Search Results (38,973)

Background: Breakpoints in the pre-examination processes and at organizational interfaces are a significant source of failures in specimen identification and tracking in anatomic pathology. While ISO 15189 emphasizes end-to-end traceability and risk-based quality management, implementing these principles in complex, multi-actor specimen pathways remains challenging. This study explores expert perspectives on specimen process chains, tracking mechanisms, and ISO 15189-oriented quality and risk management in pathology. Methods: We conducted 10 semi-structured expert interviews across three settings. Interviews were audio-recorded, transcribed, pseudonymized, and analyzed using structured qualitative content analysis (Mayring) supported by MAXQDA. A deductive category system derived from the theoretical framework and interview guide comprised six main categories and twelve subcategories. Results: Across 512 coded text segments, participants identified several factors as critical for effective implementation, including: (i) interface management along the specimen pathway, with recurrent vulnerabilities at handovers between operating theater/ward/transport and accessioning; (ii) the central role of barcode-based identification and the need for closed-loop traceability; (iii) the importance of measurable quality indicators and incident learning systems to operationalize risk management; (iv) persistent paper–digital handoffs and heterogeneous IT landscapes that undermine data integrity; (v) the need for clearly assigned responsibilities, training, and SOP governance; and (vi) implementation barriers including resources, change management, and vendor integration, alongside practical enablers such as incremental roll-out and cross-professional governance. Conclusions: Experts converge on a pragmatic ISO 15189-aligned roadmap: prioritize interface risks, standardize identifiers and handover rules, define a minimal KPI set for tracking and misidentification events, and reduce paper–digital handoffs by interoperable IT. Future work should quantify baseline error rates and evaluate the impact of digital tracking interventions on patient safety and turnaround times. Full article

Background/Objectives: This study aimed to explore perceived changes in the eating behavior of children with overweight and obesity following a nutritional intervention, considering the perspectives of children and their families participating in a specialized health promotion program. Methods: This qualitative study included five children aged 7 to 12 years and four family members enrolled in the ProSaúde Kids Program in southern Brazil. The study comprised three stages: initial semi-structured interviews; nine interactive nutritional workshops conducted from July to November 2024 with active family participation; and final interviews after the intervention. Recordings were transcribed and analyzed in ATLAS.TI^® using the collective subject discourse approach, guided by Bronfenbrenner’s Ecological Systems Theory. Results: The intervention was associated with reported changes in perceptions and eating practices. Families described greater involvement of children in food decisions, perceived reductions in consumption of ultra-processed foods, and reported reorganization of eating routines. Children expressed increased critical awareness of food-related media content and greater appreciation of body diversity. Improvements in the quality of homemade school snacks suggested meaningful family engagement, even in the absence of direct school involvement. Conclusions: The workshops were described as encouraging reflection and supporting changes in attitudes and practices. Overall, the findings indicate potential positive shifts in eating behavior, greater awareness of food choices, and enhanced family participation in the behavior-change process. Full article

Illegal artisanal and small-scale mining (galamsey) and climate stress jointly degrade ecosystems and livelihoods in Ghana. This paper demonstrates how community-driven governance can realign incentives toward environmental stewardship and inclusive livelihoods. Using an explanatory sequential mixed-methods design—quantitative difference-in-differences followed by qualitative case analysis and Participatory Action Research—we evaluate a structured program combining vocational training, financial literacy, environmental stewardship, and governance alignment. We operationalize Environmental, Social, and Governance (ESG) outcomes via transparent composite indices and triangulate survey, administrative, and focus group evidence. The study identifies conditions under which alternative livelihoods reduce participation in illegal mining, strengthen women’s economic agency, and improve adoption of climate-smart practices. Implications include practical guidance for program design (community delivery, matched incentives, oversight), policy (local climate finance and accountability mechanisms), and research (scalable indicators and rigorous impact evaluation in resource-dependent communities). Full article

Staphylococcus epidermidis (S. epidermidis) poses a significant clinical challenge, particularly in the context of biofilm-associated infections, with increasing antibiotic resistance further complicating infection eradication. In the present study, the effects of cinnamic acid and its derivatives (ferulic acid, p-coumaric acid, and sinapic acid), alone and in combination with the β-lactam antibiotic cloxacillin, on biofilm formation by a single methicillin-resistant S. epidermidis (MRSE) clinical strain were explored. The expression of the biofilm-associated icaADBC operon genes and the icaR repressor gene was assessed using Real-Time PCR as an exploratory analysis under sub-minimal inhibitory concentrations (sub-MICs) of the tested compounds. Furthermore, confocal microscopy was used to qualitatively assess selected structural changes in the biofilm. Their occurrence was demonstrated depending on the fractional inhibitory concentration (FIC) levels used. The results revealed variable and nonlinear patterns of gene expression in response to the tested concentrations. Additionally, compound-dependent differences in anti-biofilm-related responses were observed. Overall, the findings provide insight into the potential influence of cinnamic acid derivatives combined with cloxacillin on biofilm-associated processes in S. epidermidis. Full article

