Search Results (32,582)

Background/Objectives: To evaluate the effectiveness of expectant management on grades 1 and 2 cervical intraepithelial neoplasia (CIN), including factors associated with regression and progression. Methods: This multicenter study included 561 women managed expectantly and 359 who underwent immediate surgery at eight institutes between 2013 and 2023. Results: Over a 4-year period, 63% and 68% of CIN 1 and CIN 2 cases regressed, and 9% and 14% of cases progressed, respectively. The median regression times were 1.5 years for CIN 1 and 1.2 years for CIN 2. High-risk human papillomavirus (HPV) types, especially HPV 58 (adjusted hazard ratio [HR]: 0.61; p = 0.032) and high-grade initial cytology, atypical squamous cells—cannot exclude high-grade squamous intraepithelial lesion (ASC-H) and high-grade squamous intraepithelial lesion (HSIL) (adjusted HR: 0.3, p < 0.001), were associated with a lower likelihood of regression. Also, hematological disorders reduced the likelihood of regression (adjusted HR 0.39, p = 0.045). In a separate analysis of the immediate surgery group, age in the 30s (p = 0.016) and HPV 16 infection (p = 0.005) were associated with pathologic upgrading at surgery. Conclusions: CIN 1 and 2 usually regress, allowing expectant management for up to 1.5 and 1.2 years, respectively. However, HPV 58 infection or high-grade initial cytology, and hematological disorders are indications for careful monitoring. Patients in their 30s or infected with HPV 16 have a higher risk of pathologic upgrading at surgery. Full article

Participatory Guarantee Systems (PGS) have emerged in Latin America as an alternative to conventional market-driven certification, offering a community-based framework to validate sustainable agricultural and social practices. Rooted in collective responsibility and dialogue between producers, consumers, non-governmental organizations (NGOs) and state institutions, PGS aim to empower smallholders by reducing certification costs and strengthening agroecological transitions. This review examines their development across diverse Latin American contexts, highlighting both their innovative potential and the persistent challenges that limit their scalability and formal recognition. A literature-based approach combined with a stakeholder analysis was employed, integrating case studies from Brazil, Peru, Mexico, Bolivia, and other countries. To systematize findings, SWOT (Strengths, Weaknesses, Opportunities, Threats) and TOWS (Threats, Opportunities, Weaknesses, Strengths) frameworks were applied, assessing strengths and weaknesses from the perspective of producers and consumers and formulating strategies to enhance resilience and legitimacy. Results show that PGS foster social capital, technical learning, and access to local markets; however, they are constrained by high time commitments, reliance on voluntary labour, uneven participation, and limited consumer awareness. The analysis indicates that the most promising pathway is a combination of growth strategies, including leveraging short supply chains, community-based fairs, and digital platforms, with recovery strategies centred on consumer education and producer capacity building. More conservative strategies remain crucial in specific contexts: redistributing workloads, introducing compensation for administrative tasks, and strengthening conflict mediation can help preserve system viability when engagement or resources are scarce. Defence strategies, aimed at reinforcing autonomy and reducing dependence on external actors, are better conceived as long-term goals under current conditions. Full article

Postoperative venous thromboembolism (VTE) after minimally invasive surgery (MIS) for gynecologic malignancy is uncommon. Our objective was to characterize the rates and identify risk factors of postoperative VTE. A retrospective cohort study of patients undergoing MIS for gynecologic malignancy at three Canadian institutions from 2014 to 2020 was performed. The primary outcome was incidence of VTE within 90 days post-operatively. Descriptive statistics were used for clinicopathologic factors, and univariate analysis compared differences between groups. Rate and 95% confidence interval for VTE per 1000 surgeries were calculated. A total of 1786 patients met inclusion criteria, 85.3% uterine, 11.5% cervical, and 2.3% had ovarian cancer. Modes of surgery included robotic (49.4%), laparoscopic (20.7%), or combined laparoscopic/vaginal (29.9%). There were 15 VTE events at 90 days post-operatively (0.84%). Rates of VTE were lowest in patients who underwent robotic surgery, followed by combined laparoscopic/vaginal, and highest in a laparoscopic approach (p = 0.047). Pelvic lymphadenectomy (p = 0.038) and adjuvant chemotherapy (p = 0.022) were the only significant factors associated with risk of VTE. The incidence of VTE after MIS for gynecologic malignancy is low. Robotic surgery was associated with a lower incidence, although event rates are low, and further research is warranted. Full article

