Search Results (10,046)

The continuing proliferation and diversification of management system standards (MSSs) intensify the need for integration approaches that extend beyond common clause structures, aligned documents, and combined audits. Organizations increasingly manage requirements concerning quality, environment, occupational health and safety, energy, information security, business continuity, compliance, innovation, asset management, artificial intelligence, and sustainable development. Although the ISO Harmonized Structure improves formal compatibility, it does not itself provide the managerial logic needed to reconcile competing objectives and embed heterogeneous requirements in organizational processes. For organizations operating a management system against two or more MSSs, this conceptual paper argues that quality, understood not as one standardized subsystem but as a logic of quality-oriented governance, provides a foundation for such integration. Based on a structured conceptual synthesis of 53 academic and authoritative sources, this paper combines IMS research with systems theory, institutional decoupling, organizational capability, and excellence-model perspectives. It distinguishes formal integration from functional integration and introduces system coherence/reduced suboptimization as an explicit explanatory mechanism between the degree of management system integration and organizational performance. Quality culture and the process approach are conceptualized as complementary expressions of quality-oriented governance; the process approach also has a dual role as both an antecedent of integration and a construct shaped by quality culture. The model further recognizes partial mediation, contextual moderation, and diminishing returns when additional integration generates coordination costs or bureaucracy. Construct boundaries, composite versus reflective specifications, and organizational-level aggregation requirements are clarified to support future empirical validation. The proposed framework explains how quality-oriented governance can translate a growing portfolio of MSS and sustainability requirements into coherent routines, reduce the risk that improvement of individual subsystems undermines the whole, and support sustained organizational success. Full article

Eco-anxiety, commonly known as distress relating to perceived climate and ecological crises, is increasingly reported among young people, particularly in high-income and highly climate-exposed contexts such as Australia and other OECD countries. While empirical research on eco-anxiety has expanded rapidly, the underlying conceptual and theoretical frameworks remain fragmented, with limited consensus on definitions, mechanisms, and normative implications. This systematic conceptual review synthesises and critically evaluates the theoretical and conceptual models used to study eco-anxiety and related constructs among young adults in Australia and across OECD nations. By conducting a systematic search of multidisciplinary databases, the paper explores English-language studies published up to March 2026 that explicitly applied, developed, or implied conceptual frameworks of eco-anxiety or climate change anxiety in young adult samples. A broad array of models are grouped into a typology of seven families: (1) clinical and psychopathology-oriented models, (2) environmental attitudes and concern models, (3) risk perception and appraisal models, (4) existential and phenomenological frameworks, (5) socio-ecological and political-economy models, (6) coping and resilience frameworks, and (7) integrative and emergent eco-anxiety-specific frameworks. Across these families, eco-anxiety is variously conceptualised as a maladaptive symptom, a rational moral emotion, a driver of climate engagement, or a sociopolitical affect rooted in structural injustice. Major gaps include conflicting definitions, limited attention to developmental specificity in young adulthood, sparse cross-cultural and Indigenous perspectives in the Australian context, and insufficient theorisation of digital media, colonial histories, and policy in shaping eco-anxiety. The paper proposes a novel conceptual typology that locates eco-anxiety at the intersection of emotional, cognitive, relational, and sociopolitical processes. A future research trajectory underpinned by pragmatic theoretical bases that prioritise pluralistic, context-sensitive models and mixed-methods designs is suggested. Implications for measurement, intervention, and climate and mental health policy are discussed, with particular attention to young adults in Australia and OECD settings. Full article

