Search Results (825)

Background: Early cardiopulmonary resuscitation (CPR) and timely use of automated external defibrillators (AEDs) are critical determinants of survival following out-of-hospital cardiac arrest (OHCA). University students enrolled in healthcare degree programs represent a strategic target population for the dissemination of basic life support and defibrillation (BLS-D) skills. However, evidence on their level of knowledge, attitudes, and perceived preparedness remains limited in Southern Italy. Methods: A cross-sectional observational study was conducted between mid-December 2025 and 15 January 2026 among undergraduate healthcare students at the Magna Graecia University of Catanzaro (Italy). Data were collected using a structured, self-administered questionnaire assessing socio-demographic characteristics, CPR/AED knowledge, attitudes, and perceived confidence. Composite knowledge scores were calculated and categorized as poor, sufficient, good, or excellent. Statistical analyses included chi-square tests, Cramér’s V, and Spearman’s rank correlation. Results: A total of 604 students were included (mean age 24.4 ± 6.7 years; 69.9% female), of whom 46.4% reported prior BLS-D training. Knowledge levels were heterogeneous: myocardial infarction was widely recognized as a cause of cardiac arrest (81.1%), whereas recognition of non-shockable rhythms, including asystole and pulseless electrical activity, remained low (<25%). Procedural knowledge, particularly regarding the chain of survival and chest compression rate, improved with academic year and prior BLS-D training. Conversely, ventilation skills and correct AED pad placement were consistently inadequate. Attitudes toward CPR were largely positive; however, perceived confidence in performing resuscitation was moderate to low, especially in complex scenarios. More than 80% of students expressed strong interest in further training and supported mandatory BLS-D education. Conclusions: Healthcare students demonstrated favorable attitudes toward CPR but insufficient and uneven knowledge, particularly in rhythm recognition, ventilation, and AED use. Academic progression and structured BLS-D training were associated with improved competencies, although critical gaps persisted. Integrating mandatory, hands-on BLS-D training with regular refresher sessions into healthcare curricula should enhance preparedness and potentially reduce OHCA-related mortality, especially in high-risk regions such as Calabria. Full article

The recent revision of the European Energy Performance of Buildings Directive (EPBD) introduces mandatory whole-life global warming potential (GWP) reporting, creating practical challenges for building life-cycle assessment due to incomplete life-cycle phase coverage in conventional Environmental Product Declarations (EPDs). This study develops and validates an integrated BIM–LCA framework for structured whole-building GWP evaluation through harmonized life-cycle module alignment and cross-tool comparison, with emphasis on the early design stages. The workflow combines rapid BIM-based screening with detailed external LCA validation, establishing a tiered assessment strategy that enables iterative material optimization within the BIM environment prior to expert review. The methodology is applied to two residential construction systems (masonry and timber), and three functional units are evaluated: total whole-building GWP, area-normalized GWP, and material-level contributions. Five comparative scenarios are analyzed, including reference, nationally representative, optimized low-carbon, and European benchmark configurations. The results show progressive GWP reductions ranging from 5% to 30% across scenarios. Although substantial absolute deviations are observed between BIM-integrated and professional LCA tools, scenario-level rankings remain fully consistent across all functional units, confirming the robustness of the screening approach for comparative decision-making. Cross-tool validation focuses on an aligned embodied-carbon scope (A1–A3 plus selected end-of-life modules) to ensure screening robustness, while full whole-life LC-GWP (including B-modules and services) is positioned as the regulatory context for subsequent expert-stage assessment. The framework provides an efficient and transferable decision-support methodology that supports early-stage carbon optimization while preserving methodological transparency for regulatory reporting. Full article

