Search Results (80)

Background/Objectives: Effective teamwork is crucial for minimizing human error in healthcare settings. Medical teams, typically composed of physicians and nurses, supported by auxiliary professionals, achieve better outcomes when they possess strong collaborative competencies. High-quality teamwork is associated with fewer adverse events and complications and lower mortality rates. Based on this background, the objective of this study is to analyze the perception of non-technical skills and immediate learning outcomes in interprofessional simulation settings based on E-CRM items. Methods: A cross-sectional observational study was conducted involving participants from the official postgraduate Medicine and Nursing programs at the Catholic University of Murcia (UCAM) during the 2024–2025 academic year. Four interprofessional E-CRM simulation sessions were planned, involving randomly assigned groups with proportional representation of medical and nursing students. Teams worked consistently throughout the training and participated in clinical scenarios observed via video transmission by their peers. Post-scenario debriefings followed INACSL guidelines and employed the PEARLS method. Results: Findings indicate that 48.3% of participants had no difficulty identifying the team leader, while 51.7% reported minor difficulty. Role assignment posed moderate-to-high difficulty for 24.1% of respondents. Communication, situation awareness, and early help-seeking were generally managed with ease, though mobilizing resources remained a challenge for 27.5% of participants. Conclusions: This study supports the value of interprofessional education in developing essential competencies for handling urgent, emergency, and high-complexity clinical situations. Strengthening interdisciplinary collaboration contributes to safer, more effective patient care. Full article

The exponential increase in electronic waste (e-waste) from end-of-life electrical and electronic equipment presents a growing environmental challenge. E-waste contains high concentrations of rare earth elements (REEs), which are classified as critical raw materials (CRMs). Their removal and recovery from contaminated systems not only mitigate pollution but also support resource sustainability within a circular economy framework. The present study proposed the use of hazelnut shells as a biosorbent to reduce water contamination and recover REEs. The sorption capabilities of this lignocellulosic material were assessed and optimized using the response surface methodology (RSM) combined with a Box–Behnken Design (three factors, three levels). Factors such as pH (4 to 8), salinity (0 to 30), and biosorbent dose (0.25 to 0.75 g/L) were evaluated in a complex mixture containing 9 REEs (Y, La, Ce, Pr, Nd, Eu, Gd, Tb and Dy; equimolar concentration of 1 µmol/L). Salinity was found to be the factor with greater significance for REEs sorption efficiency, followed by water pH and biosorbent dose. At a pH of 7, salinity of 0, biosorbent dose of 0.75 g/L, and a contact time of 48 h, optimal conditions were observed, achieving removals of 100% for Gd and Eu and between 81 and 99% for other REEs. Optimized conditions were also predicted to maximize the REEs concentration in the biosorbent, which allowed us to obtain values (total REEs content of 2.69 mg/g) higher than those in some ores. These results underscore the high potential of this agricultural waste with no relevant commercial value to improve water quality while providing an alternative source of elements of interest for reuse (circular economy). Full article

A certified reference material (CRM) for aflatoxins (AFTB1, AFTB2, AFTG1, AFTG2) and zearalenone (ZEN) in corn/peanut blended vegetable oil (GBW(E)100863) was developed to address the critical need for matrix-specific reference materials in mycotoxin analysis. The CRM was prepared by blending naturally contaminated corn and peanut oils, followed by homogenization, sterilization, and sub-packing. Homogeneity and stability studies were conducted using high-performance liquid chromatography isotope-dilution tandem mass spectrometry with a dilute-and-shoot pretreatment process. The CRM demonstrated excellent homogeneity and stability, with no significant degradation observed under either short-term (65 °C for 14 days) or long-term (25 °C for 12 months) storage conditions. An inter-laboratory comparison involving six authoritative laboratories confirmed the CRM’s accuracy and reliability, with recovery rates ranging from 90.3% to 97.3% and low relative standard deviations (RSDs) of 3.79% to 7.99%. The CRM provided a robust metrological tool for mycotoxin analysis in complex oil matrices. This study not only enriches the national reference materials library but also supports food safety initiatives by facilitating accurate and reliable mycotoxin detection in vegetable oils, thereby enhancing regulatory compliance and public health protection. Full article

