Search Results (1,845)

Background: Health equity can only be achieved when every individual has access to quality healthcare without fear of being discriminated against. This study analyzed the sociodemographic characteristics associated with self-reported racial discrimination when receiving medical care in the United States. Methods: This quantitative cross-sectional study utilized the 2022 National Trends Survey 6. We performed a logistic regression analysis using 6102 survey responses from study participants who answered the question about perceived discrimination. Results: Older adults aged 75 years and above had significantly lower odds of reporting perceived discrimination when receiving medical care compared to those aged 18–34 years (AOR = 0.24; 95% CI: 0.10–0.58). The odds of reporting perceived discrimination were significantly higher among non-Hispanic Blacks (AOR = 7.30; 95% CI: 4.48–11.88), Hispanics (AOR = 3.56; 95% CI: 2.45–5.17), non-Hispanic Asians (AOR = 5.95; 95% CI: 2.25–15.73), and individuals identifying as non-Hispanic Other (AOR = 10.91; 95% CI: 5.42–21.98), compared to non-Hispanic Whites. Compared to individuals from households earning less than USD 20,000, the odds of reporting perceived discrimination when receiving medical care were significantly lower among individuals from households earning between USD 50,000 and <USD 75,000 (AOR = 0.42; 95% CI: 0.23–0.78) and those earning USD 75,000 or more (AOR = 0.43; 95% CI: 0.22–0.83). Conclusions: Despite having a multicultural and ethnically diverse population, racial discrimination persists in the United States and has become a barrier to achieving health equity. Health organizations should implement policies that ensure health workers attend mandatory anti-racism training. Full article

This study synthesizes the rapidly expanding evidence on how digital technologies reshape international trade, with a particular focus on small and medium-sized enterprises (SMEs). Guided by two research questions—(RQ1) How do digital tools influence the volume and composition of cross-border trade? and (RQ2) How do these effects vary by countries’ development level and firm size?—we conducted a PRISMA-compliant systematic literature review covering 2010–2024. Searches across eight major databases yielded 1857 records; after duplicate removal, title/abstract screening, full-text assessment, and Mixed Methods Appraisal Tool (MMAT 2018) quality checks, 86 peer-reviewed English-language studies were retained. Findings reveal three dominant technology clusters: (1) e-commerce platforms and cloud services, (2) IoT-enabled supply chain solutions, and (3) emerging AI analytics. E-commerce and cloud adoption consistently raise export intensity—doubling it for digitally mature SMEs—while AI applications are the fastest-growing research strand, particularly in East Asia and Northern Europe. However, benefits are uneven: firms in low-infrastructure settings face higher fixed digital costs, and cybersecurity and regulatory fragmentation remain pervasive obstacles. By integrating trade economics with development and SME internationalization studies, this review offers the first holistic framework that links national digital infrastructure and policy support to firm-level export performance. It shows that the trade-enhancing effects of digitalization are contingent on robust broadband penetration, affordable cloud access, and harmonized data-governance regimes. Policymakers should, therefore, prioritize inclusive digital-readiness programs, while business leaders should invest in complementary capabilities—data analytics, cyber-risk management, and cross-border e-logistics—to fully capture digital trade gains. This balanced perspective advances theory and practice on building resilient, equitable digital trade ecosystems. Full article

Background: This study aims to compare the logistical challenges of Home Health Care (HHC) services in Portugal and Brazil, highlighting the structural and operational differences between both systems. Methods: Guided by an abductive research approach, data were collected using a semi-structured survey with open-ended questions, applied to 13 HHC teams in Portugal and 18 in Brazil, selected based on national coordination recommendations. The data collection process was conducted in person, and responses were analyzed using descriptive statistics and qualitative content analysis. Results: The results reveal that Portugal demonstrates higher productivity, stronger territorial coverage, and a more integrated inventory management system, while Brazil presents greater multidisciplinary team integration, more flexible fleet logistics, and more advanced digital health records. Despite these strengths, both countries continue to address key logistical aspects, such as scheduling, supply distribution, and data management, largely through empirical strategies. Conclusions: This research contributes to the theoretical understanding of international HHC logistics by emphasizing strategic and systemic aspects often overlooked in operational studies. In practical terms, it offers insights for public health managers to improve resource allocation, fleet coordination, and digital integration in aging societies. Full article

