Search Results (255)

Background and Objectives: Digitalization studies often emphasize perceived benefits while overlooking professionals who cannot determine whether digital tools are useful. This study quantified digital hesitancy among anesthesia and intensive-care professionals, examined its relationship with professional role and experience, and compared it with reported barriers and technology use. Methods: A single-centre cross-sectional survey included 161 professionals (80.1% of 201 eligible departmental staff): 55 nurses and 106 physicians. A four-item Uncertainty Index measured inability to appraise digital benefits in patient safety, clinical decisions, management, and education. Barrier Burden and Resource-Efficiency indices were also calculated. Group differences were assessed using nonparametric tests, and predictors of high uncertainty were examined by multivariable logistic regression. Results: Nurses had substantially higher uncertainty than physicians (mean Uncertainty Index 1.60 vs. 0.49, difference 1.11, 95% CI 0.80 to 1.42; p < 0.001), particularly regarding educational and clinical benefits. Reported barriers were similar across professional groups, with technical problems being the most common. Any reported prior use of training simulators, irrespective of frequency or recency, was markedly lower among nurses than physicians (1.8% vs. 47.2%; absolute gap 45.4 percentage points, 95% CI 35.2 to 55.5; p < 0.001). After adjustment, physician status remained strongly associated with lower odds of high uncertainty, whereas overall seniority was not significant. In an exploratory within-nurse analysis, uncertainty was higher among more experienced nurses, reaching its highest level among those with more than 20 years of practice (Spearman ρ = 0.49, 95% CI 0.24 to 0.68; p < 0.001); the seniority bands were small (n = 7 to 18), so this gradient is hypothesis-generating. Conclusions: Digital hesitancy was concentrated among nurses and was distinct from shared technical barriers; within nurses it was higher at greater seniority. Because patient-safety outcomes and intervention effects were not measured, targeted simulator-based training and role-specific feedback should be regarded as hypotheses for prospective evaluation alongside, rather than established alternatives to, generic infrastructure improvements. Full article

Background/Objectives: We used dizziness as a tracer condition to describe documented emergency-care changes during resident physician workforce disruption and return, and whether greater diagnostic intensity was accompanied by greater diagnostic yield. Methods: This single-center retrospective observational study compared two 13-month periods: no-resident (February 2024–February 2025) and resident-return (March 2025–March 2026). Registry data for all 1652 eligible emergency department (ED) dizziness visits provided primary treating department, an administrative department-of-record field, disposition, and length of stay. Detailed chart review was limited to patients with a formally documented otorhinolaryngology (ENT) consultation. Monthly staffing and on-call coverage came from duty rosters, and brain MRI reports were classified by clinical relevance. No causal inference was intended. Results: Dizziness represented a similar proportion of ED visits across periods (5.9% vs. 5.4%; rate ratio [RR], 0.91; p = 0.061). Formally documented ENT consultation increased from 26/667 (3.9%) to 186/985 (18.9%; RR, 4.84; p < 0.001), although ENT on-call coverage was recorded throughout and combined attending/fellow staffing declined from nine to six. Neurology department-of-record decreased from 24.7% to 13.0% and otolaryngology increased from 3.3% to 17.7% (both p < 0.001), while overall admission remained stable (24.1% vs. 23.9%; p = 0.896). Crude hospital length of stay decreased from 4.68 to 3.51 days (p = 0.002), but not after otolaryngology admissions were excluded (4.68 vs. 5.54 days; p = 0.208), indicating a case-mix effect. Among ENT-consulted patients, MRI utilization increased from 57.7% to 95.7% (p < 0.001); 1/192 classifiable studies showed an acute central lesion (0.5%) and 7 (3.6%) incidental lesions. Dizziness-specific revisits did not differ at 72 h or 30 days. Conclusions: Documented consultation, imaging, and administrative departmental attribution changed markedly, whereas dizziness burden, overall admission, and short-term revisits remained stable. Differential documentation plausibly explains a substantial part of the consultation difference, which measures documented rather than actual specialist involvement, and greater imaging intensity was not accompanied by greater acute diagnostic yield. These descriptive findings do not establish that care became better, safer, or more accurate. Full article