Background: Pediatric adenotonsillectomy is commonly performed for infectious and obstructive indications, but postoperative hemorrhage remains a concern. This study describes outcomes from a high-volume territorial network in southern Modena province, Italy. Methods: Retrospective observational study of 10,753 pediatric patients (aged 3–18 years) undergoing adenotonsillectomy at Sassuolo Hospital and affiliates (Vignola, Pavullo) from 2005 to 2024. Indications included recurrent tonsillitis (Paradise criteria), obstructive sleep apnea (OSA) (polysomnography-confirmed or clinical), and recurrent otitis media or otitis media with effusion (OME). Surgical techniques included curettage adenoidectomy and Colorado microdissection needle tonsillectomy. Our institutional postoperative care protocol included analgesics, oral hydration, soft diet, antibiotics (amoxicillin) and scheduled follow-up; however, no analysis regarding this protocol was intended to demonstrate correlations with study outcomes. Primary outcomes were postoperative hemorrhage (overall and requiring revision), stratified by indication, age, and technique, and contextualized against ranges reported in large published cohorts (qualitative, exploratory comparison). Secondary outcomes included pain (VAS scores), infection rates, and tissue regrowth. Data completeness was verified via electronic records (95.6%). Statistical analyses used descriptive statistics with 95% confidence intervals (95% CI) and inferential tests for within-cohort comparisons (χ² tests, Fisher’s exact test, and t-tests where appropriate). Results: A total of 10,753 procedures were analyzed (4325 tonsillectomies, 3942 adenotonsillectomies, 2486 adenoidectomies). Postoperative hemorrhage occurred in 202 patients (1.88%; 95% CI 1.64–2.15%); surgical revision was required in 75 (0.70%; 95% CI 0.56–0.87%), with multifactorial stratification showing higher risk for infectious indications (OR 1.41 vs. OSA), younger age < 5 years (OR 2.1), and tonsillectomy origin (OR 8.25 vs. adenoidectomy); all rates are at the lower end of literature ranges (2–5% and 0.9–2.5%, respectively), in line with large published cohorts, although these comparisons are qualitative and exploratory. Mean VAS pain scores decreased from 3.2 (day 1) to 1.1 (day 7). No significant infections occurred; tissue regrowth rates aligned with the literature (adenoidal 6–26%, tonsillar 5–10%). Conclusions: Sassuolo Hospital’s experience highlights favorable postoperative outcomes and low complication rates in adenotonsillar surgery. Limitations include the retrospective design, potential selection bias and long period evaluation. Prospective studies are needed to confirm these findings. Full article

Understanding and developing habits in complex systems thinking using STEM-integrated perspectives is essential in addressing education and workforce needs in society. In this study, we investigated a learning intervention that incorporated multiple models designed to improve engineering students’ understanding of complex systems through investigating the mechanobiology of the Venus flytrap. Mechanobiology is a transdisciplinary field that integrates biology, engineering, chemistry, and physics to explore how cells and tissues sense and respond to forces in their environment. We used an exploratory, mixed-methods approach to examine the impact of this new curriculum on investigating flytrap closure and prey digestion. We then evaluated students’ understanding of complex systems characteristics (i.e., many interacting parts, decentralization, non-linear interactions, emergence, and adaptation) and in their ability to transfer these principles to other systems. Qualitative analyses demonstrate that students articulated key systems principles in relation to their understanding of flytrap mechanobiology, while descriptive summaries of pre- and post-surveys suggest broader conceptual gains. Furthermore, students demonstrated the transfer of systems thinking to other contexts and reported an enhanced understanding of real-world STEM research. Full article

Background: Partial ceramic veneers in the esthetic zone are a novel, conservative alternative to traditional veneer preparations intended to preserve maximum tooth structure. This narrative review summarizes the available clinical case reports on partial ceramic veneers and includes a case illustration demonstrating a step-by-step approach to closing a space between the maxillary left lateral incisor and canine. Methods: The review synthesizes the limited case-report evidence, focusing on patient selection, treatment planning, and clinical execution. The case illustration details each step, including a diagnostic digital wax-up to preview the proposed outcome and a minimally invasive preparation limited to rounding sharp areas and optimizing the path of insertion. Results: Published reports emphasize that careful case selection and a well-executed plan are essential. In the case illustration, hand-crafted partial veneers achieved a natural appearance, with a high esthetic outcome confirmed using the White Esthetic Score (WES) system. Conclusions: Although evidence remains limited, partial ceramic veneers can be predictable in appropriately selected cases. More long-term clinical data are needed, and the case illustration may help guide early-career clinicians. The case illustration is limited in that it does not provide quantifiable outcomes like in vitro studies; however, qualitatively, it fulfilled the patient’s esthetic and functional demands. Full article

