Search Results (1,229)

This study investigates how climate change literacy (CCL) and institutional contexts shape the climate-related behaviors of Taiwan’s public officials. Drawing on a 2024 national survey of 1940 civil servants, we apply hierarchical and comparative regression analyses to examine the relative influence of knowledge, affective dispositions, and organizational supports. Results show that solution-oriented knowledge exerts greater behavioral influence than factual awareness. At the same time, affective resources—particularly self-efficacy and environmental identity—are the strongest and most consistent drivers of engagement. Institutional factors further condition these relationships: central officials’ behaviors are shaped by departmental mandates and bureaucratic constraints, whereas local officials rely more on supervisor support and prior project involvement. These findings integrate literacy research with institutional perspectives, demonstrating that effective climate governance requires both individual agency and enabling organizational contexts. Policy implications include strengthening leadership training, creating experiential learning opportunities, and streamlining administrative structures across governance levels to accelerate climate action. Full article

Background and Objectives: Hereditary angioedema caused by C1 inhibitor deficiency (HAE-C1-INH) is a rare genetic condition characterized by recurrent, potentially life-threatening episodes of angioedema. Long-term prophylaxis (LTP) is essential for decreasing the frequency and severity of attacks. This study aims to compare the safety profiles of two first-line LTP therapies, both of which inhibit kallikrein: berotralstat (oral) and lanadelumab (subcutaneous), using data from the WHO’s VigiBase pharmacovigilance database. Materials and Methods: The study employed a retrospective quantitative design, utilizing the World Health Organization’s pharmacovigilance database, VigiAccess, which contains individual case safety reports of adverse drug reactions (ADRs) to identify cases of ADRs associated with HAE-C1-INH long-term prophylaxis. Results: A total of 644 reports for berotralstat and 3432 reports for lanadelumab were analyzed. Berotralstat was mainly associated with gastrointestinal adverse events (47.9%), while lanadelumab was linked to injection site reactions (45.9%), infections (23.3%), musculoskeletal and connective tissue disorders (10%), immune system disorders (5.3%), vascular disorders (4.7%), and metabolic issues (3.9%). Female patients were more frequently affected in both groups. Statistically significant differences were observed, reflecting the differences in administration methods and pharmacological profiles between the two drugs. Limitations include the self-reported nature of the data and the absence of detailed clinical information. Conclusions: The results confirmed the literature’s data on the gastrointestinal adverse effects of berotralstat, as well as site reactions and infections associated with lanadelumab. Notably, musculoskeletal and connective tissue disorders, immune system disorders, vascular disorders, and metabolic issues occurred more frequently in patients using lanadelumab. Full article

Background: Cervical cancer (CC) is the most common cancer among Ugandan women and the leading cause of cancer mortality. Screening has proven to be a cost-effective method in reducing its burden, yet uptake among women of reproductive age remains alarmingly low, with national adherence rates under 10%. Objective: This study explored healthcare workers’ (HWs) perspectives on barriers and facilitators to screening and attitudes toward implementing human papillomavirus (HPV) DNA testing with self-collection. Methods: A qualitative research design was employed. Twenty semi-structured interviews were conducted with purposively sampled healthcare providers and administrators across different cadres at a referral hospital and three peripheral health centres in Northern Uganda. Interviews were analysed thematically using the Social Ecological Model. Data collection and analysis proceeded iteratively until thematic saturation. Reporting follows the Consolidated Criteria for Reporting Qualitative Research (COREQ). Results: Participants described individual and interpersonal barriers such as limited awareness, poor preventive health-seeking, fear of results, stigma, and limited male involvement. Organisational barriers included staff shortages, weak referral practices, and stock-outs of supplies, while policy constraints included limited governmental support and competing priorities. Facilitators included targeted health education, routine referrals from all service entry points, outreach screening, and donor support. Most respondents favoured scaling up of self-collected HPV testing, citing higher acceptability and feasibility for outreach, contingent on sustained supplies, laboratory capacity, and training. Conclusions: Multi-level interventions are needed to strengthen facility workflows, staff capability, community engagement, and reliable supply chains. Expanding access to self-collected HPV testing may overcome major barriers and represents a promising strategy to increase screening uptake in Uganda and similar low resource settings. Full article

