Search Results (5,600)

Background: Patient safety culture is critical for enhancing the quality and safety of healthcare. Studies in low- and middle-income countries have reported challenges in developing patient safety culture, especially in implementing nonpunitive responses to errors and event reporting. However, evidence from Laos remains limited. Objectives: This study aimed to assess patient safety culture in hospitals in southern Laos, using a validated survey tool to identify strengths and areas of improvement. Methods: A cross-sectional study using purposive sampling was conducted in four provincial and twenty-three district hospitals in southern Laos. Healthcare workers on patient safety committees responded to the Hospital Survey on Patient Safety Culture. The positive response rate was analyzed. Bivariate tests (chi-square/Fisher’s exact) were applied to compare positive response rates between hospital types and professions. Results: A total of 253 valid responses (75.5%) were analyzed. “Organizational Learning–Continuous Improvement” scored over 75% in both provincial and district hospitals. In contrast, “Nonpunitive Response to Error” and “Frequency of Events Reported” were scored <20% on average. Provincial hospitals scored significantly higher than district hospitals in supervisory support and handoffs. Conclusions: This study illustrated strengths in organizational learning while identifying nonpunitive responses and event reporting as critical areas of improvement for hospitals in Laos. To improve patient safety, hospitals in Laos must promote a culture in which errors can be reported without fear of blame. Strengthening leadership support and reporting systems is essential. These findings can inform strategies to enhance patient safety in other low-resource healthcare settings. Full article

Research regarding airborne laser scanning (ALS) point cloud semantic segmentation typically revolves around supervised machine learning, which requires time-consuming generation of training data. Therefore, the models are usually trained using one of the benchmarking datasets that cover a small area. Recently, many European countries published classified ALS data, which can be potentially used for training models. However, a review of the classification schemes of these datasets revealed that these schemes vary substantially, therefore limiting their applicability. Thus, our goal was three-fold. First, to develop a common classification scheme that can be applied for the semantic segmentation of various ALS datasets. Second, to unify the classification scheme of existing ALS datasets. Third, to employ them for the training of a classifier that will be able to classify data from different sources and will not require additional training. We propose a classification scheme of four classes: ground and water, vegetation, buildings and bridges, and ‘other’. The developed classifier is trained jointly using ALS data from Austria, Switzerland, and Poland. A test on unseen datasets demonstrates that the achieved intersection over union accuracy varies between 90.0–97.3% for ground and water, 68.0–95.9% for vegetation, 77.6–94.8% for buildings and bridges, and 13.5–52.7% for ‘other’. As a result, we conclude that the developed method generalizes well to previously unseen data. Full article

Background: Growing disparities in development, governance, and logistics performance across countries pose challenges for global policymaking and Sustainable Development Goal (SDG) monitoring. This study proposes a classification of 137 countries based on multiple structural dimensions. The dataset for 2023 includes six components of the Logistics Performance Index (LPI), six dimensions of the Worldwide Governance Indicators (WGIs), and four proxies of the Human Development Index (HDI). Methods: The Uniform Manifold Approximation and Projection (UMAP) technique was used to reduce dimensionality and allow for meaningful clustering. Based on the reduced space, the K-means algorithm was employed to group countries with similar development characteristics. Results: The classification process allowed the identification of three distinct groups of countries, supported by a Hopkins statistic of 0.984 and an explained variance ratio of 87.3%. These groups exhibit structural differences in the quality of governance, logistics capacity, and social development conditions. Internal consistency checks and multivariate statistical analyses (ANOVA and MANOVA) confirmed the robustness and statistical significance of the clustering. Conclusions: The resulting classification offers a practical analytical tool for policymakers to design differentiated strategies aligned with national contexts. Furthermore, it provides a data-driven approach for comparative monitoring of the SDGs from an integrated and empirical perspective. Full article

