Search Results (972)

Background and Objectives: Effective myocardial protection is essential for successful cardiac surgery outcomes, especially in complex and prolonged procedures. To this end, Del Nido (DN) and histidine-tryptophan-ketoglutarate (HTK) cardioplegia solutions are widely used; however, their comparative efficacy in adult surgeries with prolonged aortic cross-clamp (ACC) times remains unclear. This study aimed to compare the efficacy and safety of DN and HTK for myocardial protection during prolonged ACC times in adult cardiac surgery and to define clinically relevant thresholds. Materials and Methods: This retrospective study included a total of 320 adult patients who underwent cardiac surgery under cardiopulmonary bypass (CPB) with an aortic cross-clamp time ≥ 90 min. Data were collected from the medical records of elective adult cardiac surgery cases performed at a single center between 2019 and 2025. Patients were categorized into two groups based on the type of cardioplegia received: Del Nido (n = 160) and HTK (n = 160). The groups were compared using 1:1 propensity score matching. Clinical and biochemical outcomes—including troponin I (TnI), CK-MB, lactate levels, incidence of low cardiac output syndrome (LCOS), and need for mechanical circulatory support—were analyzed between the two cardioplegia groups. Subgroup analyses were performed according to ACC duration (90–120, 120–150, 150–180 and >180 min). The predictive threshold of ACC duration for each complication was determined by ROC analysis, followed by the analysis of independent predictors of each endpoint by multivariate logistic regression. Results: Intraoperative cardioplegia volume and transfusion requirements were lower in the DN group (p < 0.05). HTK was associated with lower TnI levels and less intra-aortic balloon pump (IABP) requirement at ACC times exceeding 180 min. Markers of myocardial injury were lower in patients with an ACC duration of 120–150 min in favor of HTK. The propensity for ventricular fibrillation after ACC was significantly lower in the DN group. Significantly lower postoperative sodium levels were observed in the HTK group. Prolonged ACC duration was an independent risk factor for LCOS (odds ratio [OR]: 1.023, p < 0.001), VIS > 15 (OR, 1.015; p < 0.001), IABP requirement (OR: 1.020, p = 0.002), and early mortality (OR: 1.016, p = 0.048). Postoperative ejection fraction (EF), troponin I, and CK-MB levels were associated with the development of LCOS and a VIS > 15. Furthermore, according to ROC analysis, HTK cardioplegia was able to tolerate ACC for up to a longer duration in terms of certain complications, suggesting a higher physiological tolerance to ischemia. Conclusions: ACC duration is a strong predictor of major adverse outcomes in adult cardiac surgeries. Although DN cardioplegia is effective and economically advantageous for shorter procedures, HTK may provide superior myocardial protection in operations with long ACC duration. This study supports the need to individualize cardioplegia choice according to ACC duration. Further prospective studies are needed to establish standard dosing protocols and to optimize cardioplegia selection according to surgical duration and complexity. Full article

Establishing an entrepreneurship education ecosystem is crucial for the continual nurturing of young entrepreneurs and, consequently, the enhancement of economic development. Beyond the expansion of entrepreneurship programs, the active involvement and support from relevant resources and external stakeholders are pivotal to constructing such ecosystems. However, obstacles arise from the lower intention of external stakeholders to participate, and constraints imposed by information technology, hindering the ecosystem’s development. The Metaverse, an innovative technology amalgamating three-dimensional virtual technologies with blockchain and artificial intelligence, emerges as a potential solution to overcome these barriers and construct an entrepreneurship education ecosystem. Despite this potential, there is a lack of analysis explaining how the Metaverse achieves this. To address this gap, a framework for entrepreneurship education ecosystems is established in this study, highlighting two barriers and elucidating how these barriers impede ecosystem construction. Furthermore, four efficiencies of the Metaverse are identified as key factors with positive effects in terms of surmounting barriers to ensure the successful establishment of an entrepreneurship education ecosystem: communication convenience, enhanced simulation environment, information filtering, and the creation of valuable information. Full article

