Search Results (879)

The United States faces a maternal health crisis marked by stark racial disparities. Although doula support has emerged as an evidence-based intervention to improve perinatal outcomes by addressing social determinants of health, its integration into healthcare systems remains limited. This qualitative study, informed by phenomenological principles, examined multi-level experiences, perceived barriers, and perceived facilitators of integrating doula services into perinatal care systems and their intersection with health equity goals. We conducted 17 semi-structured interviews with 20 participants across Nebraska and Tennessee, including doulas, midwives, physicians, Medicaid administrators, and public health professionals, and analyzed data using reflexive thematic analysis guided by the Socio-Ecological Model. Three themes emerged: the integration paradox, an overarching theme capturing tensions between doula independence and healthcare system demands for standardization, including divergent views on practice models, provider dynamics, and certification; sustainable financing as the prevailing barrier, encompassing grant limitations, private pay inequities, absent Medicaid reimbursement, and the need for cost-effectiveness evidence; and cultural concordance as the prevailing facilitator, including cultural matching, addressing social determinants, and lived experience as motivation. Sustainable doula integration requires reconciling system demands for standardization with the relational, culturally responsive characteristics that define effective care, through Medicaid reimbursement pathways and policy reforms developed in partnership with doula communities. Full article

The concentration of tourist flows along short urban links caused by cruise stops in medium-sized Mediterranean ports exacerbates traffic and localized environmental externalities. This study evaluates the willingness to pay (WTP) of cruise passengers for an electric tram that would connect the Gaženica Port with Zadar’s historic center, an intervention designed to cut travel time and reduce on-street congestion and emissions. Over the course of two seasons, a two-wave, two-site, in-person survey was conducted at the port and in the city center. The instrument adopts a double-bounded dichotomous choice (DBDC) contingent valuation design with randomized starting bids that were calibrated using a pre-test that benchmarked prevailing transport pricing. Primary WTP estimates are obtained from a binary choice model with socio-demographic and environmental covariates; whereby inference relies on cluster-robust errors. Robustness is assessed through three complementary checks that do not require additional data: (i) a bivariate specification to account for within-respondent correlation between first and follow-up bids; (ii) Turnbull nonparametric bounds for the interval-censored WTP distribution; and (iii) starting-point tests using split-sample estimation and bid-set indicators. A spike adjustment based on “no–no at the lowest bid” responses is explored where appropriate. Beyond its methodological contribution, this research advances the sustainable tourism development discourse by quantifying visitors’ financial support for low-emission urban mobility infrastructure that mitigates environmental stresses while preserving residential life quality. The results integrate cruise tourist management with the more general goals of resilient and sustainable urban destinations by offering a decision-ready value input for port-city mobility planning in historic Mediterranean centers. Full article

This study presents a comparative analysis of five gender equality certification schemes alongside the ISO 53800 standard with the aim of distilling shared conceptual foundations and design principles that can inform progress toward Sustainable Development Goal (SDG) 5 on gender equality. The comparative analysis reveals marked heterogeneity in scope, design architecture, indicators, and transparency. Methodologically, the study draws on the relevant literature, documentary evidence, and semi-structured consultations with five experts in gender equality, diversity management, auditing, and ESG reporting. Building on the most effective and robust features across gender equality schemes, the study proposes a universal framework for gender equality certification. Under this framework, an ideal universal certification model should apply the same core requirements to both public and private organizations, while including simplified procedures tailored to small- and medium-sized enterprises (SMEs). Moreover, the model should rely on a limited set of key performance indicators (KPIs), focusing on the most material dimensions and prioritizing quantitative measures. It should also strengthen employee feedback mechanisms and enhance accountability in corporate governance. The framework should also pay attention to intersectional dimensions, extend responsibility across the value chain, and address the gender-related implications of artificial intelligence (AI). Importantly, an ideal universal gender equality certification should ensure a high level of transparency through the public disclosure of certified organizations, assessment criteria, KPIs, and levels or scores achieved. Furthermore, it should be supported by a free digital self-assessment tool and robust auditing arrangements, underpinned by a sufficiently large pool of accredited certification bodies and gender-balanced audit teams. Finally, it should undergo periodic review and align with Environmental, Social, and Governance (ESG) principles and other related SDGs. Full article