Background/Objectives: Endodontic–periodontal lesions (EPLs) represent complex pathological conditions arising from interactions between endodontic and periodontal infections. Existing classification systems primarily describe the etiology or periodontal tissue destruction but provide limited support for clinical interpretation, particularly pulp preservation and the sequencing of endodontic and periodontal management. This review aimed to propose a biologically informed conceptual framework intended to organize clinical reasoning considerations in EPL management. Methods: This narrative review integrates current knowledge regarding pulp vitality, pathways of infection, periodontal healing, and treatment sequencing reported in the endodontic and periodontal literature. Based on this synthesis, a conceptual framework was constructed using two clinical dimensions: the extent of remaining vital pulp and the presence or absence of coronal-originating infection (IC), defined as a potential coronal pathway of bacterial ingress that may contribute to lesion development. Results: The framework categorizes EPLs into four principal groups according to pulp vitality (vital/non-vital) and IC status (present/absent), with additional grading to describe the potential feasibility of pulp preservation and structural reassessment during initial management. Rather than prescribing specific therapies, the model organizes clinical interpretation related to pulp-preserving considerations, the timing of periodontal intervention, and evaluation of surgical management following nonsurgical treatment. Conclusions: This framework provides a biologically oriented conceptual model for understanding EPLs and structuring clinical reasoning. It is intended as a hypothesis-guided interpretive framework rather than a clinical practice guideline and is designed to support case interpretation, not to determine mandatory treatment decisions; thus, its clinical applicability requires further validation, and prospective multicenter studies are necessary before routine clinical implementation. Full article

The topic of sustainability reporting by SMEs is gaining significant importance in European contexts such as Italy. However, recent regulations, constantly evolving in terms of legal requirements and practical standards, do not yet provide solid foundations to guide small and medium-sized enterprises. This study aims to examine how Italian listed SMEs address sustainability issues in terms of Sustainable Development Goals (SDGs) in their sustainability reports, in light of the recent requirements set out in European directives (i.e., Directive 2022/2464/EU—Corporate Sustainability Reporting Directive (CSRD) and Directive 2025/794/EU—Stop the Clock). The analysis is based on a content review of 17 sustainability reports published in 2023 by Italian SMEs listed on Euronext Growth Milan of Borsa Italiana. The research protocol was structured around the key SDG themes found in the reports, using Python 3.14.2 libraries including Pandas, NumPy, NLTK, and Matplotlib. The findings highlight heterogeneous approaches to sustainability. Most firms adopt symbolic approaches based on formal narrative disclosures without addressing sustainability reporting’s substantive dimensions. They overlook both the principle of double materiality, actually recommended by the CSR Directive, and the provision of assurance statements on reports. Although mandatory sustainability reporting is not imminent, particularly in light of the “Stop the Clock” measure, this research offers significant insights into both theoretical and practical implications. From a theoretical standpoint, it contributes to the growing body of literature on sustainability practices among SMEs. From a managerial standpoint, it underscores the importance of designing tailored reporting practices for SMEs that avoid administrative costs and overload issues, at the same time fostering a substantive approach to disclosure able to convey meaningful information to stakeholders. Full article

This study investigates the predictability of Environmental, Social, and Governance (ESG) performance using financial fundamentals within the context of Taiwan, a prominent small open economy integrated into global value chains. As global markets transition toward mandatory sustainability reporting, identifying the financial ante-cedents of ESG outcomes is critical for risk management and regulatory oversight. Uti-lizing a decade of firm-level data (2014–2023) from the Taiwan Economic Journal (TEJ), we employ supervised machine learning (ML) architectures-including Decision Tree, Random Forest, and Extreme Gradient Boosting (XGBoost)-to classify firms into ESG performance tiers based on indicators such as profitability, valuation, and scale. Our empirical results provide robust support for the Slack Resources Hypothesis, identifying Return on Assets (ROA) and Firm Size (SIZE) as the most consistent predictors of ESG excellence across the semiconductor, cement, and steel sectors. Conversely, mar-ket-based indicators (Tobin’s Q) dominate predictive models for the financial industry. Methodologically, XGBoost delivers superior predictive calibration for the financial sector, while Decision Trees offer highly interpretable threshold-based logic for risk screening. Our study contributes a transparent “early-warning” framework, enabling investors and regulators to identify sustainability risks through auditable financial benchmarks. The findings suggest that while financial latitude is a structural prerequisite for ESG engagement, it is not its sole determinant, pointing toward a “virtuous circle” of financial health and managerial quality. Full article

