Search Results (497)

Background: The quality of decision-making processes is increasingly recognized as critical to public trust and policy sustainability. Objectives: This narrative review aims to identify and describe process-focused decision support models (DSMs) applied in pharmaceutical policy, and to examine their potential contributions to improving procedural quality in decisions related to pricing, reimbursement, and access to medicines. Methods: Relevant peer-reviewed and gray literature published between 2000 and 2025 was considered, drawing from key databases (e.g., PubMed and Scopus) and international policy reports (e.g., WHO, ISPOR, and HTA agencies). Studies were included if they provided insights into DSMs addressing at least one dimension of decision process quality. Results: Findings are synthesized narratively and organized by tool type, application context, and key quality dimensions. Frequently referenced tools included the Quality of Decision-Making Orientation Scheme (QoDoS), WHO-INTEGRATE, and AGREE II. QoDoS emerged as the only tool applied across regulatory, HTA, and industry settings, evaluating both individual- and organizational-level practices. WHO-INTEGRATE highlighted equity and legitimacy considerations but lacked a structured format. Overall, most tools demonstrated benefits in promoting internal consistency, transparency, and stakeholder engagement; however, their adoption remains limited, especially in low- and middle-income countries. Conclusions: Process-focused DSMs offer promising avenues for enhancing transparency, consistency, and legitimacy in pharmaceutical policy. Further exploration is needed to standardize evaluation approaches and expand the use of DSMs in diverse health systems. Full article

Introduction: Respiratory Syncytial Virus (RSV) is the leading cause of lower respiratory tract infections in infants and children, as well as hospitalizations for respiratory infections in the pediatric population, representing a significant public health concern. Nirsevimab, a long-acting anti-RSV monoclonal antibody, has recently been approved by the European Medicines Agency (EMA). The aim of this study is to assess the utility of certain parameters, such as the Number Needed to Immunize (NNI), in supporting decision-makers regarding the introduction of nirsevimab as a universal prophylactic measure. Methods: A literature review was conducted to identify the definition and application of the NNI in the context of infectious disease prevention. The following online databases were consulted: Scopus, MEDLINE, Google Scholar, Web of Science, and Cochrane Library. The search was restricted to English-language texts published between 1 January 2000 and 30 January 2025. Results: The NNI represents the number of individuals who need to be immunized to prevent clinical outcomes such as medical visits and hospitalizations caused by infectious diseases. Six studies were identified that utilized this parameter to outline the benefits of immunization and describe the advantages of using monoclonal antibodies for RSV disease. Finelli and colleagues report that to prevent one RSV-related hospitalization, 37–85 infants aged 0–5 months and 107–280 infants aged 6–11 months would need to be immunized with long-acting anti-RSV antibodies. A recent study by Mallah et al. on the efficacy of nirsevimab estimates that the NNI required to prevent one RSV-related hospitalization is 25 infants. Studies by Francisco and O’Leary report NNI values of 82 and 128 infants, respectively, to prevent one RSV-related hospitalization with nirsevimab. Mallah et al. describe NNI as a metric useful to quantify the immunization effort needed to prevent a single RSV hospitalization. A recent Italian study reports that 35 infants need to be immunized to prevent one hospitalization due to RSV-LRTI and 3 infants need to be immunized to prevent one primary care visit due to RSV-LRTI. The studies indicate that the NNI for anti-RSV monoclonal antibodies is lower than the corresponding Number Needed to Vaccinate (NNV) for vaccines already included in national immunization programs. The main limitations of using this parameter include the absence of a shared threshold for interpreting results and the lack of consideration for the indirect effects of immunization on the population. Conclusions: The NNI is an easily understandable tool that can be used to convey the value of an immunization intervention to a variety of stakeholders, thereby supporting public health decision-making processes when considered in association with the uptake of the preventative strategy. At the current status, the estimated NNI of monoclonal antibodies against RSV results favourable and confirms the use in the first year of life for the prevention of RSV disease. Full article

