The complementary integration of artificial intelligence (AI) in the workplace requires balancing performance goals with psychological needs, as both are essential for sustained outcomes. This study examines different workflows (AI-first and human-first) as cognitive forcing strategies to test whether they enhance performance and psychological outcomes compared to human-only and AI-only processing. In a one-factorial between-subjects experiment (N = 101) within a visual inspection task, evaluated at up to three measurement points, performance variables (accuracy, speed, error rates) and psychological variables (vigilance, flow, teaming experience, wellbeing when working with the AI) were assessed. Human-AI collaboration outperformed AI-only in error rates (η2=0.29) and human-only in speed (η2=0.11 - 0.14), but only when AI preceded human processing. The AI-first workflow enhanced teaming perception compared to human-only processing (η2=0.07). Moreover, human-AI collaborative processing reduced flow decrease compared to human-only processing (η2=0.07). Overall, AI processing preceding human processing produces the best balance between performance and psychological outcomes in safety-critical inspection tasks, supporting a holistic view of AI integration in the workplace.

Impact of a nurse-led in-hospital mobility intervention on older adult patient functional outcomes and perceptions.

Augmented reality and generative learning in K-12 writing: Performance outcomes and the mediating roles of motivation and metacognition

This study evaluated the effects of a multicomponent toxin binder (MTB) and an organic acid blend (OAB) on performance, immunity, oxidative status, liver histology, and jejunal inflammatory/antioxidant gene expression in broilers challenged with aflatoxin B1 (AFB1) and Clostridium perfringens. A total of 420 Ross 308 broilers were assigned to seven groups (6 replicates × 10 birds): Control (unchallenged), A (AFB1), AM (AFB1 + MTB), AMO (AFB1 + MTB + OAB), AC (AFB1+ C. perfringens), ACM (AFB1 + C. perfringens + MTB), and ACMO (AFB1 + C. perfringens + MTB+OAB). AFB1 (500 ppb) was provided throughout days 0-42; C. perfringens (1 × 10⁸ CFU/mL) was administered on days 15-24. AFB1 alone, and more markedly the AFB1+C. perfringens co-challenge, reduced body-weight gain and feed efficiency, increased hepatic superoxide dismutase activity and malondialdehyde level, enlarged central-vein diameter, upregulated jejunal NF-κB1, TNF-α, and IL-6, and downregulated hepatic total antioxidant capacity and jejunal NRF2 and SOD1 mRNA expression (P < 0.05). The co-challenge also lowered Newcastle disease antibody titers, reduced phytohemagglutinin-induced toe-web swelling, and increased the heterophil:lymphocyte ratio (P < 0.05). Although MTB attenuated several AFB1-related impairments, MTB+OAB provided superior protection under co-challenge, increasing hepatic total antioxidant capacity, lowering malondialdehyde, improving liver histoarchitecture (central-vein diameter), and normalizing the expression of immune and antioxidant genes toward control levels, alongside improvements in performance indices (P < 0.05). In conclusion, although co-exposure to AFB1 and C. perfringens caused greater detriments than AFB1 alone, adding OAB to MTB improved performance, oxidative, histological, and immunological outcomes, supporting MTB+OAB as a practical strategy for broilers under concurrent mycotoxin-enteric challenge.

Individualized physical activity program for older adults undergoing chemotherapy for hematologic malignancies.

Social media analytics (SMA) practices are playing a vital role in improving online store performance by creating insights about customer preferences, trends, and behaviors. Social media analytics (SMA) practices are a critical contributor to boost online store performance by creating insights on customer preferences, trends and behaviors. The effective utilization of such analytics helps online retailers to adjust their marketing strategies, increase customer engagement, and ultimately boost their sales. This study examines the dynamic link between SMA and customer engagement in online retail firms with special focus on the moderating role of customer voice (promotive and prohibitive) in determining the performance outcomes. Specifically, it examines the impact of consumers' promotive and prohibitive voices on the relationship between customer engagement and online store performance. Using a time-lagged study and data obtained from 407 online stores across three survey waves, the findings show there is a strong positive relationship between SMA and customer engagement. In addition, both promotive and prohibitive customer voice are found to positively moderate the engagement-performance relationship, increasing the effect of engagement on operational outcomes. The study concludes with implications and future research directions.

Machine learning-based prediction and quantification of OCD surgery and pedigree effects on racehorse performance.