The digital economy plays a transformative role in enhancing energy efficiency and promoting sustainable development globally. As a key manifestation of digital governance, e-government has emerged as a vital instrument for accelerating the digital transformation of public administration and modernizing governance systems. This study examines the impact of digital governance on urban energy efficiency by analyzing China’s E-Government Pilot City (EPC) policy as a quasi-natural experiment. Using a Difference-in-Differences (DID) approach and balanced panel data from 282 prefecture-level cities (2006–2020), we find that the EPC policy significantly improves total factor energy efficiency (TFEE) by an average of 2.60%. Mechanism analyses reveal that digital governance enhances energy efficiency through industrial structure upgrading, green technology innovation, and foreign direct investment attraction. Heterogeneity analyses indicate that the policy’s benefits are more pronounced in larger, non-resource-based, and non-old industrial base cities, as well as in regions with stronger institutional environments and advanced digital infrastructure. However, spatial spillover effects suggest that while the EPC policy boosts local energy efficiency, it may inadvertently reduce efficiency in neighboring areas due to competitive dynamics and industrial relocation. These findings underscore the importance of tailored and coordinated policy designs to maximize the energy efficiency benefits of digital governance. Full article

Objectives: This study employs structural equation modeling to investigate the health status of clinicians in tertiary medical institutions and its influencing factors. Methods: A questionnaire-based survey was conducted on 743 clinicians from five hospitals selected through random sampling, collecting data on their physical health, mental health, social health, and overall health. The analysis examined influencing factors and their interrelationships. Results: The results revealed significant differences (p < 0.001) in physicians’ scores across physical, mental, social, and overall health, with mental health scoring the lowest (58.85). Factors such as age, years of service, professional title, medical conditions, sleep duration, and exercise duration were significantly associated with clinicians’ health status. Among the 108 physicians (14.5%) diagnosed with medical conditions, mental health scores were significantly lower (p < 0.05). Clinicians aged 25~45 years, with 4~10 years of experience, and holding the title of Associate Chief Physician generally scored lower. Physicians with longer sleep duration and exercise duration scored higher in mental and social health. Structural equation modeling analysis revealed that physical health is significantly and positively related to social health (p < 0.001). Good physical health is positively related to positive emotions and negatively related to negative emotions. Social support is positively correlated with cognitive function and negatively correlated with negative emotions; meanwhile, enhanced social adaptation shows a significant positive association with both cognitive function and emotional state. Conclusions: This study recommends paying particular attention to the health status of clinicians, especially the mental health of young physicians. It is suggested that comprehensive interventions be implemented across the three dimensions of physical, social, and psychological to enhance psychological resilience and perceptions of well-being. Full article

Background and Objectives: Schizophrenia is associated with a 15–20-year reduction in life expectancy, with cardiovascular disease as the leading cause. Sudden unexpected death is common in this population, often linked to structural heart disease, antipsychotic use, and overlapping cardiometabolic, autonomic, and drug-related factors. This study aimed to determine the incidence and causes of sudden unexpected death among schizophrenia inpatients between 2014 and 2024 and compare these findings with historical data from the same institution. Materials and Methods: We conducted a retrospective cohort study of schizophrenia inpatients admitted from January 2014 to December 2024. Hospital records were reviewed to identify sudden and unexpected deaths, verified by the Forensic Medicine Service Brașov. Sudden death was defined as death in an asymptomatic patient or within one hour of new symptom onset, excluding suicide, homicide, or accidental overdose. In accordance with Romanian legislation, an autopsy was performed in every case. Results: Over the 10-year period, six schizophrenia inpatients (mean age 53.2 ± 17.8 years) died suddenly. All had long-standing schizophrenia (mean illness duration 28.7 ± 17.7 years) and were receiving second-generation antipsychotics. Cardiovascular comorbidity was present in three cases. All patients received antipsychotic treatment within 24 h before death. No deaths occurred within the first 24 h of admission; one occurred within 48 h. Compared with the 1989–2013 cohort, which included 57 sudden deaths, the incidence during 2014–2024 declined substantially (0.27% vs. 0.79%). Conclusions: The incidence of sudden unexpected death among schizophrenia inpatients declined significantly over the past decade compared with the 1989–2013 cohort, reflecting improved multidisciplinary care, prompt transfer to general hospitals, and wider use of second-generation antipsychotics. Autopsy findings emphasize the continuing importance of cardiovascular disease and airway obstruction as preventable causes of sudden death in this population. Full article

