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Search Results (809)

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Keywords = bibliographic analysis

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20 pages, 509 KiB  
Article
From Domination to Dialogue: Theological Transformations in Catholic–Indigenous Relations in Latin America
by Elias Wolff
Religions 2025, 16(7), 859; https://doi.org/10.3390/rel16070859 - 2 Jul 2025
Abstract
The aim of the article is to analyze the relationship between the Christian faith and the spiritual traditions of the indigenous peoples of Latin America, seeking to identify elements that make it possible to trace paths of dialogue and mutual cooperation. It shows [...] Read more.
The aim of the article is to analyze the relationship between the Christian faith and the spiritual traditions of the indigenous peoples of Latin America, seeking to identify elements that make it possible to trace paths of dialogue and mutual cooperation. It shows that historically, there have been tensions and conflicts between these traditions, but today, there is a path towards overcoming this reality through social solidarity, which serves as a basis for dialogue between the ways of believing. The research method is comparative and involves a qualitative analysis of the bibliography dealing with the relationship between the Church and Latin American indigenous spiritualities. The bibliographic base is documental, with emphasis on the conferences of the Latin American Episcopal Council (CELAM), the Synod for the Amazon (2019) and the magisterium of Pope Francis, read from the perspective of the Second Vatican Council and the current theology of religions. The conclusion is that the Church is developing an important social dialogue to promote justice and the rights of indigenous peoples. This dialogue serves as the basis for a dialogue with the beliefs and spiritualities of these peoples. The challenge for this is to review mission objectives and methods in order to overcome the conversionist perspective in the relationship with indigenous peoples, taking paths of mutual respect and acceptance and valuing them beyond being the recipients of evangelization. In this way, indigenous spiritual traditions can be recognized not only as “seeds” of the Word to be developed by evangelization but as an already mature fruit of God’s relationship with these peoples. Full article
(This article belongs to the Special Issue Religion and Indigenous Traditions)
30 pages, 2323 KiB  
Review
The Measurement of Innovation: A Systematic Review and Bibliometric Analysis of Global Innovation Index Research
by Marcelo Pereira Duarte and Fernando Manuel Pereira de Oliveira Carvalho
Publications 2025, 13(3), 31; https://doi.org/10.3390/publications13030031 - 26 Jun 2025
Viewed by 252
Abstract
The purpose of this review is to synthesise the accumulated knowledge on Global Innovation Index (GII) research. We utilised a corpus from the Web of Science Core Collection to systematically examine the antecedents, consequences, and relationships among the GII’s dimensions. Additionally, we employed [...] Read more.
The purpose of this review is to synthesise the accumulated knowledge on Global Innovation Index (GII) research. We utilised a corpus from the Web of Science Core Collection to systematically examine the antecedents, consequences, and relationships among the GII’s dimensions. Additionally, we employed the bibliometric techniques of bibliographic coupling and co-citation analysis to identify the leading areas of GII research and the foundational literature in this field. Our systematic review of GII empirical research allowed us to graphically represent the significant relationships among its dimensions. The findings from the bibliographic coupling revealed five recent lines of investigation in GII research: configurational methods; innovation efficiency and policy; competitiveness, entrepreneurship, and sustainable development; innovation rankings; and culture. Furthermore, the co-citation analysis highlighted four clusters of literature that have contributed to GII research. We aim to enhance the field of Innovation Studies by showcasing the current state of research on the GII, one of the most promising tools for measuring innovation activity, and to provide insights into potential future research avenues to further develop this area of study. Full article
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14 pages, 884 KiB  
Systematic Review
Challenges and Advances in Gender Equity: Analysis of Policies, Labor Practices, and Social Movements
by Kiara Geoconda Peralta-Jaramillo
Soc. Sci. 2025, 14(7), 401; https://doi.org/10.3390/socsci14070401 - 26 Jun 2025
Viewed by 190
Abstract
Gender equity is one of the most complex contemporary challenges, encompassing political, economic, labor, and cultural dimensions. This study aims to analyze the impact of public policies, labor practices, and social movements in promoting gender equity across various socio-political contexts. To answer the [...] Read more.
