Search Results (8,902)

The present paper investigates the adoption of green manufacturing approaches among industrial enterprises in Slovakia, emphasizing the interplay between institutional pressures and enterprise-level resources. Based on a survey of 88 enterprises from energy- and material-intensive sectors, the study evaluates how regional context and enterprise size influence the adoption of green practices. Using logistic regression and the chi-squared test, the findings reveal minimal regional variation, suggesting strong isomorphic effects of harmonised European Union environmental regulations. In contrast, enterprise size significantly correlates with the adoption of complex green practices, confirming the relevance of the resource-based view. These results highlight the dominance of internal capabilities over regional factors in green transition pathways within small post-transition economies. The study contributes to cross-national theorising by showing how resource asymmetries, rather than institutional diversity, shape environmental behaviour in uniform regulatory environments. Specifically, the paper examines how institutional pressures, enterprise-level resources, stakeholders, and legitimacy influence the adoption of green manufacturing practices in Slovak industrial enterprises. The study draws on institutional theory, the resource-based view, stakeholder theory, and legitimacy theory to explore the relationship between enterprise size, regional location, and the adoption levels of green manufacturing. Full article

Background/Objectives: Oral diseases are highly prevalent in Hungary and driven in part by unhealthy beverage consumption, smoking, and other behaviors. No prior study has examined the impact of beverage consumption patterns on oral health in a representative Hungarian population. This study investigated the association between beverage intake, lifestyle factors, and oral health outcomes among Hungarian adults. Methods: Data were drawn from the 2019 Hungarian European Health Interview Survey, a nationally representative cross-sectional study. Oral health outcomes and key exposures, including beverage consumption, smoking, alcohol use, and sociodemographic variables, were self-reported. Associations were assessed using multiple logistic regression models. Results: Among 5425 adults, higher dairy intake was linked to less gum bleeding (odds ratio = 0.76; 95% confidence intervals [0.59–0.96]) and lower odds of teeth missing (0.63 [0.47–0.86]). Weekly juice intake reduced gum bleeding (0.62 [0.51–0.76]) and missing teeth (0.83 [0.71–0.96]). Daily soda was associated with more gum bleeding (1.94 [1.53–2.47]), caries (1.57 [1.27–1.94]), and poor self-perceived oral health (1.32 [1.10–1.59]). Alcohol (1–4 times/week) increased gum bleeding (1.38 [1.07–1.77]) and tooth mobility (1.47 [1.02–2.11]). Smoking raised odds for caries (1.42 [1.21–1.66]) and missing teeth (1.81 [1.55–2.10]). Conclusions: Increasing dairy and fresh juice intake while reducing sugar-sweetened and acidic beverages, alongside tobacco and alcohol control and routine oral health screening, are effective strategies for improving population oral health across all sociodemographic groups. Full article

This paper examines the effectiveness of government subsidies in fostering innovation among small and medium-sized enterprises (SMEs), with a particular focus on additionality, crowding-out, and cherry-picking effects. Using the latest national survey data on Chinese high-tech SMEs, we apply robust econometric techniques—including the Heckman selection model, structural equation modeling (SEM), and propensity score matching (PSM)—to address potential selection bias and endogeneity. Our findings reveal that government subsidies positively influence both innovation inputs and outputs, suggesting a predominant additionality effect rather than a crowding-out effect, at least within high-tech SMEs. However, subsidies do not appear to alleviate the financial constraints faced by most SMEs, indicating that they are insufficient as a standalone solution to financing challenges. Furthermore, state ownership enhances input additionality but does not significantly impact output additionality. We also find evidence of cherry-picking in subsidy allocation, with loans exhibiting stronger additionality effects on innovation compared to grants and tax credits, which are more prone to selective intervention. These findings highlight the need for more targeted subsidy policies that prioritize financially constrained firms with high innovation potential while mitigating government selectivity. Our study offers valuable insights for policymakers seeking to design more effective innovation support mechanisms for high-tech SMEs. Full article