Unintentional doping, often caused by contaminated supplements or misinterpreted therapeutic prescriptions, poses significant health, ethical, and regulatory challenges in competitive sports. Understanding the cardiovascular risks associated with performance-enhancing substances (PESs) and the preventive role of nutrition requires integrated analysis. A systematic review was conducted in accordance with PRISMA guidelines. Searches of comprehensive bibliographic databases yielded studies published between 2015 and November 2025. Inclusion criteria encompassed peer-reviewed research on doping prevalence, cardiovascular outcomes, nutritional strategies, and supplement regulation. Data extraction focused on prevalence estimates, odds ratios (ORs), hazard ratios (HRs), and effect sizes for nutritional interventions. Quality assessment employed GRADE and risk-of-bias tools. From 1320 records screened, 60 studies were included in the qualitative synthesis and 31 in the meta-analysis. Surveys using indirect questioning estimated that 30–45% of elite athletes may engage in doping, while official anti-doping reports indicated that approximately 20–25% of confirmed rule violations are classified as unintentional. Supplement contamination accounted for 10–15% of unintentional cases. PES use significantly increased cardiovascular risk (HR for arrhythmias and myocardial infarction up to 3.5). Nutritional strategies—such as carbohydrate loading, optimized protein intake, omega-3 supplementation, and hydration—improved endurance by 8–12%, reduced resting heart rate by ~3 bpm, and lowered LDL cholesterol. Unintentional doping remains a major contributor to ADRVs, primarily driven by supplement contamination. Evidence-based nutrition offers safe alternatives to PESs (evidence-based nutritional strategies and structured hydration protocols), enhancing performance and cardiovascular health. Forensic toxicology and pharmacogenomic screening are essential for accurate detection and interpretation. Regulatory reforms, mandatory third-party supplement certification, and athlete education are critical to mitigate unintentional doping and ensure fair competition. Full article

Background/Objectives: Avoidant/restrictive food intake disorder (ARFID) and psychotic disorders are clinically distinct conditions yet occasionally co-occur in ways that complicate assessment and treatment. ARFID is characterised by avoidance of food due to sensory sensitivities, fear of aversive consequences, or low interest in eating, without body-image distortion. Recent meta-analytic evidence suggests that ARFID affects a substantial proportion of the population and is associated with a considerable social burden. Psychosis is characterised by positive symptoms (hallucinations and delusions), negative symptoms (avolition, blunted affect, and social withdrawal), and cognitive impairments affecting thought, perception, and behaviour. Methods: Across the limited literature, shared mechanisms between ARFID and psychotic disorders appear to converge on pathological avoidance, which may arise from sensory overstimulation, obsessive–compulsive features, or delusional beliefs about food. Case reports indicate that psychosis may both mimic ARFID and exacerbate food avoidance, while severe malnutrition can itself precipitate or worsen psychotic symptoms, blurring diagnostic boundaries. Results: Abnormalities in interoception, sensory sensitivity, and disrupted perception of bodily signals are manifestations of both ARFID and psychosis, suggesting a potential bridging pathway contributing to vulnerability and clinical overlap. Conclusions: Given the paucity of empirical studies and the reliance on isolated case reports, systematic investigation is mandatory and necessary to clarify shared mechanisms, refine differential diagnosis, and guide integrated treatment approaches. Given the heterogeneity of symptoms in comorbid patients, a personalised approach is suggested for treating these patients. Full article

Background/Objectives: Dutch legislation sets requirements for the safe reporting of and learning from incidents. It also specifies the required competence of nurses in using medical technology. However, not all certified homecare nurses are adequately trained in patient safety. Patient safety management is reflected at different levels within homecare organisations. This study aimed to report on initial consensus among homecare nurses on responsibilities in quality and safety management at organisational, team and individual levels. It also explored nurses’ educational needs related to the use of advanced medical technologies (AMTs) in homecare. Methods: An exploratory qualitative study using consensus-oriented member checking was conducted. Building on research into incidents and safety management practices of AMTs, two semi-structured group interviews were conducted online with 11 homecare nurses from across the Netherlands. In a second round, feedback and comments were solicited on the resulting conclusions and statements in writing. Results: Distinguishing between high-risk and low-risk incident reports enhances the efficiency and effectiveness of safety management for AMTs in homecare. Team-based discussions increase the likelihood of incident reporting. Nurses advocate for periodic, mandatory assessments for technical homecare teams, conducted by an external body. They also emphasise individual responsibility for maintaining up-to-date knowledge and skills and taking action accordingly. Conclusions: In this study, key statements on which Dutch technical homecare nurses reached consensus are presented. The results underscore the importance of a safe organisational and team culture for incident reporting, as well as the need for an effective and efficient incident management system at a team level. An effective learning organisation contributes to enhancing patient safety. Full article