Gender equity is one of the most complex contemporary challenges, encompassing political, economic, labor, and cultural dimensions. This study aims to analyze the impact of public policies, labor practices, and social movements in promoting gender equity across various socio-political contexts. To answer the central question of how these elements influence a reduction in gender inequalities, a Systematic Literature Review (SLR) was conducted, complemented by a Bibliometric Analysis, following PRISMA protocol guidelines. The bibliographic search, carried out in the Scopus database, covered the period from 2015 to 2025 and identified 26 relevant studies that met the predefined inclusion criteria. The results reveal that, despite progress in formulating policies aimed at combating gender-based violence and promoting equality, the implementation of these measures is hindered by a lack of inter-institutional coordination and the persistence of deeply rooted cultural norms. Likewise, structural inequalities in the labor sphere are evident, such as the gender wage gap and barriers to professional advancement. On the other hand, social movements have emerged as key actors—including governmental institutions, civil society organizations, and healthcare providers—in highlighting and transforming these disparities by driving changes in political agendas and increasing women’s representation in decision-making positions. In summary, this study underscores the need to adopt intersectional and comprehensive approaches to achieve effective and sustainable gender equity, while comparing the influence of policies across different global regions. Full article
(This article belongs to the Section Gender Studies)
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31 pages, 7787 KiB  
Review
Global Research Trends in Photocatalytic Degradation of Microplastics: A Bibliometric Perspective
by Robert O. Gembo, Zebron Phiri, Lawrence M. Madikizela, Ilunga Kamika, Lueta-Ann de Kock and Titus A. M. Msagati
Microplastics 2025, 4(3), 35; https://doi.org/10.3390/microplastics4030035 - 21 Jun 2025
Viewed by 484
Abstract
Microplastics have emerged as pervasive contaminants in various ecosystems, raising considerable concerns regarding their impact on environmental health and public safety. The degradation of microplastics is thus recognized as a pressing global challenge. Photocatalytic degradation has emerged as a promising approach due to [...] Read more.
Microplastics have emerged as pervasive contaminants in various ecosystems, raising considerable concerns regarding their impact on environmental health and public safety. The degradation of microplastics is thus recognized as a pressing global challenge. Photocatalytic degradation has emerged as a promising approach due to its potential for efficiency and environmental sustainability. Nevertheless, there remains a need to investigate emerging trends and advancements to understand and fully optimize this technique. Consequently, PRISMA guidelines were employed to define the search parameters, enable the identification of pertinent scholarly articles, and systematically gather bibliographic data from the published literature from 2005 to October 2024. A bibliometric analysis of 204 research articles derived from merged Scopus and Web of Science datasets was conducted to map the field’s research landscape. The analysis showed a robust annual publication growth rate of 17.94%, with leading contributions from China, India, Mexico, and the United Kingdom. Keyword analysis revealed that the commonly applied photocatalysts are titanium dioxide and zinc oxide in the photocatalytic degradation of polyethylene terephthalate, polypropylene, polystyrene, polyvinyl chloride, high-density polyethylene, and low-density polyethylene. Advances in collaboration across Asia and Europe have bolstered the research landscape. However, challenges persist in achieving cost-effective scalability, ensuring the safety of degradation byproducts, and translating laboratory findings into real-world applications. Emerging trends include the development of visible-light-responsive catalysts, advanced nanocomposites, and sustainable photocatalytic technologies. This study underscores the utility of bibliometric tools in identifying knowledge gaps and guiding the development of innovative approaches for microplastic degradation as part of environmental remediation efforts. Full article
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23 pages, 2459 KiB  
Review
Climate-Sensitive Health Outcomes in Kenya: A Scoping Review of Environmental Exposures and Health Outcomes Research, 2000–2024
by Jessica Gerard, Titus Kibaara, Iris Martine Blom, Jane Falconer, Shamsudeen Mohammed, Zaharat Kadri-Alabi, Roz Taylor, Leila Abdullahi, Robert C. Hughes, Bernard Onyango and Ariel A. Brunn
Climate 2025, 13(7), 133; https://doi.org/10.3390/cli13070133 - 20 Jun 2025
Viewed by 1141
Abstract
Climate change threatens health and social development gains in Kenya, necessitating health policy planning for risk reduction and mitigation. To understand the state of knowledge on climate-related health impacts in Kenya, a scoping review of 25 years of environmental health research was conducted. [...] Read more.
