World

This study analyses the effects of public hospital mergers in Portugal, particularly the creation of hospital centers, on productivity levels. Grounded in the theoretical frameworks of New Public Management and Efficiency Theory, a Data Envelopment Analysis (DEA) approach, combined with the Malmquist Productivity Index, was used to evaluate performance. Results for the 2013–2015 period show no statistically significant difference in productivity levels between merged hospitals (hospital centers) and non-merged hospitals (hospital units). However, for hospitals merged in 2007, there is evidence of significant productivity gains in the post-merger period (2008–2014). These findings partially support the assumptions of New Public Management and Efficiency Theory concerning efficiency improvements through hospital mergers in the public sector. Full article

In terms of climate change, while tourism’s natural resources may be considered climate vulnerable, a large part of tourism’s primary industries are high carbon consumers. With the growth of worldwide efforts to adopt climate resilience actions across all industries, Destination Management Organizations could become focal points for raising awareness and leadership among local tourism stakeholders. The manuscript communicates a simple, reproducible approach to observing and analyzing climate change at a high territorial granularity to empower local destinations with the capability to disseminate quantifiable information about past, current, and future climate projections. In relation to Slovakia’s 39 local destinations, the approach utilizes six sub-sets of the latest high-resolution Köppen–Geiger climate classification grid data. The main climate categories’ similarity for local destinations was measured across six periods through the Pearson Correlation Coefficient of Pairwise Euclidean Distances between the linkage matrices of hierarchical clusters adopting Ward’s Linkage Method. The Shannon Entropy Analysis was adopted for the quantification of the homogeneity of the DMOs’ main climate categories, and Weighted Variance Analysis was adopted to identify the main climate categories’ weight fluctuations. The current results indicate not only a major shift from destination climates classified as cold to temperate, but also a transformation to more heterogeneous climates in the future. Full article

The healthcare sector significantly impacts environmental sustainability, with nurses contributing to waste and energy use while also being positioned to lead change through sustainable practices. However, only one validated tool, the Nurses’ Environmental Awareness Tool (NEAT), is currently available to assess their environmental awareness. This study aimed to adapt the NEAT into Italian and evaluate its psychometric properties. The Italian version was developed using a five-phase approach, followed by a cross-sectional validation study to assess its validity and reliability. A sample of 382 nurses and nursing students was included. The Italian NEAT demonstrated optimal content and face validity indices, satisfactory goodness-of-fit indices confirming the original six-subscale structure (Comparative Fit Index 0.85–0.92; Tucker–Lewis Index 0.80–0.90; Standardized Root Mean Square Residual 0.05–0.08; Root Mean Square Error of Approximation 0.06–0.14), and good reliability values (Cronbach’s α 0.77–0.90; omega-ω ≥ 0.80). Construct validity results were likewise satisfactory. The participants’ scores suggested limited knowledge but adequate environmental awareness and ecological behaviors. The Italian version of the NEAT is designed for screening purposes, guiding educational interventions, and supporting research in both clinical and academic contexts. By contributing to the advancement of knowledge on sustainability in healthcare, it promotes environmentally responsible practices within the nursing profession. Full article

The increasing waste of agricultural products is a significant threat to food security worldwide, including Iran. The horticultural sector faces a critical challenge with significant fruit waste, particularly apples, occurring at various supply chain stages. Coping with this problem and improving apple waste management at the garden level is important for achieving sustainable agriculture and food security goals. This study aimed to identify the main factors influencing apple waste from the viewpoint of apple gardeners in Tehran province, Iran, which plays a pivotal role in apple production and supplying the fruit to markets nationwide. The statistical population of the study was apple gardeners in Tehran province (N = 9310), out of which 188 people were selected as a sample by applying the Cochran formula. The data were collected through a researcher-made structured questionnaire developed for this study. Personal face-to-face interviews were conducted with the gardeners by adopting a cluster sampling technique. A panel judgment of the faculty members in the Department of Agricultural Management and Development at the University of Tehran confirmed the questionnaire’s validity. Its reliability was confirmed with a Cronbach’s alpha value above 0.7. The collected data were later analyzed by descriptive statistics measures and confirmatory factor analysis in SPSS and Smart PLS software. This study found that inefficient harvesting practices are the primary contributors to apple waste in Tehran, particularly due to improper handling and timing. It highlighted the need for better training, improved harvesting methods, and enhanced infrastructure. Addressing these factors through targeted interventions could significantly reduce apple waste, improving both economic viability and sustainability in the region’s apple production sector. Full article

