Search Results (3,080)

The role of organizational factors in fostering and enhancing environmental sustainability has become increasingly critical due to the growing trends and concerns of environmental degradation. Developing nations have been reported to be significantly challenged with regard to adequate environmental management. As a developing nation, Libya is environmentally vulnerable in terms of both its geographical characteristics as a country in a semi-arid region and its resource-dependent economy. This research investigates the interplay among corporate environmental motivations, perceptions of corporate environmental management practices, pro-environmental attitudes, and pro-environmental behaviors among the employees of Libya’s oil sector. Libya provides a relevant context for investigating the impact of socioeconomic and corporate institutional dynamics on environmental engagement within industrial organizations. This research explores individual-level factors and how they interact with the practices of corporate environmental sustainability in a corporate sector characterized by significant and critical ecological impact. This study analyzed employee responses across multiple oil companies operating in Libya. This study sheds light on the extent to which the impacts of corporate sustainability motivations and workplace contexts shape the perceptions and behaviors of employees towards environmental sustainability. The findings of this research underscore the interconnectedness of organizational and personal dimensions of environmental sustainability, with further impacts policy and practices of environmental sustainability in similar contexts. Full article

This study investigates the essential competencies for engineers in the context of digital transformation, with the aim of proposing a refined framework to guide professional development across career levels. A mixed-methods, sequential approach was adopted: (1) a systematic literature review, conducted between 2014 and 2024, which identified 46 competencies organized into seven dimensions; (2) a quantitative survey with 392 engineers who self-assessed their level of mastery for each competency; (3) semi-structured interviews with 20 company representatives, who validated and contextualized the essential competencies according to hierarchical levels (junior, mid-level, and senior); (4) data triangulation, resulting in a final competency model by career level. The findings reveal a widespread deficit in digital competencies, regardless of hierarchical level. In total, 33 competencies assessed by career level showed statistically significant differences in employer perceptions and were identified as progressive throughout the career trajectory. Analysis of self-assessments and interviews indicates that for early-career engineers, there is a strong emphasis on personal and basic cognitive competencies. For mid-level engineers, the data show a significant valuation of social competencies. Senior engineers are perceived as having accumulated experience across all seven mapped dimensions. This study offers a practical model that can be used by educational institutions, companies, and professionals to align education, market demands, and career planning. Full article

Chronic obstructive pulmonary disease (COPD) is a heterogeneous syndrome with multiple clinical and inflammatory phenotypes. The coexistence of bronchiectasis, known as bronchiectasis–COPD overlap (BCO), identifies a subgroup with increased morbidity and mortality. Non-invasive breath analysis using electronic noses (e-noses) has shown promise in identifying disease-specific volatile organic compound (VOC) patterns (“breathprints”). Our aim was to evaluate the ability of an e-nose to differentiate between COPD and BCO patients, and to assess its utility in detecting inflammatory endotypes (neutrophilic vs. eosinophilic). In a monocentric, prospective, real-life study, 98 patients were enrolled over nine months. Forty-two patients had radiologically confirmed BCO, while fifty-six had COPD without bronchiectasis. Exhaled breath samples were analyzed using the Cyranose 320 e-nose. Principal component analysis (PCA) and discriminant analysis were used to identify group-specific breathprints and inflammatory profiles. PCA revealed significant breathprint differences between BCO and COPD (p = 0.021). Discriminant analysis yielded an overall accuracy of 69.6% (AUC 0.768, p = 0.037). The highest classification performance (76.8%) was achieved when distinguishing eosinophilic COPD from neutrophilic BCO. These findings suggest distinct inflammatory profiles that may be captured non-invasively. E-nose technology holds potential for the non-invasive endotyping of COPD, especially in identifying neutrophilic BCO as a unique inflammatory entity. Breathomics may support early, personalized treatment strategies. Full article

Self-regulatory foraging behavior in honey bees (Apis mellifera) was investigated using the framework of Perceptual Control Theory (PCT). We developed a PCT-based model to describe how bees maintain goal-directed behavior, specifically targeting a sucrose-rich feeding site while overcoming a wind disturbance. In a controlled experiment, we found that 13 of 14 bees could successfully adjust their flight paths to overcome the disturbance and consistently reach the feeding target. While they demonstrated a great deal of individual variability regarding how they overcame the wind across experimental trials, they did so by finally adopting a headwind (i.e., flying into the wind) approach pattern rather than tailwind or crosswind approach patterns. These results support the application of PCT to the study of behavior in honey bees, which can be regarded as self-regulative (i.e., non-linear and dynamic) rather than as linear sequences of inputs and outputs. Given that such dynamic models are concerned with the functions or purposes of behavior, they may also be classified as teleonomic. Full article

