Search Results (2,730)

The e-commerce market is rapidly growing, driven by increased non-face-to-face services and digital convenience. However, the expansion of parcel deliveries has substantially increased packaging waste, raising environmental concerns. As ESG (environmental, social, and governance) considerations become critical for sustained competitiveness, eco-friendly packaging has emerged as an important issue in e-commerce logistics. While prior studies have examined consumer attitudes toward eco-friendly packaging, limited attention has been paid to how consumers evaluate and trade off delivery-related eco-friendly packaging attributes at the attribute level. To address this gap, this study applies Latent Dirichlet Allocation (LDA) topic modeling to news articles to identify socially salient eco-friendly packaging attributes and subsequently employs conjoint analysis to examine their relative importance based on consumer-stated preferences. The results indicate that delivery speed (27.2%), ease of recycling (20.2%), and price (19.4%) are the most influential attributes, suggesting that traditional delivery factors and eco-friendly considerations jointly shape consumer preferences in e-commerce delivery contexts. By disaggregating eco-friendly packaging into delivery-related attributes and empirically analyzing their relative importance and trade-offs, this study provides data-driven insights into consumer preference structures, contributing to the literature on sustainable consumption and e-commerce logistics. Full article

Canada’s ageing population continues to grow rapidly and significantly more diverse, which will require unique health and home service needs. The COVID-19 pandemic exacerbated existing challenges in Canada’s healthcare system and demonstrated the need for long-term care (LTC). Semi-structured interviews were conducted with 17 decision makers, managers, and leaders in long-term ethnically focused facility care. Braun & Clarke’s six-stage process of thematic analysis was applied using an iterative, deductive approach to examine the experiences of stakeholders involved in the operational, managerial, financial, and clinical aspects of an ethnicity-focused LTC. Findings highlighted salient characteristics of impactful ethnicity-focused care and factors were uniquely shaped by the delivery of culturally specific care. Key subthemes included social isolation and emotional impact, operational and logistic difficulties during COVID-19, mitigation measures implemented in response, and the social, behavioural, and health benefits observed among seniors living in these LTC homes. Participants identified political and economic constraints (e.g., provincial funding) to establishing ethnicity-focused care homes but proposed several solutions and highlighted potential benefits that could support successful implementation. Analysis of experiences of operational challenges in safely and adequately running ethnicity-focused LTC reinforces the value of ethnicity-focused LTC during times of crisis such as the COVID-19 pandemic, as they provide a culturally safe and familiar space with preventive measures applied in a timely manner for seniors to engage with their peers in an environment that meets their health needs, ensuring safety standards. Full article

Background: Digital transformation is reshaping healthcare operations, with loyalty programs increasingly used to strengthen patient engagement and streamline administrative workflows. However, fragmented information systems and manual verification routines continue to create bottlenecks, inconsistencies, and extended lead times. Methods: This study applies a mixed-methods approach within the Business Process Management (BPM) lifecycle to redesign the eligibility verification process for a loyalty program at Casa de Saúde São Mateus Hospital. Quantitative time measurements were collected during peak periods, while qualitative insights from staff observations and discussions supported process discovery and bottleneck identification. The proposed solution integrates a centralized SQL database, automated verification routines, and a dedicated administrative interface synchronized with the MedicineOne system. Results: The redesigned process reduced eligibility verification time by approximately 80% and improved Flow Efficiency by around 11.7%. Manual interventions, data fragmentation, and discount-application errors decreased substantially. The centralized database improved data reliability, while automated checks enhanced consistency and reduced staff workload. The system also enabled more accurate beneficiary management and improved coordination across administrative activities. Conclusions: Integrating Healthcare 4.0 principles with BPM enhances internal logistics, reduces lead times, and improves operational reliability. The proposed model offers a replicable framework for modernizing healthcare service delivery. Full article