This study identifies two stage-specific configurations of CLIL teacher well-being in Andalusia: an ecology of proximity in Primary Education and a disciplinary-departmental ecology in Secondary Education. Drawing on 14 semi-structured interviews with seven Primary and seven Secondary teachers, the study used a deductive–inductive ecological analysis combining within-case, cross-case, cross-stage, and subsystem-coupling procedures in QDA Miner. Participants described professional well-being not merely as a subjective psychological state but in terms of professional viability: the perceived ecological enactability of pedagogically legitimate and sustainable practice. Primary teachers’ accounts foregrounded sustained pupil contact, tutorial responsibility, family expectations, classroom routines, and adaptation for younger learners. Secondary teachers’ accounts foregrounded subject specialisation, departmental organisation, heterogeneous language proficiency, assessment ambiguity, and the Primary–Secondary transition. Across both stages, participants described compensatory overfunctioning—additional care, coordination, material redesign, translation, and assessment work undertaken to keep CLIL operational when implementation conditions were perceived as insufficient. Protected coordination time, stage-specific training, shared assessment frameworks, appropriate materials, and transition structures emerged as potential regulatory leverage points. The study advances a phase-sensitive systems interpretation of teacher well-being by identifying a fast balancing loop of frontline adaptation and a slower reinforcing stabilisation trap through which restored continuity may conceal persistent underprovision. Full article

Background: In September 2024, South Korea launched a nationwide Tertiary Hospital Restructuring Project to refocus tertiary hospitals on severe, emergency, and rare disease care, amid a tertiary care system long burdened by patient concentration and acutely strained by the mass resignation of trainee doctors. In the early phase of implementation, understanding how the decision-makers who translate policy into institutional change perceive the project is essential. Methods: We employed a qualitative design using reflexive thematic analysis. Semi-structured, in-depth interviews were conducted with directors from five tertiary hospitals—four in the capital area and one in a non-capital area—selected through purposive sampling. Interviews were conducted between 30 October and 7 November 2025, transcribed verbatim, and analyzed following the six-phase approach of Braun and Clarke. Results: Four themes were constructed. First, directors described the project as catalyzing a cultural shift toward a high-severity-centered model, though contested at the departmental level. Second, a severity paradox emerged, in which treating sicker patients worsened profitability while large restructuring costs strained sustainability. Third, referral networks expanded but were constrained by the absence of an integrated information technology (IT) system across the referral network. Fourth, a specialist- and physician assistant (PA)-centered workforce model stabilized care yet remained institutionally unsettled. Participants recommended refined severity criteria, complexity-based reimbursement, a legal framework for PAs, an integrated IT referral system, and network-based training. Conclusions: As perceived by the participating directors, the project reshaped organizational culture and clinical case-mix, but its long-term viability depends on financial, infrastructural, and workforce supports that have not kept pace with structural change. Sustaining the reform will likely require a shift from competition toward a collaborative, region-centered network. Full article

The coexistence of undernutrition and excess weight is an important child public health challenge. This study described temporal trends and departmental spatial configurations of wasting, stunting, overweight, and obesity among children under five years of age in Peru during 2014–2024. Analyses used anthropometric assessment records from the Nutritional Status Information System (SIEN), collected in public healthcare facilities and aggregated by department and year. Annual Percentage Change summarized average temporal trends, while observed prevalence maps, Global Moran’s I, Local Indicators of Spatial Association (LISA), and a median-based bivariate classification were applied independently to 2014, 2019, and 2024. Queen contiguity was the primary spatial specification, along with KNN-4 sensitivity analysis. Wasting and obesity increased on average, stunting decreased, and overweight showed no significant long-term trend. Global autocorrelation was most consistent for wasting, whereas findings for excess-weight indicators were sensitive to the weights matrix. LISA identified local spatial classifications at nominal p < 0.05; however, these findings were exploratory because no multiple-testing correction was applied. The bivariate classification identified two, four, and three departments with concurrent high relative undernutrition and excess-weight scores in 2014, 2019, and 2024, respectively. These record-based findings show territorial heterogeneity within SIEN but do not represent population prevalence, causal geographic effects, or an integrated spatiotemporal process. Full article

