Search Results (4,485)

The increasing cultural and demographic diversity among higher education students highlights the challenges regarding accessibility and inclusion. The COVID-19 pandemic has accelerated the shift toward flexible, technology-based teaching practices. However, inclusive, and accessible pedagogical practices lack consistency, particularly when supporting students with disabilities or diverse learning needs. This study evaluates the effectiveness of the Learning Design for Flexible Education (FLeD) Tool—a web-based platform developed to support teachers in designing flexible and inclusive learning scenarios. The research adopts a qualitative approach, featuring semi-structured interviews with two Portuguese experts in accessibility and inclusion. The experts analyzed three learning scenarios designed using the FLeD Tool, through the lens of Universal Design for Learning standards. The collected dataset was analyzed using thematic analysis to identify common issues, strengths, and opportunities for improvement. The findings show a gap between institutional policies and their practical application, mainly due to inconsistent teacher training and technical limitations. While the FLeD Tool supports more flexible and inclusive pedagogical designs, experts have identified key shortcomings such as the lack of automated accessibility checks and limited support for specific disabilities. Despite the reduced number of participants (two experts) and dataset (three learning scenarios), which limits the study’s generalisability, the conclusions draw attention to the pivotal role of systematic teacher training, embedded accessibility features and solid institutional policies in bridging the gap between policy aspiration and effective inclusive practice. Full article

This study analyzes the strategic and institutional frameworks that precede the formulation of trade agreements, with a focus on the European Union’s external action and its link to the Sustainable Development Goals. Based on a documentary research design, this study examines official documents from the EU and the United Nations, as well as the academic literature indexed in Scopus and Web of Science. The methodological process involved four phases: systematic search, selection and classification, inductive content coding, and interpretative analysis. Through this process, this study identifies discursive patterns, normative tensions, and policy orientations that reveal the EU’s evolving approach to sustainable trade governance. The findings highlight the existence of a growing institutional alignment between trade policy and sustainable development frameworks, yet also expose persistent gaps in coherence and implementation. This article contributes to the academic debate by offering a critical and structured analytical lens to understand how trade agreements are politically and institutionally prefigured before their negotiation phase. Full article

In the context of both domestic and international economic landscapes, regional policy has emerged as an increasingly influential factor shaping the developmental trajectories of Chinese enterprises. Despite its growing significance, the extant literature lacks a comprehensive and systematically visualized synthesis that encapsulates the scope and trends of research in this domain. This study addresses this critical gap by conducting an integrative bibliometric and qualitative review of the academic output related to regional policy and Chinese firm growth. Drawing on a final dataset comprising 3428 validated academic publications—selected from an initial pool of 3604 records retrieved from the Web of Science Core Collection between 1991 and 2022, the research employs a two-stage methodological framework. In the first phase, advanced bibliometric tools, and software applications, including RStudio, Bibliometrix, VOSviewer, and CitNetExplorer, are utilized to implement techniques such as keyword co-occurrence analysis, thematic clustering, and the tracing of thematic evolution over time. These methods facilitate rigorous data cleansing, breakpoint identification, and the visualization of intellectual structures and emerging research patterns. In the second phase, a targeted qualitative review is conducted to evaluate the influence of regional policies on Chinese firms across three critical stages of business development: start-up, expansion, and maturity. The findings reveal that regional policy interventions generally exert a positive influence on firm performance throughout all stages of development. Notably, a significant concentration of citation activity occurred prior to 2017; however, post-2017, the volume of scholarly publications, journal-level impact (as measured by h-index), and author-level influence experienced a marked increase. Among the 3428 analyzed publications, a substantial portion—2259 articles—originated from Chinese academic institutions, highlighting the strong domestic research interest in the subject. Furthermore, since 2015, there has been a discernible shift in keyword co-occurrence trends, with increasing scholarly attention directed towards sustainable development issues, particularly those related to carbon dioxide emissions and green innovation, reflecting evolving policy priorities and environmental imperatives. Full article