Various non-clinical teaching models have been developed and are used globally. This scoping review identifies these methods and evaluates their learning outcomes. Following the PRISMA-ScR framework, MEDLINE and Embase databases were searched for English-language articles published from 2012 onward. Two reviewers screened eligible studies, resulting in a final selection of relevant full-text articles. The review addressed (1) which teaching methods/tools have been tested for endoscopy training and (2) which methods yield better colonoscopy performance outcomes. From 217 articles, 31 met inclusion criteria. The most common teaching methods were virtual reality (VR) models and physical models, both within and across studies. Other studies included box models, animal models, real-time feedback devices, traditional/verbal instruction models, didactic models and two-person colonoscopy models. Across all studies, participants ranged widely in experience from medical students to experienced specialists, with the effectiveness of training modalities closely tied to the participants' baseline experience. Despite the variety of colonoscopy teaching methods, there is limited comparative research on their effectiveness both alone and when integrated with the traditional/verbal learning model. Prior experience appears to be a clear predictor of any model's potential effectiveness. As such, it appears important to tailor any colonoscopy training method to a learner's experience level to optimise skill acquisition and clinical readiness. Further research would benefit from a direct comparison of all teaching methods across a range of user skill sets.

BACKGROUND Acute Achilles tendon rupture (AATR) is a debilitating injury that significantly impacts elite athletes, particularly those in the national football league (NFL). While return to play (RTP) and performance outcomes are critical to career longevity, these outcomes may be influenced by factors such as injury timing, player position, and unreported rehabilitation variation. Prior literature lacks a comprehensive synthesis of these outcomes in NFL athletes. AIM To systematically evaluate return-to-play rates, performance outcomes, and career longevity following AATR among NFL athletes, while considering the methodological quality of available evidence. METHODS A systematic review was conducted in May 2024 following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using PubMed, EMBASE, and Cochrane Library databases. Studies reporting outcomes following AATR in NFL players were included. Data were extracted on demographics, timing of injury, RTP, games played, and performance metrics. Pooled rates and weighted means were calculated based on sample size. Risk of bias was assessed using the Risk of Bias in Non-Randomised Studies of Interventions tool. No meta-analysis or statistical heterogeneity testing (e.g. , I ²) was performed due to the descriptive nature of the analysis. RESULTS Twelve studies including 676 NFL athletes met inclusion criteria. The weighted mean age at injury was 27.3 ± 1.4 years, with a mean of 5.2 ± 1.2 years in the NFL prior to injury. Linebackers (19.0%), wide receivers (11.9%), and running backs (9.0%) were most affected. AATRs occurred most often during the preseason (50.4%). The overall RTP rate was 66.2%, with a weighted mean time of 10.9 ± 1.3 months. Post-injury, players averaged 12.9 games/season and played for 2.2 ± 0.8 additional seasons. Performance significantly declined regardless of position. Most studies lacked data on rehabilitation protocols and exhibited moderate to critical risk of bias. CONCLUSION NFL athletes experience a relatively low return-to-play rate and substantial decline in performance following AATR. These outcomes are further influenced by high heterogeneity in study quality and the unreported variability in post-operative rehabilitation. These findings underscore the need for prospective, standardized research and may inform team physicians and athletic trainers in developing evidence-based RTP strategies.