Climate change threatens health and social development gains in Kenya, necessitating health policy planning for risk reduction and mitigation. To understand the state of knowledge on climate-related health impacts in Kenya, a scoping review of 25 years of environmental health research was conducted. In compliance with a pre-registered protocol, nine bibliographic databases and grey literature sources were searched for articles published from 2000 to 2024. Of 19,234 articles screened, 816 full texts were reviewed in duplicate, and a final 348 articles underwent data extraction for topic categorisation, trend analysis, and narrative summary. Most of the studies (97%, n = 336) were journal articles, with 64% published after 2014 (n = 224). The health topics centred on vector-borne diseases (45%, n = 165), primarily vector abundance (n = 111) and malaria (n = 67), while mental health (n = 12) and heat exposure (n = 9) studies were less frequent. The research was geographically concentrated on the Lake Victoria Basin, Rift Valley, and Coastal regions, with fewer studies from the northern arid and semi-arid regions. The findings show a shift from a focus on infectious diseases towards broader non-communicable outcomes, as well as regional disparities in research coverage. This review highlights the development of baseline associations between environmental exposures and health outcomes in Kenya, providing a necessary foundation for evidence-informed climate change and health policy. However, challenges in data and study designs limit some of the evidentiary value. Full article
(This article belongs to the Special Issue Climate, Ecosystem and Human Health: Impacts and Adaptation)
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19 pages, 534 KiB  
Article
Beyond Culture/Nature Divides: New Approaches and Tools for a Cultural Integrated Landscape Management
by Luiz Oosterbeek
Diversity 2025, 17(6), 436; https://doi.org/10.3390/d17060436 - 19 Jun 2025
Viewed by 765
Abstract
In this article, we revisit the core concepts of nature and of landscape assessment and sustainability, based on which we propose an approach to natural resource management and diversity preservation from the perspective of cultural landscapes. We build on past and contemporary debates [...] Read more.
In this article, we revisit the core concepts of nature and of landscape assessment and sustainability, based on which we propose an approach to natural resource management and diversity preservation from the perspective of cultural landscapes. We build on past and contemporary debates on the notion of nature and its relation to “Non-Nature”, attempting to systematize the main variables of the study of past societies as a methodological framework for the analysis of contemporary contexts; this is based on bibliographic references and case studies using such methodological approaches. Landscapes are structured through human activity, which relates to the technological and logistic drivers of historical studies, and are the domain of humans (anthropic nature), as opposed to non-anthropic nature (or wilderness). Sustainable resource management, focused on the preservation of biodiversity and cultural diversity as part of it, needs to overcome the divide between nature and culture, framing debates and conflicts as part of a cultural landscape of discussions served by an established methodological framework, in which education is the main driver and museum-related structures (libraries, etc.) form the flexible institutional backbone. The introduction sets the context for the argument, revisiting some of the theoretical approaches to the notions of nature and landscapes from the late 19th century in Europe, while also referring to reflections in antiquity and traditional and indigenous understandings. A section on materials and methods explains the methodological framework and data used by the author, situating it within a systematization of the humanities’ assessment of the past. A third section explores the interplay between materialities and perceptions, including the relevance of time- and space-driven approaches that shape different perceived landscapes; it proposes a definition of cultural landscape structured through these interplays. The fourth section discusses the dimension of perceived nature as a cultural landscape and characterizes its main drivers, offering two contemporary case studies as examples. A final section of conclusions discusses the role of humanities and of structures like museums, pointing to the new UNESCO program BRIDGES as a useful tool for pursuing landscape transformations. Full article
(This article belongs to the Special Issue Landscape Science and Natural Resource Management)
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21 pages, 621 KiB  
Article
Methodology Based on Critical Reflective Dialogue to Optimize Educational Leadership
by Sofía Gamarra-Mendoza and José Gregorio Brito-Garcías
Educ. Sci. 2025, 15(6), 776; https://doi.org/10.3390/educsci15060776 - 19 Jun 2025
Viewed by 387
Abstract
For educational leadership that promotes equity, there is evidence of successful leadership practices developed by educational leaders striving for social justice, such as the one planned by Leithwood. Furthermore, training programs for educational leaders seeking to replicate these practices have been dominated by [...] Read more.
