Search Results (33,264)

Background/Objectives: Early identification of terminally ill patients is crucial for enhancing care, patient and care partner satisfaction, and healthcare staff confidence in discussing disease trajectories. Yet, timely recognition remains challenging. To address this, we developed a minimally invasive intervention (MINI) for general hospital wards. We aimed to evaluate the MINI’s feasibility in facilitating an earlier identification of terminally ill patients and improving patient reported outcomes in a hospital setting. Methods: This prospective, two-arm pre-post intervention study at a university hospital evaluated the MINI alongside usual care. Patient-reported outcomes, including quality of life (SF-12), palliative care needs (IPOS), and functional status (ECOG), were collected at baseline and every three months over 12 months. Participants were allocated to a control or intervention group. Results: Of 188 patients identified using the Surprise Question, 58 completed the baseline assessment. While physical functioning (SF-12 PCS) remained comparable, the intervention group experienced clinically meaningful improvements in mental health (SF-12 MCS) at three months, with positive trends at six months. This group also showed a decline in palliative care needs, reduced emotional symptoms, and improved performance status, evidenced by significant differences in non-parametric analyses. These findings underscore the MINI’s potential to significantly improve patient well-being. Conclusions: This pilot study demonstrated the feasibility of the MINI and suggests it may foster meaningful system-wide change in patient-centred care within acute hospital settings, leading to improved patient outcomes and more confident healthcare staff in identifying terminally ill patients. However, given the small sample size, these findings should be interpreted with caution. Future research with larger cohorts and extended intervention periods is warranted to fully elucidate the MINI’s impact and refine strategies for improving care for terminally ill patients. Full article

The results of a recent palynological study of the Kulikovo section (southeastern Baltic) allow us to elaborate on issues of the presence of pollen from the “thermophilous” trees (Picea, Alnus, Corylus, Ulmus, Quercus, Tilia, Fraxinus) in Lateglacial sediments. The research shows their continuous presence throughout the interval of 13.9–12.5 ka with a total contribution from 7% to 17%. Comparing the results with regional palynological data revealed certain similarities and patterns, which are not sufficiently explained by contamination by ancient redeposited material. These taxa belonging to the hemiboreal plant group were most probably part of the Lateglacial vegetation along with subpolar and boreal plants. This correlates well with regional paleoclimate reconstructions, assuming that, during the major part of the Lateglacial, July temperatures were comparable to modern average temperatures, which range from +16.5 to +18 °C. Inclusion of hemiboreal tree vegetation in paleoreconstructions will offer an updated picture of the dynamics of the natural environment and increase the accuracy of paleoclimatic reconstructions based on palynological data, allowing us to obtain more accurate temperature values of the climate of the past. Full article

Adoption of the use of robots in the foodservice industry has increased, and research in the quality of service provided by robots is required. Our research objective is to determine interrelationships among service quality, perceived value, restaurant image, satisfaction, and revisit intentions among customers at robotic restaurants. Data collection was conducted, with 342 South Korean restaurant consumers considered suitable to offer accurate responses to the survey questions. An online survey was employed to examine hypothesized relationships. Data analysis used descriptive statistics, confirmatory factor analysis, and structural equation modeling. Three dimensions of service quality (atmosphere quality, food quality, and interaction quality) at robotic restaurants were critical for higher perceived value by diners at robotic restaurants. Perceived value increases robotic restaurant image, customer satisfaction, and customer revisit intention. Additionally, findings reveal that robotic restaurant image is a positive predictor of satisfaction, and that satisfaction is a positive predictor of revisit intention. Robotic restaurants have become pervasive in hospitality service environments. Accordingly, theoretical and empirical findings about multiple dimensions of service quality in this context likely will be of interest to marketing researchers and practitioners for sustainable restaurant business. Full article

Therapeutic phlebotomy remains a key intervention in the management of erythrocytosis and iron overload disorders, particularly polycythemia vera (PV) and hereditary hemochromatosis. Despite its historical origins as an ancient practice, venesection continues to be recommended in international guidelines for the reduction of hematocrit and iron burden, thereby mitigating thrombotic and organ-related complications. However, the evolving landscape of targeted pharmacologic therapies is reshaping the therapeutic paradigm. This review examines the current role of therapeutic phlebotomy, with a particular focus on PV, outlining its physiological rationale, clinical benefits, and well-documented limitations—including iron deficiency, procedural burden, and incomplete hematocrit control between sessions. Comparative insights are provided between phlebotomy and red cell apheresis, highlighting differences in efficacy, tolerability, and accessibility. The emergence of disease-modifying agents—such as interferons, JAK inhibitors, hepcidin mimetics, and epigenetic modulators like givinostat and bomedemstat—promises more sustained hematologic control with the potential to reduce or eliminate the need for repeated phlebotomies. While phlebotomy remains indispensable in early-stage or low-risk PV, its future utility will likely shift toward complementary or bridge therapy in the context of individualized, pharmacologically driven strategies, redefining the role of phlebotomy in the era of precision medicine. Full article