Pavement materials like hot mix asphalt (HMA) and cold recycled mixes (CRMs) are typically considered isotropic. This study evaluates the anisotropy of a cold in-place recycled (CIR) material using the shear wave velocity (V_s) parameter. The piezoelectric ring actuator technique (P-RAT) is utilized to assess the V_s parameter in three directions in CIR slabs. Similarly, the ultrasonic pulse velocity (UPV) technique is employed to measure P-wave velocities. Both methods evaluate mechanical properties in multiple directions. Complex modulus tests are conducted to link velocities results to |E*| modulus. Finally, computed tomography (CT) scans are performed on the specimens in order to evaluate anisotropy resulting from aggregate alignment. The V_s obtained using P-RAT and the V_p from UPV indicate anisotropy, as the wave velocities differ across the three directions. Differences range from 0.6 to 11.6% in V_s, influenced by measurement location. UPV results are analysed in relation to the |E*| modulus master curves, demonstrating that the first peak arrival time for the P-wave corresponds with the master curve. CT scan analysis reveals that the aggregates tend to be more aligned in the direction of the compacting wheel’s displacement, which also highlights anisotropy. Full article

Customer relationship management (CRM) is a key factor driving innovation and organizational growth. The present study investigated the relationship between data-driven CRM (DDCRM) and innovation in Taiwan. We developed a research model involving CRM theory, innovation theory, and the technology adoption model (TAM) theory to account for the cultural and organizational contexts of Taiwan and investigate this relationship. The study distributed questionnaires to employees and stakeholders within Taiwanese firms to understand their firms’ innovation and CRM practices. The results indicate that technology adoption and organizational culture have mediating effects and industry dynamics and organizational size have moderating effects on the relationship between DDCRM and innovation. That is, adopting new technology and having an organizational culture that supports innovation and company-wide collaboration can enhance the effects of implementing DDCRM practices. In addition, certain industries (e.g., the technology industry) are more likely to effectively leverage DDCRM practices to drive innovation, and although large organizations have more resources and can therefore more easily implement CRM systems, small and medium-sized enterprises (SMEs) can more quickly adapt and innovate on the basis of CRM insights. These findings highlight the importance of DDCRM in driving innovation and reveal key factors influencing the effectiveness of CRM in doing so. The study features comprehensive suggestions of operable strategies and measures for Taiwanese SMEs, hopefully assisting them in gaining a market advantage and elevating their innovation capabilities by leveraging DDCRM practices. Full article

The co-addition of chromium (Cr) and tin (Sn) is known to enhance the wettability between copper (Cu) and graphite (C_gr), but the effect of Sn content remains poorly understood. This study aims to systematically investigate the influence of Sn content a (a = 0, 10, 20, 30, 40, 50, 80, 99 at. %) on the wettability, interfacial structure, surface/interface energy (σ_lv/σ_sl), and adhesion behavior of the Cu–aSn–1Cr/C_gr system at 1100 °C. The experimental results show that as the Sn content increases, the equilibrium contact angle (θ_e) of the metal droplet shows a non-monotonic trend; the thickness of the reaction product layer (RPL, consisting of Cr carbides (Cr_mC_n)) gradually increases, accompanied by a decrease in the calculated adhesion work ($W_{\mathrm{ad}}^{\mathrm{cal}}$). A “sandwich” interface structure is observed, consisting of two interfaces: metal||Cr_mC_n and Cr_mC_n||C_gr. Sn content mainly affects the former. At metal||Cr_mC_n, Sn exists in various forms (e.g., Cu–Sn solid solution, Cu_xSn_y compounds) in contact with Cr_mC_n. To elucidate the wetting and bonding mechanisms of metal||Cr_mC_n, simplified interfacial models are constructed and analyzed based on first-principles calculations of density functional theory (DFT). The trend of theoretically calculated results (σ_metal and W_ad) agrees with the experimental results (σ_lv and $W_{\mathrm{ad}}^{\mathrm{cal}}$). Further analysis of the partial density of state (PDOS) and charge density difference (CDD) reveals that charge distribution and bonding characteristics vary with Sn content, providing the microscopic insight into the nature of wettability and interfacial bonding strength. Full article