Background: Protein A resins are indispensable for monoclonal antibody (mAb) production, yet their condition and performance are traditionally assessed using indirect or qualitative methods. In this study, the multi-attribute method (MAM), previously applied to therapeutic protein characterization, is systematically adapted for the first time as a unified liquid chromatography–mass spectrometry (LC-MS) platform for Protein A resin analysis. Method: Four Cytiva Protein A resins, MabSelect™, MabSelect SuRe™, MabSelect SuRe™ LX, and MabSelect™ PrismA, were evaluated by MAM for resin identity, Protein A ligand integrity, fouling by impurities, and cleaning performance. Results: MAM enables resin-specific peptide fingerprinting and quantitative monitoring of Protein A ligand post-translational modifications (PTMs), including deamidation, isomerization, and fragmentation induced by repeated clean-in-place (CIP) cycles. Comparative analysis of virgin and used resins revealed ligand degradation and fouling despite engineered alkaline stability, with MabSelect™ showing the greatest susceptibility. Importantly, residual monoclonal antibodies (mAbs) and host cell proteins (HCPs) were directly detected and quantified from the resin matrix, providing a molecular-level assessment of resin cleaning effectiveness not achievable with conventional approaches. Conclusions: This work establishes MAM as a novel, sensitive, and comprehensive strategy for Protein A resin lifecycle management, delivering actionable insight for resin selection, cleaning optimization, and downstream process development. Full article

Visual arts education (VAE) offers a promising pedagogical space for addressing sustainability challenges by engaging the cognitive, emotional, and ethical dimensions of learning. This study examines how engagement with contemporary visual arts and art-based pedagogical practices can foster ecological thinking, ecological literacy, and sustainability awareness among pre-service teachers. The research was conducted over one academic year (2022/2023) within two visual arts courses attended by a total of 69 second- and third-year students enrolled in a teacher education programme. Using a qualitative, interpretative research design, the study investigated how selected contemporary artworks addressing ecological themes were pedagogically contextualised and discussed, and how students engaged with these artworks through dialogue, reflection, and their own art-making processes. Data were collected from students’ written reflections, group discussions, and visual works, and analysed using an interpretative framework informed by visual hermeneutics and sustainability education discourse. The findings indicate that engagement with contemporary visual art can foster the development of ecological literacy by enabling students to integrate experiential, affective, reflective, and relational dimensions of sustainability into their understanding of environmental issues. In line with the objectives of SDG 4 (Quality Education), SDG 12 (Responsible Consumption and Production), and SDG 13 (Climate Action), the study contributes to existing literature by demonstrating the pedagogical potential of visual arts education within teacher education and Education for Sustainable Development. Full article

A novel approach for detecting preliminary signals designating upcoming entrance of a loaded system to the critical stage of impending fracture is assessed. The approach is based on the analysis of a time series of the cumulative number of acoustic events, the amplitude of which exceeds the respective average value of all the events recorded during loading. Using the “sliding window” technique, the average slope of the evolution of this time series is quantified, either against conventional or natural time (the latter provides a more detailed view of the stage before macroscopic fracture, during which the “information” gathered is very densely packed in a short interval). For the needs of this study, data from a previously published experimental protocol are exploited. The protocol comprised notched, beam-shaped specimens, made of either plain or fiber-reinforced concrete, under three-point bending. It is concluded that the slope of the evolution of the above time series systematically attains a value equal to unity slightly before the applied load attains its peak value. The results of the present analysis are in qualitative agreement with the respective ones based on either the instantaneous frequency of generation of acoustic events or the Euclidean distance between the sources of acoustic signals. Full article

