Search Results (1,396)

Background: Although surgical antibiotic prophylaxis (SAP) is considered a standard of care for preventing surgical site infections, the rising incidence of antimicrobial resistance (AMR) increases the likelihood of infections caused by multidrug-resistant organisms (MDROs), which may be associated with worse surgical outcomes. Methods: A multidisciplinary working group was convened by the Italian Multidisciplinary Society for the Prevention of Healthcare-Associated Infections (SIMPIOS) to define key measures for optimizing SAP in the era of AMR. Selecting the most appropriate SAP in patients colonized with MDROs is a complex decision that cannot be generalized, as it depends on both host factors and the specific surgical procedure. At present, there is limited evidence of SAP in these patients. Results: This position paper aims to provide practical guidance for optimizing SAP in the context of an AMR era. It is structured in three sections: (1) core principles of surgical antibiotic prophylaxis; (2) the role of screening, decolonization, and targeted prophylaxis for MDROs; and (3) barriers to changing surgeons’ prescribing behaviours. Conclusions: The working group developed 15 recommendation statements based on scientific evidence. Full article

Background and Objectives: In the context of hip fracture surgeries, episodes of hypotension are common, and have been associated in various studies with increased complications and mortality. The latest clinical guidelines recommend close hemodynamic management. Our research team hypothesized that the use of peripheral nerve blocks in this surgery could help adjust the doses of subarachnoid anesthesia for these procedures, thereby limiting the hypotensive episodes, without compromising an adequate depth and duration of intraoperative anesthesia. Materials and Methods: A retrospective study of 184 elderly patients undergoing hip fracture surgery is proposed. In total, 76 patients were operated under subarachnoid anesthesia using 9.5 mg of hyperbaric bupivacaine 0.5% and 10 mcg of fentanyl (Group S), while 108 received a reduced dose of 5 mg hyperbaric bupivacaine 0.5% and 10 mcg of fentanyl, supplemented by preoperative PENG and FLCN blocks (Group B). The main outcome of this study is to compare the number and duration of hypotensive episodes, and its secondary outcome is to compare the use of vasoactive drugs between the groups. Results: The number of hypotensive episodes and their duration were lower in Group B: −12.94 min (−8.57 to −18.03, p = 0.000). The consumption of vasoactive drugs did not reach statistical significance. None of the patients in Group B required supplementary intraoperative anesthesia. Conclusions: Reducing the dose in subarachnoid anesthesia is associated with better hemodynamic control in hip fracture surgeries, and PENG + NFCL blocks are proposed as an appropriate adjunct to ensure adequate anesthetic depth and duration despite a substantial subarachnoid anesthesia dose adjustment. Full article

Xylella fastidiosa was first detected in Portugal in 2019 in Lavandula dentata. In response, the national plant health authorities promptly established a Demarcated Zone in the affected area and implemented a series of eradication and control measures, including the systematic removal and destruction of infected and host plants. This study analyzes the economic and operational impacts of these eradication efforts in the northern region of Portugal, with a focus on Demarcated Zones such as the Porto Metropolitan Area, Sabrosa, Alijó, Baião, Mirandela, Mirandela II, and Bougado between 2019 and June 2023. During this period, about 412,500 plants were uprooted. The majority were Pteridium aquilinum (bracken fern), with 360,324 individuals (87.3%), reflecting its wide distribution and the large area affected. Olea europaea (olive tree) was the second most common species removed, with 7024 plants (1.7%), highlighting its economic relevance. Other notable species included Quercus robur (3511; 0.85%), Pelargonium graveolens (3509; 0.85%), and Rosa spp. (1106; 0.27%). Overall, destruction costs were estimated at about EUR 1.04 million, with replanting costs of roughly EUR 6.81 million. In parallel, prospection activities—conducted to detect early signs of infection and monitor disease spread—generated expenses of roughly EUR 5.94 million. While prospecting represents a significant financial investment, the results show that it is considerably more cost-effective than large-scale eradication. Prospection enables early detection and containment, preventing the widespread destruction of vegetation and minimizing disruption to agricultural production, biodiversity, and local communities. Importantly, our findings reveal a sharp decline in confirmed cases in the initial outbreak area—the Porto Demarcated Zone—from 124 cases in 2019 to just 5 in 2023, indicating the effectiveness of the eradication and monitoring measures implemented. However, the presence of 20 active Demarcated Zones across the country as of 2023 highlights the continued risk of spread and the need for sustained vigilance. The complexity of managing Xylella fastidiosa across ecologically and logistically diverse territories justifies the high costs associated with surveillance and targeted interventions. This study reinforces the strategic value of prospection as a proactive and sustainable tool for plant health management. Effective surveillance requires the integration of advanced methodologies aligned with the phenological stages of host plants and the biological cycle of vectors. Targeting high-risk locations, optimizing sample numbers, ensuring diagnostic accuracy, and maintaining continuous training for field teams are critical for improving efficiency and reducing costs. Ultimately, the findings underscore the need to refine and adapt monitoring and eradication strategies to contain the pathogen, safeguard agricultural systems, and prevent Xylella fastidiosa from becoming endemic in Portugal. Full article

