Search Results (171)

Background: Older adults with malnutrition (≥65 years) require coordinated nutrition care during hospital-to-home transitions. A key purpose of integrated electronic medical record (iEMR) systems is to support clinicians in ensuring continuity of care across settings, yet little is known about their use in nutrition care discharge practices. This study explored how clinical dietitians use the iEMR to support nutrition care discharge practices for older adults with malnutrition and identified opportunities for optimisation to enhance care continuity. Methods: Semi-structured interviews were conducted with 16 clinical dietitians (11 frontline clinicians, 5 senior leaders) from 10 public hospitals across Queensland, Australia. Analysis combined deductive coding using the Consolidated Framework for Implementation Research 2.0 with inductive thematic analysis to identify system-level, organisational and behavioural influences on iEMR use and optimisation opportunities. Results: Four themes and ten subthemes were identified. System fragmentation, policy constraints and documentation burden limited dietitians’ ability to coordinate discharge care. Workarounds were common and reflected both practical adaptation and conditional trust in iEMR. Discharge practices were also shaped by local culture, professional norms and variable expectations for iEMR use. Despite these constraints, participants expressed aspirations for an optimised iEMR with embedded referral tools, real-time alerts and analytics to support improved service delivery. Conclusions: This study identified key factors influencing iEMR use by clinical dietitians to support nutrition care transitions for older adults with malnutrition. While current systems present significant challenges, optimising iEMR alongside organisational and policy enablers holds potential to strengthen nutrition care discharge practices and care continuity. Full article

Rapid urbanization in developing countries has widened the gap between urban and rural development, due to inefficient land markets and weak institutional systems in rural areas. China’s innovative “Urban–rural Construction Land Linkage” policy was designed to address this imbalance by encouraging rural land consolidation and creating a transferable development rights mechanism. While this approach has shown potential in improving the utilization efficiency of existing construction land and continuously supplying urban development space, concerns remain about its actual benefits to villagers and rural development, with some arguing it disrupts traditional livelihoods and favors government interests over rural needs. To respond to this debate, this study investigates two core questions: first, does China’s transferable land development rights (TDR) program genuinely improve rural welfare as intended; second, why does the theoretically preferred self-organized governance model sometimes fail in practice? To address these research questions, this paper develops a new analytical framework combining the IAD framework of Ostrom with the hierarchical institutional framework of Williamson to examine three implementation approaches in China’s TDR implementation: government-dominated, market-invested, and self-organized models. Based on case studies, surveys, and interviews across multiple regions, this study reveals distinct strengths and weaknesses in each approach in improving villagers’ lives. Government-dominated projects demonstrate strong resource mobilization but limited community participation. Market-based models show efficiency gains but often compromise equity. While self-organized initiatives promise greater local empowerment, they frequently face practical challenges including limited management capacity and institutional barriers. Furthermore, this study identifies the preconditional institutional environment necessary for successful self-organized implementation, including clear land property rights, financial support, and technical assistance. These findings advance global understanding of how to combine efficiency with fair outcomes for all stakeholders in land governance, which is particularly relevant for developing countries seeking to manage urban expansion while protecting rural interests. Full article