Background/Objectives: Chronic venous disease significantly impairs health-related quality of life (HRQoL). Although the Chronic Venous Insufficiency Questionnaire (CIVIQ-20) is widely used internationally, a validated Arabic version is lacking. The objectives of this study were to translate and culturally adapt the CIVIQ-20 into Arabic and to examine its reliability, construct, and discriminative validity in Arab patients with chronic venous disease. Methods: Following standardized guidelines, the CIVIQ-20 was translated and cross-culturally adapted. For psychometric evaluation, 139 participants with chronic venous disease were selected. They completed the Arabic version of Chronic Venous Insufficiency Questionnaire-20 (CIVIQ-20-Ar) and 36-Item Short Form Health Survey (SF-36). Psychometric evaluation included internal consistency (Cronbach’s alpha) and test–retest reliability using the two-way random intraclass correlation coefficient ICC _(2,1). Minimal detectable change (MDC₉₅) was assessed, along with both convergent validity (using the SF-36 as a comparator) and known-group validity (across CEAP severity stages), using seven predefined hypotheses. Results: The CIVIQ-20-Ar questionnaire had adequate internal consistency and very strong test–retest reliability. As hypothesized, the CIVIQ-20-Ar subscales and global index demonstrated a moderate-to-strong correlation with the SF-36 summary and domain scores (r = −0.42 to −0.79, p < 0.001), with the strongest correlation in the pain subscale (r = −0.79, p < 0.001). Known-group validity was established by significant score discrimination across advancing Clinical–Etiology–Anatomy–Pathophysiology (CEAP) severity stages (p < 0.01). Conclusions: The CIVIQ-20-Ar Questionnaire has adequate psychometric properties. Therefore, vascular surgeons, phlebologists, and rehabilitation specialists can use the CIVIQ-20-Ar in routine clinical practice and research to evaluate health-related quality of life in the Arabic-speaking population with chronic venous disease. Full article

Although the South Asian population in the United States is one of the country’s most rapidly growing ethnic groups, no known studies have established a portrait of the minority stressors experienced by LGBTQ+ individuals in this demographic. Addressing this gap serves to identify if and how their intersectionality is experienced in the form of minority stress, which is an established determinant for their mental health and well-being. Minority stress theory and the subaltern status of sexual and gender minorities common in South Asian cultures offer reasons to expect challenges linked to these specific identities. Using data from a survey of South Asians residing in the United States (n = 101), we examine participants’ range of outness and experiences of discrimination within the LGBTQ+ community and beyond in this descriptive study. Results indicate substantial numbers of South Asian American LGBTQ+ individuals restrict their levels of outness to only close relatives and friends, while most experience challenges due to their sexual/gender identity and their ethnic identity. Perceptions of discrimination based on ethnic identity within and beyond the broader LGBTQ+ community are correlated with more depressive symptoms. We conclude the South Asian American LGBTQ+ population’s experiences reflect a considerable mental health burden, with important clinical implications, requiring future research using representative data at the national level. Full article

Free-living amoebae (FLA) are ubiquitous protozoa with pathogenic potential that also serve as environmental reservoirs for bacteria of public health importance. Owing to the lack of information on their occurrence in Honduras, this study aimed to isolate and characterize FLA from environmental water sources using morphological, molecular, and physiological approaches. A total of 87 water samples collected from domestic tap water, rivers, and outdoor washbasins were analyzed by non-nutrient agar culture, polymerase chain reaction, and 18S rRNA gene sequencing. Overall, 43 samples (49.4%) were positive for FLA, with the highest detection rate observed in domestic tap water (38/69; 55.1%). Molecular characterization of these 43 positive samples yielded 45 isolates in total, as two samples (codes 18.4 and 34.4) each produced two co-occurring but independently culturable isolates belonging to different genera. Of these 45 isolates, Acanthamoeba spp. accounted for 26 isolates (57.8%), predominantly belonging to genotype T4; Vermamoeba vermiformis accounted for 9 isolates (20.0%); and mixed cultures containing both genera accounted for 10 isolates (22.2%). A subset of Acanthamoeba isolates exhibited thermotolerance at 42 °C (7/26; 26.9%), with three isolates remaining viable at 45 °C, while most tolerated 0.5 M mannitol, and 57.7% retained viability at 1 M, characteristics commonly associated with pathogenic potential. To the best of our knowledge, this study constitutes the first report of free-living amoebae in environmental water sources in Honduras and provides an important baseline to strengthen water quality surveillance to mitigate potential public health risks. Full article

