Search Results (5,422)

Under the “dual carbon” goals, Taiyuan, a prefecture-level administrative unit and energy-intensive region in Shanxi Province, China, has experienced changes in soil carbon storage and soil carbon flux under rapid urbanization and industrialization. To clarify the spatial patterns of soil carbon storage and flux, 26 field sampling sites, including 78 soil samples, were analyzed using laboratory measurements and an optimized tunable diode laser absorption spectroscopy–geographic information system (TDLAS–GIS) integrated monitoring approach. This study investigated the spatial patterns of soil carbon storage and flux and discussed their potentially associated factors, providing an exploratory workflow for regional carbon monitoring. The results showed clear spatial heterogeneity, with an average soil organic carbon (SOC) content of 10.86 g/kg. High-SOC areas were mainly located in the southern and southwestern plains, while lower SOC levels occurred in urban expansion zones and highly disturbed surfaces. The western mountainous areas were important ecological barriers but were not the highest measured SOC zones. At the site level, arable land and forestland showed higher mean SOC values than grassland, with average SOC contents of 12.47, 12.07, and 8.27 g/kg, respectively, although these land-use-related differences were not statistically significant. Soil carbon flux was relatively higher in some mountainous regions and industrial–ecological transition areas but lower in several urban expansion areas. The results suggest that urbanization and industrial activity may be associated with changes in SOC and soil-atmosphere CO₂ exchange. This study describes the spatial variation characteristics of soil carbon storage and flux, establishes a reproducible TDLAS–GIS workflow for regional carbon monitoring, and provides exploratory support for ecological sustainability, sustainable land management, and the “dual carbon” strategy in northern resource-based cities. Full article

(1) Background: Medication administration errors (MAEs) are potentially harmful incidents that may be avoidable. This study aimed to assess the proportion of self-reported MAE reporting among nurses in Saudi Arabia and to identify the associated factors. (2) Methods: A descriptive cross-sectional study was conducted among 259 nurses at a teaching hospital from January to March 2023. Data were collected via an electronic questionnaire and analyzed using descriptive statistics. (3) Results: The results of this study revealed that medication administration errors were reported at a higher level. The study demonstrated that nurses notify their department when a medication administration error occurs. The primary contributing factors identified for not reporting MAEs were high workload (84.1%) and fear of legal action (42.5%). Double-checking medications was the most recommended preventive measure (99.7%). (4) Conclusions: Recommendations to increase MAE reporting include workload management and fostering a non-punitive reporting culture to enhance patient safety. Full article

Business influence increasingly unfolds in platform environments where visibility is ranked, repeated, measured, and monetized. At the same time, many platform interactions have shifted from reciprocal sociality toward creator-centered attention, mediated familiarity, and one-sided attachment. This perspective article develops the concept of parasocial business to explain how business actors convert platform visibility into credibility, trust, advocacy, and commercial value. Drawing on an integrative reading of research on parasociality, platformization, influencer labor, organizational reputation, marketing communication, and creator economies, this paper identifies three linked mechanisms: algorithmic visibility, persona design, and parasocial conversion. The conceptual analysis shows that parasocial business is not simply influencer marketing, personal branding, brand community, or consumer–brand relationship management. Its distinctive feature is the platformed conversion of repeated, persona-based familiarity into business-relevant authority and value. This paper develops the related concept of platformed authority and illustrates it through LinkedIn thought leadership, podcast-based business influence, and B2B expert visibility. This paper contributes to business administration and management research by showing how leadership communication, reputation governance, expert visibility, and organizational influence are increasingly shaped by platform infrastructures and public-facing personae. Full article

Background and Clinical Significance: Hyaluronic acid fillers are currently the most widely used materials in aesthetic medicine and represent one of the most frequently performed minimally invasive procedures worldwide. Vascular occlusion is the most severe complication associated with this type if filler injections due to the risk of tissue necrosis and permanent sequelae. Early recognition and precise identification of the affected vascular territory are essential to prevent irreversible damage. Case Presentation: his report describes a case of infraorbital artery occlusion with retrograde extension to the anterior superior alveolar artery and associated gingival ischemia, highlighting the role of high-frequency ultrasound in diagnosis and management. A 60-year-old woman developed vascular occlusion following supraperiosteal HA injection in the medial cheek. Clinical findings included livedo reticularis in the infraorbital and nasal regions, along with ipsilateral gingival anesthesia and mucosal ischemia. High-frequency ultrasound was used to assess the extent and mechanism of vascular involvement. A targeted treatment approach was implemented using low-dose hyaluronidase (100 IU/mL), with 200 IU administered in the infraorbital region and an additional 100 IU delivered under ultrasound guidance to the affected alveolar branch. Ultrasound examination revealed extrinsic compression of the infraorbital artery and secondary occlusion of the anterior superior alveolar artery consistent with retrograde embolization. Following image-guided administration of hyaluronidase, complete reperfusion was achieved, with resolution of both cutaneous and gingival ischemia and no functional or aesthetic sequelae. Conclusions: High-frequency ultrasound provides critical diagnostic information in vascular complications after HA filler injection, allowing for accurate identification of the mechanism and extent of vascular involvement. Ultrasound-guided low-dose hyaluronidase may represent an effective and safe strategy to restore perfusion while minimizing unnecessary enzyme exposure and associated adverse effects. Full article