Climate change poses an existential threat, spurring businesses and financial markets to integrate environmental accounting and ESG (Environmental, Social, and Governance) disclosures into decision-making. This study aims to examine how environmental accounting practices and ESG reporting contribute to climate change mitigation in organizations. It seeks to highlight the significance of these tools in enhancing transparency and accountability, thereby driving more sustainable corporate behavior. By synthesizing the recent literature, the study contributes a comprehensive overview of best practices and challenges at the intersection of accounting and climate action, addressing a noted gap in consolidated knowledge. We conducted a systematic literature review (SLR) following PRISMA guidelines. A broad search (2010–2024) across Scopus, Web of Science, and Google Scholar identified 73 records, which were rigorously screened and distilled to 47 relevant peer-reviewed studies. These studies span global contexts and include both conceptual and empirical work, providing a robust dataset for analysis. Environmental accounting was found to play a pivotal role in measuring and managing corporate carbon footprints, effectively translating climate impacts into quantifiable metrics. Firms that implement rigorous carbon accounting and internalize environmental costs tend to set more precise emission reduction targets and justify mitigation investments through a cost–benefit analysis. ESG disclosure frameworks emerged as critical external tools: a high-quality climate disclosure is linked with greater stakeholder trust and even financial benefits such as lower capital costs. Leading companies aligning reports with standards like TCFD or GRI often enjoy enhanced credibility and investor confidence. However, the review also uncovered challenges, like the lack of standardized reporting, risks of greenwashing, and disparities in adoption across regions, that impede the full effectiveness of these practices. The findings underscore that while environmental accounting and ESG reporting are powerful means to drive corporate climate action, their impact depends on improving consistency, rigor, and integration. Harmonizing global reporting standards and mandating disclosures are identified as key steps to improve data comparability. Strengthening the credibility of ESG disclosures and embedding environmental metrics into core decision-making are essential to leverage accounting as a tool for climate change mitigation. The study recommends that policymakers accelerate moves toward mandatory, standardized ESG reporting and urges organizations to proactively enhance their environmental accounting systems that will support global climate objectives and further research on actual emission outcomes. Full article

Background/Objectives: Early childhood education and care is an ideal setting to promote healthy eating behaviours in young children. However, successful implementation and sustainment of healthy eating policies and practices remains a key challenge in the Australian early childhood education and care (ECEC) context. This study aimed to understand the contextual factors influencing early childhood education directors’ decisions to implement healthy eating policies and practices. Methods: Twelve directors from centre-based long day care centres in New South Wales, Australia, participated in semi-structured interviews. Interview data were analysed using reflexive thematic analysis and the Consolidated Framework of Implementation Research. Results: Directors (n = 12) described alignment with centre values and goals, compatibility with work infrastructure, local champions to lead implementation, and external partnerships with government support services as key facilitators. Directors identified a need for further support to address factors within the broader ECEC sector. Directors described a lack of external partnerships with the community, competing demands for available resources, unrealistic expectations from guidelines and parents, and inconsistent practices across settings as factors inhibiting implementation success. Conclusions: Implementation and sustainment of healthy eating policies and practices can be improved by strengthening parent and community partnerships, investment in the workforce, and a coordinated approach to the provision of support. Full article

Introduction: Polio supplementary immunisation activities (SIA) are implemented to rapidly increase vaccination coverage and interrupt the transmission of poliovirus in a specified geographical area. Polio SIA complements routine immunisation and is crucial for the eradication of the disease by increasing population immunity. However, several contextual factors (i.e., implementation determinants) can influence the success or failure of polio SIA implementation; as such, understanding their dynamics can enhance proactive planning for practice improvement. This study aimed to explore and map the contextual factors of polio SIA implementation in the African region using a critical systems thinking approach. Methods: A rapid review of published and grey literature was conducted. The search included the Global Polio Eradication Initiative library for programmatic reports and two databases (PubMed and Google Scholar). Data extraction was performed using a structured tool. Thematic analysis was performed to categorise the identified contextual factors according to the domains and constructs of the Consolidated Framework for Implementation Research (CFIR). Then, a causal loop diagram (CLD) was used to map the linkages between the identified factors. Results: A total of seventy-eight contextual factors across the five CFIR domains were identified: three for innovation, twenty for outer setting, sixteen for inner setting, twenty-six for individuals, and thirteen for the implementation process. A system map of all the factors using CLD revealed multiple contingent connections, with eleven reinforcing loops and four balancing loops. Conclusions: This study identified the multilevel nature of the contextual factors that influence polio SIA, including their dynamics. The integration of CLD and CFIR in this study offers critical insights into the potential feedback loops that exists between the contextual factors which can be used as leverage points for policy and practice improvements, including tailoring strategies to enhance polio campaign implementation effectiveness, especially with the expanded use of the novel Oral Polio Vaccine type 2 (nOPV2) across countries in the region. Full article