Background/Objectives: Migrants often experience health inequities resulting from administrative insecurity, precarious employment, and barriers to healthcare access. Although non-metropolitan areas are increasingly important destinations for migrant populations, evidence on their health experiences in these settings remains limited. This study aimed to examine how migrants living in non-metropolitan areas of Spain experience health throughout the migration process and to identify implications for nursing practice and health policy. Methods: A qualitative phenomenological design was used to explore migrants’ lived experiences. Twenty-two adult migrants living in the Spanish provinces of Zamora and León participated in semi-structured, in-depth interviews. Data were analyzed using thematic analysis following Braun and Clarke, and the study adhered to the Consolidated Criteria for Reporting Qualitative Research (COREQ). Results: Five interconnected themes emerged: migration process, health perceptions, social networks, work conditions, and adaptation and integration. The central finding, “Health as Work”, revealed that participants primarily understood health as the ability to work and maintain economic stability rather than as a state of physical or mental well-being. This perspective reflected broader structural vulnerability arising from administrative insecurity, precarious employment, and limited social support. Nurses and third-sector organizations were identified as essential in facilitating healthcare navigation, promoting health literacy, and providing psychosocial support. Conclusions: Migrants’ health experiences in non-metropolitan Spain are shaped by structural vulnerability, with employment and legal status strongly influencing health and access to care. Nursing practice should integrate culturally responsive and structurally informed care, while health policies should reduce administrative and employment barriers and strengthen collaboration between healthcare services and community organizations to promote health equity. Full article

Although infertility is a serious reproductive health issue that affects both individuals and couples, prior studies have mostly examined the experiences of women, frequently ignoring the psychological and spiritual difficulties that men face. In many African contexts, fatherhood is tightly linked to masculine identity and community belonging, making infertile men susceptible to social marginalisation and humiliation. Men may be further deterred from talking about infertility or seeking help by cultural norms. Through an interdisciplinary analysis of the literature on African masculinities, reproductive health, theology, and stigma theory, this paper investigates the relationship between African men’s religious communities, masculine identity, and infertility stigma. The essay explores how cultural and religious narratives influence men’s experiences with infertility and makes the case that religious communities can offer chances for pastoral care, emotional support, and more inclusive conceptions of masculinity in addition to reinforcing pronatalist expectations that fuel the stigma associated with infertility. Full article

Background/Objectives: The early postoperative stress hyperglycemia ratio (SHR) may capture acute glycemic stress relative to chronic glycemia, but its association with infection-related events after cranial neurosurgery remains uncertain. We evaluated these associations in critically ill patients after cranial neurosurgical procedures. Methods: We retrospectively analyzed 1408 adults in MIMIC-IV after eligible cranial neurosurgical procedures. SHR was calculated from the first serum glucose measurement 6–24 h after surgery and estimated average glucose was derived from HbA1c. Primary outcomes were electronic health record (EHR)-defined suspected infection, culture-positive infection from any qualifying specimen, Sepsis-3-defined sepsis, and an EHR-based septic shock proxy. The secondary outcome was 90-day mortality. Results: In fully adjusted models, each 0.1-unit increase in SHR was associated with suspected infection (OR 1.08, 95% CI 1.04–1.12), culture-positive infection (OR 1.05, 95% CI 1.01–1.09), Sepsis-3-defined sepsis (OR 1.07, 95% CI 1.03–1.11), and septic shock (OR 1.10, 95% CI 1.05–1.15). In nested analyses, each 1-SD increase in SHR was associated with 90-day mortality (OR 1.59, 95% CI 1.29–1.96). Associations persisted in 24-h lag analyses. Adding SHR yielded small, non-significant AUC increases but improved reclassification for Sepsis-3-defined sepsis and septic shock. Conclusions: Higher early postoperative SHR was associated with EHR-derived, all-source infection-related and sepsis-related events and 90-day mortality in a heterogeneous postoperative neurocritical care cohort. These findings do not establish that SHR predicts postoperative neurosurgical infection; prospective external validation is required before clinical use. Full article