Background: The present case report study aims to describe, from both clinical and histological aspects, the bone healing pattern in a patient under oral bisphosphonates therapy. Case Presentation: an 82-year-old female patient has been under oral nitrogen bisphosphonates therapy for two years. She underwent a tooth extraction. After four months, two bone biopsies were harvested, during standard implant drilling procedures. The first one corresponded to the healed alveolar socket of the previously extracted tooth (specimen A), while the second one corresponded to the bone ridge that was edentulous before starting the bisphosphonates therapy (specimen B). Morphometric and histologic analyses were performed. Results: In both, the bone resulted vital and no evidence of empty lacunae was detected. A reduction in the haversian canal diameter was observed in specimen B. The present case report highlights histological findings suggesting that patients undergoing oral bisphosphonates therapy may be eligible for surgical therapy. A pre-operative careful anamnesis and the observance of international guidelines for treating patients taking bisphosphonates are mandatory. Conclusions: These preliminary results will be used to plan a large clinical study in order to better understand the influence of bisphosphonates on the bone healing process. Full article

The rapid rise in the use of Liquefied Petroleum Gas (LPG) as an alternative vehicle fuel in Ghana presents both opportunities and risks within the national energy transition agenda. This study investigates LPG safety as well as environmental and regulatory implications using a multi-method quantitative approach that combines structured survey data, exploratory multivariate analysis (MCA), and machine learning classification (Random Forest) to uncover emerging associations and patterns in LPG safety practices. Primary data were obtained from 384 respondents, including vehicle operators, auto-technicians, regulatory officials, and LPG station attendants across five major transport zones: Kejetia, Asafo, Ahodwo, Bantama, and Suame Magazine. The MCA identified four distinct behavioural and safety profiles—At-Risk, Proactive Safety, Compliant and Equipped, and Formal and Reported—reflecting diverse compliance and risk patterns across socio-occupational groups. The Random Forest classifier achieved a predictive accuracy of 96.5% based on cross-validated performance. Sensitivity and specificity values were high, indicating reliable discrimination among incident types. To reduce the risk of overfitting, k-fold cross-validation and monitored error convergence were performed across increasing numbers of trees. While the model shows strong predictive capability, we present these results cautiously and emphasize observed associations and emerging patterns rather than definitive predictive conclusions. The findings reveal that while economic motivations underpin LPG adoption, weak institutional enforcement and widespread informal installations heighten safety vulnerabilities. Comparisons with sub-Saharan and Asian contexts underscore the need for a structured regulatory framework, mandatory certification of installers, and periodic vehicle inspections. The study contributes to the broader discourse on informal energy transitions in developing economies by demonstrating how technical and behavioural determinants interact within weak regulatory systems. Policy recommendations emphasize the integration of data-driven risk assessment tools into regulatory oversight to enhance vehicular LPG safety and sustainability. Full article

Sustainable development, with its three pillars (environmental, social, and governance, ESG), is crucial for human well-being. Climate change is occurring faster than expected. In 2015, 193 countries signed the United Nations’ Agenda 2030, which must be achieved by 2030 along with the 17 Sustainable Development Goals. In the PDCA (Plan, Do, Check, Act) cycle, the Check phase is crucial—sustainability reporting (SR) is essential. This article provides an overview of existing SR standards (SRSs) and their future development but does not conduct a systematic review of the relevant scientific literature on the application of SRSs. The information review methodology shows that SRSs are already well-developed in large companies. The different standards are described, including voluntary ISO (International Organization for Standardization) standards, the Global Reporting Initiative (GRI) standards, the mandatory European Sustainability Reporting Standards (ESRS), and the International Financial Reporting Standards (IFRS). National SRSs are often aligned with the IFRS Sustainability Disclosure Standards. Besides the corporate SRSs, public SRSs covering governmental and non-governmental institutions, universities, and associations are described. Public SRSs should be adapted to the needs of public institutions. Finally, the SRSs for individuals and communities is discussed to cover these important parts of humanity. The social and governance sustainability reports could be extended with annual personal or community Carbon or Ecological Footprint reports. Full article