Background: Gender-diverse populations in India, including transgender and non-binary individuals, experience systemic barriers to healthcare, with dentistry remaining particularly underexplored. Despite legislative protections, oral health professionals (OHPs) often lack the knowledge, sensitivity, and preparedness needed to provide inclusive care. This study aimed to benchmark gender sensitivity, inclusivity, and clinical preparedness of Indian OHPs using the novel Oral Healthcare Professional’s Gender Sensitivity, Inclusivity, and Preparedness (OHP–GSIP ©) tool. Methods: A descriptive cross-sectional survey was conducted among 3660 registered dental practitioners across six zones of India using probability proportional to size sampling. The prevalidated OHP–GSIP © scale assessed five domains: gender sensitivity, inclusive environments, diversity in practice, professional attitudes, and preparedness for transgender oral healthcare. Data were collected through a structured online questionnaire and analyzed with SPSS 17.0 using descriptive statistics, chi-square tests, correlation matrices, and multiple regression. Results: Participants demonstrated moderate LGBTQIA+ knowledge (mean = 6.52/10, SD = 1.78) and comfort in treating transgender patients (mean = 3.81/5, SD = 1.09). Structural inclusivity was limited: only 23.5% reported gender-neutral restrooms, and 17.5% used non-binary intake forms. Over 90% expressed willingness to employ or collaborate with transgender colleagues, though this did not significantly predict clinical comfort. Regression analysis showed inclusivity in practice (β = 0.38, p < 0.001), awareness of gender-affirming clinics (β = 0.29, p < 0.001), and LGBTQIA+ knowledge (β = 0.22, p < 0.001) as the strongest predictors of comfort in treating transgender patients, collectively explaining 41% of the variance. Conclusion: While Indian OHPs displayed generally supportive attitudes toward transgender individuals, substantial gaps persist in structural inclusivity, clinical preparedness, and knowledge. Bridging these gaps requires systemic reforms in dental education, policy, and practice environments. The OHP–GSIP © tool provides a benchmark for guiding curricular integration, institutional inclusivity, and policy advocacy toward equitable, gender-affirming oral healthcare. Full article

Background/Objectives: Extra virgin olive oil (EVOO) exhibits potent antioxidant and anti-inflammatory properties. Recent findings from our Institute indicate that its bioactive compounds enhance lipid metabolism, suggesting EVOO as a promising nutritional intervention for hyperlipidemic patients. This clinical study aimed to evaluate the effects of EVOO consumption on vascular endothelial function and hemodynamic parameters in hyperlipidemic individuals, while comparing two EVOO types differing in polyphenol content and dosage. Methods: This post hoc analysis included 70 participants: 50 patients with hyperlipidemia and 20 healthy controls. All participants consumed EVOO daily for four weeks. Hyperlipidemic patients were randomized into two subgroups: one receiving high-phenolic EVOO at a low dose and another receiving low-phenolic EVOO at a high dose, ensuring equivalent total polyphenol intake. Vascular endothelial function, assessed via near-infrared spectroscopy (NIRS), served as the primary endpoint, while arterial blood pressure and heart rate were secondary endpoints. Statistical analyses employed mixed linear models. Results: Hyperlipidemic patients exhibited significant improvements in endothelial function, with increased reperfusion rate (p = 0.010) and oxygen consumption rate (p < 0.001) compared to controls. Reductions in maximum hyperemia time (p = 0.004) and hyperemia recovery time (p < 0.05) further indicated enhanced vascular function. Diastolic blood pressure (p = 0.007) and heart rate (p = 0.004) decreased significantly. Among subgroups, high-phenolic EVOO at lower doses was more effective in reducing systolic blood pressure (p = 0.049) and improving reperfusion rate (p = 0.049). Conclusions: EVOO consumption improved endothelial function and hemodynamic parameters in hyperlipidemic patients, with high-phenolic EVOO demonstrating superior vascular benefits at lower doses. Full article