Background: The U.S. Medicare Annual Wellness Visit (AWV) offers a structured opportunity for cognitive screening and personalized prevention planning among older adults. Yet, implementation of AWVs, particularly for individuals with cognitive impairment, remains inconsistent across primary care or other diverse care settings. Methods: We conducted a scoping review using the Consolidated Framework for Implementation Research (CFIR) to explore multilevel factors influencing the implementation of the Medicare AWV’s cognitive screening component, with a focus on how these processes support the detection and management of cognitive impairment among older adults. We searched four databases and screened peer-reviewed studies published between 2011 and March 2025. Searches were conducted in Ovid MEDLINE, PubMed, EBSCOhost, and CINAHL databases. The initial search was completed on 3 January 2024 and updated monthly through 30 March 2025. All retrieved citations were imported into EndNote 21, where duplicates were removed. We screened titles and abstracts for relevance using the predefined inclusion criteria. Full-text articles were then reviewed and scored as either relevant (1) or not relevant (0). Discrepancies were resolved through consensus discussions. To assess the methodological quality of the included studies, we used the Joanna Briggs Institute critical appraisal tools appropriate to each study design. These tools evaluate rigor, trustworthiness, relevance, and risk of bias. We extracted the following data from each included study: Author(s), year, title, and journal; Study type and design; Data collection methods and setting; Sample size and population characteristics; Outcome measures; Intervention details (AWV delivery context); and Reported facilitators, barriers, and outcomes related to AWV implementation. The first two authors independently coded and synthesized all relevant data using a table created in Microsoft Excel. The CFIR guided our data analysis, thematizing our findings into facilitators and barriers across its five domains, viz: (1) Intervention Characteristics, (2) Outer Setting, (3) Inner Setting, (4) Characteristics of Individuals, and (5) Implementation Process. Results: Among 19 included studies, most used quantitative designs and secondary data. Our CFIR-based synthesis revealed that AWV implementation is shaped by interdependent factors across five domains. Key facilitators included AWV adaptability, Electronic Health Record (EHR) integration, team-based workflows, policy alignment (e.g., Accountable Care Organization participation), and provider confidence. Barriers included vague Centers for Medicare and Medicaid Services (CMS) guidance, limited reimbursement, staffing shortages, workflow misalignment, and provider discomfort with cognitive screening. Implementation strategies were often poorly defined or inconsistently applied. Conclusions: Effective AWV delivery for older adults with cognitive impairment requires more than sound policy and intervention design; it demands organizational readiness, structured implementation, and engaged providers. Tailored training, leadership support, and integrated infrastructure are essential. These insights are relevant not only for U.S. Medicare but also for global efforts to integrate dementia-sensitive care into primary health systems. Our study has a few limitations that should be acknowledged. First, our scoping review synthesized findings predominantly from quantitative studies, with only two mixed-method studies and no studies using strictly qualitative methodologies. Second, few studies disaggregated findings by race, ethnicity, or geography, reducing our ability to assess equity-related outcomes. Moreover, few studies provided sufficient detail on the specific cognitive screening instruments used or on the scope and delivery of educational materials for patients and caregivers, limiting generalizability and implementation insights. Third, grey literature and non-peer-reviewed sources were not included. Fourth, although CFIR provided a comprehensive analytic structure, some studies did not explicitly fit in with our implementation frameworks, which required subjective mapping of findings to CFIR domains and may have introduced classification bias. Additionally, although our review did not quantitatively stratify findings by year, we observed that studies from more recent years were more likely to emphasize implementation facilitators (e.g., use of templates, workflow integration), whereas earlier studies often highlighted systemic barriers such as time constraints and provider unfamiliarity with AWV components. Finally, while our review focused specifically on AWV implementation in the United States, we recognize the value of comparative analysis with international contexts. This work was supported by a grant from the National Institute on Aging, National Institutes of Health (Grant No. 1R01AG083102-01; PIs: Tzeng, Kuo, & Raji). Full article

