Search Results (319)

High-quality development of agricultural enterprises is essential for China’s rural revitalization, yet the institutional conditions that support it remain poorly understood. Drawing on institutional logics and configuration theory, this study adopts a holistic systems perspective to examine how government, market, and social institutions interact to shape enterprise performance. Using provincial data (2013–2023) matched with firm-level data for 119 listed agricultural enterprises, we estimate total factor productivity as the core outcome and apply dynamic fuzzy-set Qualitative Comparative Analysis (dynamic fsQCA) to identify equifinal institutional pathways. The results reveal that high-quality development is an emergent property of complex institutional systems; instead, high-quality development emerges from several distinct configurations combining policy support, marketization, financial development, Agricultural Infrastructure Index, market stability, and urban–rural integration. Two contrasting configurations are associated with non-high-quality development, characterized by financial scarcity and infrastructure deficits or by fragmented policy support under weak regulation. Dynamic analysis further reveals clear temporal and spatial heterogeneity: some market–finance driven paths lose robustness over time, while policy–urbanization and regulation–infrastructure based configurations become increasingly stable. These findings extend institutional configuration research to the agricultural sector, demonstrate the value of dynamic fsQCA for capturing temporal effects, and offer differentiated policy implications for optimizing institutional environments to foster the high-quality development of agricultural enterprises. Full article

Introduction: Rare diseases disperse expertise across institutions and borders, making structured second-opinion systems a pragmatic way to concentrate subspecialty knowledge and reduce diagnostic delays. This scoping review mapped the design, governance, adoption, and impacts of such services across implementation scales. Objectives: To describe how second-opinion services for rare diseases are organized and governed, to characterize technological and workflow models, to summarize benefits and barriers, and to identify priority evidence gaps for implementation. Methods: Using a population–concept–context approach, we included peer-reviewed studies describing implemented second-opinion systems for rare diseases and excluded isolated case reports, purely conceptual proposals, and work outside this focus. Searches in August 2025 covered PubMed/MEDLINE, Scopus, Web of Science Core Collection, Cochrane Library, IEEE Xplore, ACM Digital Library, and LILACS without date limits and were restricted to English, Portuguese, or Spanish. Two reviewers screened independently, and the data were charted with a standardized, piloted form. No formal critical appraisal was undertaken, and the synthesis was descriptive. Results: Initiatives were clustered by scale (European networks, national programs, regional systems, international collaborations) and favored hybrid models over asynchronous and synchronous ones. Across settings, services shared reproducible workflows and provided faster access to expertise, quicker decision-making, and more frequent clarification of care plans. These improvements were enabled by transparent governance and dedicated support but were constrained by platform complexity, the effort required to assemble panels, uneven incentives, interoperability gaps, and medico-legal uncertainty. Conclusions: Systematized second-opinion services for rare diseases are feasible and clinically relevant. Progress hinges on usability, aligned incentives, and pragmatic interoperability, advancing from registries toward bidirectional electronic health record connections, alongside prospective evaluations of outcomes, equity, experience, effectiveness, and costs. Full article

