Search Results (1,253)

Understanding the utilization patterns of nuclear medicine (NM) services is essential for optimizing resource allocation and service provision. This study aimed to address the regional evidence gap by reporting the demand for NM services by sex and age at a public hospital in Jamaica. This was a non-experimental, retrospective study of NM scans that were completed at the University Hospital of the West Indies from 1 June 2022 to 31 May 2024. While all scans were reported in the descriptive totals, for patients with multiple scans during the study period, only the data from the first visit was used in the inferential statistical analysis. This was performed with the IBM SPSS (version 29.0) software and involved the use of chi-square goodness of fit and multinomial logistic regression. A total of 1135 NM scans for 1098 patients were completed (37 patients had more than one scan); 596 (54.3%) were female and 502 (45.7%) were male, with the ages ranging from 3 days to 94 years old. Among the female patients, there was a greater demand in the ≥60 years age group for cardiac amyloid scans (χ² = 6.40, p < 0.05), while females 18–59 years had a greater demand for thyroid scans (χ² = 7.714, p < 0.05) and bone scans (χ² = 3.904, p < 0.05). On the other hand, significantly more males in the ≥60 age group presented for cardiac amyloid (χ² = 4.167; p < 0.05) and bone scans (χ² = 145.79, p < 0.01). Males were significantly less likely to undergo a thyroid scan than females (p < 0.01, OR = 0.072, 95% CI: 0.021, 0.243) while individuals aged 18–59 years were more likely to undergo this scan than patients aged 60 or older (p = 0.02, OR = 3.565, 95% CI: 1.258, 10.104). Males were more likely to do a cardiac amyloid scan (p < 0.05, OR = 2.237, 95% CI: 1.023, 4.891) but less likely to undergo a cardiac rest/stress test than females (p = 0.02, OR = 0.307, 95% CI: 0.114, 0.828). Prolonged life expectancy and an aging population have the potential to impact NM utilization, thus requiring planning for infrastructure, equipment, work force, and supplies. Cancer-related and cardiovascular indications are a top priority at this facility; hence, age- and sex-specific analysis are useful in establishing models for policy makers with regard to the allocation of economic and human resources for the sustainability of this specialized service. Full article

Urban tourism has evolved into a complex adaptive system, where unregulated expansion disrupts the ecological balance and intensifies resource stress. Understanding the dynamic evolution and resilience mechanisms of the tourism ecological health network (TEHN) is essential for supporting sustainable urban tourism as a coupled human–natural system. Using Shanghai as a case study, we applied the “vigor–organization–resilience–services” (VORS) framework to evaluate ecosystem health, which served as a constraint for constructing the TEHN, using the minimum cumulative resistance (MCR) model for the period from 2001 to 2023. A resilience framework integrating structural and functional dimensions was further developed to assess spatiotemporal evolution and guide targeted enhancement strategies. The results indicated that as ecosystem health degraded, particularly in peripheral areas, the urban TEHN in Shanghai shifted from a dispersed to a centralized structure, with limited connectivity in the periphery. The resilience of the TEHN continued to grow, with structural resilience remaining at a high level, while functional resilience still required enhancement. Specifically, the low integration and limited choice between the tourism network and the transportation system hindered tourists from selecting routes with higher ecosystem health indices. Enhancing functional resilience, while sustaining structural resilience, is essential for transforming the TEHN into a multi-centered, multi-level system that promotes efficient connectivity, ecological sustainability, and long-term adaptability. The results contribute to a systems-level understanding of tourism–ecology interactions and support the development of adaptive strategies for balancing network efficiency and environmental integrity. Full article

Recent advancements in large language models (LLMs) have significantly enhanced the effectiveness of Retrieval-Augmented Generation (RAG) systems. This study focuses on the development and evaluation of a domain-specific AI chatbot designed to support international student admissions by leveraging LLM-based RAG pipelines. We implement and compare multiple pipeline configurations, combining retrieval methods (e.g., Dense, MMR, Hybrid), chunking strategies (e.g., Semantic, Recursive), and both open-source and commercial LLMs. Dual evaluation datasets of LLM-generated and human-tagged QA sets are used to measure answer relevancy, faithfulness, context precision, and recall, alongside heuristic NLP metrics. Furthermore, latency analysis across different RAG stages is conducted to assess deployment feasibility in real-world educational environments. Results show that well-optimized open-source RAG pipelines can offer comparable performance to GPT-4o while maintaining scalability and cost-efficiency. These findings suggest that the proposed chatbot system can provide a practical and technically sound solution for international student services in resource-constrained academic institutions. Full article

