Search Results (770)

Procedural physician-scientists have made significant contributions to medicine and science, with twelve proceduralists receiving a Nobel Prize. Unfortunately, several systemic challenges have jeopardized the existence, let alone the flourishing, of procedural physician-scientists: the widening gap in the National Institutes of Health salary cap, decreasing funding from nonfederal public and private agencies, and shifting priorities among U.S. hospitals, payers, and policymakers toward relative value unit productivity-based compensation and fee-for-service models. Additional pressures include prolonged training pathways and the need to maintain clinical continuity. Adopting a team science approach may offer a powerful strategy to mitigate these competing demands, support rigorous scientific inquiry, and address the growing complexity of biomedical research. Concerted efforts by the federal government, policymakers, corporations, institutions, and procedural departments will also be crucial to restoring the vitality of this diminishing workforce. Full article

As climate change intensified water scarcity in Southern Europe, tourism-dependent regions such as Portugal’s Algarve faced growing pressure to adapt their water management systems. This study investigated how hotel groups in the Algarve have adopted and communicated water reuse technologies—specifically desalination and greywater recycling—under environmental, institutional, and reputational constraints. A comparative qualitative case study was conducted involving three hotel groups—Vila Vita Parc, Pestana Group, and Vila Galé—selected through purposive sampling based on organizational capacity and technology adoption stage. The analysis was supported by a supplementary mini-case from Mallorca, Spain. Publicly accessible documents, including sustainability reports, media coverage, and policy frameworks, were thematically coded using organizational environmental behavior theory and the OECD Principles on Water Governance. The results demonstrated that (1) higher organizational capacity was associated with greater maturity in water reuse implementation; (2) communication transparency increased alongside technological advancement; and (3) early-stage adopters encountered stronger financial, regulatory, and operational barriers. These findings culminated in the development of the Maturity–Communication–Governance (MCG) Framework, which elucidates how internal resources, stakeholder signaling, and institutional alignment influence sustainable infrastructure uptake. This research offered policy recommendations to scale water reuse in tourism through financial incentives, regulatory simplification, and public–private partnerships. The study contributed to the literature on sustainable tourism and decentralized climate adaptation, aligning with UN Sustainable Development Goals 6.4, 12.6, and 13. Full article

This study examines the role of public–private partnerships in promoting the sustainable development of travel destinations through a comparative analysis of two emblematic heritage-based hospitality projects: Dar Tantora in Al Ula, Saudi Arabia, and Sextantio Le Grotte della Civita in Matera, Italy. These case studies were analysed through both architectural–urban and economic–legal perspectives to highlight how public–private partnership models can support heritage conservation, community engagement, and responsible tourism development. A mixed-methods approach was employed, combining quantitative indicators—such as projected profitability, tourist volume, and employment—with qualitative insights from interviews with key stakeholders. The analysis reveals that while both models prioritise cultural authenticity and adaptive reuse, they differ significantly in funding structures, legal frameworks, and governance dynamics. Dar Tantora exemplifies a top-down, publicly funded model integrated into Saudi Arabia’s Vision 2030 strategy, whereas Sextantio reflects a bottom-up, private initiative rooted in social enterprise. The findings offer insights into how different public–private partnership configurations can foster sustainable tourism development, depending on local context, institutional frameworks, and strategic goals. The study contributes to the broader discourse on regenerative tourism, architectural conservation, and policy-driven heritage reuse. Full article