Background: Preimplantation genetic testing for polygenic diseases (PGT-P) is a reproductive technology that has made it possible to assign risk scores to embryos for various complex polygenic conditions such as diabetes, hypertension, breast cancer, and schizophrenia. Whether there is public interest in utilizing PGT-P and what public opinions are regarding this technology is unknown. Therefore, the objective of our study was to evaluate the opinion of the general United States (US) public regarding PGT-P. Methods: A web-based questionnaire consisting of 25 questions was administered to a nationally representative sample of adult US residents according to age and sex. The survey contained a description of PGT-P, followed by questions with Likert-scale responses ranging from strongly agree to strongly disagree. Results: Of the 715 respondents recruited, 673 (94%) completed the survey. Most respondents agreed that use of PGT-P is ethical (54%), and another 37% were neutral; however, approximately 9% of respondents disagreed and were opposed to the use of PGT-P. Those that opposed PGT-P cited that it was “unethical” (46%) or “not natural” (39%), believed children could be negatively affected (31%), or stated that it went against their religion (15%). The majority of respondents did not know whether PGT-P was safe for embryos (68%) or children (67%) and felt that anyone should be able to utilize it (53%). Conclusions: Participants who were younger, were Atheist, or were Democrats were more likely to agree that “PGT-P is ethical”. This study identified that more than half of respondents supported the use of PGT-P. However, concerns regarding its safety and ethical implications persist. Full article

The article addresses the question of the relative importance of human population size and growth in relation to the environmental problems of planetary heating and biodiversity loss in the current, Anthropocene era. To what extent could policies to encourage lower fertility be justified, while observing that this subject is an inherently contested one. It is proposed that a helpful distinction can be made between specific threats to habitats and biodiversity, as opposed to those related to global energy use and warming. Pressures of over-population can be important in relation to the former. But with regard to the latter—rising per capita energy usage—reduced fertility has historically been positively, not negatively correlated. A case can be made that the high-fertility nations of sub-Saharan Africa could benefit from culturally respectful fertility reduction policies. However, where planetary heating is concerned, it is the hydrocarbon-based, per capita energy-consumption patterns of already low-fertility populations on the other five inhabited continents that is rather more critical. While it will be helpful to stabilise global human population, this cannot be viewed as a solution to the climate crisis problem of this century. That requires relentless focus on reducing hydrocarbon use and confronting the rising inequality since c.1980 that has been exacerbating competitive materialist consumerism. This involves the ideological negotiation of values to promote a culture change that understands and politically embraces a new economics of both human and planetary balance, equity, and distribution. Students of populations can contribute by re-assessing what can be the appropriate demographic units and measures for policies engaging with the challenges of the Anthropocene. Full article

The socio-economic geography of the Italian territory is framed by strong imbalances in the settlement development, with consequent inequalities in terms of accessibility to essential services. These challenges are most critical in the ‘inner areas’, which are remote from metropolitan and urban centers and affected by chronic demographic decline and depopulation. Both European and national policies have relied primarily on financial interventions, often implemented with limited integration into comprehensive urban and territorial planning frameworks. Using a case study methodology, this research examines the area-based strategies of the 72 pilot areas designated under the 2014–2020 program-ming cycle of the National Strategy for Inner Areas (SNAI). The main research question guiding this study is as follows: how does economic planning intersect with territorial governance in Italy’s inner areas, and what is the specific role of local autonomies and the management of core functions, particularly in relation to urban and regional planning? Through this lens, this study proposes a conceptual reframing of the inter-municipal ad-ministrative scale as a strategic framework for promoting more effective territorial policies. Full article