Supporting dementia carers is a global priority. As a Randomised Controlled Trial (RCT) (n = 352) of the Word Health Organization recommended, an internationally disseminated ‘iSupport’ e-health intervention was conducted, revealing no measurable benefits to the wellbeing of adult dementia carers. This process evaluation contributes original insights of the trial outcomes. Its aims were to ascertain the usability and acceptability of iSupport, participant engagement and adherence to iSupport, and contextual factors influencing its implementation and potential impact. The process evaluation followed a mixed-method design. The following data were collected from all participants randomised to iSupport (n = 175): (1) post-intervention evaluation questionnaire (n = 93) containing the 10-item System Usability Scale and bespoke items exploring acceptability, engagement, and perceived impact; (2) qualitative interviews (n = 52) with a sub-sample of participants who were purposively sampled according to age, scores on the outcome measures, and gender, as these interviews aimed to generate contextual detail and explanatory accounts; and (3) ‘Access’ data from the iSupport platform (n = 175). Descriptive statistics was used to report on the frequency of survey responses whilst a thematic analysis approach was followed to identify themes from the qualitative interview data. Data sets were analysed independently and then used with respect to one another in order to generate explanatory pathways related to the usability, acceptability, and the impact of iSupport. Despite good trial retention, 8.3% of participants (n = 32) did not spend any time on iSupport, and 54% (n = 94) spent between 30 min and 1.5 h. Factors driving this were the following: time constrains, method of delivery, and content characteristics. Positive impacts of iSupport were also described. Participants, including those with extensive caring experience, reported how iSupport had made them feel reassured, valued, and more able to ask for help. They also reported having an improved outlook on their caring role and on the needs and feelings of the person living with dementia. Research and practice should focus on exploring blended delivery, including self-directed and interactive components, such as regular contact with a health professional. These insights are critical for supporting the global implementation and adaptation of iSupport and offer valuable directions for future research. Full article

Background and Clinical Significance: Many women use pessaries to manage their symptoms of pelvic organ prolapse. Hydroxyquinoline is the active ingredient in gels and ointments that are often used to lubricate a pessary prior to vaginal insertion and to provide antimicrobial effects while the pessary is in situ. Case Presentation: A 74-year-old woman with multiple medication allergies develops vulvovaginal erythema and pruritus after increasing vaginal Trimo-San application frequency for pessary care and maintenance. These symptoms are deemed to be consistent with an allergic reaction to hydroxyquinoline, the active ingredient in Trimo-San. Conclusions: This report highlights the importance of personalized treatment in pessary management. It also demonstrates how personalized medicine can optimize outcomes and improve treatment adherence among individuals with complex medical histories. Full article

Immune organoids have emerged as a ground-breaking platform in immunology, offering a physiologically relevant and controllable environment to model human immune responses and evaluate immunotherapeutic strategies. Derived from stem cells or primary tissues, these three-dimensional constructs recapitulate key aspects of lymphoid tissue architecture, cellular diversity, and functional dynamics, providing a more accurate alternative to traditional two-dimensional cultures and animal models. Their ability to mimic complex immune microenvironments has positioned immune organoids at the forefront of cancer immunotherapy development, autoimmune disease modeling, and personalized medicine. This narrative review highlights the advances in immune organoid technology, with a focus on their applications in testing immunotherapies, such as checkpoint inhibitors, CAR-T cells, and cancer vaccines. It also explores how immune organoids facilitate the study of autoimmune disease pathogenesis with insights into their molecular basis and support in high-throughput drug screening. Despite their transformative potential, immune organoids face significant challenges, including the replication of systemic immune interactions, standardization of fabrication protocols, scalability limitations, biological heterogeneity, and the absence of vascularization, which restricts organoid size and maturation. Future directions emphasize the integration of immune organoids with multi-organ systems to better replicate systemic physiology, the development of advanced biomaterials that closely mimic lymphoid extracellular matrices, the incorporation of artificial intelligence (AI) to optimize organoid production and data analysis, and the rigorous clinical validation of organoid-derived findings. Continued innovation and interdisciplinary collaboration will be essential to overcome existing barriers, enabling the widespread adoption of immune organoids as indispensable tools for advancing immunotherapy, vaccine development, and precision medicine. Full article

