Search Results (5,853)

Pain management in multiple trauma patients presents a complex clinical challenge due to competing priorities such as hemodynamic instability, polypharmacy, coagulopathy, and the urgency of life-saving interventions. In this context, peripheral nerve blocks (PNBs) are increasingly recognized as a valuable asset for their role in managing pain in patients with multiple traumatic injuries. By reducing reliance on systemic opioids, PNBs support effective pain control and facilitate early mobilization, aligning with enhanced recovery principles. This narrative review summarizes current evidence on the use of PNBs in the context of polytrauma, focusing on their analgesic efficacy, integration within multimodal analgesia protocols, and contribution to improved functional outcomes. Despite these advantages, clinical application is limited by specific concerns, including the potential to mask compartment syndrome, the risk of nerve injury or local anesthetic systemic toxicity (LAST), and logistical barriers in acute trauma settings. Emerging directions in the field include the refinement of ultrasound-guided PNB techniques, the expanded use of continuous catheter systems, and the incorporation of fascial plane blocks for anatomically complex or multisite trauma. Parallel efforts are focusing on the development of decision-making algorithms, improved risk stratification tools, and integration into multimodal analgesic pathways. There is also growing emphasis on standardized clinical protocols, simulation-based training, and patient education to enhance safety and consistency in practice. As evidence continues to evolve, the long-term impact of PNBs on functional recovery, quality of life, and healthcare utilization must be further explored. With thoughtful implementation, structured training, and institutional support, PNBs may evolve into a cornerstone of modern trauma analgesia. Full article

Background: Pelvic fractures are complex injuries often associated with significant morbidity and mortality, requiring multidisciplinary management. This case series highlights the presentation, management strategies, and outcomes of patients with pelvic fractures treated at our institution. Methods: The medical records of 13 patients diagnosed with pelvic fractures from 1 January 2020 through 31 December 2023 were retrospectively reviewed. Demographic data, mechanism of injury, fracture pattern, associated injuries, treatment modalities, and outcomes were analyzed. Results: A total of 13 patients were included in the study, with ages ranging from 18–95 years. Six of the patients were male and seven were female. The most common mechanisms of injury were falls and pedestrians struck by vehicles. Associated injuries included traumatic brain injury (TBI), fractures including extremities, ribs, and vertebrae, visceral injury, and spinal cord injury. Treatment strategies ranged from conservative, non-surgical management to operative intervention, including interventional radiology embolization, external traction, open reduction and internal fixation (ORIF), and percutaneous screw stabilization. Additional interventions included chest tube placement, exploratory laparotomy, and craniectomy. Two patients died while in the hospital, one was discharged to a shelter, and the remaining 10 were discharged to various inpatient rehab facilities. Conclusions: Pelvic fractures pose significant clinical challenges due to their complexity and associated injuries. This case series underscores the importance of multidisciplinary intervention and treatment strategies in optimizing outcomes. Further studies should focus on the effectiveness of interventions, utilization of new technology, and multidisciplinary team planning. Full article

Background and Objectives: Surgical smoke generated by energy devices during surgery contains hazardous substances and poses health risks to staff in the operating room. Exposure to surgical smoke must be reduced to minimize the risk of health hazards. Many studies have evaluated surgical smoke qualitatively, but few have performed quantitative assessment. The aim of this study was to quantify the number of particles generated during various breast surgery procedures. Materials and Methods: In this prospective, randomized study, breast surgeries performed at Tokyo Medical and Dental University Hospital (the present Institute of Science Tokyo Hospital) between December 2022 and August 2023 were randomly assigned to two groups: the electrosurgical device group and the electrosurgical device with smoke evacuator group. The number of particles generated by energy devices during surgery was measured using a particle counter. Results: Surgical smoke was generated in all procedures. The number of measured particles was significantly less in the electrosurgical device with smoke evacuator group than in the electrosurgical device group during all procedures (all p < 0.001). Conclusions: All breast surgery procedures produced a significant amount of surgical smoke, which was effectively reduced by using an electrosurgical device with a smoke evacuator. These findings support the routine use of smoke evacuators in breast surgery to reduce occupational exposure to hazardous particles. Implementation of such devices could improve operating room safety and may inform future guidelines and institutional policies regarding surgical smoke management. Full article