For educational leadership that promotes equity, there is evidence of successful leadership practices developed by educational leaders striving for social justice, such as the one planned by Leithwood. Furthermore, training programs for educational leaders seeking to replicate these practices have been dominated by training that encourages educational leaders to focus on learning outcomes without developing a critical–reflective dialogue with the school context, the diversity of educational institutions, and, consequently, with students and their families. In this sense, the objective of the research is to examine the interaction between community members such as directors, teachers and parents in eight educational institutions in the Peruvian jungle and propose a formative theoretical model based on critical and reflective dialogue, based on a review of various theories that have contributed to the formation of a dialogue grounded in indignation and questioning of the context. The methodology follows a mixed approach, with a sample of 136 teachers and 16 key informants, using a validated questionnaire and an in-depth interview as instruments. Data analysis showed low interaction between educational leaders and the community, a disconnect with the curricula, and a low sense of responsibility and commitment, reflected only in administrative compliance. Based on these results and the bibliographic review of general and specific theories, a theoretical model based on critical and reflective dialogue was designed to develop awareness and sensitivity toward education with social justice, for the development of successful educational leadership practices. Full article
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21 pages, 1445 KiB  
Article
1D Finite Element Modeling of Bond-Slip Behavior and Deflection in Reinforced Concrete Flexural Members
by Rahaf Mohamad, George Wardeh, Mayada Al Ahmad Al Kousa and Ali Jahami
Designs 2025, 9(3), 75; https://doi.org/10.3390/designs9030075 - 18 Jun 2025
Viewed by 235
Abstract
The serviceability limit state (SLS) is a crucial aspect of structural design, ensuring that reinforced concrete structures perform satisfactorily under everyday loading conditions without excessive deflections, vibrations, or cracking that could compromise their functionality or aesthetics. This study investigates the bond-slip relationship in [...] Read more.
The serviceability limit state (SLS) is a crucial aspect of structural design, ensuring that reinforced concrete structures perform satisfactorily under everyday loading conditions without excessive deflections, vibrations, or cracking that could compromise their functionality or aesthetics. This study investigates the bond-slip relationship in flexural reinforced concrete members. The focus is on the influence of concrete fracture properties on the stress and strain distribution in the cracked zone. A 1D Finite Element Method (FEM) model was developed to better predict the distribution of stress and slip along the length of the reinforcement as well as the deflection. The proposed method uses material models and their interactions to provide a reliable analysis of the nonlinear behavior of RC beams, including crack width and crack spacing. A database built with numerous experimental results available in the bibliographic references allowed for the validation of the model. The results of some phenomenological models were discussed. A comprehensive analysis of the Eurocode 2 (EC2) method for calculating the deflection and cracking control of RC members was also performed. The results indicate a clear enhancement in the precision of deflection prediction in comparison to the perfect bond assumptions outlined in Eurocode 2. Additionally, the research successfully quantifies a 4–17% increase in deflection attributable to bond-slip effects. Full article
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18 pages, 293 KiB  
Article
Interpreting Beatrice: The Critical Reception of the Character in the Last Twenty-Five Years
by Heloísa Abreu de Lima
Humanities 2025, 14(6), 131; https://doi.org/10.3390/h14060131 - 17 Jun 2025
Viewed by 170
Abstract
A central figure in Dante’s oeuvre, Beatrice, has been the subject of diverse interpretations and enduring critical debate across centuries. This study presents a comprehensive bibliographic review of Beatrice’s reception over the last twenty-five years, mapping the principal interpretive trends and methodological approaches [...] Read more.