Since the COVID-19 pandemic, wastewater monitoring has become an additional tool in the surveillance of infectious diseases. Many EU countries put wastewater surveillance systems (WSS) in place to track SARS-CoV-2 and its variants and other pathogens, such as the influenza virus or Respiratory syncytial virus (RSV). In Germany, several research and pilot projects funded by the EU, the Federal Ministry of Education and Research, the Federal Ministry of Health, and projects at Federal State level have been launched in the last four years. In Germany, wastewater monitoring was not implemented as a public health tool before the COVID-19 pandemic, but in September 2022, it has been legally determined in the German infection protection act (Infektionsschutzgesetz, IfSG). As Germany is a federal state, competencies in epidemic management partly belong to the 16 federal states (“Länder”). In the federal states, the local health authorities at the county (“Kreise”) level also have specific risk management and communication competencies. Furthermore, WSS has been incorporated into the revised Urban Wastewater Treatment Directive (EU) 2024/3019. For this reason, the federal states and local health authorities play a pivotal role in successfully implementing wastewater monitoring as a supplementary component of disease surveillance in Germany. Between November 2021 and August 2022, the federal state of Thuringia, Germany, supported a pilot study to implement a surveillance system for SARS-CoV-2-RNA in wastewater of 23 wastewater treatment plants in 17 counties in Thuringia. Here, we describe the study design and the system behind the logistics and the planning, and we provide an overview of the options for involving the public health service. Furthermore, the possibilities for IT concepts and approaches to innovative AI solutions are shown. We also aim to explore the feasibility and potential barriers to further implementing wastewater surveillance as a supplementary public health tool in Thuringia. Full article

Adolescents and Young adults (AYAs: 15–39 years) diagnosed with cancer face unique medical and psychosocial challenges requiring specialized care. This study conducted an environmental scan of AYA-specific programming and services currently offered across Canadian tertiary care centres. Key informants from pediatric and adult cancer centres in Canada reported on program logistics, AYA specialized staff and training opportunities, and collaboration between centres, funding, and specific areas of interest for AYA care such as palliative care, fertility, fatigue, and sexual health. Surveys were completed by 13/16 (81%) pediatric sites and 19/23 (83%) adult sites. Only about half of pediatric sites (n = 8/13) and adult sites (n = 9/19) who responded reported offering any AYA-specific cancer services or programming. One third of centres without programming reported to be working on developing programming. Only 6 sites reported to offer specialized AYA training. Several barriers were reported, such as the need for collaboration among institutions and improvement of oncofertility services. Significant disparities exist regarding geographic availability of services, the range of services available, and the populations served. Findings will guide researchers, health professionals, and provincial health authorities in the development of highquality and equitable services and programs for AYAs diagnosed with cancer across Canada. Full article

Background/Objectives: Pre-hospital delivery is an unpredictable event posing significant challenges for Emergency Medical Services (EMS) teams. Despite advances in perinatal care, emergency deliveries outside the hospital environment remain associated with increased maternal and neonatal risks. This study aimed to identify predictors of out-of-hospital delivery in EMS-attended labor cases and determinants of neonatal condition immediately after delivery. Methods: We conducted a retrospective analysis of 5097 EMS records of laboring women in Poland from August 2021 to January 2022, of which 2927 were included in the final study sample. Multivariate logistic regression models with multiple imputation for missing data were used to identify predictors of pre-hospital delivery and adverse neonatal condition (Apgar ≤ 7) in EMS-managed childbirths. Results: Pre-hospital delivery was strongly associated with second-stage labor (OR ≈ 535; p < 0.0001), ruptured membranes (OR ≈ 8.7; p < 0.0001), and fewer previous pregnancies (OR = 0.86; p = 0.018), and showed a trend with higher maternal heart rate (OR = 1.015; p = 0.083). Neonatal status classified as Apgar ≤ 7 was significantly associated with preterm birth (p < 0.0001), absence of fetal movements (OR ≈ 26.4; p = 0.025), and complications during pregnancy (p = 0.036). Complications during labor and lack of prenatal care were not significantly associated with increased risk of pre-hospital delivery in the model. Conclusions: Rupture of membranes, second-stage labor, and fewer previous pregnancies are significant predictors of pre-hospital delivery in EMS-managed cases. Absence of fetal movements and preterm gestation predict worse neonatal outcomes (Apgar ≤ 7). Early identification of these factors may enhance prehospital perinatal care and improve maternal and neonatal prognosis. Full article

