and 56.1% (309/551) meeting ACG guideline criteria for BE screening. EC cell collection was successful in 97.1% (535/551), among which the EG positivity rate was 27.3% (n = 146). The provider decision impact was high, with 100% of EG-positive patients being referred for esophagogastroduodenoscopy (EGD), while 98% of EG negative patients were not referred. Among the EG-positive patients, the overall compliance with follow-up EGD was 85.4%. Conclusions: Combining EC non-endoscopic esophageal cell collection with the EG biomarker assay is effective in guiding provider decision-making for the detection of BE and EAC. Patients with positive EG results demonstrate high compliance with recommended follow-up EGD. Full article

This study explores energy consumption, thermal performance, and indoor environmental quality (IEQ) in terminal buildings. Through detailed thermal analysis, this research identifies key sources of heat loss, such as thermal bridges in walls and windows, which significantly increase energy demands for heating. IEQ measurements show that the lack of mechanical ventilation, combined with high passenger densities, frequently leads to CO₂ levels exceeding recommended thresholds, highlighting the urgent need for improved ventilation systems. Energy requirements were calculated based on the TS 825 standard and compared to actual consumption data, showing that optimizing boiler settings could save 22% of heating energy without any additional investment. Simulations and economic analyses further showed that adding thermal insulation to the building envelope and installing double-glazed windows with improved U-values could achieve significant energy savings and reduce CO₂ emissions, all with favorable payback periods. A life cycle assessment (LCA) was conducted to evaluate the environmental impact of these interventions, demonstrating significant reductions in the airport’s carbon footprint. The findings underscore the importance of aligning operational standards with international guidelines, such as ASHRAE and CIBSE, to ensure thermal comfort and optimize energy use. Full article

Background/Objectives: Moral hazard represents a significant challenge in healthcare systems globally, reflecting the tendency of insured individuals to over-utilize medical services when shielded from the full costs of care. Methods: This paper investigates the dynamics and implications of moral hazard within the Romanian public hospital sector, offering practical recommendations for healthcare policymakers to mitigate the financial risks associated with excessive healthcare utilization and ensure long-term sustainability. To achieve the objectives of this study, a quantitative research approach utilizing vignettes was employed. Vignettes allow for the simulation of real-world decision-making under conditions of insurance coverage, capturing nuanced behaviors that traditional surveys may overlook. Results: The study examined patient behaviors in the context of moral hazard in public hospitals in Romania, employing a quantitative approach based on vignettes. A total of 303 valid responses were collected. The findings indicate a significant tendency among insured patients, both publicly and privately insured, to opt for more expensive treatments compared to uninsured patients, who preferred more affordable options such as medication or physiotherapy. In the case of treatments for severe conditions, insured patients frequently chose combinations of higher-cost therapies, while uninsured individuals either delayed treatment or opted for less expensive alternatives. These results highlight the impact of moral hazard, driven by a reduced sensitivity to costs in the presence of insurance, and underscore the need for cost-sharing policies to mitigate the overutilization of medical resources. Conclusions: This paper uniquely contributes to the understanding of moral hazard by integrating insights from both Romanian public hospitals and international case studies, offering practical policy recommendations for mitigating the financial risks associated with excessive healthcare utilization. Full article

The future of Aedes aegypti control emphasizes the transition from traditional insecticides toward more sustainable and multisectoral integrated strategies, like using Wolbachia-carrying mosquitoes for population suppression or replacement. We reviewed the integration of the successful Mexican initiative, “Mosquitos Buenos”, with the key challenges outlined in the PAHO guidelines for incorporating innovative approaches into vector control programs. These challenges include establishing essential infrastructure, training personnel, managing field operations, and fostering community support. Our experience provides critical evidence to support the strategic National Plan for implementing and integrating IIT-SIT technologies to control Ae. aegypti and dengue. Furthermore, this experience serves as a foundation for other countries in the region interested in adopting these technologies. It underscores the importance of strategic planning, multisectoral collaboration, continuous evaluation, and scaling up innovative tools to ensure their long-term effectiveness and sustainability in urban areas where Aedes vectors and the diseases they transmit are endemic. Full article