This study examines the collaborative impact of Customer Relationship Management (CRM) between shopping mall management and retailers on customer traffic. Through a multiple case study involving 30 interviews with managers from various traditional shopping malls and factory outlets, the research highlights how tailored CRM strategies, such as tenant mix, accessibility, and customer engagement, foster customer satisfaction and loyalty, ultimately affect performance. Mall management focuses on attracting visitors by building a strong mall image and creating partnerships, whereas retailers emphasize customer retention through loyalty programs and personalized services. The study finds that proactive, collaborative CRM efforts, such as setting shared objectives and aligning strategies, significantly enhance customer experience and mall performance. However, existing CRM measurement systems often overlook the integrated nature of mall and retailer relationships, limiting the assessment of CRM outcomes. This research proposes an integrated model to assess CRM effectiveness across multiple organizational levels, providing insights into optimizing CRM policies to drive customer satisfaction, retention, and mall success. Limitations include the study’s focus on physical malls, with future research suggested to explore CRM adaptations bridging physical retail and e-commerce environments. Full article

Adopting advanced e-commerce practices is essential for enhancing user engagement and business performance, particularly in tourism. This study evaluates the e-commerce adoption of Kazakhstan’s tourism websites using an innovative Integrated Multi-Criteria Decision Analysis (IMCDA) methodology. Traditional evaluation methods overlook the interplay between website functionality, user experience, and strategic objectives. To address this gap, the IMCDA framework integrates qualitative and quantitative approaches by combining advanced Multi-Criteria Decision-Making (MCDM) techniques, including SPOTIS, ESP-COMET, RANCOM, and SITW, with content analysis and logistic regression. The study assessed 77 tourism websites, categorized into Online Travel Agencies (OTAs), Official Tourism Websites (OTWs), and Attraction Websites (AWs), based on 34 e-commerce features grouped into dimensions such as product information, functionality, reservations, payment systems, and customer relationship management (CRM). The findings reveal that OTAs significantly outperform OTWs and AWs in most dimensions, especially in online booking and CRM functionalities. At the same time, AWs lag in key e-commerce features like reservations and payment systems. This research highlights critical gaps in Kazakhstan’s tourism e-commerce ecosystem. It provides actionable recommendations, including enhancing CRM tools, integrating advanced booking systems, and leveraging collaborations with local financial technology providers like Kaspi Pay. The IMCDA framework offers a robust, adaptable evaluation model with practical implications for digital transformation and competitiveness in the tourism industry. This study contributes to advancing digital maturity in Kazakhstan’s tourism sector by addressing these gaps. It sets the foundation for future research to explore innovative strategies in e-commerce adoption across various regions and industries. Full article