This study examined the relationship between digital transformation (DT), strategy execution (SE), and operational efficiency (OE) in Uganda's medical facilities. Although digital adoption is promoted in healthcare modernization, little is known about its performance implications in low-resource settings. The study explored both direct and indirect effects of DT on OE, with SE as a mediator. A mixed-methods design was employed using quantitative structured questions and qualitative open-ended interviews. Data were collected from 60 heads of public and private medical facilities, including 12 purposively selected key informants for contextual depth and validation. Partial least squares structural equation modeling (PLS-SEM) tested the hypothesized relationships among DT, SE and OE, guided by the technology-organization-environment (TOE) framework and dynamic capabilities theory (DCT). DT did not directly affect OE but significantly enhanced SE, which strongly improved OE. SE fully mediated the DT-OE relationship, underscoring the role of execution capabilities in translating digital initiatives into performance outcomes. The study reveals that digital transformation alone does not enhance operational efficiency in Uganda's medical facilities; rather, its impact is realized through effective strategy execution. Policymakers should focus on integration, governance and capacity-building beyond technology adoption. The research extends TOE and DCT frameworks, emphasizing managerial execution, contextual alignment and institutional capability as key to realizing digital value. It informs curriculum design by advocating training in digital governance, strategy, and change management to build leadership capacity. Societally, successful digital health outcomes depend on governance quality and execution, not technology alone. Future longitudinal studies should explore moderating factors influencing sustainable digital health reforms. Policymakers should align digital investments with strategic goals, emphasizing interoperability, workforce readiness and sustainable financing. The findings highlight that digital health success in low- and middle-income countries (LMICs) depends more on execution quality and governance than technology adoption. The findings of this study have significant societal implications for Uganda's healthcare sector and similar LMIC contexts. The evidence that digital transformation does not directly enhance operational efficiency, but rather operates through effective strategy execution, highlights that technology alone cannot improve public health outcomes, patient satisfaction or equity in access to care. This means that while the introduction of digital tools such as electronic health records, e-prescriptions and telemedicine platforms has the potential to enhance service delivery, their societal value depends on how effectively they are implemented, aligned with strategy and integrated into patient-centered workflows. This study contributes novel empirical evidence from LMICs, emphasizing organizational and managerial enablers leadership, process alignment and executional capacity as true drivers of digital value creation. Integrating quantitative and qualitative insights, it offers actionable guidance for policymakers and practitioners.

Mild traumatic brain injury (mTBI) disproportionately affects children and adolescents and has been associated with poorer neurocognitive performance, but the biological mechanisms driving symptom variability and severity remain understudied. In accordance with the omnigenic disease model, we integrated gene-by-mTBI interaction genome-wide association studies on neurocognition from the Adolescent Brain Cognitive Development (ABCD) cohort with single-cell RNA sequencing gene regulatory networks to elucidate the cell type-specific key regulators and molecular mechanisms governing neurocognitive outcome of mTBI, specifically learning and memory performance. Our analysis revealed distinct network regulators in neuronal and glial cell types across hippocampal and cortical brain regions to orchestrate key neurodevelopmental pathways. Examples include APP for synaptic signaling in excitatory neurons, COX5A for mitochondrial function in inhibitory neurons, MOG for myelination in oligodendrocytes in the hippocampus; GRM7 for synaptic signaling in excitatory neurons, SV2A for synaptic signaling in inhibitory neurons, and MOG for myelination in oligodendrocytes in the cortex. These mechanisms also associate with learning and memory through pathway-based polygenic risk score modeling in ABCD. Our findings provide brain region- and cell type-specific insights into the complex regulatory network landscape of mTBI pathology and potential therapeutic candidates at the pathway and network levels.

Personnel within occupational employment (e.g., military/emergency services) are exposed to various stressors concurrently including psychological, cognitive, physical and environmental. Historically, stressors have been considered and studied in isolation which is not representative of reality. Assessing stressors in combination is challenging for researchers owing to the study designs required to explore such interactions. Complex study protocols can lead to logistical challenges and high demands on resources and participants. Very few studies within the literature have been found to explore multiple stressors, although in recent years, this has started to change for the better. Understanding how numerous stressors interact, whether effects on performance are additive, synergistic or antagonistic, is important. Without this, the true impact of stressors will remain unknown, and the health and performance of those within arduous occupational roles may not be optimised. This review aims to (1) explore how different study designs have enabled the exploration of the effects of combined stressors on human performance outcomes in controlled laboratory settings, simulated field studies and field-based settings, and (2) outline how future research can develop methodologies that study combinations of stressors in occupational roles.

Athlete monitoring is widely used to support training and recovery decisions in elite sport, yet practitioners often face challenges related to data quality, feasibility, and the interpretation of short-term readiness signals within longer-term training adaptation. This narrative review synthesizes conceptual and applied developments in athlete monitoring through the lens of 'training effects', encompassing positive adaptation, maintenance, or maladaptation arising from training, competition, and contextual stressors. We distinguish assessment as isolated or periodic measurement from monitoring as repeated, systematic data collection used to track change over time. Building on contemporary conceptual models, readiness is positioned as an operational proxy for training effects that can inform day-to-day decision making when interpreted longitudinally and within context. We integrate the Minimal, Adequate, and Accurate framework to support tool selection that is economical in resource use, sufficient to meet clearly defined objectives, and grounded in valid and reliable measurement. Tools and metrics are organized according to the primary construct they inform: training load, athlete state and training response. We summarize practical considerations across neuromuscular, subjective, physiological, biochemical, and sleep-related indicators, emphasizing interpretive scope, measurement variability, and implementation constraints. To operationalize individualized monitoring, we outline pragmatic approaches using athlete-specific baselines and distribution-based thresholds (e.g., standard deviation intervals, minimum detectable change), alongside decision-making considerations related to Type I and Type II errors. Overall, this framework aims to reconcile scientific rigor with real-world feasibility, supporting practitioner decision making while acknowledging that monitoring should function as a decision-support process rather than a stand-alone determinant of performance outcomes.