Background: Cold chain distribution in Agri-Biotech supply chains faces serious challenges due to strict time windows, high temperature sensitivity, and conflict between different operational objectives, and conventional static approaches are unable to address these complexities. Methods: In this study, an integrated decision support framework is presented that combines multi-objective fuzzy modeling and an adaptive digital twin to simultaneously manage logistics costs, product quality degradation, and service time compliance under operational uncertainty. Key uncertain parameters are modeled using triangular fuzzy numbers, and the digital twin dynamically updates the decision parameters based on operational information. The proposed framework is evaluated using real industrial data and comprehensive computational experiments. Results: The results show that the proposed approach is able to produce stable and balanced solutions, provides near-optimal performance in benchmark cases, and is highly robust to demand fluctuations and temperature deviations. Digital twin activation significantly improves the convergence behavior and stability of the solutions. Conclusions: The proposed framework provides a reliable and practical tool for adaptive planning of cold chain distribution in Agri-Biotech industries and effectively reduces the gap between advanced optimization models and real-world operational requirements. Full article

Rapid urban growth in many Global South cities strains waste systems and slows the shift to circular economy (CE) practice. Colombo, Sri Lanka, exemplifies this challenge, where overstretched state-led services coexist with neighborhood groups, NGOs, and informal collectors driving circular activities. This study adopts a layered social network diagnostic framework to examine how community-based waste management networks operate and how they might be reshaped to enable a city-wide CE. Using survey and interview data from 185 actors, information-sharing, collaboration, and resource-exchange networks are analyzed separately and in combination. The results reveal three principal findings: (i) Social-capital forms operate largely in parallel, with limited conversion between information, collaboration, and material exchange; (ii) the network exhibits “thin bridges and thick clusters,” in which a small number of NGO hubs mediate most cross-cluster connectivity; (iii) layers operate with mismatched coordination logics, producing gaps between awareness, collective action, and resource mobilization. As a result, ideas circulate widely but rarely translate into joint projects, local teams coordinate effectively yet remain isolated, and material flows depend on a narrow and fragile logistics spine. By diagnosing these structural misalignments, this study demonstrates a key novelty: scalable circular economy adoption depends not only on technology and policy but also on the design and alignment of underlying coordination networks. Full article

Evidence linking medication regimen complexity to patient-reported adverse drug events (ADEs) is limited. This study examined the association between regimen complexity and patient-reported ADEs among adults using community pharmacy services. A cross-sectional survey was conducted among adults with prescription experience at community pharmacies in Korea (14 January–24 February 2025). Data included MRCI-K scores, medication adherence, ADE reports, comorbidities, polypharmacy status, and demographics. Prescription records verified medication counts and drug-related risks. Determinants of regimen complexity were assessed using multivariable linear regression, and predictors of ADE reporting were examined using multivariable logistic regression. Among 201 participants, 101 (50.2%) reported at least one ADE in the past month. Polypharmacy, comorbidities, and multidose dispensing service use were independently associated with higher regimen complexity, whereas higher income, college education, and older age were associated with lower complexity. Higher MRCI-K scores (OR = 0.95, 95% CI 0.91–0.99) and older age (OR = 0.98, 95% CI 0.96–0.99) were associated with lower odds of ADE reporting. Higher medication regimen complexity and older age were associated with reduced reporting of ADEs, suggesting possible under-recognition among these populations. Patient-centered strategies are needed to enhance ADE identification in individuals with complex medication regimens. Full article