Saudi Arabia has emerged as a key middle power, leveraging niche diplomacy to expand its global influence. This study examines how the Kingdom strategically employs mediation, religious diplomacy, humanitarian aid, energy leadership, and sports diplomacy to shape regional and international dynamics. Unlike great powers, middle powers focus on specialized areas where they hold a comparative advantage, allowing them to exert influence despite material constraints. Saudi Arabia’s diplomatic recalibration aligns with its Vision 2030 agenda, prioritizing economic diversification, regional stability, and multilateral engagement. Saudi Arabia enhances its geopolitical significance by positioning itself as a mediator in regional conflicts, reinforcing its religious leadership, investing in sports diplomacy, and maintaining energy dominance. This study contributes to understanding middle power strategies in international relations, highlighting Saudi Arabia’s role as a stabilizing force in an evolving global order. Full article

This study addresses a research gap in the organization-based self-esteem (OBSE) literature: the limited integration of sustainability concepts, particularly across environmental, social, and economic dimensions. As the first bibliometric analysis on OBSE, this research systematically reviews 333 publications contained in the Web of Science Core Collection, dated from 1989 to 2024, using VosViewer software version 1.6.20 (0). Citation analysis identifies the most influential authors, institutions, and countries, and assesses the extent to which their work engages with corporate sustainability or sustainable human resource management—encompassing practices that promote social equity, environmental responsibility, and long-term organizational viability. Keyword co-occurrence analysis reveals that sustainability-related concepts are embedded within the OBSE domain to a limited extent. The findings indicate that while the OBSE literature is evolving to incorporate these topics, this integration remains limited and fragmented. Opportunities for further research, particularly on the intersection of OBSE and sustainability practices, are highlighted, as are practical implications for human resource professionals. Full article

Given the increasing complexity of leadership roles in global, sustainability-driven organizations, this study examines whether Hersey and Blanchard’s Situational Leadership Model (SLM) provides a sufficiently comprehensive framework for contemporary leadership demands or requires theoretical and practical modifications. Can SLM, originally designed for adaptability in leader–follower dynamics, effectively integrate sustainability principles such as Environmental, Social, and Governance (ESG) factors; corporate social responsibility (CSR); and ethical governance? How can leadership models evolve to balance immediate responsiveness with long-term resilience and sustainability-driven decision-making? This research systematically evaluates the synthesis of empirical evidence on the application of the SLM across diverse organizational contexts while exploring its alignment with sustainability-focused leadership approaches. The study further investigates the role of Servant Leadership as a conceptual bridge between SLM and sustainability principles, emphasizing its ethical foundation, stakeholder-oriented approach, and long-term commitment to workforce well-being. Findings suggest that while SLM remains a relevant and adaptable framework, it exhibits a deficiency in explicitly addressing the sustainability dimension. However, integrating Servant Leadership’s emphasis on ethical governance and organizational resilience into SLM could enhance its applicability to sustainability-driven leadership models. By addressing these gaps, this study contributes to contemporary leadership theory by proposing an evolved SLM framework that incorporates sustainability-focused leadership competencies. Future research should focus on refining SLM to ensure its alignment with the ethical and environmental imperatives of modern organizations, equipping leaders to navigate the complexities of sustainable corporate governance while maintaining situational adaptability. Full article

The COVID-19 pandemic greatly impacted care aides in long-term care facilities (LTCFs), exacerbating existing challenges and introducing new stressors that profoundly affected their job satisfaction, mental health, and overall well-being. This study investigates these multifaceted effects by conducting a comprehensive literature review of 18 studies from 2020 to 2023 across multiple countries. The findings reveal that care aides, mostly older and female and often immigrants with limited formal education, faced increased workloads, emotional exhaustion, physical fatigue, anxiety, and heightened stress levels during the pandemic. These factors led to decreased job satisfaction, higher burnout rates, and further pressure on LTCFs. The review emphasizes the need for strong support systems and targeted interventions, including mental health resources, counseling, adequate personal protective equipment (PPE), effective workload management, professional development opportunities, fair compensation, and supportive work environments. Addressing these issues is crucial for maintaining a stable and effective LTC workforce, improving care outcomes for residents, and enhancing the healthcare system’s resilience against future challenges. Full article

Tuberculosis (TB) remains a major cause of global mortality and is a significant public health challenge, including in specific Portuguese regions. Key aspects in understanding TB’s historical dynamics and impacts on past and present populations are to consider cultural changes and the implementation of public health policies through time. Therefore, this survey aims to provide a more accurate history of TB in Portugal, based on the analysis of sanitary measures through time, illustrating the role of TB in the evolution of public health in Portugal. For this, bibliographic research was conducted across various academic databases and major Portuguese libraries, statistical archives, and public health repositories. Therefore, a detailed chronology, along with some new statistical data, is presented and correlated with sanitary and public health measures, illustrating the role of TB in the evolution of the public health system in Portugal. This research enhances our understanding of the past and sheds light on ongoing TB challenges. Full article