Background/Objectives: Vascular invasion, especially extramural vascular invasion (EMVI), has emerged as a prognostic parameter for rectal cancer (RC) in recent years. Prediction of recurrence and metastasis development poses a significant challenge for oncologists, who need markers for prediction of adverse outcome. The aim of this study was to examine the prognostic significance of pathohistologically detected EMVI in untreated rectal cancer and its implications in separate reporting. Methods: We examined 100 untreated RC patients who underwent curative resection from January 2016 to June 2018 with a follow-up of 5 years. Patients were divided into equal EMVI− and EMVI+ groups based on histological re-examination of H&E-stained postoperative surgical samples. Results: The presence of EMVI within the selected cohort was significantly associated with female gender, T3/T4 and N1/N2 post-operative stages, positive lymph nodes, lymph node ratio LNR2 and LNR3 groups, abundant tumor-infiltrating lymphocytes, positive lympho-vascular invasion (LVI), perineural (PNI), and circumferential resection margin (CRM) (p < 0.05 in all tests). Within EMVI+ patients, local recurrences and/or metastases and death outcomes were more frequent events (p = 0.029 and p = 0.035, respectively), while survival analyses revealed that EMVI+ patients had significantly shorter overall survival (OS, p = 0.040) and disease-free survival (DFS, p = 0.028). Concerning LVI, differences in OS between LVI+ and LVI− patients were not statistically significant (p = 0.068), while LVI+ patients had significantly shorter DFS (p = 0.024). Moreover, univariate COX regression analysis demonstrated the negative impact of EMVI on OS (HR: 2.053, 95% CI: 1.015–4.152; p = 0.045) and DFS (HR: 2.106, 95% CI: 1.066–4.870; p = 0.038), which was not the case for LVI + RC patients. Conclusions: The obtained results strongly suggest the significance of separate reporting of EMVI from lympho-vascular invasion, as it is potentially a surrogate marker for adverse prognosis and outcome. Full article

Background/Objectives: Firefighters, tactical police officers, and warriors often engage in periodic, intermittent, high-intensity physical work in austere environmental conditions and have a heightened risk of premature mortality. In addition, tough decision-making challenges, routine sleep deprivation, and trauma exacerbate this risk. Therefore, identifying strategies to bolster these personnel’s health and occupational performance is critical. Creatine monohydrate (CrM) supplementation may offer several benefits to firefighters and tactical athletes (e.g., police, security, and soldiers) due to its efficacy regarding physical performance, muscle, cardiovascular health, mental health, and cognitive performance. Methods: We conducted a narrative review of the literature with a focus on the benefits and application of creatine monohydrate among firefighters. Results: Recent evidence demonstrates that CrM can improve anaerobic exercise capacity and muscular fitness performance outcomes and aid in thermoregulation, decision-making, sleep, recovery from traumatic brain injuries (TBIs), and mental health. Emerging evidence also suggests that CrM may confer an antioxidant/anti-inflammatory effect, which may be particularly important for firefighters and those performing tactical occupations exposed to oxidative and physiological stress, which can elicit systemic inflammation and increase the risk of chronic diseases. Conclusions: This narrative review highlights the potential applications of CrM for related tactical occupations, with a particular focus on firefighters, and calls for further research into these populations. Full article

Using Chlamydomonas as a model organism, we attempted to eliminate mitochondrial DNA (mtDNA) similar to rho⁰ or rho⁻ cells (completely or partially mtDNA-eliminated cells) in yeast. We successfully generated partially mtDNA-eliminated cells named as crm- cells, causing the inactivation of mitochondrial activity. We used three different chemicals to eliminate mtDNA including acriflavine (AF), ethidium bromide (EB) and dideoxycytidine (ddC) which prevents replication, inhibits POLG (DNA polymerase gamma) and terminates the mtDNA chain, respectively. The qPCR method was used to detect the mtDNA copy number and the selected rrnL6 gene for the detection of mitochondria, as well as the selected Chlamydomonas CC-124 strain. A reduction in the mitochondrial copy number led to a higher expression of AOX1, UCP1, PGRL1 and ICL1, which indicates the disturbance of the mitochondria–chloroplast ATP and NADPH balance. We selected AOX genes to further study this family and carried out a genome-wide search to identify AOX genes in green algae (C. reinhardtii). Our results revealed that C. reinhardtii contains four AOX genes, i.e., CrAOX1, CrAOX2, CrAOX3 and CrAOX4, which are distributed on Chr 3, Chr7 and Chr9. All CrAOX genes were predicted to localize in mitochondria using bioinformatics tools. Phylogenetic analysis suggests that these CrAOXs are subdivided into four groups and genes existing in the same group could perform identical functions. Collinearity analysis describes the strong evolutionary relationships of AOXs between the unicellular green algae Chlamydomonas reinhardtii and the multicellular green algae Volvox carteri. GO (gene ontology) annotation analysis predicted that CrAOXs played an integral part in carrying out alternate oxidative and respirative activities. Three putative miRNAs, cre-miR1162-3p, cre-miR1171 and cre-miR914, targeting the CrAOX2 gene were identified. Our studies have laid a foundation for the further use of partially mtDNA-eliminated cells and elucidating the functional characteristics of the AOX gene family. Full article