Background/Objectives: The demand for accessible and reliable digital health services has increased significantly in recent years, particularly in regions facing physician shortages. HomeDOCtor, a conversational AI platform developed in Slovenia, addresses this need with a nationally adapted architecture that combines retrieval-augmented generation (RAG) and a Redis-based vector database of curated medical guidelines. The objective of this study was to assess the performance and impact of HomeDOCtor in providing AI-powered healthcare assistance. Methods: HomeDOCtor is designed for human-centered communication and clinical relevance, supporting multilingual and multimedia citizen inputs while being available 24/7. It was tested using a set of 100 international clinical vignettes and 150 internal medicine exam questions from the University of Ljubljana to validate its clinical performance. Results: During its six-month nationwide deployment, HomeDOCtor received overwhelmingly positive user feedback with minimal criticism, and exceeded initial expectations, especially in light of widespread media narratives warning about the risks of AI. HomeDOCtor autonomously delivered localized, evidence-based guidance, including self-care instructions and referral suggestions, with average response times under three seconds. On international benchmarks, the system achieved ≥95% Top-1 diagnostic accuracy, comparable to leading medical AI platforms, and significantly outperformed stand-alone ChatGPT-4o in the national context (90.7% vs. 80.7%, p = 0.0135). Conclusions: Practically, HomeDOCtor eases the burden on healthcare professionals by providing citizens with 24/7 autonomous, personalized triage and self-care guidance for less complex medical issues, ensuring that these cases are self-managed efficiently. The system also identifies more serious cases that might otherwise be neglected, directing them to professionals for appropriate care. Theoretically, HomeDOCtor demonstrates that domain-specific, nationally adapted large language models can outperform general-purpose models. Methodologically, it offers a framework for integrating GDPR-compliant AI solutions in healthcare. These findings emphasize the value of localization in conversational AI and telemedicine solutions across diverse national contexts. Full article

This paper addresses the challenge of fostering cooperation among virtual power plant (VPP) operators in competitive electricity markets, focusing on the application of evolutionary game theory (EGT) and static reward–punishment mechanisms. This investigation resolves four critical questions: the minimum reward–punishment thresholds triggering stable cooperation, the influence of initial market composition on equilibrium selection, the sufficiency of static versus dynamic mechanisms, and the quantitative mapping between regulatory parameters and market outcomes. The study establishes the mathematical conditions under which static reward–punishment mechanisms transform competitive VPP markets into stable cooperative systems, quantifying efficiency improvements of 15–23% and renewable integration gains of 18–31%. Through rigorous evolutionary game-theoretic analysis, we identify critical parameter thresholds that guarantee cooperation emergence, resolving longstanding market coordination failures documented across multiple jurisdictions. Numerical simulations and sensitivity analysis demonstrate that static reward–punishment systems enhance cooperation, optimize resources, and increase renewable energy utilization. Key findings include: (1) Reward–punishment mechanisms effectively promote cooperation and system performance; (2) A critical region exists where cooperation dominates, enhancing market outcomes; and (3) Parameter adjustments significantly impact VPP performance and market behavior. The theoretical contributions of this research address documented market failures observed across operational VPP implementations. Our findings provide quantitative foundations for regulatory frameworks currently under development in seven national energy markets, including the European Union’s proposed Digital Single Market for Energy and Japan’s emerging VPP aggregation standards. The model’s predictions align with successful cooperation rates achieved by established VPP operators, suggesting practical applicability for scaled implementations. Overall, through evolutionary game-theoretic analysis of 156 VPP implementations, we establish precise conditions under which static mechanisms achieve 85%+ cooperation rates. Based on this, future work could explore dynamic adjustments, uncertainty modeling, and technologies like blockchain to further improve VPP resilience. Full article

Background: Telehealth is an essential component of modern healthcare, and it was especially relevant during the COVID-19 pandemic, but disparities in digital and technological literacy among health professionals may limit its equitable adoption and impact. Objective: This study seeks to validate an eight-item telehealth literacy survey among health professionals in Central–South Chile and to examine demographic and behavioral determinants of literacy levels, developing predictive models to identify key factors. Methods: In this cross-sectional study, 2182 health professionals from urban and rural centers in Central–South Chile completed the adapted survey along with questions on age, gender, nationality, and frequency of telehealth use. We assessed internal consistency (Cronbach’s α), explored factor structure via exploratory factor analysis (EFA), and tested associations using Pearson correlations, t-tests, one-way ANOVA, and both linear and multinomial logistic regressions. Results: The instrument demonstrated high reliability (Cronbach’s α = 0.92) and a two-factor structure explaining 65% of variance. Age negatively correlated with literacy (r = −0.26; p < 0.001), while the frequency of telehealth use showed a positive correlation (r = 0.26; p < 0.001). Female professionals and those in urban settings scored significantly higher on telehealth literacy (p = 0.005 and p < 0.001, respectively). The reduced multinomial model achieved moderate classification accuracy (51.65%) in distinguishing low, medium, and high literacy groups. Conclusions: The validated survey is a reliable tool for assessing telehealth literacy among health professionals in Chile. The findings highlight age, gender, and geographic disparities, and support targeted digital literacy interventions to promote equitable telehealth practice. Full article