The growing number of senior experts leaving the workforce (especially in more developed economies, such as in Europe), combined with the ubiquitous access to artificial intelligence (AI), is triggering organizations to review their knowledge transfer programs, motivated by both financial and management perspectives. Our study aims to contribute to the field by analyzing options to integrate intergenerational tacit knowledge transfer (InterGenTacitKT) with AI-driven approaches, offering a novel perspective on sustainable Knowledge and Human Resource Management in organizations. We will do this by building on previous research and by extracting findings from 36 in-depth semi-structured interviews that provided success factors for junior/senior tandems (JuSeTs) as one notable format of tacit knowledge transfer. We also refer to the literature, in a grounded theory iterative process, analyzing current findings on the use of AI in tacit knowledge transfer and triangulating and critically synthesizing these sources of data. We suggest that adding AI into a tandem situation can facilitate collaboration and thus aid in knowledge transfer and trust-building. We posit that AI can offer strong complementary services for InterGenTacitKT by fostering the identified success factors for JuSeTs (clarity of roles, complementary skill sets, matching personalities, and trust), thus offering organizations a powerful means to enhance the effectiveness and sustainability of InterGenTacitKT that also strengthens employee productivity, satisfaction, and loyalty and overall organizational competitiveness. Full article

Background/Objectives: Human immunodeficiency virus (HIV) has evolved from a fatal disease to a manageable chronic condition. However, stigma persists, affecting the lives and sexuality of HIV-positive people, particularly in the gay population. Research on their sexuality is limited, highlighting the need for studies that address their experiences and needs. The aim of the study is to explore the individuals’ experiences of sexuality in serodiscordant gay couples. Methods: A descriptive study was conducted using thematic content analysis. Data collection was carried out through in-depth interviews. Six gay men who have been and/or are in a serodiscordant relationship for at least one year participated in the research. Results: Five sub-themes were identified grouped into two main themes as follows: sexuality: a complex concept accentuated by HIV and the impact of serodiscordance on partners. Conclusions: It is essential to promote accurate information and health services tailored to the needs of people living with HIV while fostering gender equity and combating stigma related to HIV and the gay community. Experiencing sexuality in this context is not only possible but can be full and satisfying when adequate resources are available. Full article

The synergistic development of ecosystems and socioeconomic systems constitutes a critical foundation for achieving Sustainable Development Goals (SDGs). Large river basins characterized by ecological and socioeconomic spatial heterogeneity frequently present contradictions and conflicts in regional sustainable development, thereby impeding the realization of SDGs. This study employed the Yellow River Basin (YRB), a typical large sediment-laden river system, as a case study. Based on the secondary water resource zones, the spatial variability and temporal evolution of ecosystem service value (ESV), population (POP), GDP, nighttime light (NTL), and Human Development Index (HDI) were analyzed at the water resource partition scale. A consistent mode was applied to quantify the spatiotemporal consistency between ESV and socioeconomic indicators across water resource partitions. The results indicated that from 1980 to 2020, the ESV of the YRB increased from 1079.83 × 10⁹ to 1139.20 × 10⁹ yuan, with no notable spatial pattern variation. From upstream to downstream, the population density, GDP per unit area, and NTL per unit area displayed increasing trends along the river course, whereas the total population, GDP, and NTL initially increased and then declined. Temporally, the population fluctuated with an overall upward tendency, while GDP and NTL experienced significant growth. The spatial distribution and temporal evolution of HDI remained comparatively stable. The coefficients of variation for population, GDP, and NTL were significantly higher than those for ecosystem services and HDI. The study highlighted an overall lack of coordination between ESV and socioeconomic development in the YRB, with relatively stable spatial patterns. These findings could offer a theoretical reference for the formulation of policies to enhance the synergistic development of ecosystems and socioeconomic systems in the YRB. Full article