This study explores the role of solidarity finance in promoting local development and the empowerment of marginalized communities through financial inclusion and access to community credits. It focuses on how solidarity-based financial mechanisms provide accessible credit with fewer barriers, fostering productive activities and economic resilience. This study employed a quantitative and exploratory design, analyzing data from 51 community funds in Ecuador out of a total of 220 through a self-administered online survey, validated by auditing professionals and answered by community representatives. The 25-item questionnaire gathered data on organizational dynamics, financial practices, and perceptions of sustainability. Descriptive analysis was complemented with an analysis of variance to test hypotheses concerning associativity, self-management, and organizational performance. The results show that while associativity, self-management, and organizational management are perceived as institutional strengths, aspects such as autonomy and solidarity received lower evaluations, suggesting critical areas for strategic improvement. Notably, significant differences emerged between self-management–organization and solidarity–organization groups, emphasizing the importance of associativity (collaboration) in enhancing the sustainability of solidarity finance, which proves to be a vital mechanism for community empowerment and local development; however, its long-term sustainability depends on strengthening internal dimensions, particularly autonomy and solidarity, and reinforcing associativity as a core driver of organizational resilience. Full article

This study examines the moral agency of French secondary school headteachers through the lens of the theory of conventions. Using qualitative data from interviews with fifteen headteachers involved in professional development, this study explores how these leaders justify their practices within a centralized, bureaucratic, and hierarchical education system. It identifies a variety of conventions—civic, domestic, industrial, project, market, inspired, and fame—that headteachers draw on to navigate institutional constraints, manage professional relationships, and foster pedagogical and organizational change. Particular attention is given to how civic and domestic conventions shape leadership discourse and practices, especially regarding trust building, decision making, and reform implementation. We also compare the French context with international examples from the International Successful School Principalship Project (ISSPP), focusing on Nordic countries, where leadership emphasizes democratic participation, professional trust, and shared responsibility. This study underscores the uniqueness of the French leadership model, which resists managerial and market logics while remaining rooted in republican and egalitarian ideals. It concludes by advocating for a more context-aware, ethically grounded, and dialogical approach to school leadership. Full article

The COVID-19 pandemic precipitated unprecedented social isolation measures, profoundly disrupting daily life, educational routines, and mental health worldwide. University students, already susceptible to psychological distress, encountered intensified challenges under remote learning and prolonged confinement. This longitudinal study examined fluctuations in anxiety and mood among 102 Brazilian university students during the pandemic, distinguishing between those solely engaged in academic pursuits and those simultaneously balancing work and study. Data collected via the Brunel Mood Scale and State-Trait Anxiety Inventory in April and July 2021 revealed that students exclusively focused on studies exhibited significant increases in depressive symptoms, anger, confusion, and anxiety, alongside diminished vigor. Conversely, participants who combined work and study reported reduced tension, fatigue, confusion, and overall mood disturbance, coupled with heightened vigor across the same period. Notably, women demonstrated greater vulnerability to anxiety and mood fluctuations, with socioeconomic disparities particularly pronounced among females managing dual roles, who reported lower family income. These findings suggest that occupational engagement may serve as a protective factor against psychological distress during crises, underscoring the urgent need for tailored mental health interventions and institutional support to mitigate the enduring impacts of pandemic-related adversities on the student population. Full article