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

This study explores whether sustainability achievements—proxied through ESG (environmental, social, and governance) reporting—are associated with superior financial performance in Latvia’s manufacturing sector, where ESG maturity remains low and institutional readiness is still emerging. Building on stakeholder, legitimacy, signal, slack resources, and agency theories, this study applies a mixed-method approach (that consists of two analytical stages) suited to the limited availability and reliability of ESG-related data in the Latvian manufacturing sector. Financial indicators from three large firms—AS MADARA COSMETICS, AS Latvijas Finieris, and AS Valmiera Glass Grupa—are compared with industry averages over the 2019–2023 period using independent sample T-tests. ESG integration is evaluated through a six-stage conceptual schema ranging from symbolic compliance to performance-driven sustainability. The results show that AS MADARA COSMETICS, which demonstrates advanced ESG integration aligned with international standards, significantly outperforms its industry in all profitability metrics. In contrast, the other two companies remain at earlier ESG maturity stages and show weaker financial performance, with sustainability disclosures limited to general statements and outdated indicators. These findings support the synergy hypothesis in contexts where sustainability is internalized and operationalized, while also highlighting structural constraints—such as resource scarcity and fragmented data—that may limit ESG-financial alignment in post-transition economies. This study offers practical guidance for firms seeking competitive advantage through strategic ESG integration and recommends policy actions to enhance ESG transparency and performance in Latvia, including performance-based reporting mandates, ESG data infrastructure, and regulatory alignment with EU directives. These insights contribute to the growing empirical literature on ESG effectiveness under constrained institutional and economic conditions. Full article

Investigating the coevolution between ecosystem services (ES) and human well-being (HWB) holds significant implications for achieving the sustainable operation of human–environment systems. However, limited research has focused on ES-HWB interactions in ecotourism-dominated counties. To address this gap, this study takes Chun’an County in Zhejiang Province, China, as a case study, with the research objective of exploring the processes, patterns, and mechanisms of the coevolution between ecosystem services (ES) and human well-being (HWB) in ecotourism-dominated counties. By integrating multi-source heterogeneous data, including land use data, the normalized difference vegetation index (NDVI), and statistical records, and employing methods such as the dynamic equivalent factor method, the PLUS model, the coupling coordination degree model, and comprehensive evaluation, we analyzed the synergistic evolution of ES-HWB in Chun’an County from 2000 to 2020. The results indicate that (1) the ecosystem service value (ESV) fluctuated between 30.15 and 36.85 billion CNY, exhibiting a spatial aggregation pattern centered on the Qiandao Lake waterbody, with distance–decay characteristics. The PLUS model confirms ecological conservation policies optimize ES patterns. (2) The HWB index surged from 0.16 to 0.8, driven by tourism-led economic growth, infrastructure investment, and institutional innovation, facilitating a paradigm shift from low to high well-being at the county level. (3) The ES-HWB interaction evolved through three phases—disordered, antagonism, and coordination—revealing tourism as a key mediator driving coupled human–environment system sustainability via a pressure–adaptation–synergy transmission mechanism. This study not only advances the understanding of ES-HWB coevolution in ecotourism-dominated counties, but also provides a transferable methodological framework for sustainable development in similar regions. Full article

Pediatric palliative care (PPC) aims to enhance the quality of life of children with life-limiting conditions and their families through individualized, interdisciplinary support. Among this population, children with neurological diseases represent a substantial and growing group, often facing prolonged disease courses, cognitive impairment, and high prognostic uncertainty. Effective communication is central to PPC; however, it remains deeply influenced by cultural, religious, and spiritual frameworks that shape family perceptions of illness, suffering, and decision-making. This narrative review explores communication strategies in PPC, with a specific focus on children with neurological conditions, highlighting conceptual foundations, cross-cultural variations, and emerging best practices. Key findings highlight the importance of culturally humble approaches, family-centered communication models, and structured tools, such as co-designed advance care planning and dignity therapy, to enhance communication. Additionally, the review highlights the presence of ethical and interdisciplinary challenges, particularly in neonatal and neurology settings, where misaligned team messaging and institutional hesitancy may compromise trust and timely referral to palliative care. Future research, policy, and clinical education priorities should advocate for models that are inclusive, ethically grounded, and tailored to the unique trajectories of neurologically ill children. Integrating cultural competence, team alignment, and family voices is essential for delivering equitable and compassionate PPC across diverse care settings. Full article