Background/Objectives: This study aimed to evaluate radiation safety knowledge, perceptions, and self-reported protective practices among healthcare workers (HCWs) working in radiology and nuclear medicine departments, with particular attention to occupational dose limits, radiation protection principles, dosimetry, and personal protective equipment use. Methods: A cross-sectional survey was conducted among 138 HCWs (25 specialist doctors, 101 technicians, 9 nurses and 3 radiophysicists) in radiology and nuclear medicine departments from May to June 2024. Data were collected using a structured 31-item survey assessing sociodemographic characteristics, perceived radiation exposure risk, knowledge of radiation protection principles and occupational dose limits, dosimeter use, personal protective equipment use, and awareness of institutional radiation safety procedures. The total knowledge score was calculated by summing correct responses to knowledge items (range: 0–10) and analyzed as a continuous outcome using multivariable linear regression with HC3 robust standard error. Because of the small and uneven distribution of some subgroups, item-level subgroup comparisons were interpreted descriptively and cautiously. Results: Although most HCWs reported receiving radiation safety information through formal education or institutional training, important knowledge and self-reported practice gaps remained. While 96.4% perceived themselves to be at high risk of radiation exposure, 61.6% reported not using any PPE in routine practice and 21.0% reported not using a dosimeter. Only 13.8% correctly identified the 5-year average permissible occupational dose, whereas 32.6% correctly identified the annual maximum dose limit. Knowledge of ionizing-radiation methods was higher among postgraduates than undergraduates (100% vs. 27.5%, p < 0.001) and among nuclear medicine staff than radiology staff (100% vs. 37.8%, p < 0.001). Knowledge of all three basic radiation protection methods was also higher among postgraduates than undergraduates (100% vs. 15.6%, p < 0.001). Because some subgroup distributions were small and uneven, these item-level subgroup findings should be interpreted descriptively and with appropriate caution. In multivariable linear regression with HC3 robust standard errors, technicians (B = −3.09, 95% CI = −3.52 to −2.67, p < 0.001) and nurses (B = −3.84, 95% CI = −5.26 to −2.43, p < 0.001) had lower total knowledge scores than specialist doctors. Nuclear medicine was associated with a higher total score than radiology (B = 2.33, 95% CI = 0.81 to 3.85, p = 0.003), whereas >3 years of work experience was associated with a lower score than ≤3 years (B = −1.53, 95% CI = −2.40 to −0.66, p = 0.001). When postgraduate education was evaluated instead of professional role because of collinearity, postgraduate education was associated with a higher total knowledge score. Because of the cross-sectional design, these associations should not be interpreted as causal. The internal consistency of the knowledge subscale was minimally acceptable (Cronbach’s alpha = 0.694). Conclusions: Significant gaps and variations were observed in radiation safety knowledge and self-reported practices among HCWs. These patterns differed according to educational level, professional role, departmental affiliation, and experience; however, they should be interpreted in light of the cross-sectional design and the small and uneven distribution of some subgroups. These findings identify potential areas for future institutional quality-improvement efforts, including targeted education programs and review of radiation safety policies, whose effectiveness should be evaluated in future studies. Full article

Academic departments allocate scarce research resources under deep uncertainty as today’s choices about laboratories, early-career scholars, infrastructure, and emerging topics shape future publications, citations, grants, and scientific capacity. Unfortunately, the connection between the two is delayed, noisy, and interdependent. Economic portfolio optimization offers an established framework for such decisions, as it evaluates investments not only by expected return but also by risk, diversification, and dependence among assets. Nevertheless, research opportunities are not financial assets: their returns are multidimensional, scientometric, cumulative, and shaped by spillovers, strategic priorities, and institutional inertia. In this study, we formulate departmental research planning as a Departmental Scientometric Portfolio Optimization problem, and propose Departmental Epistemic Portfolio Optimization, an integrative decision-support heuristic that allocates resources using expected scientometric return, uncertainty, covariance, spillovers, diversity, concentration, strategic alignment, and adjustment costs. Using in silico experiments covering stable, emerging-field, monoculture, and budget-shock environments, we show that DEPO is competitive with classical portfolio and heuristic baselines while preserving high portfolio diversity, low topic concentration, and relatively smooth allocation dynamics in several settings. In the emerging-field environment, DEPO allocated sustained resources to uncertain and under-observed opportunities, demonstrating the operation of its exploration mechanism; however, this behavior did not produce a clear cumulative-return or oracle-regret advantage over the strongest feasible baselines for all tested conditions. Overall, the results suggest that departments may benefit from portfolio-based decision support when they seek to make explicit trade-offs among performance, exploration, diversity, concentration control, and institutional stability. Full article