The carbon dioxide spillover effects and influencing factors of the “Belt and Road Initiative” (BRI) in African countries must be assessed to evaluate the effectiveness, promote low-carbon transmissions in African countries, and provide recommendations for achieving the 2030 Sustainable Development Goals. This novel study employs carbon dioxide emission intensity (CEI) and per capita carbon dioxide emissions (PCE) as dual indicators to evaluate the spatial spillover effects of 54 BRI African countries on their neighboring countries’ carbon emissions from 2007 to 2023. It identifies the key factors and mechanisms affecting these spillover effects using the spatial differences-in-differences (SDID) model. Results indicate that since the launch of the BRI, the CEI and PCE of BRI African countries have significantly increased, largely due to trade patterns and industrialization structures. Greater trade openness has further boosted local economic development, thereby increasing carbon dioxide’s spatial spillover. Government management and corruption control levels show some heterogeneity in the spillover effects, which may be attributed to long-standing issues of weak institutional enforcement in Africa. Overall, this study reveals the complex relationship between BRI African economic development and environmental outcomes, highlighting the importance of developing sustainable development strategies and establishing strong differentiated regulatory regimes to effectively address environmental challenges. Full article

With the advance of digital transformation, the assessment of the environmental impact of digital tools and technologies grows more relevant. Considering the inflated expectations of environmental responsibility in higher education, this study analyses how websites of Polish universities conform to sustainable web design criteria. The sustainability audit employed a methodology encompassing carbon emissions measurement, technical website analysis, and SEO evaluation. The author analysed 63 websites of public universities in Poland using seven independent audit tools, including an original AI Custom GPT agent preconfigured in the ChatGPT ecosystem. The results revealed a substantial differentiation in CO₂ emissions and website optimisation, with an average EcoImpact Score of 66.41/100. Nearly every fourth website exhibited a significant carbon footprint and excessive component sizes, which indicates poor asset optimisation and energy-intensive design techniques. The measurements exposed considerable variability in emission intensities and resource intensity among the university websites, suggesting the need for standardised digital sustainability practices. Regulations on the carbon footprint of public institutions’ websites and mobile applications could become vital strategic components for digital climate neutrality. Promoting green hosting, “Green SEO” practices, and sustainability audits could help mitigate the environmental impact of digital technologies and advance sustainable design standards for the public sector. The proposed auditing methodology can effectively support the institutional transition towards sustainable management of digital infrastructure by integrating technical, sustainability, and organisational aspects. Full article

Floods pose a growing threat globally, causing tragic loss of life, billions in economic damage annually, and disproportionately affecting socio-economically vulnerable populations. This paper aims to improve flood-risk communication for community leaders by exploring the application of artificial intelligence. We categorize U.S. flood information sources, review communication modalities and channels, synthesize the literature on community leaders’ roles in risk communication, and analyze existing technological tools. Our analysis reveals three key challenges: the fragmentation of flood information, information overload that impedes decision-making, and the absence of a unified communication platform to address these issues. We find that AI techniques can organize data and significantly enhance communication effectiveness, particularly when delivered through infographics and social media channels. Based on these findings, we propose FLAI (Flood Language AI), an AI-driven flood communication platform that unifies fragmented flood data sources. FLAI employs knowledge graphs to structure fragmented data sources and utilizes a retrieval-augmented generation (RAG) framework to enable large language models (LLMs) to produce contextualized narratives, including infographics, maps, and cost–benefit analyses. Beyond flood management, FLAI’s framework demonstrates how AI can transform public service data management and institutional AI readiness. By centralizing and organizing information, FLAI can significantly reduce the cognitive burden on community leaders, helping them communicate timely, actionable insights to save lives and build flood resilience. Full article