Background: Computerized Provider Order Entry (CPOE) systems are critical for medication safety, but their effectiveness relies heavily on the completeness of entered data. Incomplete clinical and anthropometric information can disable Clinical Decision Support Systems (CDSSs), compromising patient safety. Objective: This study aimed to assess the longitudinal evolution of CPOE data completeness, specifically focusing on “Breadth Completeness” (the presence of essential clinical variables), and to identify factors predicting data integrity in a tertiary care setting. Methods: A retrospective cross-sectional study was conducted at a 500-bed tertiary referral center in Riyadh. Data were extracted from the Cerner Millennium CPOE system for three “steady-state” years (2015, 2017, and 2019); years involving major system overhauls (2016 and 2018) were excluded to avoid structural bias. A total of 600 unique patient encounters (200 per year) were selected using systematic random sampling from a chronologically ordered sampling frame to minimize temporal bias. The primary outcome was “Breadth Completeness,” defined as the presence of eight key variables: age, gender, marital status, weight, height, diagnosis, vital signs, and allergies. Secondary outcomes included documentation consistency (daily notes). Multivariable logistic regression, adjusted for potential confounders, was used to determine predictors of completeness. Results: The rate of primary data completeness (Breadth) improved significantly over the study period, rising from 5.5% in 2015 to 26% in 2017 and 49.5% in 2019. In the multivariable analysis, the year of documentation (OR = 17.47 for 2019 vs. 2015, p < 0.0001) and length of hospitalization (OR = 1.04, p = 0.045) were significant predictors of completeness. Pharmacist-led medication reconciliation was associated with a 2.5-fold increase in data completeness in bivariate analysis (p < 0.0001). Conclusions: While system maturity has driven substantial improvements in CPOE documentation, critical gaps persist, particularly in anthropometric data required for safety alerts. The study underscores the necessity of mandating “hard stops” for core variables and formalizing pharmacist involvement in data reconciliation to ensure patient safety. Full article

This study systematically examines the policy and technological pathways for the sustainable development of China’s 3D printing industry under the “Dual Carbon” goals. A three-dimensional sustainability framework is developed, integrating resource efficiency, environmental performance, and socio-economic value. Based on this framework, the study conducts a full-process analysis covering design, material preparation, manufacturing, post-processing, use, and recycling stages. The analysis identifies key carbon-reduction mechanisms of 3D printing, including material savings, reduced energy consumption, lightweight-enabled emission reduction, and distributed manufacturing. A comparative analysis of China, the European Union, and the United States reveals major constraints in China’s 3D printing sector, particularly in top-level policy design, standardization systems, legal frameworks, industrial coordination, and low-carbon core technologies. Based on these findings, the study proposes a dual-driven development pathway integrating policy optimization and technological innovation. From an institutional perspective, this pathway emphasizes green policy incentives, including strategic planning, standard setting, green finance, and collaborative governance. From a technological perspective, it highlights the importance of low-carbon material development, refined energy-efficiency management, life-cycle carbon accounting platforms, and value creation across the product life cycle. Overall, the study demonstrates that effective policy–technology synergy is essential for transforming theoretical carbon-reduction potential into scalable and practical outcomes, providing a systematic analytical framework for academic research and actionable guidance for policymakers and industry stakeholders. Full article

Mammalian oocyte maturation is a metabolically demanding process relying on lipid metabolism that supplies energy, structural substrates, and signaling mediators. However, a comprehensive cross-species understanding of the dynamic requirement for lipids during this process remains elusive, hindering the optimization of assisted reproductive technologies. Utilizing an integrated single-cell transcriptomic and targeted lipidomic approach, we mapped the metabolic landscape of bovine oocyte maturation. Our analysis uncovered a global transcriptional downregulation, with 3259 genes suppressed during the transition from the germinal vesicle (GV) to the metaphase II (MII) stage. This was particularly apparent in lipid catabolism pathways (e.g., for ACAA1), while mitochondrial energy production genes (ATP6) were upregulated. Lipidomics indicated a selective depletion of saturated fatty acids (SFAs; e.g., C16:0, C18:0) in MII oocytes, while monounsaturated (MUFAs) and polyunsaturated fatty acids (PUFAs) were preferentially retained. Integrated network analysis specified hexadecanoic acid (C16:0) as a central metabolic hub, which rewires its interactions from biosynthetic genes (FASN, ELOVL6) in GV oocytes to degradative enzymes (ACADVL, HADH) in MII oocytes. Expanding to a cross-species transcriptomic atlas, we identified a core set of 59 lipid metabolism genes conserved across bovine, mouse, and human oocytes. Despite this conservation, we discovered stark species-specific regulatory strategies: bovine and human oocytes significantly downregulated fatty acid degradation and elongation post-maturation, whereas murine oocytes maintain pathway activity, upregulating key regulators like Acsl3. Our work unveils an evolutionarily conserved core lipid metabolic program in mammalian oocytes that is adaptively tuned to meet species-specific physiological demands. Bovine and human oocytes prioritize catabolic flexibility, using SFAs for energy, while mouse oocytes maintain their anabolic capacity for membrane biosynthesis. These findings provide a transformative resource for the field, offering biomarkers for oocyte quality and a rationale for enhancing species-tailored lipid formulations to develop in vitro maturation systems and amend reproductive outcomes in both agriculture and medicine. Full article