As robotaxis transition from technological validation to commercial operation, converting first-time tryers into long-term users becomes pivotal for achieving sustainable development. Existing research mainly examines factors affecting initial adoption intention for robotaxis from a net-effect perspective, yet little is known about the factors affecting continuance intention and their nonlinear causal mechanisms. This study integrates the Expectation–Confirmation Model (ECM) and the Unified Theory of Acceptance and Use of Technology (UTAUT) to construct a systematic analytical framework and employs fuzzy-set Qualitative Comparative Analysis (fsQCA) for configurational analysis. Using survey data from 327 users in China with actual robotaxi experiences, the findings unveil four factor configurations driving high continuance intention and two causing non-high continuance intention. Regarding the interplay of factors driving high continuance intention, post-usage usefulness, satisfaction, and perceived safety constitute a complementary mechanism, whereas expectation confirmation and personal innovativeness form a substitutive mechanism that depends on the specific patterns of factor configurations. This study contributes to the robotaxi adoption literature by extending the research context to the post-adoption phase, developing a tailored theoretical framework, and applying a configurational approach rooted in complex systems analysis paradigms. The findings offer implications for governments to formulate synergistic policy mixes and for robotaxi companies to design user retention strategies. Full article

Spatial light field metrics, such as cylindrical illuminance, provide essential information for qualitative lighting evaluation, yet they remain far less common in practice than horizontal illuminance. To address this gap, we present a multi-sensor prototype that simultaneously measures horizontal illuminance E_h and approximates mean cylindrical illuminance E_z from a set of vertical illuminances uniformly distributed around a cylindrical surface. The device uses a flexible PCB wrapped around a support barrel, along with an inertial and magnetic measurement unit for orientation tracking. The measurements enable direct calculation of the modelling factor defined in the technical standard EN 12 464 and the visualization of the directional light distribution using polar plots and an illuminance solid. Results show that the prototype approximates mean cylindrical illuminance with high accuracy while preserving directional information, allowing the illuminance solid to be decomposed into vector and symmetric components. Compared with conventional approximation methods, the proposed multi-sensor approach reduces spatial error and yields richer data for lighting analysis. These findings indicate that multi-sensor systems can bridge the gap between theoretical spatial metrics and practical photometry and support the improved modelling evaluation and integration of qualitative lighting parameters into routine workflows. Full article

This exploratory study explores the preparedness and response strategies of tourism businesses to climate change through an in-depth qualitative analysis. Using open-ended questionnaires, we collected detailed narratives from a diverse range of tourism businesses, allowing respondents to express their perceptions, strategies and challenges in their own words. Thematic analysis of the data revealed a wide variation in how businesses understand and respond to climate risks. While most participants acknowledged climate change as a critical issue, many reported significant barriers, such as financial constraints and lack of expertise, which hindered their ability to implement meaningful strategies. Key themes that emerged from the data include the role of external support in overcoming financial and technical challenges, the diversity of mitigation strategies adopted and the gap between climate awareness and practical action. This study pinpoints the need for tailored interventions to support small- and medium-sized enterprises (SMEs) in the tourism sector, highlighting the complexity of translating climate change awareness into tangible business practices. The findings contribute to the growing discourse on sustainable tourism by offering an understanding of the challenges and opportunities that businesses face in addressing climate change. Full article

This study uses panel data from 30 Chinese provinces spanning 2010–2023. It applies Fuzzy Set Qualitative Comparative Analysis (fsQCA) to examine how different aspects of Smart Logistics affect New Quality Productive Forces. Analysis covers three areas: overall configuration, changes over time, and regional differences. The findings show: (1) New Quality Productive Forces develop from the interaction of Smart Logistics factors, not just one. System coordination limits development more than hardware does. (2) There is a strong link between Smart Logistics and New Quality Productive Forces. The connection moves from basic support to innovation and then to broader ecosystem development. (3) Regions differ: Eastern areas benefit from digital tools and innovation; central areas rely on system change and efficiency; Western areas focus on building up basics and capabilities. Full article

Anishnawbe Health Toronto (AHT) is Canada’s largest multidisciplinary Indigenous health centre. In 2023, the Executive Director of AHT spearheaded a community-centered research study looking at mental and spiritual health for its community of service users. This project sought to support cultural resurgence efforts in AHT health programming through the synthesis of Indigenous-informed models and understandings of mental health, rooted in the knowledge and experience of care providers at AHT. This project also sought to enhance Indigenous community research capacity by involving Indigenous community stakeholders in each stage of the qualitative research process. This paper details these methods, which follow Indigenous community ethics in research, and include both Indigenous approaches to research as well as qualitative methods. This paper then presents a summary of the study’s findings, describing the interdisciplinary mental health services of a team of Indigenous and non-Indigenous practitioners at AHT. Three major themes describe the unique features of these services: The Healing Relationship, Indigenous Spaces and Identities as a “Sacred Home”, and Healing Through Spirit. The connection between spirituality and Indigenous wellness is discussed by centering Indigenous values and ways of knowing as central to Indigenous healing, survivance, and cultural resurgence. Full article