Protected areas (PAs) are essential for conserving biodiversity and supporting sustainable development, particularly in ecologically rich yet administratively challenged regions like Romania. This study aims to understand how key stakeholders—local residents and protected area administrators—experience and interpret conservation management in the Southwestern Carpathians, one of Europe’s last remaining large-scale wilderness areas. Using Interpretative Phenomenological Analysis (IPA), the research offers an in-depth qualitative investigation into how individuals perceive, navigate, and negotiate conservation regulations, socio-economic pressures, and sustainable development goals. The findings highlight a deep emotional connection between residents and nature, juxtaposed with tensions over restrictions, perceived loss of autonomy, and limited compensation. Administrators, in turn, face challenges in enforcing regulations, managing tourism, and engaging communities amidst institutional fragmentation and resource constraints. Key findings emphasize the importance of environmental education, trust-building, and participatory governance in reconciling conservation aims with local development needs. The study underscores the need for inclusive, context-sensitive conservation strategies that integrate community perspectives and facilitate cooperation among local authorities, residents, and administrators. These insights contribute to a deeper understanding of stakeholder dynamics and policy implementation within protected areas, emphasizing the importance of co-produced knowledge and adaptive governance. Future research is encouraged to adopt participatory action approaches and expand stakeholder diversity to support more socially inclusive and ecologically resilient conservation practices. Full article

Climate variability and extremes adversely affect the agricultural production system, food security, livestock sector, and water resources. With the cumulative effects of climate variability, there is a need to anticipate and develop appropriate adaptation strategies to cope with changing climatic conditions. It is necessary to study the adaptation strategies that are to be followed for climate change to examine the ability of vulnerable communities and people, frequently affected by drought and other climate-related risks, to adapt to climate change impacts. Hence, the present study examined the determinants of various climate change adaptation strategies followed by farmers as a measure to face climate variability, which will be ultimately beneficial and enlightening to policymakers to gain knowledge about the measures to be taken to mitigate the impact of climate change. The study was undertaken using data collected from 105 farm households with an organized pre-tested interview schedule in the central agro-climatic zone of Afghanistan. The multivariate probit econometric model was used to analyze the factors responsible for major adaptation strategies to mitigate the impact of climate change. The key findings of the model indicated that the probability of educated farmers migrating to the non-agricultural sector for employment has increased by 1.3 percent, and those who have more land area have adopted a reduction in irrigation by 5.2 percent as an adaptive mechanism. The study also found that having access to technical guidance from extension officials increased the likelihood of farmers changing their cropping pattern by 18.6 percent and of diversifying their farms by 19.2 percent. On the other hand, expert guidance reduced the likelihood of drilling new bore wells by 20.5 percentage points and decreased the probability of selling livestock by 10.8 percentage points. The results of the study provide policy insights to improve the ability of farmers to modify their practices through improvement in extension services, irrigation infrastructure facilities, watershed development, and climate-resilient agricultural systems. Full article

The transition to low-carbon economies presents unique challenges for emerging markets, particularly in developing effective carbon pricing mechanisms that balance environmental objectives with economic development needs. This study examines the ratio legis of carbon pricing policies through a comparative analysis of China and South Korea’s established systems, utilizing the FASTER (Fairness, Alignment, Stability, Transparency, Economic efficiency, Reliability) principles evaluation framework. Using qualitative doctrinal methodology integrated and comparative policy analysis legislative frameworks and market data from 2015–2023, this paper examines Malaysia as a representative case study wherein carbon market initiatives remain in voluntary phase with approximately 150,000 carbon credits traded. The comparative results demonstrate that a choice between China’s intensity-based approach and South Korea’s absolute cap system should be guided by the following: (1) development stage, with industrializing economies benefiting from China’s flexible model; (2) institutional capacity, where limited monitoring capabilities favor phased approaches; (3) economic structure, with emissions-intensive economies requiring growth-accommodating systems; (4) policy landscape complexity; and (5) market size. The research proposes a structured implementation framework for emerging markets, demonstrated through Malaysia’s context, that enables effective emission reduction while maintaining economic competitiveness during the transition to low-carbon economies. Full article