Background/Objectives: Direct oral anticoagulants (DOACs) are now the guideline-recommended alternative to vitamin K antagonists (VKAs) for long-term anticoagulation in patients with non-valvular atrial fibrillation. However, accurately assessing their impact on ischemic stroke outcomes remains challenging, primarily due to uncertainty regarding anticoagulation status at the time of hospital admission. This preliminary study addresses this gap by using point-of-care testing (POCT) to confirm DOAC activity at bedside, allowing for a more accurate comparison of 90-day functional outcomes between anticoagulated and non-anticoagulated stroke patients. Methods: We conducted a retrospective cohort study of 786 ischemic stroke patients admitted to the University of Pécs between February 2023 and February 2025. Active DOAC therapy was confirmed using the ClotPro^® viscoelastic testing platform, with ecarin Clotting Time (ECT) employed for thrombin inhibitors and Russell’s Viper Venom (RVV) assays for factor Xa inhibitors. Patients were categorized as non-anticoagulated (n = 767) or DOAC-treated with confirmed activity (n = 19). Mahalanobis distance-based matching was applied to account for confounding variables including age, sex, pre-stroke modified Rankin Scale (mRS), and National Institutes of Health Stroke Scale (NIHSS) scores at admission and 72 h post-stroke. The primary outcome was the change in mRS from baseline to 90 days. Statistical analysis included ordinary least squares (OLS) regression and principal component analysis (PCA). Results: After matching, 90-day functional outcomes were comparable between groups (mean mRS-shift: 2.00 in DOAC-treated vs. 1.78 in non-anticoagulated; p = 0.745). OLS regression showed no significant association between DOAC status and recovery (p = 0.599). In contrast, NIHSS score at 72 h (p = 0.004) and age (p = 0.015) were significant predictors of outcome. PCA supported these findings, identifying stroke severity as the primary driver of outcome. Conclusions: This preliminary analysis suggests that ischemic stroke patients with confirmed active DOAC therapy at admission may achieve 90-day functional outcomes comparable to those of non-anticoagulated patients. The integration of bedside POCT enhances the reliability of anticoagulation assessment and underscores its clinical value for real-time management in acute stroke care. Larger prospective studies are needed to validate these findings and to further refine treatment strategies. Full article

Background: Pain is a problem faced by critically ill surgical patients and has a major impact on their outcomes. Pain assessment is therefore essential for effective pain management, with a combination of pharmacological and non-pharmacological treatment. Clinical supervision, supported by models such as SafeCare, can improve professional development, safety and the quality of care in intensive care units. Objectives: This study aimed to: (1) assess current pain assessment practices in a polyvalent Intensive Care Unit (ICU) in the Porto district; (2) identify nurses’ training needs regarding the Clinical Supervision-Sensitive Indicator—Pain; and (3) evaluate the impact of clinical supervision sessions on pain assessment practices. Methods: A quantitative, quasi-experimental, cross-sectional study with a pre- and post-intervention design was conducted. Based on the SafeCare model, it included a situational diagnosis, 6 clinical supervision sessions (February 2023), and outcome evaluation via nursing record audits (November 2022 and May 2023) in 31 total critical ill patients. Pain was assessed using standardised tools, in line with institutional protocols. Data was analysed using Software Statistical Package for the Social Sciences v25.0. Results: Pain was highly prevalent in the first 24 h, decreasing during hospitalisation. Generalised acute abdominal pain predominated, with mild to moderate intensity, and was exacerbated by wound care and mobilisation/positioning. Pain management combined pharmacological and non-pharmacological treatment. There was an improvement in all the parameters of the pain indicator post-intervention. Conclusions: Despite routine assessments, gaps remained in reassessing pain post-analgesia and during invasive procedures. Targeted clinical supervision and ongoing training proved effective in improving compliance with protocols and supporting safer, more consistent pain management. Full article