Background/Objectives: Breast milk donation is increasingly recognized as a vital public health resource, providing optimal nutrition for infants who cannot be breastfed by their biological mothers. Human milk banks play a crucial role in supporting infant health, particularly for preterm and medically vulnerable infants. Despite its recognized benefits, the practice of breast milk donation and utilization remains influenced by a complex interplay of individual, social, and cultural factors. Methods: This study systematically examines how demographic and sociocultural variables are associated with attitudes and behaviors related to breast milk donation. Data were collected from 1223 Israeli mothers via questionnaires distributed through WhatsApp groups between April and May 2025. By analyzing the questionnaire results, the research identified key predictors of willingness to donate and use donated milk, as well as patterns of awareness and perceived support within different population groups. Results: Higher education (χ² = 12.87, p = 0.0016) and settlement type (χ² = 83.096, p = 0.000) were significantly associated with greater willingness to donate breast milk. Income level had no effect on donation behavior, though higher-income participants were more open to its use (χ² = 86.838, p = 0.000). Lifestyle also influenced perceptions of social support (F(2, 1220) = 259.4036, p < 0.001) and cultural support (F(2, 1220) = 601.2383, p < 0.001) of milk donation and use. Significant correlation was found between perceived cultural and social support (t = 5.140, p = 0.000), emphasizing their interrelated influence on milk donation attitudes. Conclusions: The findings assist in guiding the development of public health policies, as well as targeted awareness campaigns, to promote equitable access to donor milk services across varied communities. From the public health perspective, the findings of this study can orientate campaigns that encourage both donation and use of breast milk focusing on segments of the population in which the level of awareness is relatively low. Full article

With rapid socio-economic development, excessive anthropogenic consumption and the exploitation of natural resources have impaired the self-healing, supply, and carrying capacities of ecosystems. The assessment and prediction of ecosystem service values (ESVs) are crucial for the coordinated development of ecology and economy. This research examines the Xiangjiang River Basin and combines land use data from 1995 to 2020, Landsat images, meteorological data, and socio-economic data. These data are incorporated into the PLUS model to simulate land use patterns in 2035 under the following five scenarios: natural development, economic development, farmland protection, ecological protection, and coordinated development. Additionally, this research analyzes the dynamics of land use and changes in ESVs in the Xiangjiang River Basin. The results show that between 1995 and 2020 in the Xiangjiang River Basin, urbanization accelerated, human activities intensified, and the construction land area expanded significantly, while the areas of forest, farmland, and grassland decreased continuously. Based on multi-scenario simulations, the ESV showed the largest and smallest declines under economic development and ecological protection scenarios, respectively. This results from the economic development scenario inducing a rapid expansion in construction land. In contrast, construction land expansion was restricted under the ecological protection scenario, because the ecological functions of forests and water bodies were prioritized. This research proposes land use strategies to coordinate ecological protection and economic development to provide a basis for sustainable development in the Xiangjiang River Basin and constructing a national ecological security barrier, as well as offer Chinese experience and local cases for global ecological environment governance. Full article

Mangroves form the dominant coastal plant community of low-energy tropical intertidal habitats and provide critical ecosystem services to humans and the environment. However, more frequent and increasingly powerful hurricanes and storm surges are creating additional pressure on the natural resilience of these threatened coastal ecosystems. Advances in remote sensing techniques and approaches are critical to providing robust quantitative monitoring of post-storm mangrove forest recovery to better prioritize the often-limited resources available for the restoration of these storm-damaged habitats. Here, we build on previously utilized spatial and temporal ranges of European Space Agency (ESA) Sentinel satellite imagery to monitor and map the recovery of the mangrove forests of the British Virgin Islands (BVI) since the occurrence of back-to-back category 5 hurricanes, Irma and Maria, on September 6 and 19 of 2017, respectively. Pre- to post-storm changes in coastal mangrove forest health were assessed annually using the normalized difference vegetation index (NDVI) and moisture stress index (MSI) from 2016 to 2023 using Google Earth Engine. Results reveal a steady trajectory towards forest health recovery on many of the Territory’s islands since the storms’ impacts in 2017. However, some mangrove patches are slower to recover, such as those on the islands of Virgin Gorda and Jost Van Dyke, and, in some cases, have shown a continued decline (e.g., Prickly Pear Island). Our work also uses a linear ANCOVA model to assess a variety of geospatial, environmental, and anthropogenic drivers for mangrove recovery as a function of NDVI pre-storm and post-storm conditions. The model suggests that roughly 58% of the variability in the 7-year difference (2016 to 2023) in NDVI may be related by a positive linear relationship with the variable of population within 0.5 km and a negative linear relationship with the variables of northwest aspect vs. southwest aspect, island size, temperature, and slope. Full article