Background: Starting in early 2022, SARS-CoV-2 Omicron has driven large outbreaks in China, a predominantly infection-naive population with high inactivated vaccine coverage. This unique context provided a substantially less-confounded opportunity to evaluate how vaccination, public health, and social measures influenced severity. Methods: We systematically reviewed 86 studies (224 severity estimates) published from 2022 to 2024, reporting symptom and clinical severity outcomes (fever, cough, and sore throat; symptomatic, severe/critical, and fatal illness) of Omicron infections in China. Using meta-regression, we evaluated the associations of study setting, age group, vaccination status, predominant subvariants, and Oxford COVID-19 Government Response Tracker (OxCGRT) indices, including the Government Response Index (GRI), Containment and Health Index (CHI), and the Stringency Index (SI), with infection outcomes, adjusting for key confounders. Results: We found the primary or booster series of inactivated vaccines conferred strong protection against severe/critical illness (pooled relative risk (RR) 0.17 [95% CI: 0.09–0.33]) but did not reduce symptom frequency (RR 0.99 [95% CI: 0.95–1.02]). Each 10-unit increase in GRI or CHI was associated with 7% (95% CI: 1–12%) and 6% (95% CI: 1–10%) lower odds of symptomatic infection and 3% (95% CI: 1–4%) lower odds of severe/critical illness. Later subvariants (BA.5, BF.7, and XBB) showed 24–38% higher odds of upper respiratory symptoms versus BA.1. Conclusions: The data collection context significantly impacted severity estimates, with higher estimates from emergency hospitals. Overall, inactivated vaccines provided strong protection against severe/critical outcomes while stringent public health measures were associated with lower severity. Our findings underscore the importance of consistent and standardized protocols to produce reliable estimates of SARS-CoV-2 severity in evolving epidemiological contexts. Full article

This study analyzes the comparative performance of ten hospitals in the Kadutu Health Zone in the Democratic Republic of Congo using the EGIPSS model. This study was carried out at the height of the COVID-19 pandemic in August and September 2021, in a changing global context where health systems were called upon to improve their resilience capacity while maintaining high levels of performance. This is a descriptive observational study using documentary review, interviews with 85 key informants, and participatory observation at ten hospitals selected based on several criteria, including the organization of a complete complementary package of activities assigned to a hospital in the DR Congo. This study mainly reveals three facts, namely that (i) university hospitals show the best performance, (ii) adaptive capacity considerably influences the other dimensions of the EGIPSS model and the overall performance of the hospital, and (iii) to adapt, hospitals need resources and good management and governance. Adapting hospitals in the Kadutu Health Zone to the changing context requires a holistic approach that combines clinical work with research, investments in infrastructure (often dilapidated and not modern), training, technology, and governance. It also involves learning from practices implemented in more efficient hospitals. Full article

Neonatal jaundice (NNJ) is a leading cause of death in the early neonatal period, disproportionately affecting newborns in sub-Saharan Africa. In a setting without access to rapid assessment via transcutaneous bilirubin meter, we sought to determine how closely the diagnosis and treatment of neonatal jaundice at an urban district hospital aligned with retrospective assessment and treatment recommendations using the BiliApp (based on the UK NICE Guideline CG98). This retrospective chart review study aimed to identify: (1) What percent of admissions within 8 days of birth to the Mother and Baby Unit (MBU) at our study site were admitted for a primary diagnosis of neonatal jaundice, and what characterized those admissions? (2) How did treatment provided compare to the recommendations of the United Kingdom NICE Guideline CG98 via the “BiliApp”? and (3) Among those with jaundice, what factors were associated with an increased likelihood of severity indicative of the need for blood exchange therapy? The charts of all neonates admitted to the MBU at Suntreso Government Hospital (SGH), in Kumasi, Ghana, in 2020 were reviewed by trained research assistants. Data were collected regarding demographics, reason for admission, diagnostic markers (e.g., serum bilirubin level), treatments performed in the hospital, and outcome. Data were analyzed using Stata 18.0. There were 1059 newborns admitted to the MBU in 2020 at less than 8 days of age. A total of 179 (16.9%) were admitted with a primary diagnosis of neonatal jaundice. According to the BiliApp, 29.4% (n = 50) of newborns admitted for jaundice had bilirubin levels that were normal or below the phototherapy threshold for their gestational age on admission; 25.3% (n = 43) were at or near the threshold for phototherapy; 21.2% (n = 36) were above the phototherapy threshold; and 24.1% (n = 41) were above the blood exchange therapy threshold. The BiliApp recommended no treatment for 21.2% (n = 36) of newborns, repeated assessment for 33.6% (n = 57), phototherapy for 21.2% (n = 36), and exchange therapy for 24.1% (n = 41). By comparison, 8.2% (n = 14) of neonates admitted for jaundice received no treatment, 77.8% (n = 133) received phototherapy only, and 14.0% (n = 24) received both phototherapy and exchange therapy. Without sufficient data on G6PD status and parent/newborn blood type to include in the analysis, the biggest risk factors for a BiliApp recommendation of exchange therapy included serum bilirubin level (OR 1.01, p < 0.001) and gestational age (OR 0.51, p < 0.001), even after controlling for breastfeeding and male sex of the newborn. Without access to rapid assessment tools, many providers in low-resource settings are put in a position to presumptively treat newborns suspected of having jaundice, rather than waiting for serum lab tests to return. Given the cost of transcutaneous bilirubin meters, additional options for rapid diagnostic testing are warranted. Full article