This study assesses the quality of financial reporting in ten Central and Eastern European countries using a methodology based on natural language processing (NLP) techniques. 570 annual reports of companies listed on the main index on the stock exchanges of 10 Central and Eastern European (CEE) countries, over the period 2019–2023, were evaluated to determine the degree of convergence of the following four measurable qualitative characteristics: relevance, exact representation, comparability and understandability. The main objective is to identify consistency in the quality of accounting information based on the application of an international financial reporting framework. The applied methodology eliminates subjective variability by implementing a standardized scoring system, aligned with the criteria developed by NiCE, using libraries such as spaCy and NLTK for term extraction, respective sentiment analysis and word frequency evaluation. The results reveal significant heterogeneity in all characteristics examined, with statistical tests confirming substantial differences between countries. The investigation of relevance revealed partial convergence, with three dimensions achieving complete uniformity, while the exact representation showed the highest variability. The assessment of comparability showed a significant difference between countries’ extreme values, and in terms of comprehensibility a formalistic approach was evident, with technical dimensions outweighing user-oriented aspects. The overall quality index varied significantly across countries, with a notable average deterioration in 2023, indicating structural vulnerabilities in financial reporting systems. These findings support initial hypotheses on the lack of homogeneity in the quality of financial reporting in the selected region, despite the implementation of international standards. Full article

Water governance in Europe faces mounting challenges from climate change, demographic pressures, and aging infrastructure—especially in Southern regions increasingly affected by drought and institutional fragmentation. In contrast, Nordic countries such as Denmark and Sweden exhibit coherent, integrated governance systems with strong regulatory oversight. This study introduces the Water Governance Maturity Index (WGMI), a document-based assessment tool designed to evaluate national water governance across five dimensions: institutional capacity, operational effectiveness, environmental ambition, equity, and climate adaptation. Applying the WGMI to eight EU countries—four Nordic and four Southern—reveals a persistent North–South divide in governance maturity. Nordic countries consistently score in the “advanced” or “model” range, while Southern countries face systemic gaps in implementation, climate integration, and territorial inclusion. Based on these findings, the study offers actionable policy recommendations, including the establishment of independent regulators, strengthening of river basin coordination, mainstreaming of climate-water strategies, and expansion of affordability and participation mechanisms. By translating complex governance principles into measurable indicators, the WGMI provides a practical tool for benchmarking reform progress and supporting the EU’s broader agenda for just resilience and climate adaptation. Unlike broader frameworks like SDG 6.5.1, the WGMI’s document-based, dimension-specific approach provides granular, actionable insights for governance reform, enhancing its utility for EU and global policymakers. Full article

Age-related macular degeneration (AMD) is the leading cause of blindness in developed countries. Predicting its progression is crucial for preventing late-stage AMD, as it is an irreversible retinal disease. Both genetic factors and retinal images are instrumental in diagnosing and predicting AMD progression. Previous studies have explored automated diagnosis using single fundus images and genetic variants, but they often fail to utilize the valuable longitudinal data from multiple visits. Longitudinal retinal images offer a dynamic view of disease progression, yet standard Long Short-Term Memory (LSTM) models assume consistent time intervals between training and testing, limiting their effectiveness in real-world settings. To address this limitation, we propose time-varied Long Short-Term Memory (TV-LSTM), which accommodates irregular time intervals in longitudinal data. Our innovative approach enables the integration of both longitudinal fundus images and AMD-associated genetic variants for more precise progression prediction. Our TV-LSTM model achieved an AUC-ROC of 0.9479 and an AUC-PR of 0.8591 for predicting late AMD within two years, using data from four visits with varying time intervals. Full article