A central figure in Dante’s oeuvre, Beatrice, has been the subject of diverse interpretations and enduring critical debate across centuries. This study presents a comprehensive bibliographic review of Beatrice’s reception over the last twenty-five years, mapping the principal interpretive trends and methodological approaches that have shaped contemporary scholarship. The analysis organizes these contributions into five key thematic areas: 1. investigations into Beatrice’s historical and allegorical significance; 2. readings informed by a biblical perspective; 3. analyses exploring the relationship between Beatrice and Dante’s conception of love; 4. examinations of her literary meaning, often through metatextual and intertextual perspectives; and 5. gender-based inquiries that situate Beatrice within broader discourses on femininity and medieval representation. Additionally, the paper considers alternative interpretations beyond these dominant categories. Finally, the study identifies points of convergence and divergence between critical approaches to Beatrice and those applied to another emblematic female figure, Fiammetta, offering a comparative perspective on their scholarly reception. Full article
33 pages, 3330 KiB  
Review
Collateral Damage from Offensive Cyber Operations—A Systematic Literature Review
by Emil Larsson
J. Cybersecur. Priv. 2025, 5(2), 35; https://doi.org/10.3390/jcp5020035 - 16 Jun 2025
Viewed by 403
Abstract
As offensive cyber operations have become more commonplace, cyber collateral damage (CCD) to society and to civilian infrastructure has expanded in impact and severity. Several research contexts, frameworks, and methods apply to these collateral effects, especially as they pertain to reducing them. To [...] Read more.
As offensive cyber operations have become more commonplace, cyber collateral damage (CCD) to society and to civilian infrastructure has expanded in impact and severity. Several research contexts, frameworks, and methods apply to these collateral effects, especially as they pertain to reducing them. To investigate and map this area of research, five leading scientific databases (Scopus, IEEE Xplore, Springer Link, ScienceDirect, and ProQuest) were searched for papers on CCD. From 716 search results, 74 relevant papers were selected. Using surface categories as well as thematic analysis, these were grouped into the main emergent categories of legal, ethical, targeting-oriented, and econometric papers, with each category showing a recent research trend. The papers were qualitatively assessed for importance and coverage and compared bibliographically to identify key papers and authors. Within the identified areas of research, significant gaps remain. While CCD is becoming increasingly well understood from a legal and operational perspective, this accounts only for a fraction of the civilian harm caused by offensive cyber operations. This study identifies potential pathways for the synthesis of the current research areas (targeting, taxonomy, econometrics) with broader definitions of collateral damage to include civilian harm. These include updating national cyber doctrines to require collateral damage estimates, as well as exploiting emerging open datasets to understand which cyber capabilities cause the greatest collateral effects. Finally, we observe that the research definitions and taxonomy of CCD differ widely and have been subjected to limited scrutiny and challenge to date. Full article
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17 pages, 3412 KiB  
Article
Bibliometric and PESTEL Analysis of Deep-Sea Mining: Trends and Challenges for Sustainable Development
by Fernanda Espínola, Emilio Castillo and Luis Felipe Orellana
Mining 2025, 5(2), 36; https://doi.org/10.3390/mining5020036 - 12 Jun 2025
Viewed by 242
Abstract
The progress toward energy transition has made it essential to secure large quantities of critical metals to meet both short- and long-term demand, driving the exploration of new approaches, such as deep-sea mining (DSM). This study conducts a bibliometric analysis to examine the [...] Read more.
The progress toward energy transition has made it essential to secure large quantities of critical metals to meet both short- and long-term demand, driving the exploration of new approaches, such as deep-sea mining (DSM). This study conducts a bibliometric analysis to examine the current scientific landscape of DSM, identifying trends, critical factors, and research gaps through a combined PESTEL and bibliographic analysis covering co-authorship, co-citation, co-occurrence, and bibliographic coupling. This comprehensive approach not only highlights emerging areas but also helps guide research efforts toward priority topics that support the advancement of DSM toward more sustainable exploitation. The results provide a general overview of recurrent themes and underexplored areas, serving as a basis for future research. While significant progress has been made in the environmental, technological, political, and legal dimensions, there remains a major gap in studies addressing the economic and social aspects of DSM, which account for less than 14% of the literature analyzed. This imbalance limits the integration of a truly sustainable framework, underscoring the need to promote interdisciplinary approaches and foster synergies among organizations and countries to build a more balanced and holistic understanding. Full article
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25 pages, 2939 KiB  
Review
The Relative Popularity of Video Game Genres in the Scientific Literature: A Bibliographic Survey
by Jakub Swacha
Multimodal Technol. Interact. 2025, 9(6), 59; https://doi.org/10.3390/mti9060059 - 11 Jun 2025
Viewed by 501
Abstract
Video games come in many genres. Although the popularity of games that belong to different genres is the subject of various research and industry reports, so far, there have been no studies investigating their popularity in research papers. This paper addresses this gap [...] Read more.