Background and Objectives: Some cancer patients in palliative care need to access intravenous administration of medications to relieve symptoms. Few studies have explicitly assessed the safety and feasibility of peripherally inserted central catheter (PICC) insertion at bedside in palliative care settings. In this study, we suggest the usefulness, safety, and feasibility of bedside ultrasound-guided PICC placement as a tool for improvement in the quality of life for patients in palliative and hospice care settings. Materials and Methods: The study population, with terminal cancer and admitted to a palliative and hospice care unit in the Veterans Health Service Medical Center, was evaluated (N = 150). The patients were divided into two groups based on the methods of PICC insertion: Group 1 (PICC at bedside, N = 75) and Group 2 (PICC in intervention room, N = 75). The two groups were matched for age, sex, the level of Eastern Cooperative Oncology Group (ECOG) performance status, and types of primary cancer. Results: The success rates of the PICC procedure for Groups 1 and 2 were 89.33% and 97.33%, respectively, with no significant difference between the groups (p = 0.102). The mean duration (days) of catheter use was longer in Group 1 (23.31 ± 16.36) compared to that in Group 2 (21.90 ± 18.95), with no statistically significant difference (p = 0.639). Multivariable logistic regression analyses confirmed that Group 1 was not inferior to Group 2 regarding procedural success (Model 2, p = 0.21) and catheter dwell time (Model 2, p = 0.66). The most common cause of catheter removal in both groups was death, followed by self-removal and hospital discharge (p = 0.386). Conclusions: This study suggests that ultrasound-guided PICC insertion at bedside may have comparable procedural outcomes with potentially reducing the risks associated with intra-hospital patient transport compared with fluoroscopy-guided placement. We suggest this bedside approach can be considered a feasible and safe method for improving the quality of life of patients in palliative care settings. Full article

The rapid integration of Artificial Intelligence Assistive Technology (AIAT) into higher education has generated new avenues for visually impaired university students, primarily in enhancing accessibility, self-autonomy, and academic performance. This study examined associations between AIAT-related perceptions and mental-health indicators (depression, anxiety, and stress) among visually impaired higher education students in the Kingdom of Saudi Arabia (KSA). A quantitative research approach was employed, using a self-administrated questionnaire targeting 390 visually impaired students in KSA universities. Partial least squares structural equation modelling (PLS-SEM) was employed as the main data analysis technique. The findings emphasised two important issues. First, performance expectancy (PE) of AIAT adoption, Effort expectancy (EE), and social influence (SI) are forceful psychological facilitators that can buffer against the feeling of depression and anxiety in visually impaired university students. Second, minimising the feeling of stress requires more than the existence of good infrastructure or social support; it necessitates systemic and ongoing interventions, comprising proactive university support, an accessible learning context, and personalised training programmes. These insights highlight the need for implementing inclusive support systems that combine technological, psychological, and university dimensions to promote the advantages of AIAT adoption for visually impaired students. Full article

This study examines the financial behavior of university students in Economics, Business Administration, and Accounting in Tegucigalpa, Honduras, using the FB–13 instrument. Exploratory and confirmatory factor analyses validate a three-dimensional structure: (1) financial planning and control, (2) savings and financial preparation, and (3) fulfillment of obligations, with high internal consistency (α = 0.915), supporting its psychometric robustness in Latin American academic contexts. Based on a sample of 714 students with diversity in gender, age, work experience, and parental status, the analyses confirmed that the FB–13 model best fits a three-factor structure. Significant correlations were identified between financial behavior and experiential variables such as age, work experience, and parenthood, while traditional sociodemographic attributes such as gender, residence, marital status, employment, and educational level showed limited associations. These findings suggest that personal experiences have a greater influence on the configuration of financial practices than conventional demographic categories. The study acknowledges limitations related to cross-sectional design, non-probabilistic sampling, and self-reported data, yet these do not diminish its contributions. By validating the FB–13 in Honduras, the research offers comparative evidence and promotes cultural diversity in financial behavior literature. Future research should move toward longitudinal and qualitative studies that explore the role of family dynamics, work contexts, and personal aspirations in responsible financial behaviors. Full article