The study examines the compliance of South African JSE-listed companies with the King IV Report principles on corporate governance and their contribution to Sustainable Development Goals (SDGs). To achieve this, integrated reports were downloaded from the websites of the top 22 JSE-listed companies representing six different economic sectors. Using content analysis of the 22 top-performing companies, this study assesses transparency in governance as well as SDG disclosure practices. Results show high compliance with King IV Report principles, especially good performance, legitimacy, and effective control, though full disclosure is not yet achieved. Similarly, while SDG-aligned reporting is robust, only a small percentage of listed companies provided full disclosure on all SDG themes. For regulators, the findings are supportive of stricter reporting and possibly mandatory disclosures aligned with King IV and SDGs. The study’s findings validate the views of stakeholder theory and the triple bottom line framework. Full article

Background: Inadvertent arterial cannulation during central venous catheter placement is a recognized complication with potentially serious consequences, particularly when involving large-caliber catheters. While management strategies have evolved from mandatory surgical repair to various percutaneous approaches, limited data exist regarding collagen-based vascular closure devices for large-bore carotid arteriotomies. Case Presentation: We report the case of a 59-year-old male patient with acute Stanford Type A aortic dissection who underwent emergency surgical repair of the ascending aorta. During central venous cannulation, a five-lumen Certofix Quinto catheter (12-French outer diameter) was inadvertently inserted into the left common carotid artery. Given the complexity of concurrent cardiac surgery and the large-bore nature of the arteriotomy, percutaneous closure with an 18-French MANTA vascular closure device was successfully performed following completion of the aortic repair. The procedure achieved immediate hemostasis without complications. Outcomes: The patient remained neurologically intact throughout a 12-month follow-up period. Serial duplex ultrasonography and computed tomography angiography confirmed carotid artery patency without evidence of stenosis, dissection, pseudoaneurysm formation, or thromboembolic complications. Conclusions: This case demonstrates the technical feasibility of using a collagen-based vascular closure device for percutaneous management of a large-bore carotid arteriotomy in the acute surgical setting. While the outcome was favorable in this patient, this approach represents an off-label application that requires further validation and should be reserved for carefully selected cases in experienced centers where the benefits of percutaneous closure are judged to outweigh the uncertainties of supra-aortic device deployment. Full article

Background: Rapid and accurate fracture detection is critical in emergency departments (EDs), where high patient volume and time pressure increase the risk of diagnostic error, particularly in radiographic interpretation. Multimodal large language models (LLMs) with image-recognition capability have recently emerged as general-purpose tools for clinical decision support, but their diagnostic performance within routine emergency department imaging workflows in orthopedic trauma remains unclear. Methods: In this retrospective diagnostic accuracy study, we included 1136 consecutive patients referred from the ED to orthopedics between 1 January and 1 June 2025 at a single tertiary center. Given the single-center, retrospective design, the findings should be interpreted as hypothesis-generating and may not be fully generalizable to other institutions. Emergency radiographs and clinical data were processed by a multimodal LLM (2025 version) via an official API using a standardized, deterministic prompt. The model’s outputs (“Fracture present”, “No fracture”, or “Uncertain”) were compared with final diagnoses established by blinded orthopedic specialists, which served as the reference standard. Diagnostic agreement was analyzed using Cohen’s kappa (κ), sensitivity, specificity, accuracy, and 95% confidence intervals (CIs). False-negative (FN) cases were defined as instances where the LLM reported “no acute fracture” but the specialist identified a fracture. The evaluated system is a general-purpose multimodal LLM and was not trained specifically on orthopedic radiographs. Results: Overall, the LLM showed good diagnostic agreement with orthopedic specialists, with concordant results in 808 of 1136 patients (71.1%; κ = 0.634; 95% CI: 68.4–73.7). The model achieved balanced performance with sensitivity of 76.9% and specificity of 66.8%. The highest agreement was observed in knee trauma (91.7%), followed by wrist (78.8%) and hand (69.6%). False-negative cases accounted for 184 patients (16.2% of the total cohort), representing 32.4% of all LLM-negative assessments. Most FN fractures were non-displaced (82.6%), and 17.4% of FN cases required surgical treatment. Ankle and foot regions showed the highest FN rates (30.4% and 17.4%, respectively), reflecting the anatomical and radiographic complexity of these areas. Positive predictive value (PPV) and negative predictive value (NPV) were 69.4% and 74.5%, respectively, with likelihood ratios indicating moderate shifts in post-test probability. Conclusions: In an emergency department-to-orthopedics consultation cohort reflecting routine clinical workflow, a multimodal LLM demonstrated moderate-to-good diagnostic agreement with orthopedic specialists, broadly within the range reported in prior fracture-detection AI studies; however, these comparisons are indirect because model architectures, training strategies, datasets, and endpoints differ across studies. However, its limited ability to detect non-displaced fractures—especially in anatomically complex regions like the ankle and foot—carries direct patient safety implications and confirms that specialist review remains indispensable. At present, such models may be explored as hypothesis-generating triage or decision-support tools, with mandatory specialist confirmation, rather than as standalone diagnostic systems. Prospective, multi-center studies using high-resolution imaging and anatomically optimized algorithms are needed before routine clinical adoption in emergency care. Full article