Unveiling the relationship between the “Water–Carbon–Ecology” (W-C-E) footprints embodied in regional trade and resource flows is crucial for enhancing the synergistic benefits between economic development and environmental protection. This study constructs an association framework based on the Multi-Regional Input–Output (MRIO) model to systematically evaluate the “W-C-E” footprints and resource flow characteristics of the Yangtze River Economic Belt and the Yellow River Basin. By integrating import and export trade data, this study reveals the patterns of resource flows within and outside these regions. This research delineates the connection patterns between the “W-C-E” footprints and resource flows across three dimensions: spatial, sectoral, and environmental–economic factors. The results indicate that the Yangtze River Economic Belt has gained significant economic benefits from regional trade but also bears substantial environmental costs. Import and export trade further exacerbate the imbalance in regional resource flows, with the Yangtze River Economic Belt exporting many embodied resources through high-energy-consuming products, while the Yellow River Basin increases resource input by importing products such as food and tobacco. Sectoral analysis reveals that agriculture, electricity and water supply, and mining are the sectors with the highest net output of “W-C-E” footprints in both regions, whereas services, food and tobacco, and construction are the sectors with the highest net input. The comprehensive framework of this study can be extended to the analysis of resource–environment–economic systems in other regions, providing methodological support for depicting complex human–land system linkage patterns. Full article

Background/Objectives: Wolf–Hirschhorn syndrome (WHS; OMIM #194190) is a rare neurodevelopmental disorder, caused by deletions in the distal short arm of chromosome 4. It is characterized by developmental delay, epilepsy, intellectual disability, and distinctive facial dysmorphism. Clinical presentation varies widely, complicating prognosis and individualized care. Methods: We assembled a cohort of 140 individuals with genetically confirmed WHS from Spain and Latin-America, and developed and validated a multidimensional, Clinician-Reported Outcome Assessment (ClinRO) based on the Global Functional Assessment of the Patient (GFAP), derived from standardized clinical questionnaires and weighted by HPO (Human Phenotype Ontology) term frequencies. The GFAP score quantitatively captures key functional domains in WHS, including neurodevelopment, epilepsy, comorbidities, and age-corrected developmental milestones (selected based on clinical experience and disease burden). Results: Higher GFAP scores are associated with worse clinical outcomes. GFAP showed strong correlations with deletion size, presence of additional genomic rearrangements, sex, and epilepsy severity. Ward’s clustering and discriminant analyses confirmed GFAP’s discriminative power, classifying over 90% of patients into clinically meaningful groups with different prognoses. Conclusions: Our findings support GFAP as a robust, WHS-specific ClinRO that may aid in stratification, prognosis, and clinical management. This tool may also serve future interventional studies as a standardized outcome measure. Beyond its clinical utility, GFAP also revealed substantial social implications. This underscores the broader socioeconomic burden of WHS and the potential value of GFAP in identifying high-support families that may benefit from targeted resources and services. Full article

Land requirements and impacts from future development are a significant concern throughout the world. In Florida (USA), the state’s population increased from 18.8 M to 21.5 M between 2010 and 2020, and is projected to reach 26.6 M by 2040. To accommodate these new residents, 801 km² of wetlands were converted to developed uses between 1996 and 2016. These conversions present a significant threat to Florida’s unique ecosystems and highlight the need to prioritize conservation and water resource protection, both for the natural and human services that wetland and upland landscapes provide. To better understand the relationship between future development and water resources, we used future development and event mean concentration (EMC) models for Escambia and Santa Rosa counties in Florida (USA) to assess impacts from development patterns on water quality/runoff and water resource protection priorities. This study found that if future development densities increased by 30%, reductions of 7713 acres for developed land, 17,768 acre feet of stormwater volume, ~88k lb/yr total nitrogen, and ~15k lb/yr total phosphorus could be achieved. It also found that urban infill, redevelopment, and stormwater management are essential and complementary tools to broader growth management strategies for reducing sprawl while also addressing urban stormwater impacts. Full article