Neuroendocrine neoplasms (NENs) of the lung are a biologically and clinically diverse group of tumors that includes well-differentiated typical and atypical carcinoids (LNETs), as well as poorly differentiated large-cell neuroendocrine carcinoma and small-cell lung cancer. Despite their relative rarity, the incidence of LNETs is increasing, primarily due to advancements in diagnostic techniques and heightened clinical awareness. While the current World Health Organization (WHO) classification offers a morphological basis for diagnosis and prognosis, particularly for extrapulmonary neuroendocrine neoplasms (ep-NENs), it has limitations in predicting the clinical behavior of pulmonary carcinoids. Recent evidence highlights the inadequacy of traditional criteria in fully capturing the biological complexity and clinical heterogeneity of these tumors. This review explores the evolving landscape of LNETs, focusing on well-differentiated forms and analyzing current classification systems, clinicopathological features, and the emerging role of novel prognostic and predictive biomarkers. Advances in histopathology and molecular profiling have begun to elucidate distinct molecular subsets within carcinoids, offering potential avenues for improved risk stratification and therapeutic decision-making. Although there are limited treatment options for advanced disease, new insights into tumor biology could facilitate the development of personalized therapeutic strategies and pave the way for future innovations in LNET management. Full article

Background: Adherence to current clinical guidelines is crucial for ensuring optimal therapy in patients with heart failure (HF). This study aims to explore how cardiologists, as specialists in heart failure, approach the clinical scenarios encountered in the management of HF patients, in line with the recommended guidelines. A heart failure-focused meeting was organized, during which participating cardiologists engaged actively. During HF meetings in which cardiologists participated, 108 questionnaires were distributed electronically. In total, 57 men and 51 women expressed their opinions regarding the Delphi analysis. Results: A strong consensus on the benefits of beta-blockers in improving prognoses for, and reducing mortality in, patients with HF and reduced systolic function emerged. The majority of cardiologists continue to prefer intravenous therapy with continuous loop-diuretic administration in combination with thiazide diuretics. The use of metolazone elicits fewer preferences, probably due to concerns about side effects. Certainly, SGLT2i is useful in reducing hospitalizations and reducing congestion; however, there is no full consensus on whether MRAi should be discontinued in favor of SGLT2i alone. The majority of participants would discontinue MRAs in the presence of hyperkalemia and worsening renal function, maintaining sacubitril/valsartan, and indicating a priority for renal safety. There was near-unanimous agreement on the early initiation of sacubitril/valsartan after the stabilization of patients hospitalized for heart failure. Conclusions: A significant majority (97%) of cardiologists expressed a preference for utilizing all of the guideline-recommended drug classes in the management of heart failure, even if this meant not always reaching the maximum tolerated dose for each medication. This approach underscores the importance of comprehensive therapy, targeting multiple pathophysiological mechanisms in heart failure. Cardiologists emphasized that while achieving optimal dosing is ideal, flexibility in treatment regimens is often necessary to accommodate individual patient characteristics, tolerance, and clinical status. The findings highlight the need for personalized treatment strategies that align with current guidelines, while also recognizing the challenges and variability in patient responses to therapy. Full article

Although the detrimental effects of exploitative leadership have been widely revealed, scholarly understanding of its formation mechanisms remains insufficient. Addressing this gap, the present study draws upon trait activation theory to investigate the antecedents and formation mechanisms of exploitative leadership through the dual lenses of personality traits and organizational contexts. Through an empirical examination of questionnaire data from 422 leader–subordinate dyads in Chinese organizations, the results of this study reveal that: three leader personality traits—self-interest, other-oriented perfectionism, and high power distance orientation—significantly and positively predict exploitative leadership behaviors; three organizational contexts—task challenge, flexible status conferral, and leader–subordinate goal misalignment—likewise serve as positive predictors of exploitative leadership behaviors; through trait activation effects, flexible status conferral significantly strengthens the positive relationships between all three personality traits and exploitative leadership, while task challenge and goal misalignment specifically amplify the positive relationships of exploitative leadership with high power distance orientation and self-interested personality, respectively. The research findings are of great value for improving the theoretical framework of exploitative leadership and guiding management practice. Full article