Background and Objectives: A surgical method is rarely very effective and simple to perform. A Lichtenstein Repair (LR) is one such exception. Because of the very high incidence of inguinal hernia, LR has become the global gold standard in inguinal hernia repair—not only due to its relative simplicity and reproducibility but also because it can be performed under local anesthesia. These attributes facilitated its worldwide adoption, including in underdeveloped and resource limited settings. Today, many variations are performed under the common name “Lichtenstein Repair”. The extent to which these modifications influence outcomes—particularly recurrence and chronic pain—remains unclear. Materials and Methods: To evaluate reasons for variation in the LR technique, a literature review of seven major surgery textbooks was performed. In addition, a questionnaire comprising 17 questions addressing the key steps of the LR was sent to 90 surgeons across 19 different hospitals in Austria (6) and Slovenia (13). The questionnaire focused on core principles described by Lichtenstein and later refined by his successors. The overall response rate was 78%. Results: Descriptions of the LR in major hernia textbooks vary substantially, partly due to the evolution of the technique over time and partly because any subaponeurotic anterior-canal mesh repair is often labeled as “Lichtenstein”. Survey responses demonstrated considerable variation and lack of standardization or uniformity in several critical steps of the LR. More than 50% of respondents reported using pre-formed meshes that they excessively trim, limiting adequate coverage of the inguinal region. Furthermore, routine patient follow-up is lacking in the majority of cases. Conclusions: The contemporary umbrella term “Lichtenstein Repair” encompasses many different anterior mesh techniques. While some surgeon-specific preferences may not compromise integrity, strict adherence to the evidence-based key principles of the original repair remains essential to minimize recurrences and chronic inguinal pain. Standardization with meticulous adherence to the key principles of the LR is critical to ensure the data submitted into registries, RCTs, and meta-analyses are accurate, comparable, and meaningful. Full article

Background: The phytoene desaturase gene is a classical visual marker for validating CRISPR/Cas9 genome editing in plants, as its loss of function produces a readily scorable albino phenotype. While the biochemical basis of pigment loss is well established, it remains unclear whether pds knockout elicits transcriptomic changes extending beyond carotenoid biosynthesis. Resolving this question is essential for correctly interpreting pds-based editing outcomes and for assessing the robustness of phenotype-only screening approaches. Methods: A CRISPR/Cas9 editing platform targeting pds was established in diploid potato. Albino, non-albino edited, and wild-type tissues were subjected to RNA-seq profiling. Differential expression, functional enrichment, and weighted gene co-expression network analysis were integrated to resolve phenotype-associated transcriptional modules, and hierarchical regulatory layers underlying albinism. Results: CRISPR/Cas9-mediated disruption of pds in potato-generated stable albino phenotypes and revealed extensive transcriptomic reprogramming that was not limited to pigment loss. Albino tissues exhibited more than 9700 differentially expressed genes relative to both wild-type and non-albino edited tissues, whereas non-albino edits showed substantially fewer changes. Functional enrichment demonstrated pervasive suppression of photosynthesis and carbon metabolism alongside activation of secondary metabolism, stress responses, hormone signaling, and cell wall remodeling. WGCNA and cross-validation resolved these changes into distinct, phenotype-associated regulatory layers: MEorangered4 captured coordinated repression of starch and sucrose metabolism (r = −0.998), MEdarkgreen marked albino-linked activation of secondary metabolism and barrier biogenesis (r = 0.855; overlap with Albino Core set, OR = 23.65), while MEblack and MEgrey60 reflected downregulation of stress signaling, proteostasis, and hormone-integrative control and were enriched in transgenic–background-associated gene sets. Conclusions: pds knockout in potato is accompanied by broad transcriptomic changes beyond pigment biosynthesis, suggesting that albinism involves coordinated regulatory and metabolic adjustment under plastid dysfunction rather than pigment loss alone. These results refine the use of pds as a visual editing marker and provide a framework for linking localized genome edits to coordinated network-level transcriptional responses in plants. Full article

