Search Results (2,885)

Jordan’s aging population faces a critical challenge: a strong cultural preference for aging at home, rooted in Islamic ethics of familial care (birr al-wālidayn), conflicts with housing stock that is largely unsafe and inaccessible. This first national mixed-methods study examines the intersection of home modifications, socio-economic barriers, and cultural constraints to aging in place. Data from 587 surveys and 35 interviews across seven governorates were analyzed using chi-square tests, linear regression, and thematic coding. Results indicate that while physical modifications significantly improve accessibility to key spaces like kitchens and reception areas (majlis) (χ² = 341.86, p < 0.001), their adoption is severely limited. Socio-economic barriers are paramount, with 34% of households unable to afford the median modification cost of over $1500. Cultural resistance is equally critical; 22% of widows avoid modifications like grab bars to prevent the ‘medicalization’ of their home, prioritizing aesthetic and symbolic integrity over safety. The study reveals a significant gendered decision-making dynamic, with men controlling 72% of structural modifications (β = 0.27, p < 0.001). We conclude that effective policy must integrate universal design with Islamic care ethics. We propose three actionable recommendations: (1) mandating universal design in building codes (aligned with SDG 11), (2) establishing means-tested subsidy programs (aligned with SDG 10), and (3) launching public awareness campaigns co-led by faith leaders to reframe modifications as preserving dignity (karama) (aligned with SDG 3). This approach provides a model for other rapidly aging Middle Eastern societies facing similar cultural-infrastructural tensions. Full article

Objective: Patient information materials are sensitive and, if poorly written, can cause misunderstanding. This study evaluated and compared the readability, actionability, and quality of patient education materials on laryngology topics generated by ChatGPT, Google Gemini, and ENT UK. Methods: We obtained patient information from ENT UK and generated equivalent content with ChatGPT-4-turbo and Google Gemini 2.5 Pro for six laryngology conditions. We assessed readability (Flesch–Kincaid Grade Level, FKGL; Flesch Reading Ease, FRE), quality (DISCERN), and patient engagement (PEMAT-P for understandability and actionability). Statistical comparisons involved using ANOVA, Tukey’s HSD, and Kruskal–Wallis tests. Results: ENT UK showed the highest readability (FRE: 64.6 ± 8.4) and lowest grade level (FKGL: 7.4 ± 1.5), significantly better than that of ChatGPT (FRE: 38.8 ± 10.5, FKGL: 11.0 ± 1.5) and Gemini (FRE: 38.3 ± 8.5, FKGL: 11.9 ± 1.2) (all p < 0.001). DISCERN scores did not differ significantly (ENT UK: 21.3 ± 7.5, GPT: 24.7 ± 9.1, Gemini: 29.5 ± 4.6; p > 0.05). PEMAT-P understandability results were similar (ENT UK: 72.7 ± 8.3%, GPT: 79.1 ± 5.8%, Gemini: 78.5 ± 13.1%), except for lower GPT scores on vocal cord paralysis (p < 0.05). Actionability was also comparable (ENT UK: 46.7 ± 16.3%, GPT: 41.1 ± 24.0%, Gemini: 36.7 ± 19.7%). Conclusion: GPT and Gemini produce patient information of comparable quality and engagement to ENT UK but require higher reading levels and fall short of recommended literacy standards. Full article

In today’s competitive digital landscape, application usability plays a critical role in user satisfaction and retention. Negative user reviews offer valuable insights into real-world usability issues, yet traditional analysis methods often fall short in scalability and contextual understanding. This paper proposes an intelligent framework that utilizes large language models (LLMs), including GPT-4, Gemini, and BLOOM, to automate the extraction of actionable usability recommendations from negative app reviews. By applying prompting and fine-tuning techniques, the framework transforms unstructured feedback into meaningful suggestions aligned with three core usability dimensions: correctness, completeness, and satisfaction. A manually annotated dataset of Instagram negative reviews was used to evaluate model performance. Results show that GPT-4 consistently outperformed other models, achieving BLEU scores up to 0.64, ROUGE scores up to 0.80, and METEOR scores up to 0.90—demonstrating high semantic accuracy and contextual relevance in generated recommendations. Gemini and BLOOM, while improved through fine-tuning, showed significantly lower performance. This study also introduces a practical, web-based tool that enables real-time review analysis and recommendation generation, supporting data-driven, user-centered software development. These findings illustrate the potential of LLM-based frameworks to enhance software usability analysis and accelerate feedback-driven design processes. Full article