Football, as a team sport, relies on a delicate balance where tactical cohesion and strategic play are as critical as physical prowess. While evidence suggests that European teams often display higher physical intensity, the tactical differences between European and American football are still not well quantified. The aim of this study is to conduct a comparative analysis of passing, possession, and goal-scoring dynamics in Euro 2024 and Copa America 2024. Data from 51 Euro matches and 32 Copa America matches, encompassing all game events with sub-second precision, were obtained from StatsBomb. Analyses were performed in MATLAB, with possession calculated as ‘pure possession,’ excluding inactive periods. Euro 2024 teams demonstrated significantly more total passes per match ($p<0.05$, Cohen’s $d=1.43$), higher pass completion rates ($p<0.05$, Cohen’s $d=1.30$), and longer possession sequences ($p<0.05$, Cohen’s $d=0.24$). They also showed greater possession in the five minutes prior to goals ($p<0.05$, Cohen’s $d=0.63$). In contrast, Copa America 2024 teams favored longer passes ($p<0.05$, Cohen’s $d=0.15$), reflecting a more direct playing style. Possession disparities between teams in individual matches did not differ significantly ($p=0.31$, Cohen’s $d=0.23$), and the distribution of shot distances for goals was also similar across tournaments ($p=0.86$, Cohen’s $d=0.02$). In summary, Euro 2024 teams emphasized control through longer possession and greater passing accuracy, while Copa America 2024 teams relied on more dynamic and direct play. These findings underscore how regional footballing philosophies shape match strategies and outcomes, offering insights into the tactical diversity of international football. Full article

Digital innovation is the core driving force to enhance the competitiveness of enterprises and promote sustainable development, and is a key enabler for achieving corporate ability goals. Executives with information technology (IT) backgrounds who have rich knowledge and skills in digital technology are the backbone of promoting the digital transformation of enterprises and optimizing the allocation of auditing resources. And they can lay the technological foundation for sustainable corporate development and play an important role in corporate audit decision-making. Based on the data of China’s A-share listed companies from 2015 to 2023, the impact of executives with IT backgrounds on auditor selection is empirically analyzed. The study shows that (1) the higher the proportion of executives with IT backgrounds in the executive team, the more the companies tend to choose high-quality auditors; (2) the degree of corporate digital innovation positively moderates the relationship between executives with an IT background and high-quality auditors; (3) the level of corporate internal control plays a mediating effect in the relationship between executives with an IT background and auditor selection; (4) for non-state-owned, large-scale, short executive tenures, and labor-intensive firms, executives with IT backgrounds exert a more significant influence on auditor selection. This study broadens previous research on corporate auditing behaviors from the perspective of executives with IT backgrounds, providing insights for companies to select suitable auditors, to make scientifically sound decisions regarding auditor selection in the context of digital innovation, further optimize internal management, enhance risk response capabilities, and thereby achieve sustainable corporate development. Full article