Based on a comprehensive review of the current research status of ecological compensation both domestically and internationally, combined with field survey data, this study delves into the issue of multi-stakeholder participation in the ecological compensation mechanisms of the Xin’an River Basin. This research reveals that the joint participation of multiple stakeholders is crucial to achieving the goals of ecological compensation in river basins. The government plays a significant role in macro-guidance, financial support, policy guarantees, supervision, and management. It promotes the comprehensive implementation of ecological environmental protection by formulating relevant laws and regulations, guiding the public to participate in ecological conservation, and supervising and punishing pollution behaviors. The public, serving as the main force, forms strong awareness and behavioral habits of ecological protection through active participation in environmental protection, monitoring, and feedback. As participants, enterprises contribute to industrial transformation and green development by improving resource utilization efficiency, reducing pollution emissions, promoting green industries, and participating in ecological restoration projects. Scientific research institutions, as technology enablers, have effectively enhanced governance efficiency through technological research and innovation, ecosystem value accounting to provide decision-making support, and public education. Social organizations, as facilitators, have injected vitality and innovation into watershed governance by extensively mobilizing social forces and building multi-party collaboration platforms. Communities, as supporters, have transformed ecological value into economic benefits by developing characteristic industries such as eco-agriculture and eco-tourism. Based on the above findings, further recommendations are proposed to mobilize the enthusiasm of upstream communities and encourage their participation in ecological compensation, promote the market-oriented operation of ecological compensation mechanisms, strengthen cross-regional cooperation to establish joint mechanisms, enhance supervision and evaluation, and establish a sound benefit-sharing mechanism. These recommendations provide theoretical support and practical references for ecological compensation worldwide. Full article

Malignant gastric outlet obstruction (MGOO) is a serious complication arising from advanced gastric or pancreatic head cancer, significantly impairing patients’ quality of life by disrupting oral intake and inducing severe gastrointestinal symptoms. With benign causes such as peptic ulcer disease on the decline, malignancies now account for 50–80% of gastric outlet obstruction (GOO) cases globally. This review outlines the pathophysiology, evolving epidemiology, and treatment modalities for MGOO. Therapeutic approaches include conservative management, endoscopic stenting, surgical gastrojejunostomy (GJ), stomach partitioning gastrojejunostomy (SPGJ), and endoscopic ultrasound-guided gastroenterostomy (EUS-GE). While endoscopic stenting offers rapid symptom relief with minimal invasiveness, it has higher rates of re-obstruction. Surgical options like GJ and SPGJ provide more durable palliation, especially for patients with longer expected survival. SPGJ, a modified surgical technique, demonstrates reduced incidence of delayed gastric emptying and may improve postoperative oral intake and survival compared to conventional GJ. EUS-GE represents a promising, minimally invasive alternative that combines surgical durability with endoscopic efficiency, although long-term data remain limited. Treatment selection should consider patient performance status, tumor characteristics, prognosis, and institutional resources. This comprehensive review underscores the need for individualized, multidisciplinary decision-making to optimize symptom relief, nutritional status, and overall outcomes in patients with MGOO. Full article

In response to global sustainability challenges and digital transformation, this conceptual paper explores the intersection of Artificial Intelligence (AI), Human Resource Management (HRM), and Circular Economy (CE). Drawing on Resource-Based View, Stakeholder Theory, Institutional Theory, and the Socio-Technical Systems perspective, we propose an integrated framework in which AI and HRM function as complementary enablers of sustainable, circular transformation. The framework identifies enablers (e.g., green HRM, digital infrastructure), barriers (e.g., ethical concerns, skill gaps), and contextual mediators. This study contributes to sustainability and digital innovation literature and suggests practical pathways for ethically aligning workforce and AI capabilities in CE adoption. Full article

This paper investigates how governance frameworks shape sustainable tourism outcomes in protected areas by comparing Tara National Park (Serbia) and Triglav National Park (Slovenia). Both parks, established in 1981 and classified under IUCN Category II, exhibit rich biodiversity and mountainous terrain but differ markedly in governance structures, institutional integration, and local community engagement. Using a qualitative, indicator-based methodology, this research evaluates ecological, economic, and social dimensions of sustainability. The findings reveal that Triglav NP demonstrates higher levels of participatory governance, tourism integration, and educational outreach, while Tara NP maintains stricter ecological protection with less inclusive management. Triglav’s zoning model, community council, and economic alignment with regional development policies contribute to stronger sustainability outcomes. Conversely, Tara NP’s centralized governance and infrastructural gaps constrain its potential despite its significant conservation value. This study highlights the importance of adaptive, inclusive governance in achieving the Sustainable Development Goals (SDGs) within protected areas. It concludes that hybrid approaches, combining legal rigor with participatory flexibility, can foster resilience and sustainability in ecologically sensitive regions. Full article