Digitalization is rapidly reshaping the global construction industry; however, its adoption in developing countries, such as Pakistan, remains limited and uneven. Hence, this study investigates and evaluates the current status of digital technology integration in Pakistan’s construction industry, with a primary focus on key tools, implementation challenges, and necessary policy interventions. Using a three-phase mixed-method approach involving a literature review, expert interviews, and a nationwide survey, this research identifies Building Information Modeling, Geographic Information Systems, and E-Procurement as essential technologies with strong potential to improve transparency, efficiency, and collaboration. However, adoption is hindered by a lack of awareness, limited technical expertise, and the absence of a cohesive national policy. This study also highlights that the private sector shows greater readiness compared to the public sector; however, systemic barriers persist across both sectors. Based on stakeholder insights, a three-part policy strategy was also proposed. This includes establishing a national regulatory framework, investing in capacity-building programs, and providing financial or institutional incentives to encourage the adoption of these measures. The findings emphasize that digitalization is not just a technical upgrade; it represents a pathway to improved governance and more efficient infrastructure delivery. With timely and coordinated policy action, the construction industry in Pakistan can align itself with global innovation trends and move toward a more sustainable and digitally empowered future. Full article

Background: Thallium is a metal that is ubiquitous in our natural environment. Despite its potential for high toxicity, thallium is understudied and not regulated in food. The California Department of Public Health was alerted to a household cluster of elevated urine thallium levels noted among a mother (peak 5.6 µg/g creatinine; adult reference: ≤0.4 µg/g creatinine) and her three young children (peak 10.5 µg/g creatinine; child reference: ≤0.8 µg/g creatinine). Objectives: This case report identifies questions raised after a public health investigation linked a household’s thallium exposure to a commercially available food product. We provide an overview of the public health investigation. We then explore concerns, such as gaps in toxicological data and limited surveillance of thallium in the food supply, which make management of individual and population exposure risks challenging. Methods: We highlight findings from a cross-agency investigation, including a household exposure survey, sampling of possible environmental and dietary exposures (ICP-MS analysis measured thallium in kale chips at 1.98 mg/kg and 2.15 mg/kg), and monitoring of symptoms and urine thallium levels after the source was removed. We use regulatory and research findings to describe the challenges and opportunities in characterizing the scale of thallium in our food supply and effects of dietary exposures on health. Discussion: Thallium can bioaccumulate in our food system, particularly in brassica vegetables like kale. Thallium concentration in foods can also be affected by manufacturing processes, such as dehydration. We have limited surveillance data nationally regarding this metal in our food supply. Dietary reviews internationally show increased thallium intake in toddlers. Limited information is available about low-dose or chronic exposures, particularly among children, although emerging evidence shows that there might be risks associated at lower levels than previously thought. Improved toxicological studies are needed to guide reference doses and food safety standards. Promising action towards enhanced monitoring of thallium is being pursued by food safety agencies internationally, and research is underway to deepen our understanding of thallium toxicity. Full article

Background: Alcohol-associated liver disease (AALD) represents significant health burdens worldwide. This study aims to provide a comprehensive overview of the AALD outcomes that were incompletely understood. Methods: The current study utilizes data from the National Health and Nutrition and Examination Survey (NHANES) from 2011–2020, using a stratified, multistage probability cluster design. AALD in the NHANES was defined using clinical laboratory data and self-reported alcohol use, among which fibrosis-4 score of >2.67. Analysis is conducted using weighted, logistic, and Cox linear regression. Results: The initial sample included 23,206 participants aged 20 and older, with recorded cardiovascular status and AST/ALT levels. Participants reporting AALD had a higher percentage of college degrees (p < 0.001) and were more likely to be daily smokers. Asians exhibited the highest rates of AALD compared to other demographics (p < 0.001). The prevalence in private insurance is significantly greater than Medicaid, but the usage trends have been increasing in Medicaid. The trends of advanced fibrosis have been increasing in blacks and Asians, while they have been decreasing among whites and Mexicans. Those with AALD also had higher mean systolic and diastolic blood pressure, as well as elevated fasting glucose levels (p < 0.001). The mortality rate among AALD participants with heart diseases was 25%, compared to 3% among those without (p < 0.001). After adjusting for potential confounding variables, no statistically significant associations were found between AALD status and HF or CAD. However, a clinically significant increase in the odds of stroke was observed within the AALD group (p < 0.001). Conclusions: Our findings indicate Asians have the highest rates of AALD. The trends of advanced fibrosis have been increasing in blacks and Asians. There is an increased prevalence of AALD with heart diseases and a significant increase in mortality with stroke. Full article