The effect of corporate ESG performance on firm competitiveness has attracted growing attention from both regulators and market participants. Most studies explore and interpret this effect from the perspective of supply-side factors such as technological innovation; however, the role of customer-side factors remains underexplored. This exploratory study aims to theoretically and empirically analyze the mediation role of the customer-side factors in the impact of corporate ESG on market share. Based on a review of the literature, we develop a theoretical model linking corporate ESG performance to customer purchase behavior. The derived hypotheses are empirically checked using panel data of Chinese listed companies from 2009 to 2023 using two-way fixed-effect regression, three-step mediation analysis, and Sobel test. The results show that the effect of ESG performance on market share is significantly positive, and this relationship is mediated by three variables: corporate reputation, firm visibility, and market coverage. Therefore, we suggest that (i) the Chinese government should strengthen mandatory ESG disclosure requirements and enhance supervision of ESG rating agencies; (ii) corporations should substantially improve their ESG performance and enhance ESG communication capabilities; (iii) customers should pay more attention to public interest, allowing individual benefits to align with social welfare, thereby achieving a win-win outcome for both customers and corporations. Full article

African swine fever (ASF) has become one of the most significant transboundary animal diseases affecting countries worldwide. Wild boars play a major role in virus persistence and in local spread through geographical contiguity, while long-distance and transboundary dissemination is more commonly associated with human-mediated activities, particularly the movement of contaminated pork products and materials. Hunting is frequently considered a central tool for disease control; however, its epidemiological impact remains debated. This review comparatively analyses the approaches adopted by countries of European continent affected by ASF, paying particular attention to the role of hunting within integrated management strategies. The review examines country-specific control measures, including surveillance systems, carcass search and removal, fencing, zoning, and population reduction policies. The analysis shows that successful eradication was associated with early detection, temporary suspension of hunting in infected core areas, rapid spatial containment through fencing, and intensive passive surveillance based on systematic carcass removal. Hunting was reintroduced only after containment, as a regulated depopulation tool under strict biosecurity supervision. In contrast, where the virus was already widespread at detection and containment measures were delayed or fragmented, intensified hunting alone did not prevent endemic persistence. These findings indicate that hunting is neither inherently protective nor detrimental; rather, its effectiveness depends on timing, coordination, and integration within a structured epidemiological framework. Effective control requires combining wildlife management with surveillance, biosecurity, and clear governance. Full article

This study explores the role of organic food within sustainable tourism in Slovenia, with particular attention to consumer expectations, trust in organic certification, willingness to pay a price premium, and the interpretation of sustainability labels, especially the Slovenia Green scheme. Data were collected through an online survey conducted in Slovenia in 2025 (n = 324) and analysed using descriptive statistics, non-parametric tests, and exploratory factor analysis to examine key dimensions of sustainable tourism perceptions. The results show that organic food is generally recognised as an important element of sustainable tourism and is most often associated with environmental protection, health benefits, and food safety. The study also identified a clear gap between consumer expectations and certification requirements, as many respondents associated the Slovenia Green label with certified organic dishes, although organic food is not mandatory within the scheme. Consumer trust in organic food was moderate to high, and most respondents expressed willingness to pay a price premium for certified organic menu items, indicating market potential within the tourism and hospitality sector. The findings highlight the need for clearer communication of certification scope, better alignment between sustainability labels and consumer expectations, and targeted education and capacity building among tourism providers. Overall, organic food remains an underutilised but strategically relevant component of sustainable tourism development in Slovenia. Full article