This article explores the persistent issue of assaults on medical staff in China that are unrelated to malpractice, which exacerbate tensions in doctor–patient relationships. These conflicts are primarily fueled by factors such as the disparity between doctors and patients, unequal distribution of medical resources, and inadequacies in the legal protection system. Drawing on Foucault’s micro-power theory, this research proposes a tripartite governance model that includes reconfiguring medical resources through public–private partnerships, implementing proactive legal mechanisms such as hospital-embedded policing systems, and establishing mandatory protocols for treatment explanations to reduce information asymmetry. The article also highlights the importance of medical conflict mediation systems to effectively resolve disputes and ensure satisfaction for all parties involved. Full article

Background: Breast cancer (BC) is the leading female cancer globally, with Bahrain having the highest incidence in the GCC. In this study, we aimed to identify and describe the high-risk pathogenic/likely pathogenic mutations in a cohort of 160 Bahraini patients who underwent genetic testing for hereditary cancer susceptibility genes. Methods: This study included 160 women referred to Bahrain’s Government Hospitals for genetic analysis between January 2021 and May 2024. All women underwent NGS cancer gene panel testing. Demographic and clinical data were recorded for each patient. Categorical variables were described using frequencies and percentages, and continuous data was depicted using means and standard deviations or medians. Results: Pathogenicity was significantly higher in individuals with high-risk mutations compared to those with medium- and low-risk mutations. However, mortality was highest among those with medium-risk mutations, exceeding that of both the high- and low-risk groups. Conclusions: In Bahrain, the genetic profile of BC germline mutations aligns closely with international data. However, further research is needed to assess moderate- and low-risk mutations and their pathogenicity within the diverse ethnic populations of the Middle East. Full article

With the development of urban construction and the improvement of residents’ quality of life, the focus of governance has shifted to a people-centered approach. In the core area of Beijing, there is a mismatch between the existing large comprehensive hospitals (LCHs) and the current demand for medical technology and services. Therefore, this study focuses on tertiary LCHs in the core area of Beijing from the perspective of supply and demand (SD) and explores in depth the problem of matching the crowd concentration and the SD of the surrounding public service facilities in the process of seeking medical treatment. By comprehensively analyzing the public service facilities within a 15-min walking distance around the hospital and considering demand, supply, and transport factors, this study identifies 15 key indicators, constructs an SD coupling model (SDCM) evaluation system, and systematically evaluates the space of public service facilities around an LCH. The results show that the higher the spatial coupling and coordination of these facilities around the LCH, the more tightly the system is connected, and the more pronounced the coupling effect is in the vicinity of the hospital, which suggests that the hospital has a clustering effect on its radiating area. Full article