The right to development, an inherent human right for all, emphasizes that all individuals and communities have the right to participate in, contribute to, and benefit from development that ensures the full realization of human rights. In Kenya, where a significant portion of the population faces poverty and vulnerability to climate change, access to rights-based needs such as clean water, healthcare, and education still remains a critical challenge. This study explored the implementation of a Human Rights-Based approach to community development through a Public–Private Development Partnership model (PPDP), with a focus on alleviating poverty and improving access to rights-based services at the community level in Narok and Nakuru counties. The research aimed to identify critical success factors for scaling the PPDP model and explore its effects on socio-economic empowerment. The study employed a mixed-methods approach for data collection, using questionnaires to obtain quantitative data, focus group discussions, and key informant interviews with community members, local leaders, and stakeholders to gather qualitative data. We cleaned and analyzed all our data in R (version 4.4.3) and used the chi-square to establish the significance of differences between areas where the PPDP model was implemented and control areas where it was not. Results reveal that communities with the PPDP model experienced statistically significant improvements in employment, income levels, and access to rights-based services compared to control areas. The outcomes underscore the potential of the PPDP model to address inclusive and sustainable development. This study therefore proposes a scalable pathway beginning with access to rights-based needs, followed by improved service delivery, and culminating in economic empowerment. These findings offer valuable insights for governments, development practitioners, investment agencies, and researchers seeking community-driven developments in similar socio-economic contexts across Africa. For the first time, it can be adopted in the design and implementation of development projects in rural and local communities across Africa bringing into focus the need to integrate rights-based needs at the core of the project. Full article

Background/Objectives: Paeonia delavayi, a high-altitude-adapted medicinal and oil-producing plant, exhibits broad elevational distribution. Understanding how environmental factors regulate its growth across altitudes is critical for optimizing cultivation and exploiting its economic potential. Methods: In this study, we conducted a comprehensive Iso-Seq and RNA-seq analysis to elucidate the transcriptional profile across diverse altitudes and three seed developmental stages. Results: Using Pacbio full-length cDNA sequencing, we identified 39,267 full-length transcripts, with 80.03% (31,426) achieving successful annotation. RNA-seq analysis uncovered 11,423 and 9565 differentially expressed genes (DEGs) in response to different altitude and developmental stages, respectively. KEGG analysis indicated that pathways linked to fatty acid metabolism were notably enriched during developmental stages. In contrast, pathways associated with amino acid and protein metabolism were significantly enriched under different altitudes. Furthermore, we identified 34 DEGs related to fatty acid biosynthesis, including genes encoding pivotal enzymes like biotin carboxylase, carboxyl transferase subunit alpha, malonyl-CoA-acyl carrier protein transacylase, 3-oxoacyl-ACP reductase, 3-hydroxyacyl-ACP dehydratase, and stearoyl-ACP desaturase enoyl-ACP reductase. Additionally, ten DEGs were pinpointed as potentially involved in high-altitude stress response. Conclusions: These findings provide insights into the molecular mechanisms of fatty acid biosynthesis and adaptation to high-altitude stress in peony seeds, providing a theoretical foundation for future breeding programs aimed at enhancing seed quality. Full article

Traditional energy conservation policies have primarily relied on economic incentives and informational campaigns. However, recent insights from behavioral and social sciences indicate that subtle behavioral interventions, particularly social nudges, can significantly influence household electricity use. This paper presents a structured review of 23 recent field studies examining how social nudging strategies, such as peer comparison, group identity, and normative messaging, have contributed to measurable reductions in electricity consumption. By analyzing intervention outcomes across different regions and formats, we identify key success factors, limitations, and policy implications. Special attention is given to ethical considerations, fairness in implementation, and potential challenges in sustaining behavior change. This study offers a framework for integrating social nudges into future energy policies, emphasizing their role as low-cost, scalable tools for promoting sustainable energy behavior. Full article