As the world’s largest developing and carbon-emitting country, China is accelerating its greenhouse gas (GHG) emission reduction process, and it is of vital importance in achieving the goals set out in the Paris Agreement. This paper examines the historical development and current operation of China’s carbon emissions trading market (CETM). The current progress of research on the implementation of carbon emissions trading policy (CETP) is described in four dimensions: environment, economy, innovation, and society. The results show that CETP generates clear environmental and social benefits but exhibits mixed economic and innovation effects. Furthermore, this paper analyses the challenges of China’s carbon market, including the green paradox, the low carbon price, the imperfections in cap setting and allocation of allowances, the small scope of coverage, and the weakness of the legal supervision system. Ultimately, this paper proposes recommendations for fostering China’s CETM with the anticipation of offering a comprehensive outlook for future research. Full article

It is well-established that principal leadership significantly influences student learning in developed countries, yet much less is known about how leadership practices manifest in complex systems like China’s, where rapid modernization intersects with deep-rooted educational traditions. In particular, Chinese principals face multiple challenges in balancing the implementation of educational reform policies, high parental expectations, and their own educational ideology, all within limited resources. The current study examines these challenges in Shenzhen, a city which typically manifests them through its rapid development. Specifically, we took a phenomenographic approach and interviewed the principals and staff from five prestigious primary schools to extract the key components behind the diverse school leaders’ styles and practices. Results showed that, the Chinese leadership practice model consists of five key components: mission setting, infrastructure reconstruction, teacher development, learning improvement, and educators’ networking. Although the first four components in this model align with established theories in developed countries, networking was identified as a distinctive and critical element for securing resources and fostering collaboration. These findings may broaden the scope of leadership theories and underscore the need to contextualize leadership practices based on local challenges and dynamics. It also offers practical insights for school leaders on navigating challenges to improve teacher and student outcomes. Full article

The rise in online learning, accelerated by the COVID-19 pandemic, has led to greater use of synchronous hybrid learning (SHL) in higher education. SHL allows simultaneous teaching of in-person and online learners through videoconferencing tools. Previous studies have identified various benefits (e.g., flexibility) and challenges (e.g., student engagement) to SHL. Whilst systematic reviews have emerged on this topic, few studies have considered the experiences of staff. The aim of this review was threefold: (i) to better understand how staff experiences and perceptions are assessed, (ii) to understand staff experiences in terms of the benefits and challenges of SHL and (iii) to identify recommendations for effective teaching and learning using SHL. In line with the PRISMA guidance, we conducted a systematic review across four databases, identifying 14 studies for inclusion. Studies were conducted in nine different countries and covered a range of academic disciplines. Most studies adopted qualitative methods, with small sample sizes. Measures used were typically novel and unvalidated. Four themes were identified relating to (i) technology, (ii) redesigning teaching and learning, (iii) student engagement and (iv) staff workload. In terms of recommendations, ensuring adequate staff training and ongoing classroom support were considered essential. Additionally, active and collaborative learning were considered important to address issues with interactivity. Whilst these findings largely aligned with previous work, this review also identified limited reporting in research in this area, and future studies are needed to address this. Full article

The ongoing decade of UN restoration matches with the European goal of bringing nature back into our lives, including in urban systems, and Nature Restoration Regulation. Within such a framework, this work is aimed at highlighting the ecological rationale and strategic value of an NRRP measure devoted to forest restoration in Italian Metropolitan Cities, and at assessing respective preliminary results. Therefore, the measure’s overarching goal (not to create urban parks or gardens, but activate forest recovery), geographic extent and scope (over 4000 ha and more than 4 million planted trees and shrubs across the country), plantation model (mandatory use of native species consistent with local potential vegetation, density of 1000 seedlings per ha, use of at least four tree and four shrub species in each project, with a minimum proportion of 70% for trees, certified provenance for reproductive material), and compulsory management activities (maintenance and replacement of any dead plants for at least five years), are herein shown and explained under an ecological perspective. Current implementation outcomes were thus assessed in terms of coherence and expected biodiversity benefits, especially with respect to ecological and biogeographic consistency of planted forests, representativity in relation to national and European plant diversity, biogeographic interest and conservation concern of adopted plants, and potential contribution to the EU Habitats Directive. Compliance with international strategic goals and normative rules, along with recognizable advantages of the measure and limitations to be solved, are finally discussed. In conclusion, the forestation model proposed for the Italian Metropolitan Cities proved to be fully applicable in its ecological rationale, with expected benefits in terms of biodiversity support plainly met, and even exceeded, at the current stage of implementation, especially in terms of the contribution to protected habitats. These promising preliminary results allow the model to be recognized at the international level as a good practice that may help achieve protection targets and sustainable development goals within and beyond urban systems. Full article