At a time when globalisation and the economic crisis have forced a reduction in public expenditure at all levels, social policy and social welfare systems’ efforts for sustainable development are focused on identifying alternative ways to provide integrated services and achieve balanced social development. Post-colonial Cyprus has experienced radical socio-political changes that have demanded rapid responses to address its needs. This paper aims to discuss the role of the Cypriot voluntary sector in the national integrated care. Within the spectrum of ensuring social rights and social justice, the voluntary sector has emerged as a key factor of social policy implementation. Through the exploration and analysis of this context, an in-depth insight is given into socio-political and economic factors, dimensions, relationships, processes, patterns, and critical junctures that, under the influence of history, have shaped the voluntary sector’s path, formed its major stages of transformation, and defined its relationship with structures and institutions. Full article

This study aims to understand the meaning nursing professionals attribute to their lived experiences of providing humanized care within a public hospital setting. Grounded in Jean Watson’s theory of human caring, the research adopts a qualitative, descriptive phenomenological design to capture the perceptions and emotions of nurses regarding humanized care. Data were collected through semi-structured interviews with nine experienced nurses, selected through purposive sampling. The interviews, conducted virtually between July and December 2024, were analyzed using Colaizzi’s method and supported by Atlas.ti software. Four main thematic categories emerged: institutional health policies, professional image and identity, strengths and challenges in care, and essential competencies for humanized care. The findings highlight the critical role of empathy, cultural sensitivity, ethical commitment, and emotional presence in delivering compassionate care. Participants emphasized that, beyond clinical procedures, humanized care requires relational and contextual sensitivity, often hindered by institutional limitations and excessive administrative burdens. The study concludes that nursing professionals are key agents in promoting ethical, empathetic, and culturally respectful practices that humanize health services. These insights offer valuable contributions for designing policies and training strategies aimed at strengthening humanized care as a cornerstone of quality healthcare systems. 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

In the context of increasing Artificial Intelligence integration in higher education, understanding the factors influencing university teachers’ adoption of AI tools is critical for effective implementation. This study adopts a perception–intention–behavior framework to explores the roles of perceived usefulness, perceived ease of use, perceived trust, perceived substitution crisis, and perceived risk in shaping teachers’ behavioral intention and actual usage of AI tools. It also investigates the moderating effects of peer influence and organizational support on these relationships. Using a comprehensive survey instrument, data was collected from 487 university teachers across four major regions in China. The results reveal that perceived usefulness and perceived ease of use are strong predictors of behavioral intention, with perceived ease of use also significantly influencing perceived usefulness. Perceived trust serves as a key mediator, enhancing the relationship between perceived usefulness, perceived ease of use, and behavioral intention. While perceived substitution crisis negatively influenced perceived trust, it showed no significant direct effect on behavioral intention, suggesting a complex relationship between job displacement concerns and AI adoption. In contrast, perceived risk was found to negatively impact behavioral intention, though it was mitigated by perceived ease of use. Peer influence significantly moderated the relationship between perceived trust and behavioral intention, highlighting the importance of peer influence in AI adoption, while organizational support amplified the effect of perceived ease of use on behavioral intention. These findings inform practical strategies such as co-developing user-centered AI tools, enhancing institutional trust through transparent governance, leveraging peer support, providing structured training and technical assistance, and advancing policy-level initiatives to guide digital transformation in universities. 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: School-based tobacco control policies are critical for preventing youth tobacco use. While many districts adopt formal policies to create smoke- and vape-free environments, the degree to which these policies are enforced at the school level may vary, influencing their effectiveness. Little is known about how consistently such policies are implemented across schools within urban school districts. Objectives: This study aimed to examine the existence and enforcement of school-level tobacco control policies in an urban public school system, using Baltimore City schools as a case example. Methods: We conducted a survey of school personnel from 20 high schools in Baltimore City in 2024. The survey instrument assessed the presence and enforcement of policies related to tobacco use prevention, communication, signage, disciplinary actions, and institutional support. Descriptive statistics (frequencies and percentages) were used to summarize responses. Spearman correlations were also used for bivariate correlations. Additional school-level and neighborhood-level contextual data were collected from the internet (neighborhood socioeconomic status and school performance). Results: While many policies existed across the 20 participating schools, their enforcement was widely inconsistent. Most schools reported the existence of policies prohibiting tobacco use in school buildings (60%) and vehicles (55%). However, few schools had visible tobacco-free signage (35%) or offered cessation programs (15%). Communication of policies to students (70%) and staff (65%) was the most commonly enforced aspect of tobacco control policies. Conclusions: Findings suggest that while tobacco control policies may be adopted across urban school systems, their enforcement at the school level remains uneven. Greater attention may be needed to support policy implementation and to reduce variability in school-level practices. Baltimore City serves as a useful case study to understand these challenges and identify opportunities for strengthening school-based tobacco prevention efforts. Full article