Background/Objectives: Nutritional support is a key component in the management of chronically ventilated patients, who are at high risk of malnutrition due to prolonged illness and metabolic stress. Enteral nutrition, particularly high-protein formulas (HPFs) and high-density formulas (HDFs), is commonly used to improve clinical outcomes; however, their effects on anthropometric and biochemical parameters remain incompletely understood. Our objective was to evaluate the association of HPFs and HDFs with changes in anthropometric and biochemical parameters in chronically ventilated patients receiving enteral nutrition. Methods: This retrospective study evaluated chronically ventilated patients receiving long-term enteral nutrition. Patients were categorized into four groups based on feeding strategy: continuous HPF, transition to HPF, transition from HPF and transition to HDF. Body weight, serum albumin and total protein were assessed at baseline and follow-up (up to 6 months). Within-group changes were analyzed using paired statistical tests. Results: Within-group analyses demonstrated changes in body weight, body mass index and serum albumin levels over time. Body weight increased significantly across all groups. The greatest increase was observed in patients transitioning to an HPF (70.82–75.35 kg, p = 0.00019), with a significant increase also following HDF administration (59.51–62.57 kg, p = 0.0389). Serum albumin increased significantly only in the transition-to-HPF group. HDF administration showed a non-significant increase in albumin and a near-significant rise in total protein. Conclusions: Enteral nutrition strategies were associated with changes in anthropometric and biochemical parameters in chronically ventilated patients. HPFs and HDFs were associated with improved body weight, with biochemical improvements most evident after HPF initiation and favorable trends observed with HDF administration. Future prospective studies with standardized protocols and objective nutritional markers are warranted. Full article

Background: Portal hypertension can lead to complications such as ascites, hepatic encephalopathy, esophageal varices, and gastrointestinal (GI) bleeding, all of which are associated with significant morbidity and mortality. Variceal bleeding is the most severe complication, with an estimated mortality of up to 30%. In children, evidence-based guidelines for the management of GI bleeding secondary to portal hypertension are lacking. In this con-text, octreotide, a synthetic somatostatin analog approved for other indications, has been increasingly used off-label and represents a paradigmatic example of drug re-purposing in pediatrics. Methods: Following the 2020 PRISMA guidelines, this systematic review evaluated the efficacy and safety of octreotide for the treatment of portal hyperten-sion-related GI bleeding in children. A comprehensive search of six sources, including five bibliographic databases (PubMed, Embase, Web of Science, Cochrane Library, and EBSCOhost) and the ClinicalTrials.gov registry, was conducted to identify studies in-cluding pediatric patients with GI bleeding secondary to portal hypertension. Results: Three non-randomized observational studies were included, assessing bleeding recurrence, packed red blood cell requirements, and adverse events following octreotide admin-istration. Overall, 33 patients were analyzed, with a mean age of 6.3 years. One study reported a reduction in rebleeding episodes and transfusion requirements after oc-treotide treatment. Across all included studies, no serious adverse events were ob-served; mild and reversible hyperglycemia was the only reported drug-related effect. Quantitative synthesis was not feasible due to substantial heterogeneity, missing data, and a serious risk of bias, resulting in very low certainty of evidence. Conclusions: Octreotide may represent a feasible therapeutic option for portal hypertension-related GI bleeding in children; however, further prospective and standardized studies are needed to establish its long-term safety and efficacy. Full article