Objectives To assess functional language performance on paediatric cochlear implant patients in Malawi. Methods Sixteen patients who received cochlear implantation before the age of 18 years from a single site were invited for an interview. Parents or guardians of twelve of these participated in the PEACH and BAPP questionnaires, whilst four others who had become adults answered independently. The PEACH scale is a 13-question survey with a maximum score of 52. The BAPP score has four domains with a total score of 16. Results Most patients acquired profound hearing loss through either mumps, meningitis, malaria or a combination (15/16). The mean age of onset of profound deafness was 8.8 years of age (range = 4–16 years) and implantation was 10.6 years (range = 4–18 years). The mean ‘Quiet Sounds’ questions were 23.56/24 (sd +/–1.75) and ‘Loud Sounds’ were 27.06/28 (sd +/–1.57). The mean total PEACH score was 50.63/52 (sd +/–2.73). There was no correlation with age of implant and PEACH score. The BAPP score was 16/16 for each patient. Conclusion Despite a very low socio-economic environment, this cohort shows cochlear implantation has a strong perceived benefit from the parents and guardians of post-lingually profoundly deaf children.

This study aims to investigate the impact of Industry 4.0 technology adoption on organizational performance in the healthcare sector, with a specific focus on the mediating roles of perceived usefulness, perceived ease of use, emotional trust and actual use. Grounded in the technology acceptance model (TAM), the research further explores how these mediators influence the relationship between technology adoption and performance outcomes. A mixed-method research approach was adopted, integrating structural equation modeling (SEM) and necessary condition analysis (NCA). SEM was employed to assess the direct and indirect (mediated) effects between variables, while NCA identified the necessary conditions required to achieve improved organizational performance. Data were collected from key stakeholders in the healthcare industry through a structured questionnaire. The results highlight the pivotal mediating roles of perceived usefulness and emotional trust in enhancing the relationship between Industry 4.0 adoption and organizational performance. Emotional trust and actual usage emerged as critical factors, indicating that both cognitive and affective dimensions significantly influence successful technology integration. The study also reveals that certain conditions, particularly related to trust and usability, are necessary (though not sufficient on their own) for achieving optimal performance outcomes. The findings provide actionable insights for healthcare managers and policymakers on how to improve technology implementation strategies. Emphasis should be placed on fostering emotional trust and user engagement alongside ensuring technological effectiveness. By addressing these mediators, healthcare institutions can more effectively leverage Industry 4.0 technologies to enhance organizational performance. This study offers a novel contribution by combining TAM with a mixed-method SEM-NCA approach to examine Industry 4.0 adoption in the healthcare supply chain. Unlike prior research, it underscores the necessity of emotional trust and actual use as core drivers of performance, providing both theoretical enrichment and practical guidance for successful technology assimilation in complex organizational settings.

Prevalence and Clinical Significance of Cusp Thickening and Reduced Cusp Motion after the Ozaki Procedure.