Video games come in many genres. Although the popularity of games that belong to different genres is the subject of various research and industry reports, so far, there have been no studies investigating their popularity in research papers. This paper addresses this gap with an analysis of bibliographic data sourced from Scopus, spanning 45 years since the emergence of the topic till today and covering nine widely recognized genres: Action, Puzzle, Rhythm, Role-Playing, Simulation, Sports, Shooter, Strategy, and Traditional. The obtained results not only reveal the current popularity of these video game genres but also illustrate its change over time and geographic distribution as well as highlight the most impactful papers referring to the respective genres and their topics, providing a number of footholds for future studies, including regarding the identified disparities in the research interest in some genres and the number of available games belonging to them, the fluctuations in the relative popularity of the respective genres, and the disparities in the share of research output dedicated to video game genres in the total research output of different countries. Full article
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27 pages, 612 KiB  
Systematic Review
Cocaine Cues Used in Experimental Research: A Systematic Review
by Eileen Brobbin, Natalie Lowry, Matteo Cella, Alex Copello, Simon Coulton, Jerome Di Pietro, Colin Drummond, Steven Glautier, Ceyda Kiyak, Thomas Phillips, Daniel Stahl, Shelley Starr, Lucia Valmaggia, Colin Williams and Paolo Deluca
Brain Sci. 2025, 15(6), 626; https://doi.org/10.3390/brainsci15060626 - 10 Jun 2025
Viewed by 686
Abstract
Aims: Cue exposure therapy (CET) is a promising treatment approach for cocaine substance use disorder (SUD). CET specifically targets the psychological and physiological responses elicited by drug-related cues, aiming to reduce their motivational impact. To advance understanding of CET for cocaine treatment, [...] Read more.
Aims: Cue exposure therapy (CET) is a promising treatment approach for cocaine substance use disorder (SUD). CET specifically targets the psychological and physiological responses elicited by drug-related cues, aiming to reduce their motivational impact. To advance understanding of CET for cocaine treatment, this systematic review aims to categorise the range of cocaine cues used in research. Methods: A systematic review of the existing literature with searches conducted on PubMed and Web of Science bibliographic databases with no time constraints in August 2024 (PROSPERO: CRD42024554361). Three reviewers were independently involved in the screening, review and data extraction process, in line with PRISMA guidelines. Data extracted included participant demographics, study design, data on the cocaine cue task, and examples (if provided). Each study was appraised and received a quality score. The secondary outcome was to summarise examples for each category type identified. The data are presented as a narrative synthesis. Results: 3600 articles were identified and screened. 235 articles were included in the analysis. Cues identified included images, paraphernalia, drug-related words, cocaine smell, auditory stimuli presented via audiotapes, video recordings, scripts, and virtual reality environments, often combining multiple modalities. Included studies recruited cocaine-dependent individuals, recreational users, polydrug users, and non-cocaine-using controls. The sample sizes of the studies ranged from a single case study to a study including 1974 participants. Conclusions: This review found that studies employed a wide range of cue categories, but detailed examples were often lacking, limiting replication. The number and combination of cues varied: some studies used only cocaine-related images, while others included images, videos, physical items, and audiotapes. The level of immersion and personalisation also differed considerably. All studies used cocaine-specific cues, most commonly images or representations of cocaine substance, cocaine use or drug paraphernalia, drug preparation items, or conversations of cocaine use and its effects. The overall quality of the included studies was deemed good, with all adhering to standard research norms. While this review highlights the breath of cue types used in the literature, further research should focus on enhancing cue exposure techniques by incorporating more immersive and personalised stimuli, and by providing clearer documentation of cue characteristics to support replication and clinical translation. Full article
(This article belongs to the Special Issue Psychiatry and Addiction: A Multi-Faceted Issue)
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27 pages, 1011 KiB  
Systematic Review
Sustainability in the Management of the Private Medical Sector in Romania: A European, USA and Japan Comparison
by Emanuel George Mesteru
Sustainability 2025, 17(12), 5360; https://doi.org/10.3390/su17125360 - 10 Jun 2025
Viewed by 445
Abstract
The private healthcare sector in Romania, led by prominent players such as Medlife, Regina Maria, Medicover and Sanador, has become a cornerstone of the country’s healthcare system. However, achieving sustainability in this sector remains a challenge. This study evaluates sustainability practices in Romania’s [...] Read more.