This article introduces the Index of Distributive and Developmental Outlook (IDDO), a composite indicator designed to jointly assess economic performance and income inequality across EU-27 Member States. While GDP per capita is widely used to evaluate national prosperity, and the Gini coefficient captures income distribution, their separate use often obscures the interaction between growth and equity—an essential dimension of sustainable development. To address this gap, the IDDO integrates normalized values of both indicators using arithmetic and geometric means. The study applies the IDDO to a longitudinal dataset covering the years 2005, 2014, and 2024, allowing for comparative and temporal analysis. Based on IDDO scores, countries are classified into four development types: balanced development, growth with inequality, equity with stagnation, and dual vulnerability. Results show that while some Member States, such as Luxembourg, Czechia, and Slovenia, maintain consistently high IDDO levels, others—including Bulgaria, Romania, and Latvia—exhibit persistent challenges in aligning growth with equitable outcomes. The findings underscore the need for cohesion policies that prioritize not only economic convergence but also distributive fairness. The IDDO provides a practical and adaptable tool for diagnosing development patterns, benchmarking performance, and informing policy design within the EU framework. Full article

Sustainable education requires addressing the challenges posed by digital transformation, including technostress among university students. This study evaluates technostress levels in higher education through the validation of the TS4US scale and its implications for sustainable learning environments. A cross-sectional study was conducted with 328 university students from four districts in Lima, Peru, using an online survey to measure technostress. Confirmatory factor analysis (CFA) was performed to assess the psychometric properties of the TS4US scale, resulting in a refined model with two latent factors and thirteen validated items. Findings indicate that 28% of students experience high technostress levels, while 5% report very high levels, though no significant associations were found between technostress and sociodemographic variables such as campus location, employment status, gender, and academic level. The TS4US instrument had been previously validated in Chile; this study confirms its structure in a new sociocultural context, reinforcing its cross-cultural applicability. These results highlight the need for sustainable strategies to mitigate technostress in higher education, including institutional support, digital literacy programs, and policies fostering a balanced technological environment. Addressing technostress is essential for promoting sustainable education (SDG4) and enhancing student well-being (SDG3). This study directly contributes to the achievement of Sustainable Development Goals 3 (Good Health and Well-being) and 4 (Quality Education) by providing validated tools and evidence-based recommendations to promote mental health and equitable access to digital education in Latin America. Future research should explore cross-country comparisons and targeted interventions, including digital well-being initiatives and adaptive learning strategies, to ensure a resilient and sustainable academic ecosystem. Full article