ABSTRACT Aims To characterise practice managers’ perspectives on the interplay between worker well-being and organisational health in veterinary and human healthcare contexts. Methods Using a convergent mixed-methods design, we analysed data from 38 Australian practice managers who completed an anonymous online survey. Participants accessed the survey via links distributed using social media and email. The survey included the General Practice-Organisational Health (GP-OH) measure, along with items on professional duties, perceptions of worker well-being, current and desired supports, and perceived interactions between the two domains of interest. Quantitative analyses were exploratory and descriptive; qualitative responses were characterised using a conventional approach to content analysis. Results Practice managers described responsibilities spanning five domains of managing a health clinic: resources, operations, leadership, strategy, and governance. They typically rated staff well-being as “neutral/normal” or “high/good,” based on observations of workers’ health and welfare, team and culture, formal feedback, and employee performance. Ratings of organisational health were similarly favourable, with mean scores above the mid-point of the GP-OH scale. Ratings of staff well-being were positively correlated with GP-OH scores (ρ = 0.59; p < 0.01). Practice managers described a mutually reinforcing relationship between worker well-being and organisational health, centred on team morale, workforce stability, clinical performance, operational efficiency, and financial outcomes. Current organisational strategies to support well-being were primarily reactive and policy-driven, but participants desired more holistic, proactive approaches. Themes were largely consistent across the two health sectors, with some small differences. Conclusions Findings were generally consistent with existing models of organisational health and employee well-being, while suggesting important contextual adaptations, particularly to settings outside the USA. Parallels in accounts from veterinary and human health practice managers suggest that organisational and managerial demands are often shared across these settings, with minor variations potentially arising from structural differences between the two sectors. Clinical relevance Practice managers are key drivers of organisational and employee welfare, and future efforts to strengthen veterinary workplaces will benefit from engaging them as partners in design and implementation. Interventions to improve professional well-being in veterinary and human healthcare may be most effective when they emphasise social connection, systemic reform, and regular staff check-ins.

This study examined the effect of background speech-shaped noise (SSN) on novel word learning. We asked whether training outcomes differ when pseudowords are learned in Quiet, +10 dB SNR, or 0 dB SNR conditions. Sixty young adults (ages 18-30 years) completed a 5-day training paradigm in which novel pseudowords were paired with pictures of familiar objects. Participants were assigned in a counterbalanced manner to one of three listening conditions (Quiet, +10 dB SNR, 0 dB SNR). Recognition accuracy was tested after each daily session. Mixed-effects models evaluated baseline group equivalence, session-by-session changes, and final performance outcomes. Groups did not differ significantly at baseline, and performance improved across all five sessions. Importantly, background noise did not disrupt word learning: by the final session, all three groups performed comparably. At intermediate sessions, participants trained at 0 dB SNR showed steeper improvements, although this did not translate into lasting group differences. Findings suggest that moderate levels of SSN do not impair novel word learning in young adults. These results are partially consistent with theories of stochastic resonance, which predict performance maintenance from low-level noise. Although preliminary, this work indicates that SSN may not be uniformly detrimental to learning and raises the possibility that controlled noise exposure could be leveraged in future training paradigms. Further research should test generalizability across populations and task types. https://doi.org/10.23641/asha.31079449.

Alternative work schedules can be desirable for trainees and provide more flexibility for service coverage needs. Continued evaluation is needed to ensure educational objectives are met and that the intended wellness components are fulfilled. Creativity and compromise are essential for balance between education, staffing, and personal needs. We conducted a retrospective review (July 2022-January 2026) of a pilot Sunday-Thursday "shifted week" neuroradiology rotation. Resident perception was evaluated through pre- and post-implementation surveys and end-of-rotation evaluations. Productivity was measured using daily case volume and work relative value units. Performance outcomes included Diagnostic Radiology In-Training Examination neuroradiology scores and report turnaround times. Shifting a Neuroradiology resident service week to a Sunday-Thursday schedule met the educational experience, staffing, and contrast coverage needs while reducing the overall call frequency for residents. Residents reported high satisfaction with the shifted rotation, with most endorsing improved educational value and stable or improved quality of life. Faculty supervision, turnaround times, and actionable result communication were maintained at levels comparable to traditional schedules.

Purpose This research formulates an integrative framework bridging established strategic theories and artificial intelligence (AI) adoption in Ibero-American small and medium-sized enterprises (SMEs), addressing how resource-constrained organizations navigate digital transformation challenges. Design/methodology/approach Employing a structured narrative literature review following Torraco (2016) and Juntunen and Lehenkari (2021), this study synthesizes 72 articles from multiple databases (2015–2024). The analysis integrates resource-based view (RBV), dynamic capabilities theory and institutional theory through thematic synthesis and systematic coding procedures. Findings Four interrelated drivers enable SMEs to overcome resource constraints: strategic synchronization, leadership commitment, technology sensing and institutional bridging. These drivers result from iterative thematic synthesis, demonstrating how organizational antecedents interact with contextual moderators through implementation processes to generate performance outcomes. Originality/value The framework extends strategic management theories to emerging market contexts, offering eight testable propositions linking capability development to AI-driven performance. For practitioners, findings highlight how SME leaders can align AI initiatives with strategic capability growth to improve competitiveness despite resource limitations.