Background: Cervical cancer remains an important preventable cause of morbidity and mortality among women in Kazakhstan. Reliable assessment of beliefs related to cervical cancer screening requires instruments that are linguistically and culturally appropriate for the target population. This study aimed to cross-culturally adapt the CCS-HBMS for bilingual Kazakh–Russian administration and to evaluate the preliminary psychometric properties of this bilingual administration format. Methods: An exploratory cross-sectional psychometric study was conducted among 199 women aged 20–60 years attending primary healthcare facilities in Astana, Kazakhstan. The 35-item CCS-HBMS underwent forward and back translation, expert review, and pilot testing and was administered in a simultaneous Russian–Kazakh bilingual format. Psychometric analyses were performed in 196 participants with complete responses to all 35 items. Internal consistency was assessed using Cronbach’s alpha, and structural validity of the original five-factor model was evaluated using confirmatory factor analysis (CFA) with the weighted least squares mean- and variance-adjusted estimator. Exploratory factor analysis (EFA) was subsequently conducted because of inadequate CFA model fit. Composite reliability (CR), average variance extracted (AVE), and the heterotrait–monotrait ratio (HTMT) were also examined. Results: Internal consistency varied across the five original subscales, with Cronbach’s α ranging from 0.481 to 0.827. Reliability was highest for Barriers (α = 0.827) and Benefits and Health Motivation (α = 0.804), followed by Susceptibility (α = 0.725), whereas lower values were observed for Seriousness (α = 0.662) and Health Motivation (α = 0.481). The original five-factor CFA model showed inadequate fit (χ²(550) = 1952.71, p < 0.001; CFI = 0.751; TLI = 0.731; RMSEA = 0.114, 90% CI 0.109–0.120; SRMR = 0.137). Parallel analysis supported retention of six factors. The six-factor solution showed lower residual misfit than the original five-factor solution (RMSR = 0.045 vs. 0.055). Given the redistribution of items across factors and the exploratory nature of these analyses, no definitive alternative factor structure was established. Convergent validity was strongest for Susceptibility (CR = 0.766; AVE = 0.523), while weaker evidence was observed for Seriousness and Health Motivation. Conclusions: The original five-factor structure of the CCS-HBMS was not supported in the present exploratory bilingual sample, and only two of the five original subscales showed Cronbach’s alpha values above 0.80. Exploratory analyses suggested a different dimensional organization but did not establish a definitive alternative factor structure. These findings should be interpreted as preliminary evidence regarding the bilingual administration format rather than as separate validation of the Kazakh- or Russian-language versions, and further evaluation in larger, more diverse, and independent samples is required. Full article

Light is a critical environmental factor in aquaculture, directly or indirectly regulating the growth, reproduction, body coloration, and biological rhythms of cultured animals. However, in koi farming, spectral composition is often overlooked or arbitrarily selected. This study aimed to evaluate the effects of different LED spectra (red light “RL”, blue light “BL”, yellow light “YL”, white light “WL”) and natural light (NL) on the growth performance, body coloration, and underlying molecular regulatory mechanisms of all-red koi (Cyprinus carpio var. koi). The results showed that WL treatment significantly suppressed the weight gain rate and specific growth rate of koi. After 60 days of BL exposure, the condition factor significantly increased, whereas YL, WL, and RL led to varying degrees of reduction. In terms of body color, BL significantly increased skin lightness (L* value) and promoted the deposition of lutein and β-carotene in the skin, while upregulating the expression of pigmentation-related genes such as gch (GTP cyclohydrolase), scarb (Scavenger receptor class B), oca2 (Oculocutaneous albinism II), and xdh (Xanthine dehydrogenase). Meanwhile, the calcium signaling, MAPK signaling, and TGF-β signaling pathways were activated, synergistically mediating light adaptation, metabolic regulation, and pigmentation. However, chronic or excessive BL irradiation exacerbated dermal loosening and vacuolation, decreased a* and b* values, and was thus unfavorable for color maintenance. In contrast, long-term exposure to RL and WL tended to inhibit growth and cause dermal tissue loosening, whereas YL was relatively beneficial to fish health but had limited color-enhancing effects. Overall, BL is the optimal spectrum for short-term (30–60 days) color enhancement, and long-term exposure to RL and WL should be avoided. In practical production, a cyclic lighting regimen is recommended, i.e., short-term BL for color enhancement followed by recovery under NL or YL. This study provides an important theoretical basis for optimizing the light environment for koi culture, improving the quality of ornamental koi, and enhancing aquaculture production efficiency. Full article