What elements of nature do people involved in conservation projects seek to protect, and why? How do they identify and relate to nature? Answers to such fundamental questions are shaped by normative assumptions that can result in distinct conservation strategies and practices. Despite their importance, normative assumptions are rarely explicitly stated in conservation sciences, possibly because an epistemology of modern science suggests that normative backgrounds are not relevant to the production of objective knowledge, or because researchers and practitioners are unaware of the diversity of positions that exist. Using a combination of qualitative and quantitative methods, we created a catalogue of existing normative positions in conservation literature and described their key characteristics. We described 72 distinctive normative positions about human–nature relationships. Each position was characterized by unique combinations of value-states belonging to one or more of the following five dimensions: ontology (the positionality of human with respect to nature), axiology (value systems and ethical frameworks), pragmatism (extent of human interventions), epistemology (knowledge sources), and agency (agents of change). We then scored each position in terms of its alignment (support, opposition, or neutrality) with respect to all value-states within each dimension. A fuzzy correspondence analysis revealed that the field of conservation is heterogeneous beyond the conventional gradient of intrinsic–instrumental–relational values. The frequency and circumstances under which stakeholders adopt different normative positions are unknown, but the list of dimensions and associated values provided in this study may serve as a checklist for scoping this diversity. Consideration of values stemming from alternative normative positions may help broaden support for conservation actions. Full article

How can we more fully analyze potential progress toward the 17 Sustainable Development Goals, globally and by country? Methodological challenges include (1) the comprehensiveness of issue coverage, integration of causal elaboration, and geographic detail in available models; (2) clear quantification of goal targets; and (3) specification of scenario interventions that connect meaningfully to the potential leverage of agents. This study uses a large-scale, global but country-based analytical system that tightly integrates multiple issue-area models to push against methodological challenges. It explores the prospects for progress toward selected quantified targets across all goals, using scenarios that consider potential agency-linked interventions relative to the Current Path (CP). The scenarios distinguish interventions focused on Human Development (HD) and natural system sustainability (NSS) plus a Combined SDG scenario (CSDG). Even with a large, integrated push through 2030 and 2050, the world in aggregate will fail to reach many targets, and a great many of the 188 countries represented will fall short. Also of interest is possible tension between the underlying thrusts of HD- and NSS-oriented interventions. Both the Current Path of key variables and intervention leverage constraints make NSS goals harder to reach than HD goals. Because synergies of action considerably outweigh trade-offs, however, complementarity better characterizes the two intervention sets. Full article

Indoor radon constitutes a public health issue in various regions across the United States as the second leading cause of lung cancer following tobacco smoke. The U.S. Environmental Protection Agency advises radon mitigation interventions for residential buildings with indoor radon concentrations exceeding the threshold level of 4 pCi/L. Despite considerable research assessing the technical effectiveness of radon mitigation systems, there remains a gap in understanding their broader influence on occupant behavior and preferences in residential design. This study aims to investigate the impact of residing in radon-mitigated homes within the Commonwealth of Kentucky—an area known for elevated radon concentrations—on occupants’ preferences regarding healthy home design attributes. The objectives of this research are twofold: firstly to determine if living in radon-mitigated homes enhances occupant awareness and consequently influences their preferences toward health-related home attributes and secondly to quantitatively evaluate and compare the relative significance homeowners assign to health-related attributes such as indoor air quality, thermal comfort, and water quality relative to conventional attributes including home size, architectural style, and neighborhood quality. The overarching purpose is to explore the potential role radon mitigation initiatives may play in motivating occupants towards healthier home construction and renovation practices. Using choice-based conjoint (CBC) analysis, this paper compares preferences reported by homeowners from radon-mitigated homes against those from non-mitigated homes. While the findings suggest a relationship between radon mitigation and increased preference for indoor air quality, the cross-sectional design limits causal interpretation, and the possibility of reverse causation—where health-conscious individuals are more likely to seek mitigation—must be considered. The results provide novel insights into how radon mitigation efforts might effectively influence occupant priorities towards integrating healthier design elements in residential environments. Full article