Background: Successful healing of chronic apical periodontitis after endodontic treatment requires a reduction in the size of the radiolucent area and the healing of the bone. This study aimed to compare the effects of different irrigation activation techniques on healing in single-rooted mandibular premolar teeth with periapical lesions of endodontic origin. Methods: A total of 132 systemically healthy patients with mandibular single-rooted premolar teeth and a periapical index (PAI) score ≥ 3 were assigned to five experimental groups (Sonic activation, Passive ultrasonic irrigation, Photon-Induced Photoacoustic Streaming, Shock Wave Enhanced Emission Photoacoustic Streaming and Manual dynamic activation) and a control group (Conventional Syringe Irrigation). After access cavity preparation, the canals were prepared up to three sizes larger than the initial apical diameter with 5 mL of 2.5% NaOCl used between each file. Final irrigation was performed via the assigned activation system. The root canals were obturated with gutta-percha in a single visit. The effects of the activation systems on healing were compared at 1-year follow-up. The primary outcome measure was the change in lesion diameter. PAI score and fractal dimension (FD) were evaluated as secondary outcomes. Results: At the 1-year follow-up, FD values significantly increased, PAI scores and lesion size decreased in all groups compared with baseline (p < 0.001). However, the increase in FD was comparable among the irrigation groups (p > 0.05). In contrast, lesion size reduction and PAI-based healing rates favored the laser-activated groups. The PAI scores and lesion size in the control group were significantly greater than that in the laser groups (p < 0.05). Conclusions: At the 1-year follow-up, all the groups presented similar FD increases, while the laser irrigation groups presented significantly greater reductions in lesion size than did the control group. Full article

The SERPINE1 gene encodes the serine protease inhibitor plasminogen activator inhibitor type-1 (PAI-1), a major negative regulator of the plasmin-dependent pericellular proteolytic cascade and a crucial determinant in the program of stromal remodeling. Recent omics approaches confirmed that high tumor SERPINE1 levels are prognostic for poor disease outcomes and shorter disease-free survival in various malignancies. Kinetic analysis of biomarkers of cell cycle transit in growth-synchronized p53 dual mutant human keratinocytes confirmed that PAI-1 transcription occurred early after growth activation of quiescent (G₀) cells and prior to G1 entry. Previous evidence has confirmed that differential residence of USF family members (USF1→USF2 switch) at the PE2 region hexanucleotide E box motif (CACGTG) in the SERPINE1 proximal promoter characterizes the G₀→G₁ transition period and the transcriptional status of the SERPINE1 gene. A consensus PE2 E box motif (5′-CACGTG-3′) at nucleotides −566 to −561 is required for USF occupancy of the PE2 E box and serum-stimulated SERPINE1 transcription. Interference with USF2 occupancy of the PE2 E Box site by a double-stranded PE2 “decoy”, or induced expression of a dominant-negative USF (A-USF) construct, attenuate serum- and TGF-β1-stimulated SERPINE1 synthesis. Tet-Off activation of an A-USF insert reduced both PAI-1 and PAI-2 transcripts while increasing the fraction of proliferating (Ki-67⁺ cells). Conversely, overexpression of USF2 or adenoviral delivery of a PAI-1 vector inhibited HaCaT colony expansion. These findings are discussed in this review and collectively suggest that the USF1→USF2 transition at the PE2 E box site and subsequent SERPINE1 transcription impact serum-stimulated keratinocyte growth and, likely, cell cycle progression. Full article

Acute gastrointestinal bleeding (GIB) is one of the most common and dangerous condition in patients admitted in Emergency Departments. The incidence and the mortality of acute GIB remain significant, although some positive trends were observed in recent years. Initial evaluation of GIB needs an accurate assessment of the medical history and the clinical presentation. Physicians should pay attention about the presence of hemorrhagic shock that usually requires urgent diagnosis and treatment. Only a prompt diagnostic approach can identify the source of bleeding and improve the outcomes in acute GIB patients. Risk stratification and time of endoscopy are fundamental issues in the management of upper and lower GIB. Small bowel capsule enteroscopy (SBCE) and device-assisted enteroscopy (DAE) are the basic approaches to suspected small bowel bleeding. Machine Learning Prognostic Models have been proposed, such as alternative prognostic tools in GIB, but they are currently recommended only to identify low-risk outpatients. Full article