The yak (Bos grunniens) is a key species in high-altitude rangelands of Asia. Despite their ecological and economic importance, yak production faces persistent challenges, including low milk yields, vulnerability to climate changes, emerging diseases, and a lack of systematic breeding programs. This review presents the genomic, physiological, and environmental dimensions of yak biology and husbandry. Genes such as EPAS1, which encodes hypoxia-inducible transcription factors, underpin physiological adaptations, including enlarged cardiopulmonary structures, elevated erythrocyte concentrations, and specialized thermoregulatory mechanisms that enable their survival at elevations of 3000 m and above. Copy number variations (CNVs) and single nucleotide polymorphisms (SNPs) present promising markers for improving milk and meat production, disease resistance, and metabolic efficiency. F1 and F2 generations of yak–cattle hybrids show superior growth and milk yields, but reproductive barriers, such as natural mating or artificial insemination, and environmental factors limit the success of these hybrids beyond second generation. Infectious diseases, such as bovine viral diarrhea and antimicrobial-resistant and biofilm-forming Enterococcus and E. coli, pose risks to herd health and food safety. Rising ambient temperatures, declining forage biomass, and increased disease prevalence due to climate changes risk yak economic performance and welfare. Addressing these challenges by nutritional, environmental, and genetic interventions will safeguard yak pastoralism. This review describes the genes associated with different yak traits and provides an overview of the genetic adaptations of yaks (Bos grunniens) to environmental stresses at high altitudes and emphasizes the need for conservation and improvement strategies for sustainable husbandry of these yaks. Full article

Vaccine equity and access remain critical challenges in global health, particularly in regions with complex socio-political landscapes, like the Middle East. This review examines disparities in vaccine distribution within the Middle Eastern context, analyzing the unique challenges and opportunities across the region. It provides an overview of the area’s diverse finances and its impact on healthcare accessibility. We examine vaccination rates and identify critical barriers to vaccination, which may be particular issues in developing countries, such as vaccine thermostability, logistical hurdles, financial constraints, and socio-cultural factors, or broader problems, like political instability, economic limitations, and deficiencies in healthcare infrastructure. However, we also highlight successful efforts at the regional and national levels to improve vaccine equity, along with their outcomes and impacts. Ultimately, by drawing on the experiences of previous programs and initiatives, we propose strategies to bridge the gaps in vaccine access through sustainable financing, local manufacturing, and the strengthening of health systems. This approach emphasizes the importance of regional collaboration and long-term self-sufficiency in enhancing global health security and achieving more equitable outcomes in the Middle East. Full article

This study employs k-means clustering to analyze local organizations responsible for land improvement in Greece, identifying four distinct groups with consistent geographic patterns but divergent financial and operational characteristics. By integrating unsupervised machine learning with spatial analysis, the research offers a novel perspective on irrigation water pricing and cost recovery. The findings reveal that organizations located on islands, despite high water costs due to limited rainfall and geographic isolation, tend to achieve relatively strong financial performance, indicating the presence of adaptive mechanisms that could inform broader policy strategies. In contrast, organizations managing extensive irrigable land or large volumes of water frequently show poor cost recovery, challenging assumptions about economies of scale and revealing inefficiencies in pricing or governance structures. The spatial coherence of the clusters underscores the importance of geography in shaping institutional outcomes, reaffirming that environmental and locational factors can offer greater explanatory power than algorithmic models alone. This highlights the need for water management policies that move beyond uniform national strategies and instead reflect regional climatic, infrastructural, and economic variability. The study suggests several policy directions, including targeted infrastructure investment, locally calibrated water pricing models, and performance benchmarking based on successful organizational practices. Although grounded in the Greek context, the methodology and insights are transferable to other European and Mediterranean regions facing similar water governance challenges. Recognizing the limitations of the current analysis—including gaps in data consistency and the exclusion of socio-environmental indicators—the study advocates for future research incorporating broader variables and international comparative approaches. Ultimately, it supports a hybrid policy framework that combines data-driven analysis with spatial intelligence to promote sustainability, equity, and financial viability in agricultural water management. Full article

This study explores sustainable rural tourism entrepreneurship within the Urlaub am Bauernhof (UaB) cooperative network in Austria, offering an integrated model that unites financial, social, environmental, institutional, and marketing dimensions. Employing exploratory factor analysis (EFA) and Structural Equation Modeling (SEM) on data from 393 farm-based accommodation stakeholders, this research identifies sustainable entrepreneurship as comprising six interconnected dimensions: Economic Resilience and Diversification, Sociocultural Integration, Environmental and Regional Commitment, Market Visibility and Strategic Communication, Quality Assurance and Institutional Support, and Perceived Value and Branding. This multidimensional and hierarchically structured framework reflects the complex yet coherent nature of sustainability-driven entrepreneurship in cooperative tourism networks. The findings confirm the multidimensional nature of sustainable entrepreneurship and support the hypothesized structural relationships. The UaB network is presented as a transferable model that demonstrates how cooperative frameworks can enhance sustainability, regional identity, and rural revitalization, offering valuable insights and practical guidance for rural regions in the Western Balkans, where economic challenges, depopulation, and underdeveloped tourism infrastructure prevail. By illustrating a successful cooperative approach rooted in sustainability and regional identity, this study contributes to policy-making aimed at fostering resilient, culturally rich, and environmentally responsible rural tourism entrepreneurship in transitioning contexts. Full article