Bike-Sharing Systems (BSS) are increasingly viewed as a sustainable and flexible component of urban mobility, particularly in rapidly growing cities such as Casablanca. The effectiveness of such systems depends, critically, on strategic planning decisions, most notably the number and location of stations. This study proposes a spatially explicit modeling framework to support the design of a BSS network based on urban demand characteristics. Ten categories of urban attractors are identified and grouped into four main criteria: socioeconomic activities; education, culture, and health; leisure spaces; and public mobility hubs. A modified Huff model is used to estimate the spatial distribution of potential demand and to identify candidate locations for bike-sharing stations. Walking accessibility is represented by shortest-path distances on the pedestrian network. Building on these demand estimates, the station deployment problem is formulated as a minimum set covering location problem whose objective is to determine the smallest number of stations required to cover a predefined proportion of total mobility demand within a 1000 m walking-network distance. Coverage is constrained separately for each arrondissement, while stations located near administrative boundaries may serve demand in neighboring arrondissements. At the baseline $\gamma =0.5$, the model selects 45, 70, and 154 stations for coverage targets of 60%, 80%, and 100%, respectively. The proposed approach provides a systematic and data-driven basis for BSS planning and helps integrate bike sharing into a more efficient, environmentally sustainable, and multimodal urban mobility system in Casablanca. Full article

The freshwater sleeper (Odontobutis potamophilus) is a high-value freshwater fish endemic to China, farmed mainly in rice–crayfish–Odontobutis potamophilus integrated culture (RCO) and recirculating aquaculture systems (RAS). How these models differ in growth, physiological status, and feeding remains unclear. The same batch of fry was reared for three months (92 days) in six paddy fields (RCO, 3 individuals/m², no artificial feed, with access to natural food organisms and stocked crayfish) and six RAS tanks (6 individuals/m², fed Cirrhinus molitorella and pellet feed twice daily). Growth indicators were calculated from individual data of the sampled fish (n = 138 per model). Per group, 150 fish were sampled for stomach contents, 138 for morphometrics, and six for serum alanine aminotransferase (ALT), glutamic–oxaloacetic transaminase (AST), and glucose (GLU) assays; muscle nutritional composition was also determined. Relative weight gain rate (RWG) and specific growth rate in wet weight (SGRw) were significantly higher in RAS, with positive allometric growth in both models. Muscle crude protein was higher in RCO, whereas crude fat and serum ALT, AST, and GLU levels were higher in RAS, suggesting a heavier metabolic burden on the liver in RAS, which awaits confirmation with a broader panel of liver function markers. RCO stomachs contained nine food categories but had a 38% vacuity rate, whereas RAS fish consumed only C. molitorella (86% occurrence, 14% vacuity). Because stocking density and feeding regimen differed simultaneously between the two models, the observed differences reflect the overall effects of each culture model rather than the effect of the rearing system alone. These findings reveal a growth-metabolism trade-off between the two culture models as currently practiced: RAS produced faster growth accompanied by higher serum transaminase levels and body fat, whereas RCO maintained lower metabolic markers with slower growth. Moderate supplementary feeding in RCO and dietary diversification in RAS may reconcile yield and fish health. Full article

Background/Objectives: The Daily Health Coach (DHC) is a 12-week Instagram-based nutrition and wellbeing programme originally co-designed and tested in New Zealand to deliver evidence-based, weight-neutral content on nutrition, movement, body image, and wellbeing. This formative, mixed-methods adaptation study examined the acceptability of DHC New Zealand content for young Australian women and identified refinements to improve relevance, engagement, and safety before effectiveness evaluation. Methods: Using the CODES framework, we conducted three adaptation phases: user acceptance testing, co-design workshops, and early beta testing. Following data-quality screening, 291 young women aged 18–24 years who completed all 12 survey sections were included in Phase 1. Participants rated 84 Instagram-style posts for understanding and usefulness and provided open-ended feedback. Twelve young women participated in co-design workshops, and seven adapted artefacts were beta-tested with eight target users using cognitive walkthrough and think-aloud methods. Quantitative findings were examined descriptively, with sensitivity analyses undertaken to assess robustness to response-quality and sample-composition concerns. Results: Participant-level mean understanding was 3.99 ± 0.75/5, usefulness was 3.89 ± 0.74/5, and the combined score was 7.87 ± 1.47/10. Post-level combined means ranged from 7.66 to 8.11/10; all 84 posts met a ≥7.5 descriptive benchmark adapted from prior message-testing work, although this is an interpretive aid rather than a validated cut-off. Sensitivity analyses showed a similar overall pattern: ratings were higher in a higher-confidence response-quality sample (n = 199; 8.34 ± 1.20/10), while four posts fell marginally below 7.5 when analysis was restricted to participants not reporting Aboriginal and/or Torres Strait Islander identity (n = 101). Qualitative feedback identified six refinement areas: content features, engagement strategies, clarity, educational accuracy, relevance, and miscellaneous concerns. Co-design and beta testing generated four adaptation priorities: tone, design, engagement, and understanding. Conclusions: DHC New Zealand content was generally well understood and favourably rated but required targeted refinement for the Australian context. Findings provide formative guidance for final adaptation and subsequent effectiveness evaluation. Full article