This paper presents a concept for a Learning Factory (LF) designed for interdisciplinary engineering education. Learning factories are experiential learning environments that bridge the gap between theory and practice while supporting the demands of digital transformation. The proposed LF concept was developed using an integrated approach that assessed stakeholder needs and reviewed institutional infrastructure and capacity. These inputs were triangulated into a concept consisting of five core thematic components: Lean processes as an educational anchor, Enterprise Resource Planning (ERP) systems, Internet of Things (IoT)-based integration, simulation, and physical prototyping. Validation workshops with Small- and Medium-sized Enterprise (SME) managers, academic experts, and students confirmed the perceived relevance of this structure and its potential. The resulting concept focuses on practice-orientated, team-based learning methods that are in line with the principles of Education 4.0. The design sets goals in four key dimensions: educational integration, technological readiness, industrial relevance with SME orientation and flexibility and scalability. These design principles and practical insights can be utilized for future academic implementations of learning factories. Full article

Background: Large-volume paracentesis (LVP) of the peritoneal and pleural cavities is a common diagnostic and therapeutic intervention in patients with liver cirrhosis or advanced heart failure, which are both frequently associated with ascites or pleural effusion. Although generally regarded as a low-risk procedure, LVP may lead to complications such as intrapleural or intra-abdominal hemorrhage, and more commonly abdominal wall bleeding, as well as organ puncture and infection. Performing LVP in patients with coagulopathy or bleeding disorders, whether disease-related or due to anticoagulant therapy, poses a significant clinical challenge. The safety thresholds for such procedures remain inconsistent, and strategies to mitigate bleeding risk are still debated among professional societies. Methods: This review integrates institutional experience with a systematic synthesis of the current international literature to identify the safest and most effective approaches for performing LVP in patients with coagulopathy. The methodological framework included a comparative analysis of existing professional guidelines, as well as a critical evaluation of published evidence regarding risk stratification, pre-procedural correction strategies, and peri-procedural management. The evidence grading was assessed with the STAIR checklist. Results: Analysis of the evidence revealed substantial variability among professional recommendations concerning acceptable platelet and INR thresholds, as well as differing approaches to the management of patients receiving anticoagulant or antiplatelet therapy. Despite these discrepancies, the aggregated data support the conclusion that LVP can be performed safely in most patients with mild-to-moderate coagulopathy, provided that appropriate risk assessment and technical precautions are implemented. Conclusions: The resulting evidence-informed suggestions provide a practical framework for clinicians performing LVP in high-risk patients. By emphasizing systematic pre-procedural evaluation, individualized management of coagulopathy, and adherence to standardized procedural techniques, this work aims to promote safety, consistency, and confidence in the performance of large-volume paracentesis across diverse clinical settings. Full article

Corporate Social Responsibility (CSR) is a critical pillar of sustainable business, yet powerful market forces often influence its adoption. This study investigates the complex interplay between market concentration—specifically, a firm’s reliance on major customers—and its commitment to CSR in the unique context of an emerging market. Drawing on stakeholder, agency, and resource dependence theories, we argue that high customer concentration (CC) creates a power asymmetry, pressuring firms to prioritise the short-term financial demands of key buyers over long-term societal investments. Analysing a decade of data from the Tehran Stock Exchange, our findings confirm that CC significantly erodes CSR engagement. More intriguingly, we challenge the conventional view of institutional investors as uniform champions of sustainability. Instead, we find that their moderating role is contingent upon certain conditions. Under extreme customer dependence, institutional ownership may paradoxically exacerbate the negative impact on CSR, potentially due to heightened pressure for short-term financial performance. This research contributes to the literature on sustainable business administration by demonstrating that governance mechanisms do not operate in a vacuum but are shaped by underlying market structures. For policymakers and managers, our results underscore the need for strengthened governance and incentives that safeguard sustainability commitments against the pressures of concentrated buyer power, particularly in emerging economies. The study underlines that achieving sustainability goals requires a nuanced understanding of the market environments in which firms operate. Full article