Background/Objectives: BRIGHTLIGHT was the national evaluation of adolescent and young adult (AYA) cancer services in England. BRIGHTLIGHT results were not available when the most recent healthcare policy (NHSE service specifications for AYA Cancer) for AYA was drafted and therefore did not consider BRIGHTLIGHT findings and recommendations. We describe the co-development and delivery of a Policy Lab to expedite the implementation of the new service specification in the context of BRIGHTLIGHT results, examining the roles of multi-stakeholders to ensure service delivery is optimised to benefit AYA patients. We address the key question, “What is the roadmap for empowering different stakeholders to shape how the AYA service specifications are implemented?”. Methods: A 1-day face-to-face policy lab was facilitated, utilising a unique, user-centric engagement approach by bringing diverse AYA stakeholders together to co-design strategies to translate BRIGHTLIGHT evidence into policy and impact. This was accompanied by an online workshop and prioritisation survey, individual interviews, and an AYA patient workshop. Workshop outputs were analysed thematically and survey data quantitatively. Results: Eighteen professionals and five AYAs attended the face-to-face Policy Lab, 16 surveys were completed, 13 attended the online workshop, three professionals were interviewed, and three AYAs attended the patient workshop. The Policy Lab generated eight national and six local recommendations, which were prioritised into three national priorities: 1. Launching the service specification supported by compelling communication; 2. Harnessing the ideas of young people; and 3. Evaluation of AYA patient outcomes/experiences and establishing a national dashboard of AYA cancer network performance. An animation was created by AYAs to inform local hospitals what matters to them most in the service specification. Conclusions: Policy and research evidence are not always aligned, so when emerging evidence does not support current guidance, further exploration is required. We have shown through multi-stakeholder involvement including young people that it was possible to gain a different interpretation based on current knowledge and context. This additional insight enabled practical recommendations to be identified to support the implementation of the service specification. Full article

With continuous advancements in semiconductor technology, mastering efficient designs of high-quality and advanced chips has become an important part of science and technology education. Chip performances will determine the futures of various aspects of societies. However, novice students often encounter difficulties in learning digital chip designs using Verilog programming, a common hardware design language. An efficient self-study system for supporting them that can offer various exercise problems, such that any answer is marked automatically, is in strong demand. In this paper, we design and implement a web-based Verilog programming learning assistant system (VPLAS), based on our previous works on software programming. Using a heuristic and guided learning method, VPLAS leads students to learn the basic circuit syntax step by step, until they acquire high-quality digital integrated circuit design abilities through self-study. For evaluation, we assign the proposal to 50 undergraduate students at the National Taipei University of Technology, Taiwan, who are taking the introductory chip-design course, and confirm that their learning outcomes using VPLAS together are far better than those obtained when following a traditional method. In our final statistics, students achieved an average initial accuracy rate of over 70% on their first attempts at answering questions after learning through our website’s tutorials. With the help of the system’s instant automated grading and rapid feedback, their average accuracy rate eventually exceeded 99%. This clearly demonstrates that our system effectively enables students to independently master Verilog circuit knowledge through self-directed learning. Full article

This article examines the accessibility of public space for individuals with disabilities in the Netherlands, as well as the relevant legal frameworks intended to promote accessibility. It discusses the Convention on the Rights of Persons with Disabilities (UN CRPD) and efforts to implement its provisions at the local level. The article first provides an overview of Dutch legislation and regulations concerning accessibility in public spaces. It then presents an analysis of the experiences of individuals with disabilities in navigating streets and pavements in two Dutch cities, Utrecht and Almere. The central question is to what extent equal participation in public space has been realised. The findings indicate that national legislation remains inadequate in addressing the accessibility of streets and pavements. Despite the constitutional amendment in January 2023, which prohibits discrimination on the grounds of disability, substantive equality is largely dependent on the individual policies and bylaws of the 342 municipalities. The involvement of individuals with disabilities in shaping the inclusive use of public space is therefore crucial at the local level. This article highlights local initiatives that have successfully drawn the attention of municipal policymakers and civil servants to the importance of accessible streets. Full article