Background: Healthcare workers (HCWs) remain at risk of occupational exposure to Mycobacterium tuberculosis. Although workplace-related risk factors have been extensively investigated, the contribution of host metabolic factors to tuberculosis infection (TBI) susceptibility remains poorly understood. This study evaluated QuantiFERON-TB Gold Plus (QFT-Plus) conversion and its association with demographic, occupational, and metabolic risk factors. Methods: A retrospective cohort study was conducted among 3309 HCWs undergoing annual routine occupational health surveillance at Policlinico Tor Vergata in Rome (Italy) from 2017 to 2025. Data included age, sex, job category, night-shift work, departmental risk level, and biochemical parameters (lipid profile, blood glucose, and vitamin D levels). Associations with QFT-Plus conversion were assessed using univariate analyses, binary logistic regression, and multivariate Cox regression models. Results: During follow-up, 87 participants (2.6%) experienced QFT-Plus conversion. In univariate analysis, age ≥ 40 years (3.98% vs. 1.50%; p < 0.001) and hypercholesterolemia (3.8% vs. 2.1%; p = 0.004) were significantly associated with conversion. However, neither variable remained statistically significant in multivariate analyses (age: p = 0.734; hypercholesterolemia: p = 0.834). Occupational factors, including job category, night-shift work, and assignment to high-risk departments, were not significantly associated with QFT-Plus conversion. Likewise, hyperglycemia and vitamin D deficiency showed no significant associations. Conclusions: QFT-Plus conversion incidence was low, supporting the effectiveness of current hospital infection control measures in this low-incidence setting. No demographic, occupational, or metabolic factor emerged as an independent predictor of conversion. These findings should be interpreted considering the limited number of conversion events and the multifactorial nature of TBI susceptibility. Full article

The present study aims to examine the effect of transformational and transactional leadership styles on the effectiveness of talent management in the Jordanian Ministry of Health, where the mediating variable is employee engagement while the moderating variable is organizational culture. The current study fills an important void in the literature because few studies have integrated all these relationships within the public healthcare sector in a Middle East context. A cross-sectional quantitative study was performed using stratified random sampling over 154 departmental units within the Ministry of Health. A structured questionnaire was used to gather data from 379 healthcare professionals, which were then analyzed by applying Structural Equation Modeling (SmartPLS 4). The results show that transformative leadership (β = 0.238; p = 0.043) as well as transactional leadership are significant to the success of talent management. Leadership styles also positively affect employee engagement (β = 0.66; p = 0.001), and employee engagement in turn has a positive influence on the effectiveness of talent management (β = 0.309; p = 0.001). Organizational culture is shown to have a moderating effect (β = 0.102; p = 0.012), which strengthens the relationship between leadership and talent management. The findings underscore the need for culturally appropriate leadership development and engagement strategies in public healthcare systems. Based on the findings, policy-makers in the Ministry of Health might consider investing in leadership competency building and develop supportive organizational cultures as strategic approaches to strengthen talent management and organizational performance. Full article

Background: In Saudi Arabia, nurses have long lacked a formally defined scope of practice, contributing to role ambiguity and role overlap. In 2023, the Saudi Commission for Health Specialties (SCFHS) released the first national Scope of Nursing and Midwifery Practice document. This study explored how nurse managers and supervisors perceived the scope of practice following this update in Makkah Cluster Hospitals. Methods: As the second, explanatory phase of a larger sequential explanatory mixed-methods study, a qualitative descriptive study was conducted between May and August 2025 with 20 nurses in managerial roles (Nursing Directors, Nursing Supervisors, and Head Nurses) at two hospitals within the Makkah Health Cluster. Participants were selected through purposive sampling, restricted to managerial and supervisory positions to capture a cross-departmental, organizational perspective on scope enactment. Interviews were conducted via Zoom in Arabic, translated into English, and analyzed using inductive thematic analysis consistent with the approach of Braun and Clarke. Trustworthiness was addressed through credibility, transferability, dependability, and confirmability, with reporting guided by the Consolidated Criteria for Reporting Qualitative Research (COREQ). Results: Four themes emerged from the accounts of the 20 participants (10 men and 10 women from both hospitals): (1) expanding the scope of nursing practice, (2) bridging the gap between training and practice, (3) overcoming barriers to full professional practice, and (4) promoting nurse empowerment and accountability. Participants described a tension between a formally defined scope and inconsistent enactment across departments and shifts. Unclear job descriptions, administrative constraints, staffing shortages, and resource deficits were the primary barriers, whereas autonomy and continuous development were identified as essential enablers. Conclusions: The nurse managers and supervisors in this study perceived the scope of nursing practice as variably enacted and frequently constrained following the 2023 SCFHS update. These findings suggest that regulatory publication alone may be insufficient, highlighting the need to operationalize the framework through revised job descriptions, simulation-based professional development, adequate staffing, and leadership-supported autonomy aligned with Saudi Vision 2030. Because these findings reflect the perspectives of nursing leaders rather than bedside clinical nurses, their application to direct patient care contexts should be interpreted with appropriate caution. Full article