The agri-food sector is going through a massive digital transformation thanks to new technologies such as the Internet of Things (IoT), big data, and Artificial Intelligence (AI). Regional disparities and implementation barriers prevent widespread uptake despite significant research advances. Drawing on bibliometric and survey data collected up to the end of 2023, this study examines global research trends and stakeholder perceptions in Andalusia (Spain) to identify challenges and opportunities in agricultural digitalization. Bibliographic analysis revealed that research has moved from early remote sensing to precision agriculture, IoT, robotics and big data, and that AI has recently taken over in predictive analytics, automation, and decision-support systems. However, our survey of Andalusian stakeholders highlighted a limited adoption of cutting-edge tools such as AI, blockchain, and predictive models due to economic constraints, technical challenges, and skepticism. Participants emphasized the importance of trust-building, as well as the use of simple tools that require minimal input and provide immediate benefits. Priorities for the responders were also improving market transparency, optimizing resource use, and system interoperability. The findings show that closing the gap between research and practice requires developing digital solutions that are user-centered, simplified, and context-adapted, especially when dealing with complex technologies like AI and predictive systems. This must be supported by targeted public policies and collaborative innovation ecosystems, all essential elements to accelerate the integration of smart agricultural technologies and align scientific innovation with real-world needs. Full article

Cities worldwide face significant challenges in managing stormwater, a concern worsened by rapid urbanization and the impacts of climate change. Bioretention landscapes helped solve these issues by replicating natural ecosystems to effectively capture, filter, and treat stormwater while offering additional ecosystem services. However, most studies and existing guides have been for colder and drier climates. Adapting bioretention practices to tropical and wet equatorial climates, characterized by intense rainfall patterns and high temperature and humidity, presents unique challenges and knowledge gaps. This systematic literature review aims to address these gaps by synthesizing existing research from 2010 to 2022 on bioretention landscapes in tropical and wet equatorial climates. Following the methodology outlined in PRISMA guidelines, we identified 10 key studies primarily focusing on countries within the Köppen–Geiger climate zones Aw, Af, and Am, which are tropical and wet equatorial climates. These studies spanned across different continents, including locations such as Malaysia, Singapore, Burkina Faso, and India. Data synthesis revealed critical design elements, including planting selection, substrate layer composition, and performance metrics. Our findings highlight the necessity for climate-specific design approaches and identify key research gaps that can inform future studies and guide practical applications in designing bioretention landscapes for tropical and wet equatorial climates. Full article

Despite the growing human–wildlife interactions (HWIs) globally, little attention has been paid to their effects on women and children, who often bear the brunt of loss of property and livelihoods. A systematic scoping review of four databases was undertaken to map and synthesize English-language evidence on the nature, causes, and impact of human–wildlife interactions on women and children across cultures. The 42 studies retained reveal that the proximity of human habitation to forest areas; expansion, deforestation, and encroachment of animal space; humans’ dependence on forest resources for livelihood; displacement of carnivores; and animals coming into the human space in search for food are the predominant causes of HWIs. Various types of HWIs and widely varying frequencies and durations of HWIs were reported. Individual and collective aspects of physical, psychological, economic, social, and environmental impacts on women and children were identified. The themes extracted were gendered roles, multi-factor vulnerabilities of women, religious beliefs, low participation of women in decision-making, social superstition against tiger widows, and perceptions of coexistence. Attention to perceptions of HWIs in different cultures and societies was limited, with notable gaps in the coverage of women and children and important geographic areas. These findings stress the need to bridge the geographical and cultural gap through multi-disciplinary actions on the determinants and effects of HWIs on women and children. Full article

Revitalizing Japan’s remote areas has become an urgent challenge, particularly in regions with aging populations. Despite their rich cultural and natural resources, these areas struggle to attract younger demographics, including young families and children. To address this, local governments have introduced temporary events to enhance urban vibrancy and create inclusive spaces. However, research on optimizing event design faces significant challenges due to the vast amount of data required for comprehensive analysis, making it difficult to gain deeper insights into user experience. Recent advancements in natural language processing (NLP) and AI have opened new possibilities for analyzing large-scale, multi-person interview data. While models like ChatGPT-4 have enhanced data-driven decision-making, structuring user metadata and identifying shared themes across events remain key challenges. This research integrates visual segmentation, spatial perception analysis, and NLP-driven keyword extraction into a novel, scalable approach. Using Matsue City as a case study, the method enhances the visual attractiveness of temporary event spaces by optimizing spatial layout, product visibility, and user engagement, ensuring they remain appealing and inclusive despite demographic challenges. From a data perspective, the proposed model improves the analysis of complex qualitative datasets and supports a more accurate interpretation of public event experiences. This integrated approach not only bridges spatial design and participant engagement but also establishes a replicable AI-assisted framework for systematically enhancing temporary event spaces, overcoming current limitations in large-scale data processing. Full article