This study aimed to examine reading interest profiles among preservice Chinese language teachers and related factors making them begin to like or dislike reading. In total, 321 college students majoring in Chinese language education in elementary and secondary schools participated in this study and completed a reading interest questionnaire. The questionnaire contains one close-ended question asking about their reading interest levels across seven periods (from preschool to college) and three open-ended questions asking about the reasons influencing their reading interest levels. Latent profile analysis (LPA) was used to identify reading interest profiles, and qualitative analysis was used to examine factors influencing their reading interests. The LPA results revealed three profiles, namely, mountain (up-down), valley (up-down-up), and upslope (up). The qualitative analysis revealed that motivators encouraging students to read included literacy sponsors, improved reading ability, reading time, extrinsic motivators, curiosity and desire for knowledge, access to reading, discovery of preferred texts, and relief from academic stress and relaxation. By contrast, barriers associated with the decline in reading interest included academic burdens and pressure, the availability of alternatives, a lack of reading ability, a loss of reading autonomy, a lack of literacy sponsors, limited access to reading, and inappropriate texts. Literacy researchers and educators should listen to students’ voices, understand their reading experiences, and consider developing appropriate intervention programs for literacy at different periods. Full article

In general, the justification for the divine punishment in the Christian cosmos hinges on the notion of free will. Despite doctrinal complexities involving sin, grace, and divine sovereignty, individuals are held morally responsible for choosing evil over good. According to an ancient Chinese legend, however, the tyrant King Zhou (11th C. BCE) who lost his throne due to a changed mandate from Heaven was born with extreme evil tendencies. But if his evilness was determined before his birth and all his evil deeds are consequences of his natural tendencies, what might justify his punishment? Through an examination of Confucian responses to this question, this essay argues that Confucians did not ground moral responsibility in volitional freedom but rather in the extremity of one’s moral conduct. Their framework reveals a distinctive form of compatibilism—one in which blame is assigned not on the basis of freedom to choose otherwise but on how radically one’s actions deviate from shared ethical expectations. This suggests that the assumption of free will as a necessary condition for moral responsibility may reflect culturally specific intuitions, rather than a universal moral standard. Full article

The question of whether a God is needed to justify or ground moral facts is mooted by the fact that true moral facts exist in all possible universes that contain rational agents. This can be demonstrated in three stages. First, it is necessarily the case that true moral facts can only be described as the imperatives that supersede all other imperatives. Second, it is necessarily the case that for any rational agent there will always be true hypothetical imperatives that supersede all other imperatives. And third, if there are true hypothetical imperatives that supersede all other imperatives, they are then, necessarily, the only true moral facts. As this follows for any rational agent in any possible universe, the presence of God is irrelevant to the existence of moral facts. God could be more capable of identifying those true moral facts, but he cannot author or ground them. And though a God could casuistically alter moral imperatives by altering the corresponding physics, he is constrained in what he can make true this way by moral fundamentals that are always necessarily true. God is therefore not necessary for there to be moral facts. Full article