The increasing use of Arabic and Urdu on social media platforms, particularly Twitter, has created a growing need for robust Named Entity Recognition (NER) systems capable of handling noisy, informal, and code-mixed content. However, both languages remain significantly underrepresented in NER research, especially in social media contexts. To address this gap, this study makes four key contributions: (1) We introduced a manual entity consolidation step to enhance the consistency and accuracy of named entity annotations. In the original datasets, entities such as person names and organization names were often split into multiple tokens (e.g., first name and last name labeled separately). We manually refined the annotations to merge these segments into unified entities, ensuring improved coherence for both training and evaluation. (2) We selected two publicly available datasets from GitHub—one in Arabic and one in Urdu—and applied two novel strategies to tackle low-resource challenges: a joint multilingual approach and a translation-based approach. The joint approach involved merging both datasets to create a unified multilingual corpus, while the translation-based approach utilized automatic translation to generate cross-lingual datasets, enhancing linguistic diversity and model generalizability. (3) We presented a comprehensive and reproducible pseudocode-driven framework that integrates translation, manual refinement, dataset merging, preprocessing, and multilingual model fine-tuning. (4) We designed, implemented, and evaluated a customized XLM-RoBERTa model integrated with a novel attention mechanism, specifically optimized for the morphological and syntactic complexities of Arabic and Urdu. Based on the experiments, our proposed model (XLM-RoBERTa) achieves 0.98 accuracy across Arabic, Urdu, and multilingual datasets. While it shows a 7–8% improvement over traditional baselines (RF), it also achieves a 2.08% improvement over a deep learning (BiLSTM = 0.96), highlighting the effectiveness of our cross-lingual, resource-efficient approach for NER in low-resource, code-mixed social media text. Full article

Background: High-intensity gait training (HIT) is an evidence-based intervention recommended for stroke rehabilitation; however, its implementation in routine practice is inconsistent. This study examined the real-world implementation of HIT in an inpatient rehabilitation setting in Norway, focusing on fidelity, barriers, and knowledge translation (KT) strategies. Methods: Using the Knowledge-to-Action (KTA) framework, HIT was implemented in three phases: pre-implementation, implementation, and competency. Fidelity metrics and coverage were assessed in 99 participants post-stroke. Barriers and facilitators were documented and categorized using the Consolidated Framework for Implementation Research. Results: HIT was delivered with improved fidelity during the implementation and competency phases, reflected by increased stepping and heart rate metrics. A coverage rate of 52% was achieved. Barriers evolved over time, beginning with logistical and knowledge challenges and shifting toward decision-making complexity. The KT interventions, developed collaboratively by clinicians and external facilitators, supported implementation. Conclusions: Structured pre-implementation planning, clinician engagement, and external facilitation enabled high-fidelity HIT implementation in a real-world setting. Pragmatic, context-sensitive strategies were critical to overcoming evolving barriers. Future research should examine scalable, adaptive KT strategies that balance theoretical guidance with clinical feasibility to sustain evidence-based practice in rehabilitation. Full article

Extracorporeal cardiopulmonary resuscitation (ECPR) is an established intervention for select patients experiencing refractory cardiac arrest. Among modifiable predictors of survival and neurologic recovery during ECPR implementation, timely restoration of circulation remains critical in the setting of refractory cardiac arrest (CA). The in-hospital cardiac arrest (IHCA) setting is particularly amenable to reducing the low-flow interval through structured system-based design and implementation. Despite increasing utilization of ECPR, the literature remains limited regarding operational standards, quality improvement metrics, and performance evaluation. Establishing operational standards and performance metrics is a critical first step toward systematically reducing low-flow interval duration. In support of this aim, we conducted a comprehensive literature review structured around the Extracorporeal Life Support Organization (ELSO) framework for ECPR implementation. At each step, we synthesized evidence-based best practices and identified operational factors that directly influence time-to-circulation. Our goal is to provide a stepwise evaluation of ECPR initiation to consolidate existing best practices and highlight process components with potential for further study and standardization. We further evaluated the literature surrounding key technical components of ECPR, including cannula selection, placement technique, and positioning. Ongoing research is needed to refine and standardize each stage of the ECPR workflow. Developing optimized, protocol-driven approaches to ensure rapid, high-quality deployment will be essential for improving outcomes with this lifesaving but resource-intensive therapy. Full article