Practising the calculation of determinants is important in linear algebra. A pioneering study involving 580 first-year university students evaluated the impact of game-based learning in higher mathematics education. The participants formed two groups: an experimental group of 279 students and a control group of 301. The experimental group students played the non-digital educational card game DETerminator, designed to help students learn and practise calculating determinants in small square matrices. In contrast, the control group received no intervention, allowing for a clear outcome comparison. Students in the experimental group worked in smaller teams during didactic gameplay sessions that involved solving matrix-determinant problems in a competitive and collaborative classroom setting, enhancing their understanding through interaction and teamwork. The objective of this paper is to provide a detailed presentation of the DETerminator game and showcase its integration as an effective teaching tool for practising essential concepts and theorems related to determinants. Moreover, a quasi-experiment was conducted to explore how incorporating game-based learning can lead to successful and enjoyable mathematical education experiences for students. We used a quantitative approach to assess the effectiveness of the card game on academic achievement. At first, a pre- and post-test design was employed with the experimental group of 279 participants to evaluate the short-term effects of game-based learning. The Wilcoxon test was utilised for hypothesis testing, revealing a large effect size of 0.63. Moreover, the results from related midterm exam problems were statistically analysed to obtain the medium-term impact. The outcomes were compared using the Mann–Whitney U-test. The results demonstrated that the experimental group statistically outperformed the control group, but achieving a small effect size of 0.16, with a mean score of 3.14 out of 7 on the designated midterm exam tasks, compared to the control group’s mean score of 2.5. The small effect size suggests that, although the intervention had a positive effect, it is worth considering what other options there are for increasing the medium-term effect. A Likert-scale questionnaire was used to evaluate students’ attitudes towards the game. Our findings show the importance of incorporating game-based learning strategies in mathematics education at the university level, especially for enhancing students’ proficiency in key topics such as the determinant of a matrix. Full article

This study examines the feasibility of applying eye tracking as a rigorous method for assessing user experience in web design. A controlled experiment was conducted with 102 participants, who interacted with both guideline-compliant websites and systematically degraded variants violating specific principles of Material Design 2. Eleven websites were presented in A/B conditions with modifications targeting three design dimensions: contrast, link clarity, and iconography. Eye-tracking indicators—time to first fixation, fixation duration, fixation count, and time to first click—are examined in conjunction with subjective ratings and expert assessments. Mixed-effects models are employed to ensure robust statistical inference. The results demonstrate that reduced contrast and unclear links consistently impair user performance and increase search effort, whereas the influence of icons is more context-dependent. The study contributes by quantifying the usability costs of guideline deviations and by validating a triangulated evaluation framework that combines objective, subjective, and expert data. From a practical perspective, the findings support the integration of eye tracking into A/B testing and guideline validation, providing design teams with empirical evidence to inform and prioritize improvements in user interfaces. Full article

The aim of the study was to explore the impact of an intervention based on the manipulation of the margin of error and the provision of ball speed feedback on the ability to spike in introductory volleyball. To this end, an exploratory study without a control group was conducted. The sample consisted of two U-14 volleyball teams, one male team with 14 players (13.2 ± 0.75 years), and one female team with 12 players (14 ± 0 years). The intervention involved reducing the height of the net, providing immediate feedback on the speed of the ball after the spike, and challenging the target zone of the spike. It was applied across 12 sessions, with eight spikes per player per session. The study variables recorded in each spiking were ball speed (which was measured using the Pocket Radar Ball Coach instrument), jump height (which was measured using the VERT Wearable Jump Monitor), and target area for sending the ball (which was filmed using a high-speed video camera). The players’ perception of the intervention was also assessed. The most significant results indicated that the achievement of the impact in the more restricted target area of the spiking, compared to the larger target area, led to a significant increase in jumping, both in men and women. As maintaining spike ball speed was necessary to validate the challenge, speed values did not decrease when hitting toward the restricted zone. In fact, for male players, there was an unexpected significant increase in spike ball speed. The initial speed was the variable that best predicted the maximum speed acquired throughout the treatment. Reducing the net height while restricting the spiking area can have a positive impact on spike kinematics, provided that spike velocity is maintained. Full article

In this paper, we propose a distributed prescribed performance formation tracking control method for unknown Euler–Lagrange systems subject to input amplitude constraints. We address the challenge of maintaining formation tracking within predefined performance bounds when the agents’ inputs are subject to saturation. This is achieved by designing a distributed virtual velocity reference modification mechanism, which modifies the desired velocity reference of each agent whenever saturation occurs. We establish sufficient feasibility conditions for the input constraints that ensure prescribed performance formation tracking of the desired trajectory and guarantee the boundedness of all closed-loop signals. Simulations on a team of underwater vehicles validate the method’s effectiveness. Full article