This paper explores how school culture and key organizational culture dimensions, power distance, humane orientation, performance orientation, and in-group collectivism, affect different types of conflict (task, relationship, and process) in primary schools in Serbia. It also examines how gender and teachers’ organizational commitment moderate these relationships. Data were obtained by surveying 380 respondents, all of whom were primary school teachers in Serbia. The participants were between 23 and 65 years old. Of the total sample, 19.47% were male, and 80.53% were female. The mean values ranged from 1.8046 to 4.9847, with standard deviations between 0.7699 and 1.4785. The research was conducted using a simple random sampling technique. Teachers were given questionnaires through Google Forms, which they completed online. Printed versions were also distributed and later entered into the database. The study was guided by two research questions and two hypotheses. Data analysis was performed using SPSS (Statistical Package for the Social Sciences). The findings reveal that the school culture dimension of teacher professionalism and goal setting (r = −0.297 **; β = −0.496) and the organizational culture dimension of humane orientation (r = −0.303 **; β = −0.198) have the most substantial negative effects on conflict, indicating their beneficial role in reducing it. In contrast, power distance shows a strong positive relationship with conflict, particularly with relationship conflict (r = 0.230 **; β = 0.201). Additionally, excessive emphasis on teacher collaboration and performance orientation appears to increase relationship conflict (β = 0.226; β = 0.261, respectively). Gender differences emerged: cultural dimensions were more effective in reducing conflict among women than men. Among male teachers, power distance had a stronger influence, significantly increasing task conflict (r = 0.303 **). The school culture and organizational culture dimensions significantly reduce the conflict dimensions in the case of high teacher commitment. The dimension power distance has a statistically significant and positive effect on conflicts when organizational commitment is high (r = 0.247 **). Therefore, school culture and organizational culture dimensions achieve stronger effects in committed women, while power distance achieves stronger effects in committed men. Full article

The question of the relationship between the Armenian and Byzantine churches has always interested researchers, often becoming a problem of study. Since the chosen problem concerns not only the mentioned churches but was also a fierce problem of the entire Christian world in the context of the debate between the supporters of Monophysitism and Dyophysitism, we set ourselves the goal of studying the issue in this context within the framework of the end of the 9th century and in the 10th century, when particularly important development took place. One of the main results of the article is that despite the accepted opinion that the Armenian Church has always insisted on its confession, based on political considerations, the Armenian political and religious leaders sometimes expressed readiness for a church union with Byzantium. The main method of this article is the genetic method, with the help of which the origin, sequence of events, and patterns of development of the phenomenon under research are studied. Full article

We analysed the socioeconomic, behavioural, and protection factors (PFs) influences on the HIV combined prevention (CP) strategy among Brazilian Amazonian men who have sex with men (MSMs). PFs are resources that reduce the effect of adversity and help people maintain their well-being. Methods: Cross-sectional study employing a convenient sample of MSMs living in the metropolitan region of Belém. A questionnaire containing socioeconomic, behavioural, PFs, and behaviour/knowledge concerning CP questions was used. “Behaviour/knowledge concerning CP” was defined as a dependent variable and received a maximum score of 16 points. The Mann–Whitney and Kruskal–Wallis tests and multiple linear regression were employed. Results: Our sample comprised 384 MSMs scoring an average of 7.83 points (±1.9). Contributing to lower scores were “not talking about sex life with confidants”, “not talking with work colleagues about personal life and sexually transmissible infections”, and “not participating in non-governmental organisations.” On the other hand, “not being happy in the neighbourhood of residency” contributed to higher scores. Conclusion: Peer support and social inclusion are essential for increasing MSMs’ access to CP. Full article

Bartonella spp. is a Gram-negative bacterium transmitted by arthropod vectors, implicated in a range of zoonotic infections affecting both humans and animals. Among zoonotic species, B. henselae is primarily associated with domestic cats and B. vinsonii with dogs. In Italy, Bartonella infections have been reported in both southern and northern regions. This study investigates the presence of Bartonella spp. in fleas and ticks collected from companion animals in Piedmont region, northwestern Italy. A total of 176 flea and 85 tick specimens were obtained from 92 animals (dogs and cats) between May 2018 and February 2020. Arthropods were morphologically identified using identification keys, and screened for Bartonella DNA by PCR targeting the 16s rRNA gene. Positive samples were further analyzed by amplifying the rpoB gene. Selected 16s-positive and all rpoB-positive samples were sequenced and subjected to phylogenetic analysis. Fleas were mostly identified as Ctenocephalides felis, recovered from 44 cats and 12 dogs; a single C. canis specimen was found in one cat. Ticks were Ixodes ricinus (from 14 cats and 10 dogs), Rhipicephalus sanguineus s.l. (3 cats, 7 dogs), and Dermacentor marginatus (one dog). Bartonella prevalence was 38.4%, with 34.2% positivity in fleas and 45.6% in ticks. All sequences corresponded to B. henselae. These findings confirm the active circulation of B. henselae in ectoparasites of pets and raise questions about the potential role of ticks in its transmission. Full article