Ischemic stroke remains a major cause of mortality and long-term disability worldwide, and improved strategies for identifying individuals at elevated vascular risk are needed. Serum autoantibodies have emerged as potential biomarkers reflecting vascular injury and immune activation; however, their integrative biological significance and incremental predictive value beyond established clinical risk factors remain unclear. We analyzed 833 participants, including patients with acute ischemic stroke (AIS) or transient ischemic attack (TIA) and healthy controls. Serum levels of anti-PDCD11 antibody (Ab), anti-DNAJC2 antibody, and anti-PAI-1 (SERPINE1) antibody were quantified, and multivariable logistic regression and machine-learning (ML) models (logistic regression and random forest) were constructed using clinical variables with and without antibody markers. Model performance was evaluated using cross-validation, bootstrap-derived confidence intervals, calibration metrics, and reclassification indices. Model interpretability analyses, principal component analysis (PCA), unsupervised clustering, and propensity score matching were performed to explore latent biological structures. Clinical-only models demonstrated excellent discrimination (bootstrap Area Under the Curve (AUC) 0.917 for random forest and 0.919 for logistic regression). The addition of antibody markers yielded similar performance (AUC 0.913 and 0.923, respectively) without evidence of meaningful improvement in reclassification. However, SHapley Additive exPlanations (SHAP) analysis identified antibody markers as influential contributors following major clinical risk factors. PCA revealed a dominant antibody component explaining approximately 79% of the variance, which remained independently associated with stroke after age adjustment. Unsupervised clustering further identified a high-risk subgroup characterized by consistently elevated antibody levels. These findings support the presence of a latent antibody axis associated with vascular vulnerability. Although antibody markers did not substantially enhance global predictive performance, they captured integrated biological signals reflecting cumulative vascular and immunological stress. Autoantibody profiling may complement conventional risk assessment by improving biological characterization of stroke susceptibility. Prospective validation in independent cohorts is required prior to clinical implementation. Full article

Bribery remains prevalent across African countries, yet little is known about how fear of retaliation for reporting corruption interacts with national institutional contexts to shape bribery behaviour. Using Round 9 Afrobarometer data from 42,655 respondents across 39 African states, this study examines how perceptions of reporting risk combine with macro-level conditions of state capture and symbolic law to influence the likelihood of paying bribes. Hierarchical logistic regression results show that individuals who fear retaliation are significantly more likely to engage in bribery, but this relationship is conditioned by institutional strength. High levels of state capture and weak rule-of-law systems intensify the effect of retaliation risk, whereas judicial independence mitigates it. Aspects of symbolic law—judicial accountability, access to justice, and enforcement—further shape how fear translates into corrupt exchanges. The findings demonstrate that reducing bribery requires credible, protective, and functional institutions, not simply increased anti-corruption awareness. The study advances corruption research by integrating behavioural risk perceptions with multi-dimensional measures of institutional weakness, offering a cross-national explanation for when fear becomes behaviourally consequential. Full article

The global shift toward sustainable food packaging has renewed interest in bio- and plant-derived materials as alternatives to conventional plastics. Leaf-based packaging, a long-standing practice in many regions, represents a low-technology and culturally embedded option that is gaining attention, particularly in low- and middle-income countries. Despite this interest, evidence on its functional suitability, safety, regulatory alignment, and real-world adoption remains scattered and uneven. This systematic review synthesises current knowledge on leaf-based food packaging to determine where, how, and under what conditions it may be viable. Following PRISMA-ScR 2020 guidelines, peer-reviewed studies published between 1997 and 2025 were identified from major scientific databases and assessed using study-type-appropriate quality appraisal tools. Evidence was organised through a thematic framework addressing consumer awareness and willingness to pay, practical adoption and cultural patterns, economic trade-offs, and functional co-benefits alongside microbial and toxicological risks within existing regulatory and end-of-life systems. Comparative analysis considered differences between low- and middle-income and high-income contexts. The findings show that leaf-based packaging is most suitable for short shelf-life and low-risk foods, especially within traditional food service settings. Adoption is encouraged by cultural familiarity and environmental perceptions but limited by performance variability, hygiene concerns, compliance requirements, and infrastructure constraints. Scalability remains restricted by cost-effectiveness and compatibility with formal packaging and waste systems. Leaf-based materials should therefore be viewed as a context-specific sustainability option rather than a universal replacement for plastics, requiring targeted and risk-informed integration into appropriate food systems. Full article