Background/Objective: The global increase in life expectancy has led to a higher prevalence of multimorbidity among older patients, often requiring frequent and complex healthcare. Enhancing self-care skills during hospitalization is a key priority in promoting patient autonomy and improving outcomes. The objective of the study was to analyze the effect of the primary nursing model on the therapeutic self-care of older patients with multimorbidity during hospitalization. Methods: It was a quasi-experimental study conducted in two comparable medical-surgical units of a private hospital in Portugal. The intervention unit adopted the primary nursing model, while the control unit maintained standard nursing care. A convenience sample of older patients with multimorbidity was recruited (n = 206; intervention group = 106, control group = 100). Therapeutic self-care was measured using the Portuguese version of the Therapeutic Self-Care Scale at admission, discharge, and follow-up. Statistical analyses included independent samples t-tests to assess between-group differences. Results: At baseline, the intervention group had significantly lower self-care scores than the control group (t_(191.045) = −2.24; p = 0.026). However, between admission and follow-up, the intervention group showed significantly greater improvements in self-care scores compared with the control group (t_(187.55) = 2.68; p = 0.008). Conclusions: The primary nursing care model contributed to enhanced therapeutic self-care skills in older patients with multimorbidity during and after hospitalization. Nurse managers and clinical teams can consider the primary nursing model as an effective care organization strategy to foster self-care, promote patient-centered outcomes, and improve care continuity for older patients with complex needs. Trial Registration: ClinicalTrials.gov Identifier: NCT06702150 (Registered 12 November 2024). Full article

Background/Objectives: Novice nurses often struggle to assertively voice patient safety concerns due to limited clinical experience and hierarchical healthcare environments. Immersive virtual reality simulation (IVRS) may provide opportunities to practice assertive communication skills essential for interprofessional collaboration in a psychologically safe environment. This study aimed to evaluate the short- and long-term effectiveness of an IVRS speak-up training program in enhancing communication clarity and collaborative attitudes, as well as reducing experiences of nursing malpractice among novice nurses. Methods: A quasi-experimental study was conducted with 36 novice nurses (18 participants each in control and experimental groups). The experimental group received a 200 min IVRS speak-up training program incorporating TeamSTEPPS communication strategies through four virtual reality scenarios. The control group received a 110 min conventional group lectures and discussions on communication training covering the same TeamSTEPPS strategies. Communication clarity and collaborative attitudes were measured at baseline, immediately post-intervention, and 6 weeks post-intervention. Nursing malpractice experiences were assessed at 6 weeks post-intervention. Results: Communication clarity showed no significant interaction effect between groups and time points (F = 0.84, p = 0.437), though both groups demonstrated immediate post-intervention improvements. Collaborative attitudes showed a significant interaction effect (F = 4.23, p = 0.020), with the experimental group exhibiting significantly greater and sustained improvements at immediate and 6-week follow-up compared with the control group. No significant difference in nursing malpractice experiences was observed between groups (Z = 0.16, p = 0.872). Conclusions: The IVRS speak-up training program effectively enhanced novice nurses’ assertive communication skills in immersive, interactive environments tailored for realistic practice compared to conventional group discussion-based training. This program improved communication clarity in the short term and enhanced collaborative attitudes up to 6 weeks. Integrating or boosting IVRS training into novice nurses’ communication education may foster interprofessional collaboration and advance patient safety in clinical practice. Full article

Inclusive education is a legal right, and its origin is linked to human rights, which has established a resonance in global movements. In this study, we analyzed inclusive pedagogical practices that favor creativity in the high school context. We chose to carry out a qualitative scoping systematic review and defined the inclusion and exclusion criteria in advance to guide the team’s work. We selected articles from the Web of Science database on 14 April 2025 (registration: INPLASY202570121; (registered 30 July 2025)), and we performed a quality control check on the reporting using the PRISMA-ScR checklist. We established the timeframe between 2008 and 2025 and identified 368 articles, of which 25 were chosen for this study. The data were analyzed with the support of Rayyan and VOSviewer software (version 1.6.20). The findings demonstrate a wide range of practices developed across diverse high school contexts employing multiple strategies that advance an inclusive perspective. Moreover, among these strategies, several explicitly foster creativity through varied resources, collaborative work, and the use of assistive technologies. Overall, the articles show a significant convergence around multifaceted approaches that design and implement innovative strategies to address student diversity. Full article