Background/Objectives: Healthcare institutions, similar to other service providers, should prioritize their clients—in this case, patients—to effectively meet their needs. However, fulfilling this objective becomes increasingly challenging due to numerous factors. Therefore, this study explores student patient satisfaction by examining the effects of environmental quality dimensions (Internal Spaces, External Spaces, And Social Environment) and green practices, as well as investigating how environmental knowledge moderates the relationship between green practices and patient satisfaction. Methods: Given the latent nature of the variables investigated, structural equation modeling (SEM) was employed. Some variables were conceptualized as hierarchical constructs comprising higher-order and lower-order components. Before testing the relationships among variables, reliability and validity assessments were performed. For this purpose, the SmartPLS 4 software was used. Since the focus of the research was on students’ health in general, the sample consisted of 280 students from the University of Novi Sad (Republic of Serbia). Results: Among the three environmental quality dimensions, only the Social Environment had a significant and positive influence on patient satisfaction. Furthermore, the green practices emerged as a significant determinant of patient satisfaction. However, the moderating effect of environmental knowledge on this relationship was found to be non-significant. Conclusions: This research underscores the significance of patient satisfaction as a critical objective for healthcare institutions. Special attention should be directed toward enhancing positive interactions between medical staff and patients and adopting green practices. Consequently, certain managerial aspects related to human resource management (such as adequate staffing and organization of personnel) should be considered. In addition, issues concerning financial challenges and benefits regarding the implementation of green practices in healthcare were presented. Full article

Gastrodia elata, known as Tianma in Chinese, is a valuable medicinal and nutritional resource. The favorable climate of Zhaotong City, Yunnan Province, China, facilitates its growth and nurtures rich biocultural diversity associated with Tianma in the region. Local people not only cultivate Tianma as a traditional crop but have also developed a series of traditional knowledge related to its cultivation, processing, medicinal use, and culinary applications. In this study, field surveys employing ethnobotanical methods were conducted in Yiliang County, Zhaotong City, from August 2020 to May 2024, focusing on Tianma. A total of 114 key informants participated in semi-structured interviews. The survey documented 23 species (and forms) from seven families related to Tianma cultivation. Among them, there were five Gastrodia resource taxa, including one original species, and four forms. These 23 species served as either target cultivated species, symbiotic fungi (promoting early-stage Gastrodia germination), or fungus-cultivating wood. The Fagaceae family, with 10 species, was the most dominant, as its dense, starch-rich wood decomposes slowly, providing Armillaria with a long-term, stable nutrient substrate. The cultural importance (CI) statistics revealed that Castanea mollissima, G. elata, G. elata f. flavida, G. elata f. glauca, G. elata f. viridis, and Xuehong Tianma (unknown form) exhibited relatively high CI values, indicating their crucial cultural significance and substantial value within the local community. In local communities, traditionally processed dried Tianma tubers are mainly used to treat cardiovascular diseases and also serve as a culinary ingredient, with its young shoots and tubers incorporated into dishes such as cold salads and stewed chicken. To protect the essential ecological conditions for Tianma, the local government has implemented forest conservation measures. The sustainable development of the Tianma industry has alleviated poverty, protected biodiversity, and promoted local economic growth. As a distinctive plateau specialty of Zhaotong, Tianma exemplifies how biocultural diversity contributes to ecosystem services and human well-being. This study underscores the importance of biocultural diversity in ecological conservation and the promotion of human welfare. Full article

Background/Objectives: The prevalence of people with incurable and progressive diseases in primary health care is high. Family doctors and nurses must be active agents in the early identification of palliative needs and the implementation of palliative approaches in cases of low to intermediate complexity. While there is a need for early referral of more complex palliative care (PC) cases to specialized teams, primary health care (PHC) professionals lack the confidence or skill to describe their role. This study sought to explore and describe (a) the practices of PHC professionals regarding their PC provision; (b) the barriers regarding access and referral of patients to specialized PC services; and (c) the strategies used or recommended to mitigate difficulties in accessing and referring to specialized PC. Methods: A descriptive qualitative study was carried out, using five focus groups conducted with nursing and medical staff at three local health units in the central region of Portugal. Semi-structured interviews were conducted, and then recorded, transcribed, and analyzed through a thematic analysis approach. The reporting of this research follows the COREQ checklist. Results: In total, 34 PHC professionals participated in this study. The majority of participants were women (n = 26) and family doctors (n = 24). Their mean age was 43.8 ± 11.9 (range: 29 to 65 years). The findings were organized into three core themes: (1) the contours of palliative action developed by PHC teams; (2) barriers to access and safe transition between PHC and specialized PC; and (3) ways to mitigate difficulties in accessing and referring to specialized PC. Conclusions: Our findings highlight the fundamental role of PHC professionals in providing primary PC, and in identifying PC needs and referring patients to PC early on, while exposing the systemic and interpersonal challenges that hinder these processes. To overcome these challenges, it is essential to invest in the development of integrated care models that promote practical, low-bureaucratic referral processes and capture the human resources necessary for the adequate follow-up of users. Full article