Background and Objectives: Sarcopenic obesity, or the coexistence of sarcopenia and obesity, carries an additional load of health risks, including functional decline and metabolic disorders. Despite its increasing importance, data on Korean adults’ prevalence and risk factors are poor. The objective of this study was to estimate the prevalence of sarcopenic obesity, sarcopenia, and obesity to identify factors associated with each condition using the most recent nationally representative data. Materials and Methods: This study analyzed data from 4332 adults aged ≥ 40 years who participated in the 2022–2023 Korea National Health and Nutrition Examination Survey (KNHANES). Sarcopenia was defined using the appendicular skeletal muscle index (SMI) via bioelectrical impedance analysis (BIA), and obesity by waist circumference per Korean criteria. Participants were categorized into four body composition groups. Complex sample logistic regression was used to identify factors independently associated with each condition. Results: The prevalence rates of sarcopenic obesity, sarcopenia-only, and obesity-only were 1.9%, 14.4%, and 35.5%, respectively. Sarcopenic obesity was significantly more common among older women with low education level, poor subjective health, diabetes, and low HDL-C. They were associated with older age, lower physical activity, lower education level, past smoking, and poor health condition. Obesity was associated with male sex, diabetes, hypertension, dyslipidemia, and moderate-to-poor perceived health. Conclusions: Sarcopenic obesity, while less prevalent, is relatively uncommon and represents a high-risk phenotype associated with metabolic and functional deficits. These results highlight the importance of identifying vulnerable subgroups and implementing targeted strategies that address both muscle loss and adiposity in aging Korean adults. Full article

Background: Electrocardiograms (EKGs) are essential tools in emergency medicine, often used to evaluate chest pain, dyspnea, and other symptoms suggestive of cardiac dysfunction. Yet, EKGs are not universally administered to all emergency department (ED) patients. Understanding and predicting which patients receive an EKG may offer insights into clinical decision making, resource allocation, and potential disparities in care. This study examines whether integrating structured clinical data with free-text patient narratives can improve prediction of EKG utilization in the ED. Methods: We conducted a retrospective observational study to predict electrocardiogram (EKG) utilization using data from 13,115 adult emergency department (ED) visits in the nationally representative 2021 National Hospital Ambulatory Medical Care Survey–Emergency Department (NHAMCS-ED), leveraging both structured features—demographics, vital signs, comorbidities, arrival mode, and triage acuity, with the most influential selected via Lasso regression—and unstructured patient narratives transformed into numerical embeddings using Clinical-BERT. Four supervised learning models—Logistic Regression (LR), Support Vector Machine (SVM), Random Forest (RF) and Extreme Gradient Boosting (XGB)—were trained on three inputs (structured data only, text embeddings only, and a late-fusion combined model); hyperparameters were optimized by grid search with 5-fold cross-validation; performance was evaluated via AUROC, accuracy, sensitivity, specificity and precision; and interpretability was assessed using SHAP values and Permutation Feature Importance. Results: EKGs were administered in 30.6% of adult ED visits. Patients who received EKGs were more likely to be older, White, Medicare-insured, and to present with abnormal vital signs or higher triage severity. Across all models, the combined data approach yielded superior predictive performance. The SVM and LR achieved the highest area under the ROC curve (AUC = 0.860 and 0.861) when using both structured and unstructured data, compared to 0.772 with structured data alone and 0.823 and 0.822 with unstructured data alone. Similar improvements were observed in accuracy, sensitivity, and specificity. Conclusions: Integrating structured clinical data with patient narratives significantly enhances the ability to predict EKG utilization in the emergency department. These findings support a personalized medicine framework by demonstrating how multimodal data integration can enable individualized, real-time decision support in the ED. Full article