Background/Objectives: Standardised institutional patient satisfaction surveys are the primary quality-monitoring tool in Romanian public hospitals, but their ability to capture the full range of patient experiences remains uncertain. This study quantifies the discrepancy between institutional patient satisfaction scores and an independent, unmediated national feedback instrument, the Patient Feedback Mechanism (MFP), at Targoviste County Emergency Hospital (SJUT) over a six-year period (2019–2024), and examines item-level MFP results across eight dimensions of the patient experience, including dimensions not captured by the institutional indicators routinely reported by SMCSP. Methods: A sequential design combined six years of institutional satisfaction data (2019–2024) from SJUT (N = 32,176 questionnaires) with item-level MFP results for the same period, covering eight questions on medical services, cleanliness, out-of-pocket medication costs, staff involvement, communication, recommendation intent, self-reported health outcome, and willingness to report requests for money from staff. Hypotheses were tested using two-proportion z-tests with Wilson confidence intervals, Mann–Kendall trend analysis, and Cohen’s h for effect sizes. Results: Institutional satisfaction remained consistently high (96.88–97.45%), while MFP satisfaction with medical services ranged from 70.7% to 88.9% across the same years, yielding gaps of 7.9 to 26.7 percentage points, significant in every year (p < 0.001; Cohen’s h ranging from 0.32 to 0.82). The gap did not follow a monotonic trend (Mann–Kendall p = 0.469); instead, it widened to a peak in 2021 and narrowed progressively through 2024. A parallel comparison between the Quality and Patient Safety Management Service (SMCSP) overall impression item (exceeding 99%) and the MFP recommendation item (69.9–76.3%) showed even larger gaps, of 23.3 to 29.6 percentage points. The MFP item on willingness to report requests for money from staff, which is not part of SMCSP’s reported institutional indicators, remained in a narrow 4.0–5.5% range between 2019 and 2023 with no significant trend (Mann–Kendall p = 0.82); a higher 2024 value (6.9%) coincides with a national redesign of this item and is not directly comparable to earlier years. Conclusions: Institutional surveys and an independent national feedback instrument offer structurally distinct perspectives on hospital performance, reflecting differences in administration rather than equivalent estimates of patient satisfaction. The discrepancy between sources is significant and persistent, though not monotonic, widening sharply during 2021 before narrowing. One item with no institutional equivalent documents a measurable, non-trivial proportion of patients willing to report informal payment requests every year, although the available data do not establish whether this proportion is rising over time. Systematic use of existing MFP data, already collected nationally, can complement institutional surveys at minimal additional cost, provided the two instruments are interpreted as structurally different rather than as alternative estimates of the same quantity. Full article

Against the backdrop of rapid digital acceleration and a tightening UK labor market, Small and Medium-sized Enterprises (SMEs) are pressured to move beyond manual administrative processes to bridge the national productivity gap. This study investigates how Human Resource Information Systems (HRIS) transform HR functions from administrative burdens into strategic assets within resource-constrained UK SMEs. Adopting an interpretivist, multiple case study qualitative approach, data were collected through semi-structured interviews with 12 HR managers across the hospitality, retail, and recruitment sectors and analyzed using thematic analysis via NVivo 14. The findings reveal a three-stage, non-linear pathway of value creation: administrative liberation through automation, strategic visibility via data-driven insights, and digital friction stemming from cultural and structural barriers. While HRIS enhances operational efficiency and evidence-based decision-making, its strategic value is mediated by organizational readiness, digital literacy, and change management capabilities. This research contributes to strategic human resource management literature by conceptualizing “digital friction” as a key mediating construct between technology implementation and value realization under resource poverty. For practitioners, it provides a deployment roadmap highlighting that managing the socio-technical “human element” is as critical as the core technological infrastructure for long-term competitiveness. Full article

Cathaya argyrophylla Chun et Kuang is an endangered relict gymnosperm endemic to China. Its habitat has been severely fragmented due to Quaternary glaciations, a condition further exacerbated by modern, fragmented administrative management. We compiled 98 spatially filtered occurrence records across four provinces and developed a combined analysis framework integrating the Biomod2 ensemble model with the Marxan systematic planning algorithm. Our optimal model (TSS = 0.911, AUC = 0.986) identified mean diurnal range and ultraviolet-B seasonality radiation as the dominant ecophysiological drivers of the species’ distribution. Currently, suitable habitats cover 7.10% of the study area, with highly suitable habitats accounting for only 3.08% (21.76 × 10³ km²). Priority conservation areas account for 2.48% (17.55 × 10³ km²) of the total area. A gap analysis revealed that 76.98% (13.51 × 10³ km²) of the optimized priority conservation areas currently lack formal protection under China’s protected area system and the World Database on Protected Areas. Under four future climate scenarios (2030s–2090s), projections indicated overall habitat contraction, with limited spatial expansion observed only under specific scenarios (SSP1-2.6 in the 2030s and 2090s; SSP5-8.5 in the 2030s), and the population centroid was projected to shift southeastward by an average of 42.67 km in Huaihua City. Twenty-one core habitat patches were identified under current climate conditions. As these core habitat patches are concentrated along interprovincial boundaries, specifically the Dalou Mountains and the Yuecheng Ridge, our findings emphasize the need to bridge local administrative barriers. This spatial framework provides actionable guidelines for establishing transboundary protected areas, optimizing in situ conservation networks, and implementing model-based assisted migration. Full article