Background: Pancreatic cancer (PC) is expected to be the second leading cause of cancer-related death by 2030. Surgical resection with R0 margins remains the only available treatment capable of improving the overall survival of the patients; thus, appropriate characterization of pancreatic tumors is mandatory for the correct assessment of PC resectability. Despite advances in pancreatic surgery, POPF remains a frequent and dreaded complication that impacts the morbidity and mortality of PC patients, entailing both clinical and economic consequences. Soft pancreatic texture is known as an independent risk factor for POPF occurrence in pancreatic surgery. Intraoperative exploration of the pancreas is most frequently assessed subjectively, through the surgeon’s palpation. Intraoperative elastography is a modern ultrasound technique suitable to replace the surgeon’s intraoperative palpation to better evaluate pancreatic lesions, pancreatic texture, and improve surgical management. Thus, intraoperative elastography could provide quantifiable and reproducible information in pancreatic parenchyma characterization. Real-time intraoperative assessment of pancreatic texture through an objective method could improve surgical decisions. This systematic review analyzes the role of intraoperative elastography in differentiating benign from malignant pancreatic tumors and the efficacy of this technique in the assessment of pancreatic texture as a predictor of postoperative pancreatic fistula (POPF). Methods: We conducted a comprehensive systematic literature research on PubMed, Google Scholar, Scopus, Web of Science, Embase and Cochrane Library Database using PRISMA framework guided by the words “intraoperative elastography” or “intraoperative elasticity imaging” or “intraoperative shear wave elastography” or “intraoperative strain elastography” and “pancreatic cancer” or “pancreatic neoplasm” or “pancreatic adenocarcinoma” or “pancreatic tumor” or “pancreatic fistula” or “postoperative pancreatic fistula” or “pancreatic leak”. Articles that were listed between 2000 and 2025 and written in the English language were screened for potentially relevant articles. The primary outcome was to evaluate the use of intraoperative elastography in differentiating between benign and malignant lesions of the pancreas. The second outcome was to assess the role of intraoperative elastography in the evaluation of pancreatic texture as a predictive factor for the occurrence of postoperative pancreatic fistula. Results: From a total of 17 publications, 2 scientific articles were considered relevant for the role of intraoperative elastography in differentiating benign from malignant pancreatic lesions, while 4 articles analyzed the role of intraoperative pancreatic elastography as a predictor of postoperative pancreatic fistula (POPF). Based on the results, detection of pancreatic cancer through intraoperative SWE is possible at cut-off values of 3 m/s and 28.7 kPa, and values of 2.2 m/s or less obtained after intraoperative elastography of the pancreas are considered an independent risk factor for POPF in pancreatic surgery. Reported cut-off values should, however, be interpreted as exploratory and should represent a starting point for further studies aimed at validating their clinical implementation. Conclusions: Intraoperative elastography can be a promising tool in pancreatic tumor characterization and could differentiate between benign and malignant pancreatic tumors and predict the risk of POPF, but further prospective studies are required before cut-off values can be routinely applied in clinical practice. Full article