Background/Objectives: The global shortage of healthcare professionals has exacerbated ethical and organizational challenges that threaten the sustainability of health systems. High turnover rates, combined with the emigration and attrition of qualified nurses, make it essential to understand how institutional factors affect professional well-being and workforce retention. This essay examines how organizational ethics—particularly ethical climate, organizational justice, and ethical leadership—influence healthcare professionals’ experiences and their intentions to remain in or leave the sector. Methods: The discussion adopts a conceptual and reflective approach, drawing on key theories and empirical findings from the literature on organizational ethics and turnover. It explores the relationships between ethical environments, professional recognition, and moral well-being within healthcare organizations. Results: Evidence suggests that ethical and fair organizational climates strengthen trust, professional commitment, and long-term retention. Conversely, perceptions of injustice, lack of recognition, or moral distress tend to increase dissatisfaction and the intention to leave the profession. Conclusions: The essay underscores ethics as a central component of workforce sustainability in healthcare and calls for leadership and policy actions that move beyond individual coping strategies toward systemic ethical practices promoting fairness, recognition, and well-being at work. Full article

Island ecosystems, are characterized by isolation, limited land, and tourism-driven economies, face persistent waste management challenges. Spatial constraints and inadequate infrastructure often limit the development of waste recovery and recycling systems, leading to practices such as open dumping or burning that pose serious environmental and health risks. This paper examines how circular economy (CE) principles, reduce, reuse, recycle, can transform waste into a resource and enhance local resilience. A refined definition of “small islands” is introduced, combining UN criteria with a tourism-intensity filter to capture the strong link between visitor flows and solid waste generation. Barriers to CE adoption are classified into institutional, technical, geographical, financial, and social dimensions, and connected to enabling practices in four thematic areas: multi-stakeholder partnerships, recycling and composting innovations, policy and regulatory tools, and community engagement. Comparative case studies from Europe, Asia, Africa, and the Pacific reveal that integrated approaches are more durable than isolated efforts. Successful initiatives blend technology with governance, education, financial mechanisms, and community participation. The analysis highlights that no single model fits all islands; strategies must be locally adapted to be effective and transferable. Overall, the study shows that circular transitions are both feasible and necessary, offering environmental gains, economic value, and alignment with the EU Green Deal and global sustainability goals. Full article

This study reconceptualizes resilience by centering marginalized teachers’ agentic resistance as a critical pathway to wellbeing. Using critical qualitative inquiry, we conducted in-depth interviews with 17 U.S. teachers who identified with marginalized racial, gender, and/or sexual identities to explore how they resist structural oppression and sustain their professional and personal identities. Findings revealed that resistance emerged in various ways, including inclusive curriculum design, confrontation with colleagues or administrators, embodied identity expression, and support drawn from contexts and resources for resistance. These resources included social movements and ancestors’ legacies, demonstrating that resistance is not merely individual coping but a collective, identity-affirming practice. We argue that resilience must be reframed to include intentional and proactive resistance, which enables marginalized teachers to challenge oppressive school structures, promote educational equity, and sustain their own flourishing. This study offers a critical framework that shifts resilience from passive endurance to politically engaged practice, emphasizing the need for institutional supports that empower marginalized teachers to resist, persist, and thrive in inequitable educational systems. Full article

This article examines the institutional reliability of expert evidence in construction litigation in England and Wales. Drawing on doctrinal analysis, practitioner interviews, and comparative evaluation of Australia, Singapore, and international arbitration, it argues that reliability should be understood not as an ethical virtue of individual experts but as a systemic property of evidentiary governance. Despite the procedural safeguards of Part 35 of the Civil Procedure Rules, expert independence remains undermined by adversarial incentives, methodological inconsistency, limited judicial capacity, and weak enforcement. Comparative models demonstrate that concurrent evidence, expert accreditation, and structured judicial oversight can effectively realign procedural incentives with epistemic integrity. The article proposes four interdependent reforms—accreditation, methodological standardisation, judicial capacity-building, and feedback-based oversight—to embed reliability as a procedural norm within the Technology and Construction Court. By reframing reliability as an institutional obligation rather than a moral aspiration, the study contributes to wider debates on evidentiary governance, procedural justice, and the regulation of expertise in technologically complex adjudication. Full article