Glycoconjugation is a well-established technology for vaccine development: linkage of the polysaccharide (PS) antigen to an appropriate carrier protein overcomes the limitations of PS T-independent antigens, making them effective in infants and providing immunological memory. Glycoconjugate vaccines have been successful in reducing the burden of different diseases globally. However, many pathogens still require a vaccine, and many of them display a variety of glycans on their surface that have been proposed as key antigens for the development of high-valency glycoconjugate vaccines. CDAP chemistry represents a generic conjugation strategy that is easily applied to PS with different structures. This chemistry utilizes common groups to a large range of PS and proteins, e.g., hydroxyl groups on the PS and amino groups on the protein. Here, new fast analytical tools to study CDAP reaction have been developed, and reaction conditions for PS activation and conjugation have been extensively investigated. Mathematical models have been built to identify reaction conditions to generate conjugates with wanted characteristics and successfully applied to a large number of bacterial PSs from different pathogens, e.g., Klebsiella pneumoniae, Salmonella Paratyphi A, Salmonella Enteritidis, Salmonella Typhimurium, Shighella sonnei and Shigella flexneri. Furthermore, using Salmonella Paratyphi A O-antigen and CRM₁₉₇ as models, a design of experiment approach has been used to study the impact of conjugation conditions and conjugate features on immunogenicity in rabbits. The approach used can be rapidly extended to other PSs and accelerate the development of high-valency glycoconjugate vaccines. Full article

A certified reference material of ricin (CRM-LS-1) was produced by the EuroBioTox consortium to standardise the analysis of this biotoxin. This study established the N-glycan structures and proportions including their loci and occupancy of ricin CRM-LS-1. The glycan profile was compared with ricin from different preparations and other cultivars and isoforms. A total of 15 different oligomannosidic or paucimannosidic structures were identified in CRM-LS-1. Paucimannose was mainly found within the A-chain and oligomannose constituted the major glycan type of the B-chain. Furthermore, the novel primary structure variants E138 and D138 and four different C-termini of the A-chain as well as two B-chain variants V250 and F250 were elucidated. While the glycan proportions and loci were similar among all variants in CRM-LS-1 and ricin isoforms D and E of all cultivars analysed, a different stoichiometry for isoforms D and E and the amino acid variants were found. This detailed physicochemical characterization of ricin regarding the glycan profile and amino acid sequence variations yields unprecedented insight into the molecular features of this protein toxin. The variable attributes discovered within different cultivars present signature motifs and may allow discrimination of the biotoxin’s origin that are important in molecular forensic profiling. In conclusion, our data of in-depth CRM-LS-1 characterization combined with the analysis of other cultivars is representative for known ricin variants. Full article