The October 2024 cut-off low event triggered one of the most catastrophic floods recorded in the Valencia Metropolitan Area, exposing significant vulnerabilities in urban planning, infrastructure resilience, and emergency preparedness. This study presents a novel comprehensive assessment of the event, using a multi-sensor satellite approach combined with socio-economic and infrastructure data at the metropolitan scale. It provides a comprehensive spatial assessment of the flood’s impacts by integrating of radar Sentinel-1 and optical Sentinel-2 and Landsat 8 imagery with datasets including population density, land use, and critical infrastructure layers. Approximately 199 km² were inundated, directly affecting over 90,000 residents and compromising vital infrastructure such as hospitals, schools, transportation corridors, and agricultural lands. Results highlight the exposure of peri-urban zones and agricultural areas, reflecting the socio-economic risks associated with the rapid urban expansion into flood-prone plains. The applied methodology demonstrates the essential role of multi-sensor remote sensing in accurately delineating flood extents and assessing socio-economic impacts. This approach constitutes a transferable framework for enhancing disaster risk management strategies in other Mediterranean urban regions. As extreme hydrometeorological events become more frequent under changing climatic conditions, the findings underscore the urgent need for integrating remote sensing technologies, early warning systems, and nature-based solutions into regional governance to strengthen resilience, reduce vulnerabilities, and mitigate future flood risks. Full article

The present study explores residents’ perceptions of Stintino (Sardinia, Italy) as a tourist destination. The municipality is predominantly known for La Pelosa beach, widely regarded as one of the most attractive coastal sites in Europe. However, its popularity has raised critical issues related to carrying capacity and seasonal overcrowding, contributing to a tourism model centered almost exclusively on beach-related activities. This study aims to investigate how locals conceptualize their place beyond the dominant seaside narrative, particularly considering Stintino’s identity as a former fishing village with a strong maritime tradition. As part of Italy’s designated inner areas, Stintino also embodies a deep-rooted connection to cultural heritage, further reinforcing the need for its preservation. Adopting a photovoice-based participatory visual methodology, this study engaged 15 local stakeholders from key sectors (hospitality, fishing tourism, retail, gastronomy, and cultural institutions) who produced and discussed photographic representations of their lived experience of the territory. The visual material was thematically analyzed using a conceptual framework informed by theories of place perception and social representations. The findings suggested a multifaceted territorial storytelling rooted in local heritage, symbolic spaces, and everyday practices. Tourism governance strategies could incorporate community-based approaches, such as participatory mapping and inclusive narrative development, to foster more sustainable and place-sensitive promotion models. Full article

In today’s hyperconnected world, disaster announcements—regardless of actual impact—can significantly shape consumer behaviour and brand perception in the hospitality sector. This study investigates how customers respond online to disaster-related signals, focusing on digital marketing activities by luxury hotels in Santorini, Greece. Drawing on a case study of the Santorini Earthquake in February 2025—during which the Greek government declared a state of emergency—we use big data analytics, including web traffic metrics, social media interaction and fuzzy cognitive mapping, to analyse behavioural shifts across platforms. The findings indicate that disaster signals trigger increased engagement, altered sentiment and changes in advertising efficiency. This study provides actionable recommendations for tourism destinations and hospitality brands on how to adapt digital strategies during crisis periods. Full article