The rapid diffusion of electric vehicles (EVs) is reshaping mobility markets and creating new opportunities for embedded financial services. This study examines consumer acceptance of embedded EV insurance, which refers to coverage bundled directly at the point of vehicle sale in Taiwan, China. Using survey data from 400 licensed drivers, we analyze how demographic factors and five psychological drivers—perceived savings, convenience, trust, expected satisfaction, and fairness—shape the likelihood of choosing embedded insurance over traditional stand-alone policies. Welch’s t-tests show that younger drivers perceive greater savings and convenience, while older drivers express stronger fairness concerns. Logistic regression results indicate that convenience (OR = 2.05) and perceived savings (OR = 1.76) substantially increase adoption likelihood, whereas fairness concerns reduce it (OR = 0.71). Theoretically, this study advances consumer behavior research by demonstrating how functional value perceptions (convenience and savings) and fairness evaluations jointly influence decisions in digitally mediated insurance contexts. It also contributes to embedded finance theory by revealing how insurance embedded within EV purchasing ecosystems reshapes consumer decision processes and alters traditional insurer–consumer relationships. These findings offer strategic implications for automakers, insurers, and policymakers designing consumer-centric embedded financial products in emerging mobility markets. Full article

The global maritime and logistics sectors are undergoing rapid digital transformation driven by emerging technologies such as automation, the Internet of Things (IoT), and blockchain. Artificial Intelligence (AI), with its ability to analyze complex datasets, predict operational patterns, and optimize resource allocation, offers a transformative potential beyond the capabilities of conventional technologies. However, mixed results are shown in its implementation. This study examines the current state of AI applications to unlock higher levels of efficiency and competitiveness in logistics firms. A mixed-methods approach was employed, combining surveys from logistics companies with in-depth interviews from key stakeholders in ports and logistics firms to triangulate insights and enhance the validity of the findings. Our results reveal that while technologies such as automation and digital tracking are increasingly utilized to improve operational transparency and cargo management, AI applications remain limited and largely experimental. Where implemented, AI contributes to strategic decision-making, predictive maintenance, customer service enhancement, and cargo flow optimization. Nonetheless, financial conditions, data integration challenges, and a shortage of AI-skilled professionals continue to impede its wider adoption. To overcome these challenges, this study recommends targeted investments in AI infrastructure, the establishment of collaborative frameworks between public authorities, financial institutions, and technology-driven Higher Education Institutions (HEIs), and the development of human capital capable of sustaining AI-enabled transformation. By strategically leveraging AI, Oman can position its ports and logistics sector as a regional leader in efficiency, innovation, and sustainable growth. Full article

Introduction: Timely access to healthcare is essential for improving population health and reducing inequities. Immigrants often experience unique cultural, linguistic, and systemic barriers that delay care-seeking and service utilization. Despite the rapid growth of the Nepalese community in Canada, there is limited empirical evidence examining their healthcare access. This study aimed to assess the prevalence and determinants of delays in accessing healthcare among Nepalese immigrants. Methods: A community-based participatory research (CBPR) framework guided a cross-sectional survey conducted between January and June 2019. The research process was co-led by academic investigators, community scholars, and local Nepalese organizations to ensure cultural and contextual relevance. A snowball sampling strategy was used to recruit 401 Nepalese adults. Data were analyzed using descriptive statistics and multivariable logistic regression to examine sociodemographic and health-related factors associated with delayed healthcare access. Results: Of the 401 respondents, 66.3% (n = 266) reported experiencing a delay in accessing healthcare within the preceding 12 months. Delays were more common among participants aged 26–45 years, those who were married, employed, or had an undergraduate degree or lower. After adjusting for covariates, older age, lower education, having a family doctor, higher income (≥$26,000), and one or more chronic conditions were associated with increased odds of delay. Family size and the number of years living in Canada have had little effect on care delay. Conclusions: Delays in accessing healthcare are common among Nepalese immigrants in Calgary, reflecting the intersection of individual, cultural, and systemic determinants. These findings underscore the importance of community-engaged, culturally responsive strategies to address barriers and promote equitable healthcare access for immigrant populations. Strengthening partnerships between health systems and immigrant communities may enhance trust, navigation, and continuity of care. Full article