This convergent mixed-methods study explores the lived experiences of Black women DEI leaders at predominantly white institutions within the context of an increasingly contentious national discourse surrounding diversity, equity, and inclusion (DEI) in higher education. Conducted prior to the 2024 election, a period marked by escalating resistance to DEI efforts, this research explores how America’s racial reckoning influenced institutional DEI initiatives and shaped the realities of those leading this work. Data were collected through a climate survey of 20 DEI administrators and semi-structured interviews with three senior-level Black women DEI leaders. The survey findings suggest that institutional commitments to DEI were largely reactive, emerging as crisis responses to national calls for racial justice. These efforts resulted in the short-term elevation of Black women into leadership roles, often without sustained structural support. The interview data revealed that Black women senior DEI leaders routinely encounter discrimination, marginalization, and the paradox of hypervisibility and invisibility within their roles. This study concludes with implications and suggestions for institutional policy and structural reform aimed at fostering more equitable and sustainable DEI leadership environments. Full article

Digital competence refers to the integration of digital technology in teaching and learning, as outlined in the national curriculum of Estonia for upper secondary schools. This study presents original research findings on Estonian science teachers’ use of digital tools and materials, their digital competence, and the main benefits and challenges they face. The findings emphasize the need for continued professional development, accessible digital resources, and equitable digital infrastructure to maintain Estonia’s leadership in digital science education. A survey of 58 secondary school science teachers revealed that computers (desktops, laptops, and tablets) are the primary digital tools used. The article explores digital literacy advancements in secondary science education, research methodologies used to assess digital tool usage, and key findings from recent studies. However, challenges such as digital equity, technological barriers, and digital fatigue persist. Additionally, discrepancies were found in teachers’ responses regarding digital tool effectiveness, implementation strategies, and perceived barriers. While some teachers reported a successful integration and improved student outcomes, others highlighted difficulties in aligning digital resources with curriculum requirements and pedagogical approaches. Full article

Purpose: Following George Floyd’s death, the push for law enforcement accountability policies has intensified. Despite robust legislative action, challenges in enacting and implementing meaningful reforms persist. This study analyzes police accountability policies (PAP) in the U.S. from 2020 to 2022, identifying barriers and facilitators through expert perspectives in enforcement oversight, policy advocacy, and community engagement. Methods: The study used a dual approach: analyzing 226 police accountability bills from all 50 U.S. states, D.C., and Puerto Rico via the National Conference of State Legislatures database, and categorizing them into six key areas such as training, technology use, and certification. Additionally, a survey was conducted among experts to identify the challenges and drivers in passing police accountability legislation. Findings: A legislative analysis showed that although 48 states passed police accountability laws, California, New Jersey, Oklahoma, and Colorado have made significant strides by passing multiple pieces of legislation aimed at enhancing law enforcement accountability and ensuring better policing practices. The most common policies focused on training and technology, enacted by 16 and 12 states, respectively. However, crucial certification and decertification policies were adopted in just 13 states, highlighting the inconsistent implementation of measures critical for police accountability and transparency. The survey identified several barriers to passing PAP, including inadequate support from local governments (72.7%). Structural exclusion of poor and minority communities from policing resources was also a significant barrier (54.5%). Facilitators included community support (81.8%) and a cultural shift in policing towards viewing officers as “guardians” rather than “warriors” (63.6%). Conclusions: While some progress has been made in passing PAP, considerable gaps remain, particularly in enforcement and comprehensive reform. Resistance from law enforcement institutions, lack of community support, and structural inequalities continue to impede the adoption of effective PAP. Full article

Background: Point-of-care ultrasound (POCUS) is gaining recognition as a valuable diagnostic tool in various fields of medicine, including pediatrics. Its application at the point of care enables real-time clinical decision-making, which is particularly advantageous in pediatric settings. Although global interest in POCUS is growing, many European countries—including Poland—still lack formal training programs for POCUS at both the undergraduate and postgraduate levels. Nevertheless, the number of pediatricians incorporating POCUS into their daily clinical practice in Poland is increasing. However, the extent of its use and perceived value among pediatricians remains largely unknown. This study aimed to evaluate the current level of POCUS utilization in pediatric care in Poland, focusing on pediatricians’ self-assessed competencies, perceptions of its clinical utility, and key barriers to its implementation in daily practice. Methods: This cross-sectional study was conducted between July and August 2024 using an anonymous online survey distributed to pediatricians throughout Poland via national professional networks, with a response rate of 7.3%. Categorical variables were analyzed using the chi-square test of independence to assess the associations between key variables. Quantitative data were analyzed using descriptive statistics, and qualitative data from open-ended responses were subjected to a thematic analysis. Results: A total of 210 pediatricians responded. Among them, 149 (71%) reported access to ultrasound equipment at their workplace, and 89 (42.4%) reported having participated in some form of POCUS training. Only 46 respondents (21.9%) reported frequently using POCUS in their clinical routine. The self-assessed POCUS competence was rated as low or very low by 136 respondents (64.8%). While POCUS was generally perceived as a helpful tool in facilitating and accelerating clinical decisions, the main barriers to implementation were a lack of formal training and limited institutional support. Conclusions: Although POCUS is perceived as clinically valuable by the surveyed pediatricians in Poland, its routine use remains limited due to training and systemic barriers. Future efforts should prioritize the development of a validated, competency-based training framework and the implementation of a larger, representative national study to guide the structured integration of POCUS into pediatric care. Full article