China’s national strategies emphasize both achieving carbon peaking and neutrality (“dual carbon” objectives) and fostering high-quality economic development. This dual focus highlights the critical importance of the Green and Low-Carbon Transition (GLCT) of the economy and the development of New Quality Productive Forces (NQPF). Firms are central actors in this transformation, prompting the core research question: How does corporate engagement in GLCT contribute to the formation of NQPF? We investigate this relationship using panel data comprising 33,768 firm-year observations for A-share listed companies across diverse industries in China from 2012 to 2022. Corporate GLCT is measured via textual analysis of annual reports, while an NQPF index, incorporating both tangible and intangible dimensions, is constructed using the entropy method. Our empirical analysis relies primarily on fixed-effects regressions, supplemented by various robustness checks and alternative econometric specifications. The results demonstrate a significantly positive relationship: corporate GLCT robustly promotes the development of NQPF, with dynamic lag structures suggesting delayed productivity realization. Mechanism analysis reveals that this effect operates through three primary channels: improved access to financing, stimulated collaborative innovation and enhanced resource-allocation efficiency. Heterogeneity analysis indicates that the positive impact of GLCT on NQPF is more pronounced for state-owned enterprises (SOEs), firms operating in high-emission sectors, those in energy-efficient or environmentally friendly industries, technology-intensive sectors, non-heavily polluting industries and companies situated in China’s eastern regions. Overall, our findings suggest that corporate GLCT enhances NQPF by improving resource-utilization efficiency and fostering innovation, with these effects amplified by specific regional advantages and firm characteristics. This study offers implications for corporate strategy, highlighting how aligning GLCT initiatives with core business objectives can drive NQPF, and provides evidence relevant for policymakers aiming to optimize environmental governance and foster sustainable economic pathways. Full article

Wildlife strikes in aviation are among the most reported safety incidents. As such, strikes have become the fundamental unit of understanding of the risk posed by wildlife. However, the management of wildlife risks to aviation has shifted to a hazard management philosophy. This literature review examines the argument that current wildlife strike reporting requirements are inadequate for modern wildlife hazard management techniques. This review utilised bibliometric analysis software to identify relevant academic research sourced from the Web of Science, as well as industry materials, to compile a final catalogue (n = 542). Further filtering revealed a limited set of relevant papers (n = 42) and even fewer papers that addressed the above question. Analysis of these papers and the wider catalogue noted limitations in current reporting requirements as they relate to hazard and risk management concepts. This analysis was supplemented with a review of international standards and relevant national requirements, concluding that while academics and industry have adopted systematic safety and hazard management techniques, and international guidance material has kept pace, international standards, the foundation for many national reporting systems, remain decades behind. This paper proposes the use of robust consensus-building methodologies, such as the Delphi technique, in the industry as a means of streamlining and supporting international standards development. Full article

Educators must understand current practices and gaps in knowledge regarding environmental sustainability in simulation education to reduce the environmental impact of plastic waste while still maintaining fidelity in simulation education. Therefore, a scoping review was conducted to answer the PICO question, “In healthcare institutions and hospitals, what are the environmentally sustainable practices that can be translated into simulation labs as best practice?” Fourteen studies were identified through a search of seven databases, critically appraised, and analyzed. Three key themes emerged: (1) the 5 R’s, (2) getting people motivated, and (3) larger external collaboration. These themes highlight practical strategies and motivational factors for sustainable practices. An expanded 5 R’s framework (reduce, reuse, recycle, research, and rethink) was introduced to guide a holistic approach. The literature highlights the importance of education, stakeholder engagement, and clearly defined standards as key drivers for motivating individuals and teams to engage in sustainable behaviors. These efforts are most effective when supported by interdisciplinary collaboration, regulatory frameworks, national policies, and technological innovation. Sustainability initiatives should extend beyond individual institutions to foster broader systemic change. Full article