Small and medium-sized enterprises (SMEs) constitute a substantial share of industrial production. However, their operational performance is frequently constrained by delivery delays caused by inefficiencies in workforce scheduling and task sequencing. These limitations reduce overall competitiveness, particularly in project-based manufacturing environments where task heterogeneity and multi-skill variability are prominent. To address this challenge, this study develops an artificial intelligence based workforce planning framework tailored to capital-constrained manufacturing settings. The new proposed hybrid system integrates a Genetic Algorithm (GA), Monte Carlo Simulation (MCS), and Taguchi methodology to generate robust, uncertainty-aware labor assignments. The framework is validated through 18-month deployments in two manufacturing facilities with differing levels of technological maturity, demonstrating consistent improvements in operational outcomes. Furthermore, specific weekly examples were validated against the solutions of exact mixed integer linear programming solvers on the deterministic core to assess the optimality gap and ensure constant solution quality. Across the deployments, the system achieved 13% and 15% reduction in task completion times. The resulting GA–MCS–Taguchi pipeline operates efficiently on standard SMEs hardware, requires only short historical performance windows for calibration, and exhibits high user adoption in real industrial settings, which indicates strong operational viability and practical deployability. Full article

Background: Optimal nutritional care is essential to improving outcomes in hemodialysis, yet translation of evidence into routine practice remains uneven across settings. To inform health system planning and implementation priorities, we mapped global research on hemodialysis-related nutrition. Methods: We searched the Web of Science Core Collection for English-language original articles on nutrition and hemodialysis from 1 January 2006 to 13 October 2025. Publication trends, productivity by country and institution, influential journals and authors, citation impact, and conceptual structure via Keyword Plus co-occurrence, trend, and thematic evolution analyses were assessed using the bibliometrix package (version 5.0) in R. Results: A total of 332 articles from 115 journals were identified, with substantial growth and multidisciplinary authorship, though international collaboration remains limited. The United States contributed 21.4% of publications and achieved the highest citation impact, while China, Japan, Iran, and Brazil formed the next tier of contributors. The Journal of Renal Nutrition accounted for 16.6% of papers. Highly cited studies established links between dietary intake, mineral and electrolyte management, and survival, while supporting the use of intradialytic oral nutritional supplements. Thematic evolution showed a shift from biochemical markers toward patient-centered priorities, including diet quality, adherence, body composition, mental health, and quality of life. Emerging directions point to whole-diet approaches and microbiome-modulating strategies. Conclusions: Global research on diet and hemodialysis has progressed from foundational nutrient studies to multidimensional, patient-focused approaches. Our findings suggest opportunities for health systems to strengthen dietitian-led models of care, integrate patient-reported outcomes, and prioritize scalable nutrition interventions within routine dialysis services. Full article