Water governance in Europe faces mounting challenges from climate change, demographic pressures, and aging infrastructure—especially in Southern regions increasingly affected by drought and institutional fragmentation. In contrast, Nordic countries such as Denmark and Sweden exhibit coherent, integrated governance systems with strong regulatory oversight. This study introduces the Water Governance Maturity Index (WGMI), a document-based assessment tool designed to evaluate national water governance across five dimensions: institutional capacity, operational effectiveness, environmental ambition, equity, and climate adaptation. Applying the WGMI to eight EU countries—four Nordic and four Southern—reveals a persistent North–South divide in governance maturity. Nordic countries consistently score in the “advanced” or “model” range, while Southern countries face systemic gaps in implementation, climate integration, and territorial inclusion. Based on these findings, the study offers actionable policy recommendations, including the establishment of independent regulators, strengthening of river basin coordination, mainstreaming of climate-water strategies, and expansion of affordability and participation mechanisms. By translating complex governance principles into measurable indicators, the WGMI provides a practical tool for benchmarking reform progress and supporting the EU’s broader agenda for just resilience and climate adaptation. Unlike broader frameworks like SDG 6.5.1, the WGMI’s document-based, dimension-specific approach provides granular, actionable insights for governance reform, enhancing its utility for EU and global policymakers. Full article

This article investigates the macroeconomic and labor market conditions that shape the adoption of artificial intelligence (AI) technologies among large firms in Europe. Based on panel data econometrics and supervised machine learning techniques, we estimate how public health spending, access to credit, export activity, gross capital formation, inflation, openness to trade, and labor market structure influence the share of firms that adopt at least one AI technology. The research covers all 28 EU members between 2018 and 2023. We employ a set of robustness checks using a combination of fixed-effects, random-effects, and dynamic panel data specifications supported by Clustering and supervised learning techniques. We find that AI adoption is linked to higher GDP per capita, healthcare spending, inflation, and openness to trade but lower levels of credit, exports, and capital formation. Labor markets with higher proportions of salaried work, service occupations, and self-employment are linked to AI diffusion, while unemployment and vulnerable work are detractors. Cluster analysis identifies groups of EU members with similar adoption patterns that are usually underpinned by stronger economic and institutional fundamentals. The results collectively suggest that AI diffusion is shaped not only by technological preparedness and capabilities to invest but by inclusive macroeconomic conditions and equitable labor institutions. Targeted policy measures can accelerate the equitable adoption of AI technologies within the European industrial economy. Full article