Personality represents enduring patterns, providing insights into an individual’s aptitude and behavior. Integrating these insights with learning tendencies shows promise in enhancing learning outcomes, optimizing returns on investment, and reducing dropout rates. This interdisciplinary study integrates techniques in advanced artificial intelligence (AI) with human psychology by analyzing data from the trades of Technical and Vocational Education and Training (TVET) education, by combining them with individual personality traits. This research aims to address dropout rates by providing personalized trade recommendations for TVET, with the goal of optimizing outcome-based personalized learning. The study leverages advanced AI techniques and data from a nationwide TVET program, including information on trades, trainees’ records, and the Big Five personality traits, to develop a Personality-Aware TVET Course Recommendation System (TVET-CRS). The proposed framework demonstrates an accuracy rate of 91%, and a Cohen’s Kappa score of 0.84, with an NMAE at 0.04 and an NDCG at 0.96. TVET-CRS can be effectively integrated into various aspects of the TVET cycle, including dropout prediction, career guidance, on-the-job training assessments, exam evaluations, and personalized course recommendations. Full article

The purpose of this review is to compile and discuss available evidence in humans on the efficacy of YHM supplementation on performance in different exercise modalities. Yohimbine (YHM) is a naturally occurring alkaloid that induces increases in sympathetic nervous system (SNS) activation effectively initiating “fight or flight” responses. In supplement form, YHM is commonly sold as an isolated product or combined into multi-ingredient exercise supplements and is widely consumed in fitness settings despite the lack of empirical support until recently. YHM primarily acts as an α2-adrenergic receptor antagonist effectively increasing norepinephrine release from sympathetic neurons. YHM has been implicated in improving or altering cardiovascular function, blood flow, lactate metabolism, and muscle function. Emerging evidence has suggested that YHM may have the potential to improve performance in a wide range of exercise modes including endurance, sprint, and resistance exercise. Performance enhancement with YHM is mediated by mechanistic underpinnings of physiological and psychological alterations to exercise responses including increased sympathetic activation, adaptive hemodynamic changes, increased alertness, and decreased fatigue. However, YHM use is not without risk as it has high interindividual variability in bioavailability, can be deceptively potent, lacks widely accepted dosing recommendations, and, when taken in large doses, has been empirically documented to result in serious side effects. Despite this, the evidence presented in this review suggests low doses of YHM are tolerable and may serve as an ideal exercise training aid due to acute enhancement of physical performance. However, safety concerns remain outstanding and temperance should be used when using YHM and similar sympathomimetics. Full article

Proper selection and application of preprocessing steps are crucial for obtaining accurate segmentation in brain Magnetic Resonance Imaging (MRI). The aim of this study is to evaluate the impact brain extraction (BE) and bias field correction (BFC) methods have on regional brain volume (RBV) measurements of preterm neonates’ T2w MRI at term-equivalent age (TEA). Five BE methods (Manual, BET2, SWS, HD-BET, SynthStrip) were applied together with two BFC methods (SPM-BFC and N4ITK), before segmenting the neonatal brain into eight tissue classes (cortical grey matter, white matter, cerebral spinal fluid, deep nuclear grey matter, hippocampus, amygdala, cerebellum, and brainstem) using an automated segmentation software (MANTiS). Quantitative assessments were conducted, including the coefficient of variation (CV), coefficient of joint variation (CJV), Dice coefficient (DC), and RBV. HD-BET, together with N4ITK, showed the highest performance (mean ± standard deviation) regarding CV of 0.047 ± 0.005 (white matter) and 0.070 ± 0.005 (grey matter), CJV of 0.662 ± 0.095, DC of 0.942 ± 0.063, and RBV without significant differences (except in the brainstem) from the manual segmentation. Therefore, such combination of methods is recommended for improved skull-stripping accuracy, intensity homogeneity, and reproducibility of RBV of T2w MRI at TEA. Full article