Background/Objectives: Understanding the impact of dietary habits in terms of obesity, health outcomes, and functional decline is critical in Europe’s growing elderly population. This study analyzed trends in Mediterranean diet (MD) adherence, obesity prevalence, and grip strength among middle-aged and elderly Europeans using data from the Survey of Health, Ageing and Retirement in Europe (SHARE). Methods: Data from four SHARE waves (2015–2022) across 28 countries were analyzed. Dietary patterns were assessed through food frequency questionnaires classifying participants as MD-adherent or non-adherent where adherent implies daily consumption of fruits and vegetables and occasional (3–6 times/week) intake of eggs, beans, legumes, meat, fish, or poultry (an unvalidated definition of the MD pattern). Handgrip strength, a biomarker of functional capacity, was categorized into low, medium, and high groups. Body mass index (BMI), self-perceived health (SPHUS), chronic disease prevalence, and CASP-12 scores (control, autonomy, self-realization, and pleasure evaluated on the 12-item version) were also evaluated. Statistical analyses included descriptive methods, logistic regressions, and multiple imputations to address missing data. Results: A significant majority (74–77%) consumed fruits and vegetables daily, which is consistent with MD principles; however, the high daily intake of dairy products (>50%) indicates limited adherence to the MD, which advocates for moderate consumption of dairy products. Logistic regression indicated that individuals with two or more chronic diseases were more likely to follow the MD (odds ratio [OR] = 1.21, confidence interval [CI] = 1.11–1.32), as were those individuals who rated their SPHUS as very good/excellent ([OR] = 1.42, [CI] = 1.20–1.69). Medium and high maximal handgrip were also strongly and consistently associated with higher odds of MD adherence (Medium: [OR] = 1.44, [CI] = 1.18–1.74; High: [OR] = 1.27, [CI] = 1.10–1.48). Conclusions: The findings suggest that middle-aged and older adults are more likely to adhere to the MD dietary pattern if they have more than two chronic diseases, are physically active, and have a medium or high handgrip. Although an unvalidated definition of the MD dietary pattern was used, the results highlight the importance of implementing targeted dietary strategies for middle-aged and elderly adults. Full article

Agricultural development is vital for East Africa’s economic growth, yet the region faces significant disparities and systemic barriers. A critical problem exists due to the lack of an integrated quantitative framework to systematically comparing agricultural capacities and facilitate optimal resource allocation, as existing studies often overlook combined internal and external factors. This study proposes a comprehensive multi-criteria decision-making (MCDM) model to assess, categorize, and strategically profile the agricultural development capacity of 18 East African countries. The method employed is an integrated Entropy-MAIRCA model, which objectively weighs six criteria (the food production index, arable land, production fluctuation, food export/import ratios, and the political stability index) and ranks countries by their distance from an ideal development state. The experiment applied this framework to 18 East African nations using official data. The results revealed significant differences, forming four distinct strategic groups: frontier, emerging, trade-dependent, and high risk. The food export index (C4) and production volatility (C3) were identified as the most influential criteria. This model’s contribution is providing a science-based, transparent decision support tool for designing sustainable agricultural policies, aiding investment planning, and promoting regional cooperation, while emphasizing the crucial role of institutional factors. Full article

Background: The 2022 conflict in Ukraine triggered mass migration, leading to a significant influx of Ukrainian refugee children into Poland. This situation raises concerns about hepatitis B virus immunity, as Ukraine’s hepatitis B vaccination coverage has been inconsistent compared to Poland’s high vaccination rates. Objective: To evaluate hepatitis B immunity and infection prevalence among Ukrainian refugee children residing in Southern Poland and to assess implications for vaccination strategies in the host country. Methods: A prospective cross-sectional study was conducted on 1322 Ukrainian refugee children (0–18 years) presenting to a pediatric infectious diseases department in Southern Poland between February 2022 and March 2024. Data on vaccination history, demographic characteristics, and selected laboratory parameters, including hepatitis B surface antigen and anti-HBs antibody levels, were collected. Protective immunity was defined as anti-HBs antibody levels ≥10 IU/L. Results: Among the participants (mean age 9.9 years; 50.2% female), 83.2% were reported as vaccinated according to national immunization programs, but only 64.9% demonstrated protective anti-HBs antibody levels. Protective antibody prevalence declined significantly with age, with less than half of adolescents aged 15–18 years showing immunity. Five children (0.4%) were diagnosed with chronic hepatitis B, four of whom were unvaccinated. Conclusions: This study identifies a significant gap in hepatitis B immunity among Ukrainian adolescent refugees residing in Southern Poland, with less than half possessing protective anti-HBs antibody levels. This immunity gap and the high risk of sexual transmission of the hepatitis B virus in adolescents highlight the urgent need for comprehensive surveillance, screening, and catch-up vaccination programs. Full article