Influenza poses a significant public health threat, causing millions of severe cases and hundreds of thousands of deaths annually. Vaccination remains the most effective measure to reduce transmission, complications, and the strain on healthcare systems. Despite its importance, vaccination uptake remains suboptimal among college students, a key population for infectious disease transmission and a target group for public health interventions. The primary objective of this study was to examine the psychological and contextual determinants of influenza vaccination among college students in Israel, utilizing the Theory of Planned Behavior (TPB) as the guiding framework. A cross-sectional online survey was conducted among 591 students at Ashkelon Academic College between April and May 2023. The questionnaire included validated items assessing attitudes toward vaccination, subjective norms, perceived behavioral control, and vaccination history. Hierarchical logistic regression was used to assess the predictive power of these variables in explaining actual vaccination behavior. The results indicated that prior vaccination was the strongest predictor of current influenza vaccine uptake (OR = 38.7, p < 0.001). Positive attitudes (e.g., belief in vaccine protection), strong social influences (e.g., parental vaccination behavior and trust in healthcare professionals), and high perceived behavioral control (e.g., accessibility and convenience) were all significantly associated with increased vaccination likelihood. The final model explained 68% of the variance in vaccination behavior (Nagelkerke R² = 0.68, p < 0.001). These findings affirm the TPB as a robust framework for understanding vaccination behavior and underscore the importance of habitual vaccination, public trust, and systemic accessibility. The study contributes to the field by illustrating how national healthcare infrastructure interacts with individual-level beliefs to shape preventive health actions. Practical applications include the development of targeted interventions to promote first-time vaccination, address vaccine safety concerns, and leverage trusted social networks. Future research should investigate how digital communication, policy variation, and sociocultural context influence the components of the TPB across diverse populations. Full article

Urbanization has transformed natural landscapes, resulting in increased land surface temperatures and the intensification of urban heat island (UHI) effects. This study explores the relationship between land-use/land-cover (LULC) changes and land surface temperature (LST) from 2017 to 2024, using satellite data from Landsat and Sentinel. The results from supervised classification reveal a 50.9% increase in built-up land, from 21,256 hectares in 2017 to 32,099 hectares in 2024, accompanied by a 6.3% decline in woodland. Analysis of the LST data highlights rising temperatures in urbanized and deforested areas, with LST peaking at 36.96 °C in 2020 before slightly decreasing to 31.03 °C in 2024, potentially influenced by increased rainfall. However, hotspots of elevated LST persist, indicating sustained thermal stress. The urban thermal field variance index (UTFVI) showed worsening ecological conditions, particularly in densely urbanized zones. The study highlights the pressing need for integrating urban heat island (UHI) considerations into urban planning, as elevated urban temperatures threaten public health and escalate energy consumption. Additionally, the research aligns with Sustainable Development Goal 11 (SDG 11), emphasizing the creation of inclusive, safe, resilient, and sustainable cities. By providing policymakers with key UHI indices, this study contributes to climate-resilient urban environments, mitigating heat risks through green infrastructure and sustainable urban design. Full article

Climate-smart agriculture (CSA) has emerged as a critical strategy to address the intertwined challenges of climate change, food insecurity, and environmental degradation, particularly among smallholder farmers in Southern Africa. This study reviews the existing literature on the adoption and scaling of CSA innovations among smallholder farmers in South Africa, focusing specifically on the roles played by institutional mechanisms, policy frameworks, and market dynamics. The findings reveal that while CSA interventions—such as conservation agriculture, drought-tolerant crop varieties, and precision irrigation—have demonstrated positive outcomes in enhancing productivity, food and nutritional security, and climate resilience, adoption remains uneven and limited. Key barriers include insecure land tenure, insufficient extension and climate information services, limited access to credit and inputs, and fragmented institutional support. The analysis highlights the importance of secure land rights, functional farmer cooperatives, effective NGO involvement, and inclusive governance structures in facilitating CSA adoption. Further, the review critiques the implementation gaps in South Africa’s climate and agricultural policy landscape, despite the existence of comprehensive strategies like the National Climate Change Response Policy and the Agricultural Policy Action Plan. This study concludes that scaling CSA among smallholder farmers requires a holistic, multi-level approach that strengthens institutional coordination, ensures policy coherence, improves market access, and empowers local actors. Targeted financial incentives, capacity-building programs, and value chain integration are essential to transform CSA from a conceptual framework into a practical, scalable solution for sustainable agricultural development in South Africa. Full article