Based on county-level panel data from 2010 to 2023 covering 1991 counties, this study employs an Staggered Difference-in-Differences (DID) model integrated with double/debiased machine learning (DDML) and causal inference techniques. The objective of this paper is to assess whether and how the overlapping implementation of cultural-tourism integration (CTP) policies and the county-level National Ecological Civilization Pilot Zone (NECPZ) policy generates synergistic effects on rural residents’ income. The findings reveal that the policy overlap significantly promote farmers’ income. The synergy test shows that the synergy of these policies amplifies the effect of each individual policy and generates a “1 + 1 > 2” synergy effect. Mechanism analysis indicates that the policy overlap facilitates farmers’ income growth by enhancing the appeal and the development of the local tourism market. Heterogeneity analysis shows that the income-enhancing effect is more pronounced in counties with better public cultural services, stronger primary-level governance, and more advanced digital infrastructure. Furthermore, GDP growth rate, agricultural mechanization, and the industrial structure exert a nonlinear moderating effect on the policy effects. Based on these findings, the study proposes breaking down departmental and hierarchical barriers and building institutional synergy to transform ecological resources into economic value. According to local conditions, pilot projects should be prioritized in counties with stronger foundations, while guarding against the risk of diminishing marginal returns from excessive investment, so as to maximize policy synergies and promote fiscal efficiency. Full article

Hepatitis B virus (HBV) infection remains a major public-health challenge in Peru, particularly in historically hyperendemic Amazonian and Andean regions; however, the structure, evolution, and equity of national HBV research have not been systematically evaluated. We conducted a PRISMA-informed bibliometric analysis of all peer-reviewed and theses on HBV in Peru published between 1988 and 2023 using Scopus, Google Scholar, and the Peruvian National Repository (RENATI). Bibliometric indicators, collaboration networks, thematic structure, and temporal thematic evolution were analyzed in R using bibliometrix- and network-based approaches. The final corpus comprised 232 documents, with a marked increase in production after 2005 and a publication peak in 2018. Scientific output was strongly concentrated in Lima-based institutions, while several departments historically associated with HBV endemicity exhibited minimal or absent research production. Nearly half of the corpus corresponded to undergraduate and postgraduate theses. Thematic analyses revealed persistent predominance of epidemiology, seroprevalence, and vaccination-related research, whereas molecular virology, therapeutics, and translational research remained peripheral or poorly represented. International collaboration was markedly limited. Overall, Peruvian HBV research has expanded quantitatively but remains geographically centralized and shows only limited correspondence with the contemporary geographic distribution of HBV incidence, while also remaining only partially aligned with the contemporary global HBV research frontier. These findings provide an evidence-based framework to guide research-priority setting, territorial equity policies, and strategic investment in infectious disease research capacity in Peru. Moreover, the weak association observed between scientific production and departmental HBV incidence suggests that factors beyond contemporary epidemiological burden contribute to the current distribution of research activity in Peru, highlighting a critical but often overlooked dimension of health inequity in low- and middle-income countries (LMIC) research systems. Full article