Building psychological safety is vital for preventing workplace bullying and for sustaining employee well-being, organizational performance, and work engagement. This study developed and evaluated a short-term intervention promoting psychological safety and communication skills. The program provided strategies for addressing during high-stress situations and fostered a shared understanding of honest communication. A cluster randomized controlled trial was conducted in a pharmaceutical company, with departments assigned to intervention or control groups. The effects were examined using a generalized linear mixed-effect model. In the intervention group, psychological safety with supervisors and teams significantly increased, preceding a significant rise in consultation tendencies, whereas bullying and supervisor-related intimidation significantly decreased. Work engagement declined in the control group but remained stable in the intervention group. These findings demonstrate that the program enhanced psychological safety, enabling employees to express opinions without irrational fear, which in turn increased consultation, improved communication, reduced bullying, and sustained work engagement. The group-based format further emphasized mutual understanding and skill-sharing, providing broad organizational benefits. This study positions psychological safety as a proximal mechanism that facilitates consultation behaviors and demonstrates the feasibility of integrating brief, evidence-based training into routine organizational development. Full article

Type 2 diabetes mellitus (T2D) and cardiovascular disease (CVD) are not merely coexisting epidemics but co-evolving manifestations of a shared cardiometabolic continuum. Despite advances in glycemic, lipid, and blood pressure control, residual cardiovascular risk remains high, underscoring the limitations of siloed approaches. In this perspective, we argue for reframing T2D and CVD as interconnected conditions driven by inflammation, adipose tissue dysfunction, and organ crosstalk. Beyond metformin, which remains foundational, several glucose-lowering drug classes are now evaluated not only for glycemic control but also for their cardiovascular and renal impact. Landmark trials and recent meta-analyses confirm that sodium-glucose co-transporter 2 inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists improve cardiorenal outcomes. More recently, tirzepatide, a dual glucose-dependent insulinotropic polypeptide (GIP)/GLP-1 receptor agonist, has shown unprecedented efficacy in weight and glucose management, with potential to further transform cardiometabolic risk reduction. Yet enthusiasm for these therapies must be tempered by heterogeneity of response, treatment costs, and inequitable access. Integrated care models, supported by multidisciplinary teams, digital health tools, and value-based reimbursement, are essential to close the gap between trial efficacy and real-world outcomes. Attention to sex, age, ethnicity, and comorbidity profiles is critical to ensure equity, as is the adaptation of strategies to low- and middle-income countries where the burden of cardiometabolic disease is rapidly rising. Ultimately, advancing cardiometabolic medicine requires not only novel therapies but also a unifying framework that integrates biology, behavior, economics, and health systems to deliver the right treatment to the right patient at the right time. Full article

Persistent cost overruns, schedule delays, and weak control mechanisms continue to hinder construction project delivery in Saudi Arabia, where 64% of projects exceeded their planned time and 53% experienced cost overruns. Although project control systems (PCSs) have received increasing attention, existing research lacks an empirically grounded and theory-informed framework explaining how project control system determinants (PCSDs) influence performance. This study addresses this gap by developing and testing an Input–Process–Output (IPO) model linking organisational, human, and technological inputs with operational control stages and project outcomes. Data were collected from 222 completed construction projects in Saudi Arabia using a cross-sectional survey of professionals directly involved in their delivery. Partial Least Squares Structural Equation Modelling (PLS-SEM) was applied to test hypothesised relationships, supported by Importance–Performance Map Analysis (IPMA) to identify high-impact but underperforming areas. Seventeen of twenty hypotheses were supported, highlighting the dominant role of post-operational controls, the significant indirect influence of in-operational controls, and the most impactful total effects of organisational factors on project performance through control processes. The IPMA results identified leadership and team capacity, estimation accuracy, stakeholder integration, PMO engagement, audits, knowledge management, and corrective scheduling actions as priority areas for improvement. This study provides the first empirical tests of a multi-dimensional PCS effectiveness model in the region, contributing both to the academic literature and practical efforts aimed at improving project delivery outcomes in alignment with national development goals, such as Saudi Vision 2030. Full article