Land use change plays a pivotal role in understanding surface processes and environmental dynamics, exerting considerable influence on regional ecosystem management. Traditional monitoring approaches, which often rely on manual sampling and single spectral features, exhibit limitations in efficiency and accuracy. This study proposes an innovative technical framework that integrates automated sample generation, multi-feature optimization, and classification model refinement to enhance the accuracy of land use classification and enable detailed spatiotemporal analysis in the Ebinur Lake Basin. By integrating Landsat data with multi-temporal European Space Agency (ESA) products, we acquired 14,000 pixels of 2021 land use samples, with multi-temporal spectral features enabling robust sample transfer to 12028 pixels in 2011 and 10,997 pixels in 2001. Multi-temporal composite data were reorganized and reconstructed to form annual and monthly feature spaces that integrate spectral bands, indices, terrain, and texture information. Feature selection based on the Gini coefficient and Out-Of-Bag Error (OOBE) reduced the original 48 features to 23. In addition, an object-oriented Gradient Boosting Decision Tree (GBDT) model was employed to perform accurate land use classification. A systematic evaluation confirmed the effectiveness of the proposed framework, achieving an overall accuracy of 93.17% and a Kappa coefficient of 92.03%, while significantly reducing noise in the classification maps. Based on land use classification results from three different periods, the spatial distribution and pattern changes of major land use types in the region over the past two decades were investigated through analyses of ellipses, centroid shifts, area changes, and transition matrices. This automated framework effectively enhances automation, offering technical support for accurate large-area land use classification. Full article

This study explores the use of artificial intelligence (AI) in religious leadership in Germany, focusing on the interplay between technological innovation, theological principles, and human interaction. Drawing on qualitative methods, 23 Christian leaders and experts were interviewed to examine their perceptions, assessments, and potential applications of AI and related technologies in their work, alongside ethical and theological considerations. The findings reveal a prevailing ambivalence towards AI: while it is generally accepted as a tool for administrative tasks, its use in pastoral contexts encounters resistance due to ethical concerns and theological tensions. Despite predominantly neutral to positive attitudes, many leaders lack proactive engagement in exploring AI’s transformative potential—pointing to a marked lack of agency. Digital competence among leaders emerges as a significant factor influencing the openness to AI adoption. This study identifies key barriers to the integration of AI into religious practice and underscores the need for strategic education and planning. It advocates for a balanced approach to leveraging AI in ways that align with religious values while embracing innovation in a digitalizing society. Full article

Integrating artificial intelligence (AI) and machine learning (ML) into pharmaceutical manufacturing processes holds great promise for enhancing efficiency, product quality, and regulatory compliance. However, implementing good manufacturing practices (GMP) in regulated environments introduces complex challenges related to validation, data integrity, risk management, and regulatory oversight. This review article comprehensively analyzes current regulatory frameworks and guidance for AI/ML in pharmaceutical Good Manufacturing Practice (GMP) settings, identifies gaps and uncertainties, and proposes considerations for future policy development. Emphasis is placed on understanding regulatory expectations across various agencies, including the US FDA, EMA, and MHRA. This article examines verified case studies and pilot programs that demonstrate the successful application of AI/ML under regulatory scrutiny, as well as recent developments in regulatory frameworks and implementation strategies. Ultimately, this article emphasizes the importance of a risk-based life cycle approach and the need for advancements in regulatory science to accommodate the dynamic nature of AI/ML technologies. Full article

The concept ‘mobility of care’ captures all the daily travel necessary for the upkeep of a household, including trips to grocery stores, health-related appointments, errands, and caring activities for dependents. Since it was originally coined in 2009, a handful of studies have shown how poorly mobility of care trips are captured in transportation surveys. These preliminary analyses also find that care trips comprise a substantial proportion of daily mobility. As women disproportionately engage in ‘mobility of care’ travel, the under-consideration of care trips is argued to result in a gender bias in transport planning. Despite this, transport policy related to mobility of care has received less attention. Given that transport policy shapes how transport systems operate, this paper explores the extent to which recent transport policies consider mobility of care. A critical policy review framework is used to systematically examine seven policy documents (435 pages) from the Toronto Transit Commission (TTC), the largest transit agency in Canada. Results indicate that mobility of care is rarely directly considered or significantly discussed. Instead, transport policy often uses the commute to work as the default trip. Mentions of care destinations and trip characteristics associated with mobility of care are more common in recent years and most frequently discussed in relation to the COVID-19 pandemic or specialized services for seniors and people with disabilities. Policies that likely facilitate mobility of care indirectly are also identified, including fare discounts, transfer windows, and accessibility policies. The review concludes with preliminary recommendations on how transit agencies can more directly plan for mobility of care. Full article