Objectives: This study aimed to describe implant survival rates and associated risk factors in patients treated with two sinus augmentation techniques—Lateral Window (LW) and Transcrestal (TC)—at a single center. Methods: A retrospective cohort analysis was performed using medical records of patients who underwent maxillary sinus augmentation and subsequent dental implant placement between 2015 and 2019 at the Rambam Healthcare Center. Data on demographic variables, surgical approach, graft materials, implant characteristics, and clinical outcomes were collected from electronic medical records. Results: A total of 135 patients met the inclusion criteria, contributing 144 TC procedures (with 144 implants) and 46 LW procedures (90 implants) to the final analysis. The overall implant failure rate was 7.7%, with a significantly higher failure rate for TC (11.11%) compared to LW (2.22%). Procedure type was a significant predictor of implant survival (OR 1.62); however, as residual bone height (RBH) data were unavailable, confounding by indication cannot be excluded and this finding should be interpreted with caution. Implant length demonstrated a significant influence on outcomes (OR 1.28 per mm increase); shorter implants (8 mm) exhibited lower survival rates (81.3%) compared to 10 mm implants (92.3%). Smoking status was identified as a negative predictor of implant survival (OR 0.23). Schneiderian membrane ruptures occurred in nine cases, seven of which were LW procedures. Smoking was the only factor affecting graft survival (OR 0.29). Conclusions: In this retrospective cohort, implant survival rates were higher in the LW group than in the TC group; however, given that individual residual bone height data were unavailable and case assignment, although governed by standardized departmental criteria, was not randomized, the possibility of confounding by indication cannot be excluded. Smoking and shorter implants were significant risk factors for implant failure. Smoking was also associated with graft failure. Full article

This study develops a cooperative multi-agent deep reinforcement learning (MARL) framework for simulation-based cost-overrun mitigation in smart grid construction projects under dynamic engineering uncertainty. Modern smart grid construction involves digital substations, renewable-energy-connected facilities, flexible transmission assets, intelligent monitoring systems, and geographically distributed contractors; therefore, cost escalation is driven by sequential interactions among procurement, schedule execution, equipment deployment, supervision, weather, logistics, and price volatility. The proposed framework models procurement management, construction scheduling, equipment allocation, and supervision-control units as decentralized agents embedded in a calibrated construction simulation environment. The environment is parameterized from 42 smart grid construction projects in Henan Province, China and generates disturbance scenarios involving weather efficiency loss, transportation delay, market-price volatility, labor shortage, and supply-chain interruption. A hybrid DQN–PPO mechanism represents mixed decision structures: value-based DQN modules handle discrete managerial choices such as task acceleration, supplier switching, and procurement timing, whereas PPO modules adjust continuous resource-allocation and recovery-intensity decisions. A hierarchical reward function combines local departmental objectives with project-level penalties for cost overrun, schedule delay, idle resources, recovery expenditure, safety risk, and environmental impact. The experimental protocol uses 30 paired random seeds, nonparametric bootstrap confidence intervals, Holm-adjusted Wilcoxon signed-rank tests, and comparison with deterministic optimization, rolling-horizon MPC, stochastic/robust optimization, single-agent DRL, MAPPO, MADDPG/MATD3, QMIX, and HAPPO baselines. The proposed framework achieves a mean cost-overrun rate of 6.83% and a mean schedule deviation of 16.82 days, reducing cost overrun by 18.7% and schedule deviation by 21.4% relative to rule-based construction management under the reported disturbance settings. The calibrated simulation evidence establishes a statistically evaluated decision-support framework for coordinated construction cost control and provides an artifact-level reproducibility pathway through configuration files, random-seed lists, anonymized synthetic benchmarks, and aggregated logs. Full article

This study investigates how Languages Other Than English (LOTE) students negotiate their identification amid growing uncertainties about the value of multilingual learning and language degrees. Drawing on ecological systems theory (EST), it identifies eight influencing factors ranging from microsystem to macrosystem that shape students’ identification. These factors are organised across three interconnected spheres: the individual sphere, shaped by personal interest and symbolic resonance with language and culture; the social sphere, driven by socially valued expectations in academic and career domains; and the relational sphere, grounded in interpersonal connections within the departmental community. Relational belonging—nurtured within inclusive and supportive peer–teacher networks—represents a key stabilising force, fostering students’ identification with the major. By proposing a dynamic model of identification, the study suggests that LOTE programmes should strengthen activities related to identity support and cultural engagement. Full article