Emerging hospitality markets confront a two-speed ecosystem where operational digitalization outpaces strategic AI readiness, creating a benefit–feasibility gap. Providers recognize substantial technology value yet face implementation constraints from costs, integration complexity, and skills shortages, while guests demonstrate acceptance conditional on trust, with privacy concerns suppressing willingness to pay. Drawing on dual-perspective empirical evidence from Albania’s accommodation sector consisting of a national provider readiness assessment (N = 1821) and a guest acceptance study (N = 689) conducted in prior research, this Design Science Research study develops a segment-differentiated technological blueprint through systematic integration of Design Thinking, service blueprinting, and systems thinking methodologies. Integrated TAM-TOE-DOI framework analysis reveals three distinct provider segments requiring differentiated implementation pathways: Tech Leaders positioned for AI capabilities, Selective Adopters benefiting from smart modules, and Skeptics requiring foundational capabilities. Empirical evidence establishes that regional ecosystem characteristics outweigh organizational scale in determining adoption feasibility, trust operates as a gating condition moderating acceptance and financial commitment, and supply–demand misalignment creates bottlenecks invisible to single-perspective assessments. Theoretical contributions extend TAM-TOE-DOI frameworks from explanatory constructs to design requirements, conceptualize supply–demand alignment as an adoption mechanism, and generate two generalizable design principles: dual-constraint satisfaction requiring simultaneous provider feasibility and guest acceptance, and trust-as-architecture embedding trust mechanisms as structural properties. The proposed segment-differentiated technological blueprint offers actionable implementation pathways aligned with varying levels of provider readiness, providing transferable guidance for policymakers, technology vendors, education providers, and accommodation providers across the Western Balkans, the Mediterranean, and other post-transition economies facing similar heterogeneity in readiness and resource constraints. Full article

Expanded and intensified agriculture is a major driver of habitat loss for endangered species such as the Oriental White Stork (Ciconia boyciana), making wildlife-friendly farming an increasingly important approach for reconciling biodiversity conservation with agricultural development. Building on a 2018 feasibility study in the Sanjiang Plain, this research employs a choice experiment to examine how preferences for Oriental White Stork-friendly farming have evolved among urban consumers and residents of stork habitats under expanding green consumption and increasing experience with environmentally friendly farming. The results reveal pronounced preference heterogeneity and persistent cognitive separation between wildlife conservation and agricultural production, particularly among urban consumers, despite a stable group being willing to pay a premium for stork-friendly products. Rural residents’ decisions remain largely economically driven, though younger farmers with prior experience in environmentally friendly practices show more positive attitudes. Significant urban–rural differences suggest policy complementarities, whereby price-oriented incentives may encourage price-sensitive farmers to adopt green agriculture, while intrinsically motivated farmers require support through an Oriental White Stork-oriented value chain. Overall, the findings demonstrate that Wildlife-Friendly Farming cannot be effectively promoted through a one-size-fits-all approach; instead, stratified, group-specific policy and market mechanisms are essential for aligning producer incentives with consumer demand and supporting the long-term viability of biodiversity-friendly agricultural systems. Full article

The arachidonic acid pathway plays a pivotal role in the biosynthesis of important inflammatory and signal transducing agents such as prostaglandins, leukotrienes and thromboxanes. When this pathway is deregulated, it leads to pathological conditions such as cardiovascular diseases, metabolic diseases, and cancer. Two key enzymes of the pathway are cyclooxygenases (COXs) and lipoxygenases (LOXs), which are responsible for the production of prostaglandins and leukotrienes, respectively. Consequently, these enzymes have long been recognized as key therapeutic targets for the treatment and management of inflammatory disorders and other pathological conditions associated with inflammation. In this review, we describe the new evidence over the last 4 years regarding the arachidonic acid pathway. Moreover, we will pay attention to the structure and function of the COX-2 and 5-LOX enzymes and their role in inflammation, as well as define their active sites. Later, we will discuss the most potent, dual inhibitors of COX-2 and 5-LOX enzymes, based on in vitro and in vivo experiments, from 2020–2024. Structure–activity relationship (SAR) analysis of these compounds revealed four key structural features required for potent dual inhibition of cyclooxygenase-2 (COX-2) and 5-lipoxygenase (5-LOX). We refer to these criteria as “The Rule of Four for Inflammation”. Full article