The integration of artificial intelligence (AI) chatbots in online learning environments has transformed the way students engage with educational content, offering personalised learning experiences, instant feedback, and scalable support. This study investigates the role of AI-driven chatbots in the Pedagogical Information and Communication Technology (ICTPED) Massive Open Online Course (MOOC), a professional development course aimed at enhancing teachers’ Professional Digital Competence (PDC). The study pursues two connected aims: (1) to examine how chatbots support content comprehension, self-regulated learning, and engagement among pre- and in-service teachers, and (2) to explore, through a cultural-historical perspective, how chatbot use contributes to the development of students’ digital agency. Based on data from 46 students, collected through structured questionnaires and follow-up interviews, the findings show that chatbots functioned as interactive learning partners, helping students clarify complex concepts, generate learning resources, and engage in reflection—thereby supporting their PDC. At the same time, chatbot interactions mediated learners’ development of digital agency, enabling them to critically interact with digital tools and navigate online learning environments effectively. However, challenges such as over-reliance on AI-generated responses, inclusivity issues, and concerns regarding content accuracy were also identified. The results underscore the need for improved chatbot design, pedagogical scaffolding, and ethical considerations in AI-assisted learning. Future research should explore the long-term impact of chatbots on students’ learning and the implications of AI-driven tools for digital agency development in online education. Full article

Sentinel-1 cross-polarization (cross-pol) SAR data, known for their unsaturated backscattering characteristics, hold strong potential for high-wind-speed retrieval in tropical cyclones (TCs). However, significant inherent noise in cross-pol data limits retrieval accuracy, especially under moderate-to-high wind conditions. Existing noise suppression methods remain insufficient due to their limited consideration of spatially varying noise characteristics within different TC structural regions. To address these challenges, this study proposes an enhanced two-dimensional noise field reconstruction framework based on Bayesian estimation, tailored to the structural features of TCs. The method begins by statistically characterizing cross-pol SAR backscatter to differentiate structural regions within TCs. Noise-scaling coefficients are then calculated to suppress scalloping artifacts, followed by the computation of power balance coefficients in sub-swath transition zones to mitigate abrupt inter-strip power variations through signal power equalization. Comparative assessments against the European Space Agency (ESA) noise vectors show that the proposed approach achieves an average signal-to-noise ratio (SNR) improvement of 2.54 dB. Subsequent sea surface wind speed retrievals using the denoised cross-pol data exhibit significant improvements: wind speed bias is reduced from −2.69 m/s to 0.65 m/s, accuracy is improved by 2.04 m/s, and the coefficient of determination (R²) increases to 0.88. These findings confirm the effectiveness of the proposed method in enhancing SAR-based wind speed retrieval under complex marine conditions associated with tropical cyclones. Full article

A new active composite film intended for bread packaging is described here. The active film has the aim of prolonging bread’s shelf life while avoiding the use of nanoparticles that, with very few exceptions, are a type of material not allowed by regulatory agencies like EFSA (European Food Safety Agency) and FDA (US Food and Drug Administration) in food contact materials. Moreover, the increasing consumer demand for natural and wholesome products, possibly “clean label”, and packaged in natural, non-petroleum-based materials has been taken into consideration. Accordingly, precursor materials from renewable sources were used to prepare the active film: pectin from citrus peel (PEC) and carboxymethyl cellulose (CMC) were used as the matrix, with oleic acid (OA) as plasticizer. Moreover, the bread preservative calcium propionate (CaP) was used as the crosslinker, and also zeolite microparticles loaded with silver ions (AgZ) were added to the films as an additional antimold agent. This strategy allows us to avoid the addition to bread of the now commonly used preservatives ethanol and calcium propionate, moving the latter to the packaging. Permeance measurements revealed excellent barrier properties against O₂ and CO₂, while the typical high water vapor permeance of polysaccharide films was mitigated by the non-hydrophilic OA plasticizer. Moreover, the quantities of Ag⁺ and CaP released in bread are low and below the limits imposed by regulatory agencies. The antimold activity of the films is excellent, with Aspergillus niger, Penicillium janthinellum, and wild-type Penicillim molds reduction on bread in the 99.20–99.95% range for the films containing only CaP and in the 99.97–99.998% range for the films containing both CaP and AgZ. Finally, the rheological properties of the film-forming solutions were investigated, demonstrating their potential application as coatings on natural packaging materials for bread, such as paper. Full article