Ficus carica L. is traditionally used for diabetes management. This study evaluated the antihyperglycemic activity, safety, possible mechanisms, and phytochemical composition of its aqueous leaf extract (EAcFc). EAcFC activity was evaluated in streptozotocin–nicotinamide-induced type 2 diabetic (ST2D) mice under acute and subchronic conditions. EAcFc showed low acute toxicity (LD₅₀ > 3000 mg/kg). Acute and subchronic oral administration of EAcFc (300 mg/kg) significantly reduced blood glucose levels in ST2D mice. Although sustained HbA1c reduction was not observed, EAcFc improved lipid profiles, notably reducing triglyceride concentrations in ST2D males (from 156 ± 19.4 to 89.7 ± 3.3 mg/dL at week 4) and females (from 138 ± 2.0 to 77 ± 16.0 mg/dL at week 4). In oral sucrose and lactose tolerance tests (3 g/kg load), EAcFc (300 mg/kg) significantly attenuated postprandial hyperglycemia at 30, 60, and 120 min, an effect comparable to acarbose (50 mg/kg). No significant activity was observed during the oral glucose tolerance test (1.5 mg/kg load), suggesting the effect is not mediated by SGLT-1 inhibition. Preparative TLC and NMR analysis identified narcissin, nicotiflorin, and β-sitosterol. Thus, EAcFc possesses antihyperglycemic and lipid-modulating properties partially associated with α-glucosidase inhibition and bioactive flavonoids and phytosterol. Full article

Ship self-sinking accidents threaten maritime safety, human life, property, and the marine environment, and understanding their causal-factor associations is essential for developing effective preventive measures. This study aims to identify the multi-level factors, recurrent association patterns, and critical structural nodes involved in ship self-sinking accidents. A hybrid framework integrating grounded theory, the Human Factors Analysis and Classification System (HFACS), FP-growth association rule mining, and complex network analysis was applied to 150 accident investigation reports released by the China Maritime Safety Administration between 2014 and 2024. Findings suggest that adverse weather and sea conditions, inadequate ship safety management, and crew incompetence are the most frequent factors. Thirty causal factors were identified and classified into four HFACS levels, and 229 association rules were generated to construct a directed weighted causal-factor association network with 19 nodes and 229 edges. Network results indicate that inadequate ship safety management, crew incompetence, ship unseaworthiness, insufficient maintenance of hull weathertight integrity, and improper or untimely emergency measures occupy critical positions in the association structure. This research offers insight into ship self-sinking accidents and identifies priority intervention points for more targeted maritime supervision, safety management and accident prevention. Full article

Objective: To characterize the structural organization of Enhanced Recovery After Surgery (ERAS) component implementation in gynecologic oncology and determine whether ERAS elements operate as an interconnected perioperative system during early pathway integration. Methods: This study represents a secondary analysis of the prospective multicenter Enhanced Recovery in Gynecologic Oncology (ERGO) cohort, including the first 300 consecutive patients undergoing surgery for gynecologic malignancy across five tertiary institutions. Components with prevalence between 5% and 95% were included in a regularized Ising network model to estimate conditional dependencies between pathway elements. Node-level centrality metrics and global network characteristics were calculated to identify structurally influential ERAS components and to describe the overall implementation architecture. Results: Thirteen central ERAS components met the predefined prevalence criterion (5–95%) and were included in the conditional dependency network. The estimated network demonstrated substantial inter-component connectivity, indicating that ERAS practices were frequently implemented in coordinated patterns rather than as isolated interventions. Centrality analysis identified postoperative laxatives or chewing gum, tranexamic acid administration, perioperative intravenous fluid management, and avoidance of drain placement as highly connected elements within the network. Early nutritional advancement and postoperative bowel stimulation measures also demonstrated relatively central positions within the recovery-related component cluster. Community detection analysis revealed distinct modules of co-adopted ERAS practices spanning multiple perioperative phases. Conclusions: ERAS implementation in gynecologic oncology appears to follow a structured architecture characterized by interconnected perioperative practices rather than independent protocol elements. Understanding these implementation structures may help guide targeted quality-improvement strategies aimed at optimizing ERAS integration in routine clinical practice. Full article