A method for the determination of trace levels of silicon from biological materials by inductively coupled plasma mass spectrometry (ICP-MS) has been developed. The volatility of water-soluble silicon species, hexafluorosilicic acid (H₂SiF₆), and sodium metasilicate (Na₂SiO₃) was investigated by evaporating respective solutions (50 µg/mL silicon) in nitric acid (HNO₃), nitric acid + hydrochloric acid (HNO₃ + HCl), and nitric acid + hydrochloric acid + hydrofluoric acid (HNO₃ + HCl + HF) at 120 °C on a hot-block to near dryness. The loss of silicon from H₂SiF₆ solutions was substantial (>99%) regardless of the digestion medium. Losses were also substantial (>98%) for metasilicate solutions heated in HNO₃ + HCl + HF, while no significant loss occurred in HNO₃ or HNO₃ + HCl. These results show that H₂SiF₆ species were highly volatile and potential losses could confound accuracy at trace level determinations by ICP-MS if digestates prepared in HF are heated to eliminate HF. Among the various matrices comprising major elements, sodium appeared to be effective in reducing silicon loss from H₂SiF₆ solutions. Excess sodium chloride (NaCl) matrix provided better stability, improving silicon recoveries by up to about 80% in evaporated HF digestates of soil and mine waste samples, but losses could not be fully prevented. To safely remove excess acids and circumvent the adverse effects of excess HF (e.g., risk of high Si background signals), a two-step digestion scheme was adopted for the preparation of biological samples containing trace silicon levels. A closed-vessel digestion was performed either in 4 mL of concentrated HNO₃ and 1 mL of concentrated HCl or 4 mL of concentrated HNO₃, 1 mL of concentrated HCl and 1 mL of concentrated HClO₄ on a hot plate at 140 °C. Digestates were then evaporated to incipient dryness at 120 °C to remove the acids. A second closed-vessel digestion was carried out to dissolve silicates in 0.5 mL of concentrated HNO₃ and 0.5 mL of concentrated HF at 130 °C. After digestion, digestates were diluted to 10 mL. The solution containing about 5% HNO₃ and 5% HF was directly analyzed by ICP-MS equipped with an HF-inert sample introduction system. The limit of detection was about 110 µg/L for ²⁸Si when using the Kinetic Energy Discrimination (KED) mode. The method was used to determine silicon in various plant and tissue certified reference materials. Data were acquired for ²⁸Si using KED and standard (STD) modes, and ⁷⁴Ge and ¹⁰³Rh as internal standard elements. There was not any significant difference between the accuracy and precision of the results obtained with ⁷⁴Ge and ¹⁰³Rh within the same measurement mode. Precision, calculated as relative standard deviation for four replicate analyses, varied from 5.3 (tomato leaves) to 21% (peach leaves) for plant and from 2.2 (oyster tissue) to 33% (bovine liver) for tissue SRM/CRMs. Poor precision was attributed to material heterogeneity and the large particle size distribution. An analysis of lung tissue samples from those with occupational exposure to silica dust revealed that tissues possessed substantial levels of water-soluble silicates, but the most silicon was present in the particulate matter fraction. Full article

This was a prospective observational study based on clinical simulation courses taught in 2017 at the IDEhA Simulation Center of Alcorcón Foundation University Hospital. Two courses in metabolic emergencies (MEs) and respiratory emergencies (REs) were offered to primary care physicians all over Spain. The main objective was to teach nontechnical skills (crisis resource management). Using a modified five-level Kirkpatrick–Phillips education evaluation model, level I (reaction, K1), level II (learning, K2) and level III (behavioral change, K3) changes were evaluated through surveys at the end of the courses and one year later. Thirty courses were held (15 ME courses and 15 RE courses) with 283 primary care physicians. The overall satisfaction (K1) was high: ME courses, 9.5/10; RE courses, 9.6/10. More than 80% of the participants rated the organization, resources, content, debriefing and scenarios as excellent, with no significant differences between the two courses. After one year (156 responses), the respondents for both courses reported that they would repeat the training annually (K2), encourage debriefing with colleagues (K3) and have modified some aspects of their workplace (K3), citing improvements in procedures and in the organization of the health team as the most important. After the ME course, few participants, i.e., 5 (6%), reported providing improved care to patients; after the RE course, 15 (19%) participants reported providing improved care; the difference between groups was significant (p < 0.05). Compared with the ME course, the RE course imparted greater knowledge about patient safety (K2) (38 (49%) vs. 24 (31%) (p < 0.05)) and more useful tools for daily clinical practice (K3) (67% vs. 56.4%) and resulted in participants paying more attention to personal performance and to colleagues when working as a team (K2) (64% vs. 50%). Clinical simulation courses are highly valued and potentially effective for training primary care physicians in patient safety and CRM tools. Future studies with objective measures of long-term impact, behavior in the workplace (K3) and benefits to patients (K4) are needed. Based on the results of our study, the areas that are important are those aimed at improving procedures and the organization of health teams. Full article