The construction sector significantly contributes to global environmental degradation through intensive resource extraction, high energy consumption, and substantial waste generation. Addressing this unsustainable trajectory requires integrated approaches that simultaneously improve operational efficiency and material circularity. Lean Construction (LC) and Circular Economy (CE) offer complementary frameworks for enhancing process performance and reducing environmental impacts. However, their combined implementation remains underdeveloped and fragmented. This study conducts a systematic literature review (SLR) of 18 peer-reviewed articles published between 2010 and 2025, selected using PRISMA 2020 guidelines and sourced from Scopus and Web of Science databases. A mixed-method approach combines bibliometric mapping and qualitative content analysis to investigate how LC and CE are jointly operationalized in construction contexts. The findings reveal that LC improves cost, time, and workflow reliability, while CE enables reuse, modularity, and lifecycle extension. Integration is further supported by digital tools—such as Building Information Modelling (BIM), Design for Manufacture and Assembly (DfMA), and digital twins—which enhance traceability and flow optimization. Nonetheless, persistent barriers—including supply chain fragmentation, lack of standards, and regulatory gaps—continue to constrain widespread adoption. This review identifies six strategic enablers for LC-CE integration: crossdisciplinary competencies, collaborative governance, interoperable digital systems, standardized indicators, incentive-based regulation, and pilot demonstrator projects. By consolidating fragmented evidence, the study provides a structured research agenda and practical insights to guide the transition toward more circular, efficient, and sustainable construction practices. Full article

Long-acting (LA) antiretroviral therapies for human immunodeficiency virus (HIV), such as injectable formulations of cabotegravir and rilpivirine (CAB+RPV LA), are now available. Considering the limited data on the out-of-hospital administration of this combination, evaluating the implementation strategies needed is essential to support future clinical efforts. To gather data on barriers and facilitators of implementation for CAB+RPV LA in alternative outpatient facilities, this study used qualitative interviews informed by the Consolidated Framework for Implementation Research (CFIR), with 13 staff participating in the HOLA study (NCT06185452). Data analysis followed qualitative descriptive methods, assisted by Atlas.ti software version 22. The study adhered to the COREQ guidelines. Findings reveal five main factors to consider for implementation: operational and infrastructure adaptations, integrated management of human and organizational resources, need for coordination and follow-up, professional attitudes and work environment, and patient experience and patients’ needs perceived by professionals. This study emphasizes the comprehensive operational and infrastructure adaptations, adequate staff training, and supportive professional environment required for the successful implementation of CAB+RPV LA, while considering patients’ needs throughout the externalization process (trial registration number: NCT06643897). Full article

Sexual dysfunction is a prevalent and often under-addressed concern among prostate cancer survivors, significantly affecting quality of life for patients and their partners. The True North Sexual Health and Rehabilitation eClinic (SHAReClinic) is a virtual, biopsychosocial intervention developed to improve access to sexual health support for prostate cancer survivors and their partners. This study used a qualitative descriptive design to examine barriers and facilitators influencing the integration of SHAReClinic into oncology care across nine Canadian health care centres. Semi-structured interviews were conducted with 17 knowledge users, including health care providers and institutional leaders. Data were analyzed using a hybrid deductive–inductive thematic approach guided by the Consolidated Framework for Implementation Research (CFIR) 2.0. Participants described SHAReClinic as a much-needed resource, particularly in the absence of standardized sexual health pathways in oncology care. The virtual format was seen as accessible and well suited to addressing sensitive topics. However, limited funding, lack of institutional support, and workflow integration challenges emerged as primary barriers to implementation. Findings offer practical, theory-informed guidance for integrating SHAReClinic into oncology care and highlight key considerations for developing sustainable and scalable survivorship care models. Full article