Background: In Italy, workplace safety regulations require the training of first-aid officers to manage medical emergencies, including acute coronary syndromes. Although clinical guidelines recommend the early use of acetylsalicylic acid in myocardial infarction, little is known about the implementation of this recommendation in practice. This study aims to assess the use of acetylsalicylic acid for ST-elevation myocardial infarction (STEMI) in workplace and non-workplace settings, with a focus on informing the evaluation and improvement of first-aid training programs and emergency response protocols. Methods: We conducted a retrospective, observational cohort study using 2019 data from the Regional Agency for Emergency Urgency. Cases were identified and stratified by event location (workplace vs non-workplace), to analyze patterns of acetylsalicylic acid administration. A logic model has been developed to program a stepwise plan of action for policies development. Results: A total of 2174 STEMI cases were identified, of which 380 (17.5%) occurred in the workplace. Workplace cases were younger and more likely to be male. Acetylsalicylic acid was administered in only 31 cases overall, with no statistically significant difference between settings. This assessment advocates for the implementation of targeted actions, which may include updates to current legislation and policies. Conclusions: These findings highlight an urgent need to systematically evaluate existing workplace first-aid training and emergency protocols. Integrating modules on acetylsalicylic acid administration into training curricula, along with performance monitoring mechanisms, may significantly enhance early STEMI management and patient outcomes. Updating safety programs to align with evidence-based practices should follow a structured approach. Full article

Climate change affects all human and ecological systems. The rapid climate impacts are increasingly evident on all economic activities, including tourism. Regarding the fact that “the window is closing”, climate resilience is urgently needed to protect tourism resources and maintain the quality of tourism offerings. Since the recent climate and tourism scientific literature emphasizes the necessity to mobilize existing knowledge, standardize practices, and explore appropriate tools related to tourism adaptation, we provided desk research and discussed the latest achievements of the Intergovernmental Panel on Climate Change’s (IPCC) and related knowledge platforms. According to the results of this review, it seems that the vast majority of the authors use vulnerability assessment (VA) to provide a solid basis for climate change adaptation (CCA) options applicable to tourism. Also, there is a lack of application of the latest IPCC recommendations founded in climate risk assessment (CRA). In the context of CRA, vulnerability was often assessed in a static way, with limited consideration of future hazards, probabilistic estimates, and the interactions between climatic and non-climatic drivers. Moreover, the methodologies applied to assess climate-related issues in tourism have been highly heterogeneous, hindering comparability and aggregation of results. Since risk is a useful conceptual framework for understanding tourism’s climate issues and modalities to reach its climate resilience, we discussed the significance of shifting the vulnerability concept towards a risk-centered framework. This review paper also provides a basis for a common understanding of CRA, a step-by-step approach to its assessment, and the explanation of CCA options to strengthen the tourism community, since a decisive decade of climate action is upon us. Full article

The clinical case presented demonstrates how a person living with type 2 diabetes and treated with insulin reuses the same pen needle several times to save money and performs an incorrect maneuver while screwing the needle, which breaks, remains stuck at the end of the pen, and causes loss of insulin during subsequent use. The findings in this case study are observed in many others in clinical practice but have only been sporadically published. Who is responsible for incorrect injections? Indeed, health workers, diabetic patients, and all the other actors involved in diabetes care and insulin utilization share responsibility. Recommendations and guidelines are not enough to fill this gap. Moreover, not all healthcare providers (HCPs) know or adhere to them. It is observed daily that more than half of insulin users make mistakes that affect glycemic control, increase the risk of complications, and reduce the quality of life of people living with diabetes, who, by a rough estimate, make up a population of over 100 million in the world. This case study offers us the opportunity to briefly review the literature on the most common errors made during insulin injection technique and, therefore, consider how necessary it is to promote structured and coordinated actions among various actors to promote the culture of therapeutic education. Full article