Background: Emotional intelligence (EI), particularly the ability to regulate one’s emotions, is a key protective factor against stress and burnout in high-demand occupations, including leadership and healthcare. Compassion and gratitude practices have been proposed as brief, scalable methods to strengthen emotion regulation, yet empirical evidence from randomised controlled trials remains limited. Objective: This study evaluated whether a four-week, self-directed online programme combining daily loving-kindness meditation and gratitude journaling improves EI among leaders. Methods: Forty-five leaders in Germany from diverse occupational sectors were recruited via LinkedIn and Xing and were randomised using a computer-generated random sequence to an intervention or wait-list control group. EI was measured pre- and post-intervention with the Emotional Competence Questionnaire (EKF), comprising recognising one’s own feelings (RU), recognising others’ feelings (RO), regulating one’s own feelings (RC; primary outcome), and expressing feelings (RE). Adherence was reported in categorical form (e.g., daily, 3–5×/week, 1–2×/week). Treatment effects were tested using mixed-design ANOVAs. Results: A significant Group × Time interaction emerged for emotion regulation (RC), indicating greater improvement in the intervention group compared with the control group. No significant interaction effects were found for RU, RO, or RE. Adherence data did not permit dose–response analysis. Conclusions: A brief, self-directed online compassion and gratitude programme selectively improved emotion regulation—the EI facet most strongly linked to stress buffering and resilience. Although effects did not extend to other EI dimensions, findings suggest that low-threshold digital practices may strengthen a core emotional skill relevant to psychological well-being in leadership roles. Because the sample did not primarily comprise healthcare professionals, implications for healthcare settings re-main conceptual; targeted trials in clinical populations are warranted. Full article

Background/Objectives: Conversations about end-of-life care or advance care planning are often difficult and emotionally challenging to initiate. Tailoring messages to the specific audiences can make these sensitive discussions more manageable and effective. The Evidence-based Model for the Transfer and Exchange of Research Knowledge (EMTReK), compromising six core components (message, stakeholders, processes, context, facilitation, and evaluation) offers a structured framework for research dissemination and knowledge transfer in palliative and long-term care settings. Knowledge translation bridges research and practice, with its effectiveness depending on stakeholder engagement, tailored communication, and systematic application of evidence in policy and practice. This study explores stakeholder perspectives on a dementia care intervention, using EMTReK as an analytical framework to examine how knowledge transfer and exchange (KTE) actions were implemented across long-term care settings. Methods: A qualitative analysis was conducted on primary data comprising case narratives from multinational research groups involved in the “Caregiver Decision Support” (mySupport) study (2019–2023). Teams from Canada, the Czech Republic, Ireland, Italy, the Netherlands, and the United Kingdom evaluated the mySupport intervention through interviews, with analysis guided by components of the EMTReK model. Results: Facilitated Family Care Conferences were found to be effective mechanisms for supporting knowledge transfer and intervention uptake in dementia care across nursing homes in Europe and Canada. Despite challenges posed by the COVID-19 pandemic, Family Care Conferences adapted through stakeholder engagement, interactive learning, and innovative communication methods. Using EMTReK as an analytical framework, the research team identified key elements that contributed to successful implementation, including the importance of flexibility to accommodate local contexts. Conclusions: The transnational application of the EMTReK model for advance care planning in long-term dementia care highlights the importance of tailored, culturally relevant knowledge translation strategies, which, despite challenges from the COVID-19 pandemic, were successfully implemented through local adaptations and diverse dissemination methods, emphasising the need for further research on their impact on resident and family outcomes. Full article

This paper investigates risk factors and their propagation pathways in multinational building projects. An initial set of 30 key risk variables associated with transnational engineering projects was identified. Using Interpretive Structural Modeling (ISM), we constructed a hierarchical framework to elucidate the interrelationships and transmission dynamics among risk factors. The Cross-Impact Matrix Multiplication Applied to Classification (MICMAC) method was then employed to categorize these factors into three distinct layers: root causes, intermediaries, and surface-level outcomes. Our analysis revealed 16 risk transmission pathways. Among the 30 variables, four were identified as root drivers, 22 as propagation factors, and four as surface triggers. Risk typically migrates from the root layer to the surface within three to four steps. Notably, ten factors—most prominently stakeholder demand mismatch, sociocultural conflict, and inefficient information exchange—collectively account for 55% of the total causal influence, forming the “risk core” of the system. This study enhances the theoretical understanding of risk evolution in international construction projects and offers practical guidance for effective risk management. Full article