Background and Objectives: Effective palliative care relies on accurate identification and management of symptoms, especially in patients referred for palliative radiotherapy (PRT). This study aimed to identify symptom clusters (SCs)—defined as ≥2 interrelated symptoms—in patients evaluated at a multidisciplinary Radiotherapy and Palliative Care (RaP) outpatient clinic, using the Edmonton Symptom Assessment System (ESAS). Materials and Methods: We retrospectively analyzed data from patients referred to the RaP clinic between February 2017 and April 2020. Demographic and clinical characteristics, including ESAS scores at first visit, were collected. SCs were identified with principal component analysis (PCA) and unsupervised k-means clustering (KMC), determining the number of SCs based on the maximum gap statistic and interpretability. Associations with ECOG performance status (PS), primary tumor and metastases site, and PRT administration were analyzed. Exploratory survival analyses were performed. Results: Among 215 patients (median age = 71 years; 53% male), the mean total ESAS score was 24.03 (SD = 15.28). PCA identified four SCs: SC_PCA1 (tiredness, drowsiness, dyspnea, malaise), SC_PCA2 (depression, anxiety), SC_PCA3 (nausea, loss of appetite) and SC_PCA4 (pain). KMC revealed three SCs: SC_KMC1 (pain, tiredness, drowsiness, malaise), SC_KMC2 (nausea, loss of appetite, dyspnea), and SC_KMC3 (depression, anxiety). Worse ECOG PS correlated with physical SCs (p < 0.05). Psychological SCs were associated with lower likelihood of receiving PRT (OR_PCA2 = 0.26, CI: 0.07–0.80, OR_kmc3 = 0.19, CI: 0.02–0.85, p < 0.05), but when associated with pain/systemic clusters correlated with greater PRT use. A trend toward shorter survival was seen in SC_KMC2. Conclusions: SC analysis could improve personalized symptom management and clinical decision-making in the PRT setting. Full article

This quantitative study exαmines the pivotal role of electronic communication (EC) and public relations (PR) within secondary education institutions. In an era of rapid digital transformation, educational organizations increasingly integrate modern communication practices to enhance transparency, collaboration, and active engagement within the school community. The research, based on a quantitative analysis of 196 educators and administrators, investigates perceptions regarding the frequency and effectiveness of digital tools using descriptive statistics, correlation analysis, and regression modeling. Key findings reveal a universal adoption of EC, with 72.96% of participants reporting daily use and 75.51% evaluating its effectiveness as high. Advanced statistical analysis through Multiple Linear Regression (R² = 0.538, p < 0.001) indicates that perceived effectiveness and frequency of use are the primary predictors of overall satisfaction. However, the study identifies significant institutional gaps, such as the absence of an official electronic communication protocol for crisis management (59.69%) and heightened concerns regarding data breaches (82.65%). The study concludes that there is an urgent need to establish unified communication strategies and provide continuous staff training in digital security and ethics. Full article

Introduction: The Iberian killifish (Apricaphanius iberus), an endemic cyprinodontid of the Spanish Mediterranean coast, is a key conservation species due to its restricted distribution, high sensitivity to habitat alteration and invasive fish, and ecological role in saline wetlands. Classified as Endangered by national administration and listed in Annex II of the EU Habitats Directive, its populations have undergone severe declines across its native range. Coastal salt pans have become critical refuges for the persistence of this species, often supporting some of the highest population densities recorded. However, the conservation value of these anthropogenic systems strongly depends on hydrological management, which directly influences habitat stability and suitability. Objectives: This study aims to assess the long-term population responses of A. iberus under contrasting hydrological management regimes in coastal salt pans. Methodology: We analysed ten years of monitoring data across five salt pan circuits in the perimeter area of the Mar Menor coastal lagoon (SE Spain), covering a salinity gradient and three management regimes: economic exploitation (EE), preventive management (PM), and non-management (NM). Population metrics (occurrence, abundance and breeder proportion) were evaluated. Results: Population performance differed markedly among management regimes. EE circuits showed consistently high occurrence and abundance, including in hypersaline ponds, high breeder proportions, low interannual variability, and weak dependence on meteorological conditions and ephemeral prey. PM circuits displayed intermediate patterns. In contrast, NM circuits exhibited low occurrence and abundance, low breeder proportions, high temporal fluctuations, and strong dependence on meteorological variability. Conclusions: Hydrological management is a key determinant of A. iberus population stability in coastal salt pans. Maintaining or restoring traditional management practices enhances habitat suitability, buffers environmental variability, and supports conservation actions such as reintroduction. These findings highlight the critical role of managed anthropogenic wetlands as refuges for endangered fishes and provide a transferable framework for conservation under global change. Full article