To address urban flooding challenges exacerbated by climate change and urbanization, this study develops an integrated assessment framework combining the analytic hierarchy process (AHP), entropy weight method, and cloud model to quantify urban flood resilience. Resilience is deconstructed into resistance, adaptability, and recovery and evaluated through 24 indicators spanning water resources, socio-economic systems, and ecological systems. Subjective (AHP) and objective (entropy) weights are optimized via minimum information entropy, with the cloud model enabling qualitative–quantitative resilience mapping. Analyzing 2014–2024 data from 27 Chinese sponge city pilots, the results show resilience improved from “poor to average” to “good to average”, with a 2.89% annual growth rate. Megacities like Beijing and Shanghai excel in resistance and recovery due to infrastructure and economic strengths, while cities like Sanya enhance resilience via ecological restoration. Key drivers include water allocation (27.38%), economic system (18.41%), and social system (17.94%), with critical indicators being population density, secondary industry GDP ratio, and sewage treatment rate. Recommendations emphasize upgrading rainwater storage, intelligent monitoring networks, and resilience-oriented planning. The model offers a scientific foundation for urban disaster risk management, supporting sustainable development. This approach enables systematic improvements in adaptive capacity and recovery potential, providing actionable insights for global flood-resilient urban planning. Full article

Background: Unhoused individuals face significant health disparities and encounter numerous barriers to accessing adequate healthcare, resulting in high rates of chronic disease, mental illness, and untreated conditions in Houston, TX. The purpose of this study was to identify prevalent health conditions within a sample of unhoused adults and to identify patterns in patient characteristics and clinical health outcomes. Methods: This study utilized clinical and demographic data from n = 191 patients who received care at a student-run clinic embedded within a homeless drop-in center in Houston, TX. Data included patient demographics, chief complaints, social determinants of health (SDOHs), past medical history, on-site diagnoses, and provider actions. Results: The most prevalent issues were housing insecurity (36.1%), cardiovascular conditions (38.7%), and substance use (17.8%). Nearly half of all patients (46.6%) declined treatment or left before receiving care. Significant associations were found between patient demographics and provider responses, including differences by gender and age in treatment type and diagnostic categorization. Conclusions: These findings underscore critical challenges in treatment adherence, diagnostic bias, and retention among unhoused populations. The study provides actionable recommendations for improving care coordination and continuity in low-barrier, student-run clinics serving medically underserved communities. Full article

Background: This paper examines the human and safety culture factors of the seemingly intractable problem of foreign object retention in surgery. Objectives: It reports selected findings of the FOR-RaM (Foreign Object Retention—Reduction and Mitigation) research project, which sought to discover and understand challenges to Foreign Object Management across surgical and maternity settings in Irish hospitals and to recommend changes to address these challenges. Methods: This paper presents the findings from surgical settings in one hospital site. A qualitative action research study was conducted with a wide range of stakeholders in the study hospital; the qualitative methods included 18 Semi-structured interviews with hospital staff, structured observations in surgical settings and Action Learning Sets to validate the data collected. Result: The results highlight a number of safety culture and human factors considerations which may facilitate or hinder Foreign Object Management, such as (individual and team) Goals, the Processes required for successful Foreign Object Management, Culture, Teamwork, Information Management, and Training. Full article

This study develops a three-dimensional evaluation framework integrating policy instruments, policy themes, and policy subjects to analyze China’s ESG (Environmental, Social, and Governance) policies. Based on 82 central government policy documents issued between 2007 and 2024, it employs content analysis, Latent Dirichlet Allocation (LDA) topic modeling, and social network analysis. The findings reveal a structural imbalance in policy instruments, with overreliance on environmental instruments and insufficient application of supply side and demand side mechanisms. Four major policy themes are identified: environmental governance, corporate responsibility and disclosure, technological innovation, and financial development. These themes show evolving priorities aligned with national strategies. Social network analysis shows weak coordination among stakeholders, with only a few central agencies driving most policies. This research contributes a systematic and quantitative approach to ESG policy evaluation, offering insights into structural shortcomings and governance fragmentation. It provides actionable recommendations for optimizing instrument use, enhancing thematic design, and improving multi-agency collaboration in ESG policymaking. This study contributes to the achievement of the United Nations Sustainable Development Goals (SDGs), particularly SDG 12 (Responsible Consumption and Production) and SDG 13 (Climate Action), by evaluating China’s ESG policies and proposing a more balanced and pragmatic policy framework. Full article