Based on a literature review, the present article aims to present ecotourism as a transformative factor in the economic, social, cultural, and environmental contexts, revealing key elements for the sustainable development of ecotourism. To ensure that this objective is met, the review combines the insights of classical authors and many recent authors who have best addressed the subject. The review carefully selected consensual and contradictory arguments, reflecting on the relevance of each group, particularly in aspects such as the influence of emotional experience on behaviour and satisfaction, strategy and competitive advantage, cooperation and sustainability, and the influence of resilience on ecotourism. The impact of each perspective was presented without ignoring the major constraints that ecotourism faces in its search for a position in the tourism industry. This led the study to accept the fact that the active participation of the community is indispensable in the formula for the success of ecotourism. Some statistical data were consulted and analysed, which enabled the study to determine the quantitative impact of ecotourism on economic, social, and environmental life. In terms of benefits to communities, the review clarifies the fact that ecotourism serves as an instrument that mobilizes not only the additional value of products and services traded in the process, but also the return on investments and job creation. The combination of visiting activities with the involvement of tour guides contributes to maximizing profits in the destinations, thus supporting solid economic, social, and environmental development for the benefit of both ecotourism promoters and local communities. However, the analysis makes it clear that the economic, social, and environmental benefit depends on the degree of involvement of the local population. In terms of usability, for other studies, this review can contribute to the understanding and positioning of ecotourism in the search for a balance between satisfying socioeconomic and environmental interests. Additionally, it can serve as an aid to policy makers in their decisions related to ecotourism. Full article

Since the early 21st century, urban shrinkage has become a significant global phenomenon. Dongguan, in Guangdong Province, China, is known as a “world factory”. It experienced notable urban shrinkage following the 2008 financial crisis. However, the city demonstrated remarkable recovery and ongoing development in subsequent years. On that basis, this study focuses on the following three points: (1) identifying the spatiotemporal factors contributing to the growth and shrinkage of manufacturing cities, taking Dongguan as an example; (2) explaining the influencing factors of the growth and shrinkage of Dongguan City during three critical periods, 2008–2014 (post-crisis), 2015–2019 (as machinery replaced human work), and 2020–2023 (the COVID-19 pandemic and recovery); and (3) selecting representative towns and streets for on-site observation and investigation, analyzing the measures they have taken to cope with growth and shrinkage during different periods. The key findings include the following: (1) The spatial dynamics of growth and shrinkage in Dongguan show significant temporal patterns, with traditional manufacturing areas shrinking from 2008 to 2014, central urban areas recovering from 2015 to 2019, and renewed shrinkage from 2020 to 2023. However, some regions maintained stability through strategic innovations. (2) Various factors, particularly industrial upgrading and technological innovation, drove the urban dynamics, enhancing economic resilience. (3) The case study of Houjie Town revealed successful adaptive mechanisms supported by policy while facing challenges like labor mismatches and inadequate R&D investment. This research offers insights for improving urban resilience and promoting sustainable development in Dongguan. Full article

Renewable energy projects are critical for sustainable development, yet their success often hinges on local community acceptance. This study refines the Community Acceptance Framework to classify and better understand the social and behavioral factors that shape community responses to renewable energy projects. To support the reclassification, we draw selectively on three psychological concepts to refine definition and streamline categories. Based on a systematic review of 212 studies, we identified 29 influencing factors and categorized them into a seven-dimensional framework: social, economic, environmental, political, process, project details, and temporal. The findings reveal that financial capital, which reflects economic gains, emerges as the most frequently cited factor influencing local acceptance. However, when viewed dimensionally, the social dimension encompassing factors such as social capital, cognitive response, and cultural capital accounts for the largest share of influencing factors. Additionally, the often-overlooked political and temporal dimensions highlight the importance of governance quality and timely community engagement. While the framework offers a more robust and context-sensitive tool for analyzing acceptance dynamics, empirical validation is needed to assess its practical applicability. Nevertheless, the refined CAF can guide policymakers, researchers, and practitioners in designing renewable energy initiatives that are both technically sound, economically viable, and socially inclusive. Full article