Background/Objectives: Smartphones used by medical students may serve as reservoirs for microbial contamination and contribute to the transmission of healthcare-associated microorganisms. This study aimed to determine the level of microbial contamination of smartphones, prevalence of methicillin-resistant Staphylococcus species (MRSS), and associated risk factors among undergraduate medical students in Klang Valley, Malaysia. Methods: An analytical cross-sectional study was conducted among students from three public and three private universities using convenience and snowball sampling. Demographic, behavioural, and environmental data were collected via an online questionnaire. Smartphone swabs were cultured to determine total viable count (TVC). MRSS were identified using enrichment and selective culture, Gram staining, 16S rRNA PCR-sequencing, and cefoxitin disc diffusion. Descriptive statistics, Fisher’s exact test, and multivariable binary logistic regression were performed. Results: A total of 148 smartphones were analysed. High microbial contamination (≥13 CFU per smartphone sampling unit, 75th percentile of TVC) was detected in 38 (25.7%) smartphones, while MRSS were recovered from 9 (6.1%) smartphones; all were methicillin-resistant coagulase-negative staphylococci: Staphylococcus epidermidis, Staphylococcus haemolyticus, and Staphylococcus ureilyticus. Male students (adjusted odds ratio [AOR] = 2.497, p = 0.025) and students from public universities (AOR = 2.730, p = 0.016) were more likely to have highly contaminated smartphones. MRSS contamination was associated with high microbial contamination (OR = 12.194, p = 0.001) and those living with elderly individuals (OR = 6.304, p = 0.013). Following the study, participants received their culture results, smartphone hygiene education through a dedicated website, and alcohol swabs as part of a health promotion initiative. Conclusions: This study highlights smartphones as potential fomites for the transmission of antimicrobial-resistant staphylococci. Integrating microbiological surveillance with targeted smartphone hygiene promotion may help reduce microbial contamination and the potential for transmission in healthcare training environments. Full article

Hypertension constitutes a major global public health burden. Although angiotensin-converting enzyme (ACE) inhibitors are beneficial, their adverse effects have prompted the search for safer natural alternatives. ACE-inhibitory peptides have drawn extensive research attention, attributed to their low toxicity and high bioavailability. This article reviews current advances regarding the preparation, separation, purification, and in vitro activity evaluation of these peptides obtained from different marine fish species. Raw material sources are classified into major commercial species and minor or cultured species, highlighting the influence of species and tissue origin on peptide bioactivity. Enzymatic hydrolysis, particularly single-enzyme and dual-enzyme approaches, is the main preparation method. Subsequent separation and purification, involving ultrafiltration, gel filtration chromatography, and reversed-phase high-performance liquid chromatography (RP-HPLC), are crucial for enriching bioactive fractions and identifying novel peptide sequences. Also, the classical hippuryl-histidyl-leucine (HHL)-high-performance liquid chromatography (HPLC) assay remains the standard for the evaluation of in vitro activity using IC₅₀ values. Future work emphasizes integrated in vitro and in vivo validation, AI-assisted screening, and the sustainable utilization of processing by-products to advance marine peptides as novel antihypertensive agents. Full article