This study investigates the evolutionary game dynamics of medical knowledge sharing (KS) among Chinese hospitals under government regulation, focusing on the strategic interactions between general hospitals, community health service centers, and governmental bodies. Leveraging evolutionary game theory, we construct a tripartite evolutionary game model incorporating replicator dynamics to characterize the strategic evolution of the involved parties. Our analysis examines the regulatory decisions of the government and the strategic choices of Chinese hospitals, considering critical factors such as KS costs, synergistic benefits, government incentives and penalties, and patient evaluations. The model is analyzed using replicator dynamic equations to derive evolutionary stable strategies (ESSs), complemented by numerical simulations for sensitivity analysis. Key findings reveal that the system’s equilibrium depends on the balance between KS benefits and costs, with government regulation and patient evaluations significantly influencing Chinese hospital behaviors. The results highlight that increasing government incentives and penalties, alongside enhancing patient feedback mechanisms, can effectively promote KS. However, excessive incentives may reduce willingness to regulate, suggesting the need for balanced policy design. This research provides novel theoretical insights and practical recommendations by (1) pioneering the application of a tripartite evolutionary game framework to model KS dynamics in China’s hierarchical healthcare system under government oversight, (2) explicitly integrating the dual influences of government regulation and patient evaluations on hospital strategies, and (3) revealing the non-linear effects of policy instruments. These contributions are crucial for optimizing Chinese medical resource allocation and fostering sustainable collaborative healthcare ecosystems. Full article

Facing severe depopulation and aging, rural Japanese communities—particularly marginal settlements (genkai shūraku)—increasingly require revitalization strategies that integrate local culture and elder well-being. This study examines the Ōsawa Engawa Café, a community-led initiative in a mountainous tea-growing village, as a site of ikigai-zukuri—the active creation of life purpose among elderly residents. With the use of a mixed-methods approach, including spatial analysis, household surveys, and interviews, Chi-square Automatic Interaction Detection (CHAID) decision tree analysis was applied to identify factors shaping distinct household café operational states: Operating, Discontinued, and Never Operated. Qualitative findings reveal that support from local leaders, experts, and the government enabled the Ōsawa Engawa café’s launch. Broad household participation, often guided by elderly women, sustained the initiative by sharing local culture—such as engawa (verandas), Zairai tea (native variety), and omotenashi (hospitality)—thereby nurturing residents’ ikigai through daily engagement. Complementing these insights, the CHAID analysis revealed a hierarchy of influential factors: high-frequency support from out-migrated family members was the strongest predictor of continued operation; in the absence of such support, co-resident family cooperation proved essential; where both were lacking, agricultural engagement distinguished households that discontinued from those that never operated. Practically, the Ōsawa model offers a replicable, bottom-up strategy that activates the Rural Cultural Landscape (landscapes shaped by traditional rural life and culture, RCL) through community engagement grounded in cultural practices and elderly ikigai-zukuri, contributing to sustainable rural livelihoods. Theoretically, this study reframes ikigai-zukuri as a key socio-cultural pillar of community resilience in aging rural areas. Fostering such culturally embedded, purpose-driven initiatives is essential for building vibrant, adaptive rural communities in the face of demographic decline. However, the study acknowledges that the Ōsawa model’s success is rooted in its specific socio-cultural context, and its replication in other cultural settings may be limited without contextual adaptation. Full article

Healthcare institutions are under increasing pressure to deliver high-quality, patient-centered care while reducing their environmental footprint. Integrating quality and environmental management systems (ISO 9001 and ISO 14001) into a unified integrated management system (IMS) offers a potential pathway to meet these dual imperatives. This study investigates the effects of IMS implementation in three European hospitals through a comparative qualitative analysis of institutional reports, audit documentation, and performance indicators. The methodology combines a literature-informed conceptual framework with a multi-case analysis guided by four domains: environmental impact, care quality, process efficiency, and stakeholder engagement. The data were collected from institutional documentation over a six-year period (three years before and after IMS implementation), covering key indicators such as energy and water consumption, medical waste recycling, audit compliance, and patient satisfaction. The findings show that IMS adoption was associated with a 20–28% improvement in resource efficiency, increased recycling rates, and consistent gains in compliance and satisfaction metrics. These results were supported by strategic leadership, cross-functional training, and digital monitoring tools. The study concludes that IMS enhances institutional performance and sustainability while aligning healthcare operations with broader governance and policy goals. Further research is recommended to explore the long-term impacts and generalize the findings across healthcare systems. Full article