The private healthcare sector in Romania, led by prominent players such as Medlife, Regina Maria, Medicover and Sanador, has become a cornerstone of the country’s healthcare system. However, achieving sustainability in this sector remains a challenge. This study evaluates sustainability practices in Romania’s private medical sector using the Triple Bottom Line (TBL) framework, comparing them to those of the EU, USA and Japan. Using statistical methods and benchmarking, we identify correlations between healthcare expenditures, financing schemes and sustainability metrics. A bibliographic review highlights global trends in sustainable healthcare management, including environmental, social and economic strategies and provides insights into the cost-effectiveness of green initiatives. Special focus is given to the role of technology in driving sustainability through innovations in telemedicine, digital health records and operational optimization. Using statistical methods (Pearson and Spearman correlation coefficients), we have performed an analysis of health expenditure data for EU countries, the USA and Japan. The dataset was extracted from the Organisation for Economic Co-operation and Development (OECD) data portal and included various health expenditure indicators, financing schemes and administrative data for all EU countries, the USA and Japan for the period 2018–2023. We have performed a structured analysis that explores correlations between these indicators, with a focus on financial schemes, expenditures and management sustainability. The analysis shows strong correlations between healthcare expenditures, financing schemes and administrative costs. Countries with efficient governance, balanced financing and proactive population health strategies (e.g., Japan and Nordic countries) demonstrate better management sustainability. However, countries like the USA and Eastern EU nations face challenges due to high administrative costs and inefficient financing models, respectively. Addressing these issues is critical to sustaining healthcare systems in the long term. The findings reveal that while Romanian providers excel in patient satisfaction and technological innovation, they lag behind their European counterparts in environmental sustainability and equitable access. Recommendations are proposed to address these gaps, drawing on successful strategies implemented in other European healthcare systems. This study fills a gap in the literature by providing a structured analysis of sustainability practices in Romania’s private healthcare sector, contextualized within a global comparative framework. Full article
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12 pages, 425 KiB  
Perspective
Exploring Use-Rates of and Scientific Evidence on Sutureless Devices in Aortic Valve Replacement: A Bibliographic Meta-Analysis and Clinical Considerations
by Cristiano Spadaccio, Arnaldo Dimagli, Clayton J. Agler, Dane C. Paneitz, Stanley B. Wolfe, Antonio Nenna, Asishana A. Osho and David Rose
J. Clin. Med. 2025, 14(12), 4049; https://doi.org/10.3390/jcm14124049 - 7 Jun 2025
Viewed by 413
Abstract
Sutureless aortic valve replacement (SuAVR) has emerged as a potential alternative to conventional surgical aortic valve replacement (SAVR), particularly in minimally invasive settings. However, its global adoption remains limited, with a notable concentration of use and scientific production in select European countries. This [...] Read more.
Sutureless aortic valve replacement (SuAVR) has emerged as a potential alternative to conventional surgical aortic valve replacement (SAVR), particularly in minimally invasive settings. However, its global adoption remains limited, with a notable concentration of use and scientific production in select European countries. This bibliographic meta-analysis systematically reviewed 538 studies to assess the evidence landscape surrounding SuAVR, highlighting a predominance of observational data, sparse randomized controlled trials (1.3%), and significant geographical imbalances in research output. Europe accounted for 80% of publications, while North America contributed less than 10%. Key structural factors—including reimbursement policies, earlier regulatory approvals, and population characteristics—appear to influence SuAVR adoption. Despite procedural advantages such as reduced cross-clamp times, concerns over cost, pacemaker implantation rates, and uncertain long-term durability persist. Importantly, SuAVR may offer its greatest clinical value by facilitating minimally invasive surgery, a niche still underutilized worldwide. The limited randomized data and industrial focus on transcatheter approaches have further hindered widespread acceptance. Our findings underscore the need for high-quality comparative trials and standardized guidelines to define the role of SuAVR in modern valve therapy. Full article
(This article belongs to the Section Cardiology)
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