Digital transformation offers transformative potential for public service delivery, yet many local administrative organizations (LAOs) in Thailand struggle with integrating digital tools effectively into their workflows. This study investigates the integration of social listening tools (SLTs) to enhance the efficiency and responsiveness of public service delivery in Thailand’s LAOs. The primary goal is to redesign traditional, manual workflows through the development of a digital-by-design framework, addressing inefficiencies in public engagement and service provision. Employing a mixed-method approach, this research combines interviews and focus groups with municipal staff from four municipalities in Northeast Thailand to identify challenges and co-create solutions. The redesigned workflow integrates digital practices into existing organizational structures and achieves a significant 282% improvement in efficiency, measured in transactions per manpower-hour. Additionally, the new process enhances operational speed, responsiveness, and public engagement. To ensure sustainability, this study recommends a phased implementation strategy and consistent staff training. This research contributes to the public administration literature by providing a practical, scalable framework for digital transformation in local governance. It underscores the potential of SLTs to modernize public sector workflows, enabling more dynamic, responsive, and citizen-centric interactions between LAOs and the communities they serve. Full article

This study addresses occupational safety in reinforced concrete construction, an area marked by high accident rates and significant worker injury risks. By focusing on activity–body part (A–BP) combinations, this research introduces a novel framework for quantifying injury risks across construction activities. Reinforced concrete construction tasks are categorized into ten specific activities within three major work types: rebar work, formwork, and concrete placement. These are further analyzed concerning six critical body parts frequently injured on-site: head/face, arm/shoulder, wrist/hand, torso, leg/pelvis, and foot/ankle. Using data from 2283 construction accident reports and expert surveys, the probability and severity of injuries for each A–BP element were calculated. Probability scores were derived from actual incident data, while severity scores were determined via expert evaluations, considering injury impact and the required recovery time. To ensure precision and comparability, scores were standardized across scales, enabling a final risk assessment for each A–BP. Results identified that wrist and hand injuries during rebar work activities, particularly cutting and shaping, exhibited the highest risk, underscoring the need for focused protective measures. This study contributes to construction safety management by providing detailed insights into injury risk based on activity–body part interactions, offering safety managers data-driven recommendations for tailored protective equipment, enhanced training, and preventive protocols. This research framework not only helps optimize safety interventions on conventional construction sites but also establishes a basis for future studies aimed at adapting these strategies to evolving construction methods. Full article

Forestry has a profound impact on environmental protection, economic development, and social welfare. With the improvement of global environmental protection awareness, the construction of platform supply chain of forest products has become the core driving force to promote sustainable development of forestry. Studying the resilience of supply chain of platform of forest products is of great importance to solve the contradiction between economic development and natural ecosystem protection. However, the existing resilience evaluation methods are not suitable for the dynamic and complex performance evaluation of the current forest products platform supply chain. Therefore, in order to make up for this shortcoming, this paper evaluates and analyzes the supply chain resilience of the forest products platform based on AI recommendation and extension theory. Firstly, this paper combined the characteristics of forest products and used AI recommendation technology to build a forest products platform supply chain resilience performance evaluation index system. Secondly, the AHP method was used to calculate the index weight, and the resilience evaluation model of the platform supply chain of forest products was constructed. Finally, in order to ensure the authenticity and credibility of the evaluation results, three practical cases were analyzed to illustrate the resilience level of the platform supply chain of forest products, and the effectiveness of the application of AI recommendation and extension theory in the resilience performance evaluation of forest products platform supply chains was verified. The scientific value of this paper is that it provides a new idea and a new method for the resilience performance evaluation of the forest products platform supply chain and makes theoretical and practical contributions to the fruitful application of AI recommendation in the supply chain field. In addition, this study also provides a new practical guideline for protecting the natural environment and realizing the sustainable development of forestry. Full article