Objectives: This study aims to provide conceptual clarity on self-direction support in the care of vulnerable older adults, particularly those with dementia. It focuses on how self-direction is supported in meaningful daily activities and social participation. The goal is to define and operationalize the concept by identifying its key attributes, antecedents, and consequences across care contexts. Methods: A two-phase approach will be used. First, an integrative review will synthesize empirical evidence from gerontology, occupational therapy, psychology, nursing, and health ethics to examine current conceptualizations and practices. Second, a concept analysis will explore the theoretical structure of self-direction support. Findings will be synthesized into a conceptual framework. Expected outcomes: This study is expected to provide a clearer conceptual framework outlining the core components of self-direction as described in existing literature. This framework will define key attributes, identify influencing factors, and propose measurable indicators. The framework aims to guide professionals in balancing autonomy, safety, and care needs. Conclusions: As this is a study protocol, no results are presented; findings will be reported in the forthcoming review. The anticipated outcomes are expected to contribute to theory and practice by framing self-direction within social health. The framework may inform future research, policy, and intervention development to strengthen self-direction in meaningful activities and participation among vulnerable older adults. Further validation across settings and cultural contexts will be required. Full article

In response to persistent gaps in pain management competencies among nurses in Saudi Arabian teaching hospitals and similar healthcare settings globally, this manuscript presents a developed and validated action plan designed to support the effective transfer of pain management competencies into clinical practice. The action plan was developed to address the critical need for structured, practical strategies that enhance nurses’ ability to apply pain management knowledge in diverse interdisciplinary environments. The action plan was validated through a rigorous three-round e-Delphi technique involving 12 expert panel members, achieving a 75% consensus on its content and structure. The final validated plan includes clear action statements, implementation methods, designated responsibilities, and defined timeframes. The core action statements focus on the following: (i) motivating nurses to pursue further study; (ii) equipping nursing teams with appropriate pain management tools; (iii) developing content-specific, practice-oriented short training programs; (iv) tailoring training to accommodate different learning styles; (v) using diverse teaching methods; (vi) creating strategies to encourage participation in training; and (vii) promoting the application of acquired knowledge in clinical settings. Adoption and implementation of this action plan by nursing leadership are anticipated to significantly enhance the transfer of pain management competencies, ultimately improving patient outcomes. The plan is adaptable for use in similar healthcare settings worldwide, offering a replicable model for strengthening nursing practice through targeted competency development. Full article

The COVID-19 pandemic initially focused clinical efforts on hospitalized patients. However, as the pandemic progressed, attention shifted to outpatients who often experience milder symptoms yet still contribute to viral transmission. This scoping review aimed to document and evaluate the clinical outcomes assessed in randomized controlled trials (RCTs) involving outpatients with COVID-19, identifying gaps and areas for improvement in trial design. This review followed the PRISMA-ScR guidelines. A comprehensive search of four electronic databases (PubMed, Scopus, Cochrane CENTRAL, and Web of Science) was conducted for RCTs published between December 2019 and December 2023. Studies were included if they involved outpatients with confirmed COVID-19 and reported clinical outcomes. Data were extracted from eligible studies, and outcomes were categorized using the COMET taxonomy. A total of 91 studies were included, representing a wide geographical distribution, with the USA, Iran, and Brazil contributing the most studies. The most frequently investigated treatments included hydroxychloroquine, fluvoxamine, convalescent plasma, and ivermectin. Key outcomes focused on hospitalization rates, symptom resolution, and disease progression. Mortality, although less common in outpatients, was reported in 65 studies, underscoring the importance of outpatient interventions. This review highlights the need for standardized outcome measures in outpatient COVID-19 trials. Full article