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 presents a comprehensive inventory of bryophytes in Serra dos Órgãos National Park (PARNASO), aiming to evaluate species richness, floristic composition and threatened taxa. Despite the state of Rio de Janeiro being one of the most extensively sampled regions for bryophytes in Brazil, detailed surveys of its conservation units remain scarce. Data were obtained through bibliographic review, herbarium specimen analysis, and new field collections. A total of 504 species were recorded, belonging to 202 genera and 76 families. The park harbors three locally endemic species, eight endemic to Rio de Janeiro, and sixty-nine species endemic to Brazil. Additionally, eleven species were identified as threatened, comprising seven Endangered (EN), two Critically Endangered (CR), and two Vulnerable (VU) according to the IUCN guidelines. PARNASO includes four distinct ecosystems along an altitudinal gradient: sub-montane forest (up to 500 m), montane forest (500–1500 m), upper-montane forest (1500–2000 m), and high-altitude fields (above 2000 m). Montane Forest showed the highest species richness, followed by high-altitude fields, upper-montane forest, and sub-montane forest. The findings highlight PARNASO’s importance in preserving bryophyte diversity in a highly diverse yet understudied region. This work contributes valuable baseline data to support conservation strategies and future ecological studies in Atlantic Forest remnants. Full article

As an important ecological barrier and animal husbandry resource base in arid and semi-arid areas, grassland degradation directly affects regional ecological security and sustainable development. Ili Prefecture is located in the western part of Xinjiang, China, and is a typical grassland resource-rich area. However, in recent years, driven by climate change and human activities, grassland degradation has become increasingly serious. In view of the lack of comprehensive evaluation indicators and the inconsistency of grassland evaluation grade standards in remote sensing monitoring of grassland resource degradation, this study takes the current situation of grassland degradation in Ili Prefecture in the past 20 years as the research object and constructs a comprehensive evaluation index system covering three criteria layers of vegetation characteristics, environmental characteristics, and utilization characteristics. Net primary productivity (NPP), vegetation coverage, temperature, precipitation, soil erosion modulus, and grazing intensity were selected as multi-source indicators. Combined with data sources such as remote sensing inversion, sample survey, meteorological data, and farmer survey, the factor weight coefficient was determined by analytic hierarchy process. The Grassland Degeneration Comprehensive Index (GDCI) model was constructed to carry out remote sensing monitoring and evaluation of grassland degradation in Yili Prefecture. With reference to the classification threshold of the national standard for grassland degradation, the GDCI grassland degradation evaluation grade threshold (GDCI reduction rate) was determined by the method of weighted average of coefficients: non-degradation (0–10%), mild degradation (10–20%), moderate degradation (20–37.66%) and severe degradation (more than 37.66%). According to the results, between 2000 and 2022, non-degraded grasslands in Ili Prefecture covered an area of 27,200 km², representing 90.19% of the total grassland area. Slight, moderate, and severe degradation accounted for 4.34%, 3.33%, and 2.15%, respectively. Moderately and severely degraded areas are primarily distributed in agro-pastoral transition zones and economically developed urban regions, respectively. The results revealed the spatial and temporal distribution characteristics of grassland degradation in Yili Prefecture and provided data basis and technical support for regional grassland resource management, degradation prevention and control and ecological restoration. Full article