Background: The U.S. Medicare Annual Wellness Visit (AWV) offers a structured opportunity for cognitive screening and personalized prevention planning among older adults. Yet, implementation of AWVs, particularly for individuals with cognitive impairment, remains inconsistent across primary care or other diverse care settings. Methods: We conducted a scoping review using the Consolidated Framework for Implementation Research (CFIR) to explore multilevel factors influencing the implementation of the Medicare AWV’s cognitive screening component, with a focus on how these processes support the detection and management of cognitive impairment among older adults. We searched four databases and screened peer-reviewed studies published between 2011 and March 2025. Searches were conducted in Ovid MEDLINE, PubMed, EBSCOhost, and CINAHL databases. The initial search was completed on 3 January 2024 and updated monthly through 30 March 2025. All retrieved citations were imported into EndNote 21, where duplicates were removed. We screened titles and abstracts for relevance using the predefined inclusion criteria. Full-text articles were then reviewed and scored as either relevant (1) or not relevant (0). Discrepancies were resolved through consensus discussions. To assess the methodological quality of the included studies, we used the Joanna Briggs Institute critical appraisal tools appropriate to each study design. These tools evaluate rigor, trustworthiness, relevance, and risk of bias. We extracted the following data from each included study: Author(s), year, title, and journal; Study type and design; Data collection methods and setting; Sample size and population characteristics; Outcome measures; Intervention details (AWV delivery context); and Reported facilitators, barriers, and outcomes related to AWV implementation. The first two authors independently coded and synthesized all relevant data using a table created in Microsoft Excel. The CFIR guided our data analysis, thematizing our findings into facilitators and barriers across its five domains, viz: (1) Intervention Characteristics, (2) Outer Setting, (3) Inner Setting, (4) Characteristics of Individuals, and (5) Implementation Process. Results: Among 19 included studies, most used quantitative designs and secondary data. Our CFIR-based synthesis revealed that AWV implementation is shaped by interdependent factors across five domains. Key facilitators included AWV adaptability, Electronic Health Record (EHR) integration, team-based workflows, policy alignment (e.g., Accountable Care Organization participation), and provider confidence. Barriers included vague Centers for Medicare and Medicaid Services (CMS) guidance, limited reimbursement, staffing shortages, workflow misalignment, and provider discomfort with cognitive screening. Implementation strategies were often poorly defined or inconsistently applied. Conclusions: Effective AWV delivery for older adults with cognitive impairment requires more than sound policy and intervention design; it demands organizational readiness, structured implementation, and engaged providers. Tailored training, leadership support, and integrated infrastructure are essential. These insights are relevant not only for U.S. Medicare but also for global efforts to integrate dementia-sensitive care into primary health systems. Our study has a few limitations that should be acknowledged. First, our scoping review synthesized findings predominantly from quantitative studies, with only two mixed-method studies and no studies using strictly qualitative methodologies. Second, few studies disaggregated findings by race, ethnicity, or geography, reducing our ability to assess equity-related outcomes. Moreover, few studies provided sufficient detail on the specific cognitive screening instruments used or on the scope and delivery of educational materials for patients and caregivers, limiting generalizability and implementation insights. Third, grey literature and non-peer-reviewed sources were not included. Fourth, although CFIR provided a comprehensive analytic structure, some studies did not explicitly fit in with our implementation frameworks, which required subjective mapping of findings to CFIR domains and may have introduced classification bias. Additionally, although our review did not quantitatively stratify findings by year, we observed that studies from more recent years were more likely to emphasize implementation facilitators (e.g., use of templates, workflow integration), whereas earlier studies often highlighted systemic barriers such as time constraints and provider unfamiliarity with AWV components. Finally, while our review focused specifically on AWV implementation in the United States, we recognize the value of comparative analysis with international contexts. This work was supported by a grant from the National Institute on Aging, National Institutes of Health (Grant No. 1R01AG083102-01; PIs: Tzeng, Kuo, & Raji). Full article

Introduction: Tacrolimus is a cornerstone immunosuppressant in kidney transplantation (KT), but its narrow therapeutic index necessitates precise monitoring. Early post-transplant tacrolimus trough concentrations (C0) are critical, as suboptimal levels can increase rejection and infection risks. This study evaluated the impact of C0 levels at discharge on early post-transplant outcomes in a large Korean cohort. Materials and Methods: This retrospective analysis included 5293 KT recipients from the Korean Organ Transplant Registry (KOTRY) who received a kidney transplant between 2014 and 2019. Recipients were categorized into three groups based on C0 levels at discharge: <5.9 ng/mL, 5.9–9.5 ng/mL, and >9.5 ng/mL. Clinical outcomes, including serum creatinine (sCr), biopsy-proven acute rejection (BPAR), and infections requiring hospitalization, were analyzed using the Kruskal–Wallis test and chi-squared test. Results: The BPAR rates were 22.5%, 20.9%, and 21.5% for the low, middle, and high C0 groups, respectively (p = 0.221). However, the incidence of infections requiring hospitalization was significantly higher in the high C0 group (28.1%) compared to the middle (23.9%) and low (21.7%) groups at 1-year follow-up (p < 0.001). In high-risk recipients, lower C0 levels correlated with increased BPAR rates (33.9% vs. 29.1% and 26.4%, p = 0.030). Higher intrapatient variability (IPV) between discharge and 6 months was linked to higher infection risk in all recipients and increased BPAR and infection risk in high-risk patients. Conclusions: Optimal C0 levels at discharge are essential to balance rejection and infection risks in KT. Lower C0 levels and higher IPV increase the risk of adverse outcomes, especially in high-risk sensitized recipients, underscoring the need for careful monitoring and personalized management. Full article