This essay explores the question: can we have an objective ethics without God? This question is raised by James Sterba, who argues in the affirmative. As an atheistic ethicist, Sterba is motivated to maintain an objective morality that is not based in theism and that can withstand the problems with Darwinism. Sterba examines what he sees as one of the most popular theistic attempts to ground human morality, viz., divine command theory. In rejecting both divine command theory and theism, Sterba offers what he believes can offer objective morality: a basic moral norm that all people should adhere to. This article examines Sterba’s criticism of divine command theory along with his own efforts at establishing an objective morality in what he considers a universal abstract principle. In the end, this article argues that Sterba’s axiomatic principle is unclear as to its ontological foundation as well as its causal efficacy in attempting to obligate objective human ethics. It will be argued that Sterba is correct about human nature being the locus of morality, but that atheism fails at providing human teleology to account for such morality. Full article

Orthotopic transplantation of ovarian tissue at one day of age is a promising solution for preserving female genetic material in avian species; using sterile recipients can ensure that all offspring are donor-derived. This study focuses on the suitability of the Mulard duck as a sterile recipient for Pekin duck donors and provides an investigation of the hormonal background. Firstly, native Pekin ovarian tissue was grafted into Mulard duck recipients, resulting in a 40% adhesion rate and follicular development in 50% of the adhered grafts. Secondly, the transplantation of cryopreserved ovarian tissue resulted in a 66% adhesion rate, with 33% of the adhered grafts showing follicular development. Ovulation occurred in 16% of the recipients with adhered grafts, but the eggs did not move into the oviduct. Estrogen levels were elevated in the recipients with adherence but were lower than in the control Pekin group, while progesterone levels remained unchanged. Consequently, recipients received buserelin acetate, a GnRH analogue, to stimulate follicular and oviductal activity. In this group, graft adhesion occurred in 31% of animals, and primordial follicle development in 25%. The hormonal levels of the recipients with adhered ovaries were elevated, but the GnRH analogue treatment did not affect the ovulation process. We conclude that while the Mulard duck shows potential as a sterile recipient in ovarian transplantation, several questions remain unanswered regarding the adequacy of follicular maturation and ovulation. Full article

This study investigates how Environmental, Social, and Governance (ESG) principles can be effectively integrated into the Balanced Scorecard (BSc) framework within local government organizations (LGOs) to enhance strategic planning and sustainability performance. Addressing a gap in the literature on ESG–BSc integration in the public sector, particularly in the Greek context, the study employs a dual-method approach. First, a bibliometric analysis of 3053 academic publications (1993–2025) was conducted using Scopus data to assess the evolution and thematic focus of ESG and BSc research. Second, a structured questionnaire—comprising both closed- and open-ended questions—was administered to 17 administrative staff members of a Greek LGO in 2024. This expert sample provided insights into strategic planning practices, ESG awareness, and performance management barriers. The findings reveal low levels of ESG–BSc application, a limited strategic capacity, and institutional resistance. In response, the study proposes a novel, context-sensitive ESG-integrated BSc model tailored for small municipalities, emphasizing stakeholder participation, operational simplicity, and the alignment with national sustainability policies. The model serves as a practical tool to support public sector performance measurement, bridging the gap between sustainability goals and local governance strategy. Full article

The concept of governance has gained increasing attention across various fields of study. However, its application within the specific context of educational policies, particularly within compulsory public education, remains fragmented and underexplored. To answer the questions “How is governance conceptualized in the context of the compulsory public education system?” and “What contributions to future research emerge from this review?”, 32 peer-reviewed articles published in open-access journals between 2019 and 2023 were extracted from the Web of Science, Scopus, and ERIC databases and selected following PRISMA guidelines. Results from this systematic literature review analysis suggest a sustained yet moderate interest in the field, as evidenced by the reviewed publications, different theoretical and conceptual approaches, and research themes that illustrate different aspects of educational systems. Research gaps include the lack of a consolidated and integrated theoretical–conceptual framework on educational governance; the under-representation of specific actors, contexts, and points of view about how educational policies intentions are interpreted and enacted; insufficient critical analyses of, among others, educational leadership, digital transformation, and non-state actors’ influence in educational governance; and limited discussion of governance’s effects on educational justice, equity and quality. The main limitations relate to geographic, linguistic, and cultural biases of the analyzed studies, the exclusion of non-open-access articles, and the predominance of qualitative methodological approaches, which restrict generalizability. To address these challenges, future research should follow the adoption of interdisciplinary approaches, longitudinal and context-sensitive studies, and the use of mixed methodologies. These findings could contribute to a more informed discussion, avoiding reductionist interpretations and more open and critical perspectives on how educational governance transcends organizational and technical structures by incorporating political, ethical, and contextual dimensions that challenge the quality of educational systems. Full article