The issue of stray cats and dogs is a global concern with considerable implications for animal welfare and public health. This review aims to provide an updated and comprehensive analysis of non-surgical contraceptive methods tested in studies controlled in vivo in feline and canine females. Immunocontraception via vaccination against gonadotropin-releasing hormone (GnRH), the luteinizing hormone receptor, zona pellucida proteins, and sperm, or use of viral-vectored delivery, is yet developing. Hormonal treatment (progestins, androgens, or GnRH) analogs act directly to block the reproductive axis. However, it produced essential side effects. Analogs of kisspeptin, non-steroid anti-inflammatory drugs such as firocoxib, and delivery of cytotoxins to the pituitary have shown non-conclusive results. Additional methods have also been tested, such as intraovarian injection of necrosing compounds or intravaginal and intrauterine devices. At present, neither of these methods offers permanent sterility that can replace surgical sterilization techniques. To our knowledge, none are currently authorized by the Food and Drug Administration (FDA) or the European Medicines Agency (EMA) for contraceptive methods or sterilization of cats or dogs. Therefore, it is necessary to continue the development of a compound that warrants the sterility of cats and dogs. Full article

In recent years, corporate ESG performance has been widely incorporated into investment decisions and capital allocation considerations, becoming a focal point and hot topic for research by governments and organizations worldwide. However, due to various reasons, significant discrepancies have emerged in ESG ratings for the same company across different institutions, and this growing divergence in ESG ratings has increasingly drawn the attention of scholars. Studying the differences in ESG (environmental, social, and corporate governance) ratings is of great significance. This not only helps to understand the root causes of differences, improve the objectivity, consistency, and comparability of ratings, but also helps users better understand the meaning and limitations of rating results. It is beneficial for investors to understand the focus of different ratings and develop more effective investment strategies. It can promote rated companies to improve the quality and transparency of ESG-related information disclosure. It can also provide a reference for regulatory agencies and policymakers, identify market failures and potential risks, and promote the development of more unified standards and frameworks. At the same time, this study can also promote the in-depth development of relevant academic research and theories. Based on this, this study systematically reviews the relevant literature on ESG rating divergence, focusing on its existence, causes, influencing factors, and impacts. The study finds that, in addition to the widespread existence of rating divergence in corporate ESG performance, scholars also disagree on the measurement and methods of this divergence. The reasons for rating divergence are mainly that ESG is a qualitative indicator; top-level design, intermediate calculations, and bottom-level data collection across multiple stages exacerbate divergence; and controversies in practice further deepen divergence, among others. The influencing factors and impact effects of ESG rating divergence are diverse. Given the existence of ESG rating divergence, all parties should treat ESG ratings with caution. This paper offers corresponding recommendations and looks forward to the future, providing a foundation for subsequent research. Full article

The organizational culture significantly impacts employee behavior, satisfaction, and retention. Historically associated with hierarchical, fire-service-based structures, EMS cultures vary considerably, and their influence remains unclear. We aimed to identify organizational cultures within EMS agencies and examine their association with clinicians’ intent to leave within 12 months. We performed a cross-sectional survey of nationally certified civilian EMS clinicians aged 18–85 in the United States who recertified with the National Registry of Emergency Medical Technicians between October 2022 and April 2023. Respondents completed the validated Organizational Culture Assessment Instrument (OCAI), categorizing organizational cultures into adhocracy, clan, hierarchy, market, or mixed. Multivariable logistic regression evaluated the organizational culture and clinicians’ intention to leave, adjusting for personal demographics, workplace characteristics, and job satisfaction. In total, 30,762 survey respondents were included. Mixed and hierarchy cultures predominated, followed by clan, market, and adhocracy. Clinicians in adhocracy and hierarchy cultures had significantly higher adjusted odds of intending to leave EMS compared to clan and mixed. The organizational culture in EMS significantly influences clinicians’ intentions to leave. Adhocracy, hierarchy, and market cultures are associated with an increased likelihood of turnover, but clan-oriented environments do not increase risks. These findings suggest that optimizing EMS agency cultures towards collaboration and supportive environments may enhance clinician retention. Full article