The increasing use of Arabic and Urdu on social media platforms, particularly Twitter, has created a growing need for robust Named Entity Recognition (NER) systems capable of handling noisy, informal, and code-mixed content. However, both languages remain significantly underrepresented in NER research, especially in social media contexts. To address this gap, this study makes four key contributions: (1) We introduced a manual entity consolidation step to enhance the consistency and accuracy of named entity annotations. In the original datasets, entities such as person names and organization names were often split into multiple tokens (e.g., first name and last name labeled separately). We manually refined the annotations to merge these segments into unified entities, ensuring improved coherence for both training and evaluation. (2) We selected two publicly available datasets from GitHub—one in Arabic and one in Urdu—and applied two novel strategies to tackle low-resource challenges: a joint multilingual approach and a translation-based approach. The joint approach involved merging both datasets to create a unified multilingual corpus, while the translation-based approach utilized automatic translation to generate cross-lingual datasets, enhancing linguistic diversity and model generalizability. (3) We presented a comprehensive and reproducible pseudocode-driven framework that integrates translation, manual refinement, dataset merging, preprocessing, and multilingual model fine-tuning. (4) We designed, implemented, and evaluated a customized XLM-RoBERTa model integrated with a novel attention mechanism, specifically optimized for the morphological and syntactic complexities of Arabic and Urdu. Based on the experiments, our proposed model (XLM-RoBERTa) achieves 0.98 accuracy across Arabic, Urdu, and multilingual datasets. While it shows a 7–8% improvement over traditional baselines (RF), it also achieves a 2.08% improvement over a deep learning (BiLSTM = 0.96), highlighting the effectiveness of our cross-lingual, resource-efficient approach for NER in low-resource, code-mixed social media text. Full article

Septic shock is a life-threatening complication of sepsis, particularly in patients with hematologic diseases who are highly susceptible to it due to profound immune dysregulation. Recent advances in artificial intelligence offer promising tools for improving septic shock diagnosis, prognosis, and treatment in this vulnerable population. In detail, these innovative models analyzing electronic health records, immune function, and real-time physiological data have demonstrated superior performance compared to traditional scoring systems such as Sequential Organ Failure Assessment. In patients with hematologic malignancies, machine learning approaches have shown strong accuracy in predicting the sepsis risk using biomarkers like lactate and red cell distribution width, the latter emerging as a powerful, cost-effective predictor of mortality. Deep reinforcement learning has enabled the dynamic modelling of immune responses, facilitating the design of personalized treatment regimens helpful in reducing simulated mortality. Additionally, algorithms driven by artificial intelligence can optimize fluid and vasopressor management, corticosteroid use, and infection risk. However, challenges related to data quality, transparency, and ethical concerns must be addressed to ensure their safe integration into clinical practice. Clinically, AI could enable earlier detection of septic shock, better patient triage, and tailored therapies, potentially lowering mortality and the number of ICU admissions. However, risks like misclassification and bias demand rigorous validation and oversight. A multidisciplinary approach is crucial to ensure that AI tools are implemented responsibly, with patient-centered outcomes and safety as primary goals. Overall, artificial intelligence holds transformative potential in managing septic shock among hematologic patients by enabling timely, individualized interventions, reducing overtreatment, and improving survival in this high-risk group of patients. Full article

In the context of digital transformation and Industry 4.0, the engineering profession is evolving rapidly, demanding new skill sets to maintain employability and support career development. This study identifies the competencies engineers must acquire to meet these challenges, addressing concerns from employers who perceive graduates as underprepared for real-world demands. A systematic literature review was conducted in accordance with PRISMA guidelines, using the Methodi Ordinatio technique to select and rank 59 peer-reviewed articles published between 2014 and 2024. The review identified 47 key competencies, which were organized into a comprehensive framework of seven dimensions: 4 transversal, 9 social, 15 personal, 4 cognitive, 7 digital, 3 green, and 5 technical skills. The results highlight that, while technical expertise remains essential, soft skills—such as leadership, teamwork, communication, and adaptability—are increasingly critical for success in the digital era. The proposed framework offers insights for curriculum development, corporate training, and policymaking, contributing to aligning education and professional development with the evolving demands of Industry 4.0. Future research will focus on the empirical validation of the framework to reinforce its applicability across academic and professional settings. Full article