Although product returns present significant challenges for retailers, the service recovery paradox suggests they can also generate value. When return services are managed effectively, they can offset initial customer dissatisfaction and increase repurchase likelihood beyond what would occur without a return. However, prior research often treats returns as homogeneous, overlooking how different return types trigger distinct customer responses. Using transaction-level data from 27,178 orders at a major U.S. online apparel retailer between 2016 and 2019, this study investigates how customer-reported return reasons influence subsequent repurchase behavior. Return reasons are categorized by locus of responsibility—customer-, retailer-, or intermediary-attributed—and analyzed using logistic regression. The findings reveal substantial heterogeneity in post-return outcomes: customer-attributed returns are positively associated with repurchase, retailer-attributed returns are negatively associated, and intermediary-attributed returns show no significant effect. By demonstrating that return recovery effects depend on attribution, this study provides both theoretical insights and practical guidance for managing returns in a sustainable manner that enhances customer retention, improves operational efficiency, and strengthens the long-term sustainability of retail return management systems. Full article

This paper addresses critical issues related to the structural design of a micro-factory housing a mobile 3D printing system for plastic recycling. Rather than a simple comparison, it quantifies the “modification penalty”, the structural and economic cost of retrofitting a repurposed ISO shipping container (ISCC) versus deploying a purpose-built cold-formed steel (CFS) volumetric structure. Finite Element Analysis of a standard 20-foot shipping container revealed a serviceability failure in its roof under standard imposed loads. Concurrently, an initial analysis of an equivalent CFS structure also indicated non-compliance, with significant floor and roof deflections. Both platforms were subsequently redesigned with structural reinforcements to achieve full compliance with Australian Standards. The comparative evaluation moves beyond static analysis to incorporate critical performance metrics. While the CFS structure proved to be 575 kg lighter with a lifespan 300–400% longer, the modified ISCC was 47% cheaper in initial capital outlay ($7161 vs. $13,549). However, when considering the totality of performance factors, specifically the ISCC’s inherent vulnerability to resonance (8–18 Hz), which overlaps with transport frequencies, and the logistical burden of losing CSC certification upon modification, the CFS platform is conclusively identified as the superior engineering solution. Its design flexibility, predictable performance, and amenability to purpose-built optimization make it a more reliable and operationally secure platform for this specialized application. Full article

Background: Neurogenic bowel dysfunction (NBD) is a major chronic sequela of spinal cord injury (SCI) with substantial implications for rehabilitation and long-term management. However, population-level evidence describing how gastrointestinal (GI) diagnostic codes are used following SCI, particularly within administrative healthcare systems, remains limited. Methods: We conducted a nationwide retrospective cohort study using administrative claims data from the Korean National Health Insurance Service (NHIS). A total of 584,266 adults with trauma-related SCI encounters between 2009 and 2019 were identified. GI diagnostic codes—paralytic ileus (K56), irritable bowel syndrome (K58), and functional bowel disorders (K59)—were evaluated as administrative proxies for bowel dysfunction. Demographic characteristics, disability status, regional factors, and health behaviors were analyzed using multivariable logistic regression. Results: GI diagnostic codes were frequently recorded after SCI, most commonly irritable bowel syndrome (approximately 30%) and functional bowel disorders (approximately 37%), whereas paralytic ileus was uncommon. Greater disability severity, female sex, older age, and rural residence were consistently associated with higher odds of GI diagnostic coding. Physical activity showed robust inverse associations across all models. Inverse associations observed with smoking and alcohol consumption were interpreted as reflecting residual confounding or health-related selection, rather than biological protective effects. Conclusions: Patterns of GI diagnostic coding after SCI likely reflect the clinical burden and management needs of neurogenic bowel dysfunction within healthcare systems, rather than the development of new gastrointestinal diseases. These findings underscore the importance of individualized bowel management, incorporation of structured physical activity into rehabilitation programs, and equitable access to SCI rehabilitation services, particularly for individuals with greater disability or those living in rural areas. Full article