Salt accumulation in arable lands causes significant abiotic stress, resulting in a 10% loss in global arable land area and jeopardizing food production and agricultural sustainability. In order to attain high and sustainable food production, it is imperative to enhance traditional agricultural practices with modern technology to enable the restoration of arable lands afflicted by salinity. This review consolidates recent rice-specific advancements aimed at enhancing salt stress resilience through integrated strategies. We explore the functions of primary and secondary metabolic pathways, organic amendments, microbial symbiosis, and plant growth regulators in reducing the negative impacts of salt. Furthermore, we highlight the significance of emerging genetic and epigenetic technologies, including gene editing and transcriptional regulation, in developing salt-tolerant rice cultivars. Physiological studies reveal salt stress responses in rice plants, biochemical analyses identify stress-related metabolites, microbial investigations uncover beneficial plant–microbe interactions, and molecular approaches enable the identification of key genes—together providing essential insights for developing salt-tolerant rice varieties. We present a comprehensive overview of the multilayered strategies—ranging from agronomic management and physiological adaptations to molecular breeding and microbial applications—that have been developed and refined over recent decades. These approaches have significantly contributed to understanding and improving salinity tolerance mechanisms in rice. This review provides a foundational framework for future research and practical implementation in stress-resilient rice farming systems. Full article

Background: The digital transformation in dentistry is increasingly reshaping treatment procedures, offering new opportunities and advancements. While digitalization promises enhanced efficiency and quality of care through the standardization, acceleration, and simplification of workflows, it also introduces challenges related to mental health. Studies investigating digitization-associated stressors and resources, as well as health- and work-related outcomes, in the dental sector are still rare. In the context of ongoing digitalization, further studies are needed to examine the need for and the current status of the implementation of measures preventing techno-stress and stress-related outcomes. This study explores the use of digital tools in dental practices and their relationship to the techno-stress among German dentists. It identifies key stressors and resources associated with digital technologies, aiming to inform preventive measures, as well as training and support strategies to mitigate digital stress. Methods: A qualitative study was employed, involving ten problem-centered, guideline-based expert interviews with German dentists. The interviews were analyzed using MAXQDA software, following the focused interview analysis framework by Kuckartz and Rädiker. Coding and thematic analysis adhered to the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist and qualitative research quality criteria by Mayring. Results: This study identified a dual impact of digitalization in dentistry. On the one hand, digital tools significantly enhance workflow efficiency, diagnostic accuracy, and patient outcomes. On the other hand, they pose challenges like technostress, high financial costs, and the need for continuous learning. Findings reveal that the perceived usefulness of digital technologies is closely linked to the level of techno-stress experienced, while the amount, intuitiveness, and ease of use significantly influence stress levels. Conclusions: Digital transformation offers substantial benefits for dental practices but requires a balanced approach to implementation. Participants highlighted the need for proactive measures, such as targeted training, technical support, and stress-reducing interventions to reduce techno-stress levels. The digital transformation must be supported by coordinated efforts across academia, industry, and policy to strengthen digital competencies—creating a healthier, more resilient digital work environment. Future research should focus on the causal relationship between techno-stress and adverse long-term consequences, such as burnout or mental disorders, among dentists. Full article

Tethered drones—defined in this work as multirotor aerial platforms physically connected to a ground station via a cable—have emerged as a transformative subclass of Tethered Unmanned Aerial Vehicles (TUAVs), offering enhanced power autonomy, communication robustness, and safety through a physical ground connection. This review provides a comprehensive analysis of the current state of tethered drone systems technology, focusing on critical system components such as power delivery, data transmission, tether management, and modeling frameworks. Emphasis is placed on the tether multifunctional role—not only as a physical link but also as a sensor, actuator, and communication channel—impacting both hardware design and control strategies. By consolidating fragmented research across disciplines, this work offers a unified reference for the design, implementation, and advancement of TUAV systems, with tethered drones as their principal application. Full article