Background: Justice-involved adolescents exhibit high rates of mental health disorders with complex comorbidity patterns. Understanding these patterns is crucial for developing targeted interventions in this vulnerable population. Methods: We applied multiple machine-learning techniques to electronic records from 124 justice-involved adolescents (11–21 years; mean = 15.7 ± 1.9). Analyses included association rule mining, K-Means clustering with t-SNE visualization, and topic modeling of clinicians’ recommendation notes. Results: Hyperkinetic disorders (F90.0/F90.1) and family-stress factors (Z63.5) together accounted for approximately 45% of all ICD-10 entries. A four-cluster K-Means solution built on age + F-codes alone showed weak separation (silhouette = 0.044), whereas adding Z-codes markedly improved cohesion (silhouette = 0.468) and isolated a distinct hyperkinetic–family-stress subgroup. Association-rule mining returned one robust rule, F81 → F90.0 (support = 0.048, confidence = 0.46, lift = 1.59), underscoring the frequent co-diagnosis of learning and attention-deficit disorders. Topic modeling of clinicians’ recommendation notes recovered five coherent intervention themes—vocational guidance, parent counseling, psycho-education, family psychotherapy, and psychiatric follow-up—which aligned closely with the data-driven clusters. Conclusions: These findings demonstrate how routine clinical data can reveal actionable comorbidity profiles and guide tailored interventions for complex adolescent mental-health presentations. Full article

This article discusses unattributable small-scale marine oil spills, particularly focusing on their environmental and socio-economic impacts in Musandam, Oman. There is a research gap in the literature on unattributable small-scale marine oil spills that reflects the lack of attention paid to these minor yet frequent spills, whose perpetrators invariably escape detection and accountability. The research method combines a literature review with extensive fieldwork, including community mapping, key informant interviews, and focus group discussions, to understand the extent, causes, and challenges of untraceable spills. The findings reveal significant ecological damage, economic losses for local fishers and tourism, and systemic issues of untraceability, limited enforcement, and inadequate compensation mechanisms. The article recommends establishing a regional compensation scheme, deploying advanced detection technologies, improving spill reporting, and fostering regional cooperation to enhance spill traceability, upgrade remediation techniques, and obtain redress for affected communities. These recommendations aim to inform policy actions that mitigate environmental risks and uphold environmental justice in the Arabian Gulf region. Full article

A growing number of scientific and policy institutions recognize predominantly plant-based diets as the most sustainable dietary patterns, for both public health and the environment, and are therefore encouraging citizens to shift their eating habits. Alongside this, more people are adopting vegan or vegetarian diets in response to environmental concerns and animal welfare. In this context, the responsibility for planning nutritionally adequate diets cannot be solely individual, with household solutions, but collective actions are needed at the industrial and agricultural level. Historically, the food industry has improved the nutritional value of animal-derived foods through feed modification and supplementation. Today, similar efforts are needed to enhance the nutrient profile of plant-based foods. In addition, nutrient recommendations originally designed for mixed diets may not be directly applicable to populations following exclusively plant-based diets, given the differences in bioavailability and metabolism. This review aims to (1) identify nutrients that may be absent or present in insufficient amounts in plant-based and especially vegan diets; (2) explore potential solutions, ranging from soil management and crop biofortification to food processing, fortification, and supplementation; and (3) call for a revision of dietary reference intakes that better reflects the specific needs of populations consuming total or predominantly plant-based diets. Full article

This systematic review synthesizes evidence on economic instruments that mobilize renewable-energy investment in emerging economies, analyzing 50 peer-reviewed studies published between 2015 and 2025 under PRISMA 2020. We advance an Institutional Capacity Integration Framework that ties instrument efficacy to regulatory, market, and coordination capabilities. Green bonds have mobilized roughly USD 500 billion yet work only where robust oversight and liquid markets exist, offering limited gains for decentralized access. Direct subsidies cut renewable electricity costs by 30–50% and connect 45 million people across varied contexts, but pose fiscal–sustainability risks. Carbon pricing schemes remain rare given their administrative complexity, while multilateral climate funds show moderate effectiveness (coefficients 0.3–0.8) dependent on national coordination strength. Bibliometric mapping with Bibliometrix reveals three fragmented paradigms—market efficiency, state intervention, and international cooperation—and highlights geographic gaps: sub-Saharan Africa represents just 16% of studies despite acute financing barriers. Sixty-eight percent of articles employ descriptive designs, constraining causal inference and reflecting tensions between SDG 7 (affordable energy) and SDG 13 (climate action). Our framework rejects one-size-fits-all prescriptions, recommending phased, context-aligned pathways that progressively build capacity. Policymakers should tailor instrument mixes to institutional realities, and researchers must prioritize causal methods and underrepresented regions through focused initiatives for equitable global progress. 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