The adjuvant treatment landscape for hormone receptor-positive (HR+), human epidermal growth factor receptor 2-negative (HER2–) early breast cancer (EBC) is rapidly evolving, with a diverse range of therapeutic options—including endocrine therapies, bisphosphonates, ovarian function suppression, olaparib, CDK4/6 inhibitors, and emerging agents such as immunotherapy. While these advances have markedly improved patient outcomes, they also introduce challenges related to implementation, monitoring, and resource allocation. Notably, therapies like CDK4/6 inhibitors require particularly close monitoring, creating logistical and capacity challenges for medical oncologists, whose workloads are already stretched due to rising cancer incidence and treatment complexities. These challenges underscore the need for innovative care delivery solutions to ensure patients with EBC continue to receive optimal care. This paper offers a comprehensive guide—a playbook—of multidisciplinary-team-based care models designed to optimize adjuvant treatment delivery in EBC. Drawing on real-world evidence and successful applications across Canadian centers, we explore models led by nurses, nurse practitioners (NPs), general practitioners in oncology (GPO), and pharmacists. Each model leverages the unique expertise of its team to manage treatment toxicities, facilitate adherence, and enhance patient education, thereby promoting effective and sustainable care delivery. Importantly, these models are not intended to compete with one another, but rather to serve as a flexible recipe book from which breast cancer care teams can draw strategies tailored to their local resources and patient needs. By detailing implementation strategies, benefits, and challenges—in many instances supported by quantitative metrics and economic evaluations—this work aims to inspire care teams nationwide to optimize the adjuvant management of patients with HR+, HER2– EBC. Full article

The contribution of small-scale sporting events to tourism sustainable development in local communities has been well recognized in the literature. Small-scale running events in particular are essential in the promotion of sustainable tourism in the community due to their localized impact. Although research has largely focused on the demand side—including participants, spectators, and host communities—limited attention has been given to the supply side, particularly the perspectives of sport event organizers and their role in implementing sustainable practices. This study aims to address this gap and answer key research questions that concern the factors which contribute to the success of these events in relation to their economic, social, and environmental impacts through the lens of the events’ primary decision-makers, their organizers. This study employs an exploratory research method, conducting interviews with twenty-five organizers of diverse Greek running events that represent a variety of geographical contexts and event characteristics of the country, based on their long-standing presence. Findings contribute to sustainable sport tourism literature by developing a theoretical framework which encompasses the three dimensions of sustainability, highlighting inclusivity as a key component within the social dimension. Results indicate that organizers perceive their running events as having a positive economic impact and enhancing social cohesion. They are also aware of the potential environmental impact, like trail preservation, and consequently implement responsible measures to protect the environment. Organizers share a variety of specific strategies and practical suggestions aimed at improving the sustainability of running events, such as managing waste effectively or improving accessibility for diverse participants, offering transferable insights for other event planners and local authorities. This paper showcases the key role of organizers in developing partnerships to implement effective sustainable sport event practices in the destination. Full article

Driven by the urgent need to mitigate climate change and achieve net-zero emissions, carbon pricing has emerged as a critical policy tool in major economies worldwide. This study compares carbon pricing in the EU, China, Canada, and Singapore, evaluating effectiveness in emission reductions, with the EU ranking first with high carbon prices, road market coverage, and strict penalties, based on carbon price per capita. Conversely, Singapore’s position as fourth in carbon price per capita among these four most mature carbon markets, Singapore has a high GDP per capita and lower carbon prices. Canada’s fragmented provincial policies and China’s limited market coverage, despite being the top global emitter. Our analysis reveals three critical success factors: (1) higher carbon prices per capita are essential for carbon reduction, (2) the necessity of penalties on carbon price per capita from EUR 20–EUR 100, and (3) expanded market coverage maximizes impact. To address global disparities, we propose a Uniform Carbon Pricing Mechanism under the Global Carbon Resilience Framework (GCRF), based on carbon price per capita tiered pricing: EUR 100/t (developed), EUR 30–50 (developing), and EUR 5–15 (least-developed countries). This balanced system supports vulnerable regions while cutting emissions, proving that fair carbon pricing is crucial for climate goals and economic stability. Full article