In parallel with technical training on knowledge and skills of task-specific medical or surgical procedures, wide arrays of soft skills training would contribute to obstetric safety in the contemporary healthcare setting. This article, as a service evaluation, explored the effect of a specialty-based Crew Resource Management (CRM) training series that transforms the concept of human factors into sustainable measures in fostering clinical safety culture of the Department of Obstetrics and Gynaecology (O&G) in the Queen Elizabeth Hospital. Within the last decade, a tri-phasic programme has been implemented by an inter-professional workgroup which consists of a consultant anaesthesiologist, medical specialists and departmental operations manager from O&G, a nurse simulation specialist, hospital administrators, and a research psychologist. (1) Phase I identified different patterns of attitudinal changes (in assertiveness, communication, leadership, and situational awareness, also known as “ACLS”) between doctors and nurses and between generic and specialty-based sessions for curriculum planning. (2) Phase II evaluated how these specific behaviours changed over 3 months following CRM training tailored for frontline professionals in O&G. (3) Phase III examined the coping style in conflict management and the level of sustainability in self-efficacy over 3 months following specialty-based CRM training. The findings showed the positive impacts of O&G CRM training on healthcare professionals’ increased attitude and behaviour in “ACLS” by 22.7% at a p < 0.05 level, character strengths in conflict management, and non-inferior or sustained level of self-efficacy under tough conditions in the clinical setting up to 3 months after training. As a way forward, incorporating a scenario-based O&G CRM programme into existing skills-based training is expected to change service framework with an innovative approach. In addition, exploring actual clinical outcomes representing a higher level of organisational impacts can be a strategic direction for further studies on the effect of this practical and educational approach on obstetric safety culture. Full article

Background/Objectives: Workplace violence remains an important vocational psycho-social risk for nurses employed in the emergency department (ED). We investigated the characteristics of workplace violence against ED nurses, and associations with self-assessed resilience, socio-demographic and vocational parameters, including turnover intention. Methods: ED nurses employed in all public hospitals in the Republic of Cyprus (RC) participated. After obtaining informed consent, data were collected using census sampling (January–June 2024) via the translated 2016 Italian National Survey on Violence towards Emergency Nurses Questionnaire (QuINVIP16) for investigating workplace violence characteristics, and the Connor-Davidson Resilience Scale (CD-RISC-25) for assessing self-perceived resilience. Results: A total of 132 nurses (53.0% response rate) participated. Verbal violence was reported by 70.5% to 92.4% of participants. Long waiting times, overcrowded EDs, and perception of inadequate attention from healthcare professionals were reported as the primary triggers for violence towards participants by patients/visitors. One-third of participants reported that violence-reporting systems were unclear, while 1 out of 4 reported inadequate safety measures against violence. Participants with higher scores of self-perceived resilience were less likely to report turnover intention due to workplace violence (p < 0.001), while those with lower self-perceived resilience reported a significant decrease in work motivation (p = 0.005). Those who experienced decreased work motivation after exposure to a violent episode were more likely to consider a) leaving the profession [OR (95%CI): 79.1(17.7–353.2); p < 0.01], and b) moving to a different work setting [OR (95%CI): 17.0(3.8–76.2); p < 0.01], and actually applying to be transferred to a different work setting [OR (95%CI): 19.6(4.2–91.5); p < 0.01]. Moreover, those who had not attended communication skills training were 4 times more likely to consider leaving the profession following exposure to violence [OR (95%CI): 4.2(1.1–16.2); p = 0.04]. Conclusions: This study is among the few to link workplace violence with both resilience and actual turnover behaviors among emergency nurses, in general and particularly in the post-pandemic era. By showing how personal resilience in the face of violence is shaped by organizational support, such as reporting systems and training, the present findings move beyond individuals-level explanations, and highlight workplace violence as a systematic administrative challenge. This insight represents an important advance in current knowledge, and calls for multifaceted interventions that strengthen both personal and institutional capacity to address violence. Full article

Background/Objectives: Trophoblast cell surface antigen 2 (Trop2), a transmembrane glycoprotein overexpressed in a broad spectrum of epithelial malignancies but minimally expressed in normal tissues, has emerged as a clinically relevant prognostic biomarker and therapeutic target, particularly in breast cancer. This study aims to develop an enhanced way of targeting Trop2 expression in tumors and blocking it using extracellular vesicles (EVs) bioengineered to express a nanobody sequence against Trop2 (NB60 E). Methods: Here, a plasmid construct was designed to express the Trop2 sequence, NB60, flanked with HA tag and myc epitope and a PDGFR transmembrane domain in the C-terminal region, and was transfected into HEK293T cells for EVs isolation. The potency of NB60 E to knock down Trop2 in letrozole-resistant breast cancer cells (LTLT-Ca and MDA-MB-468 cells) was initially investigated. Thereafter, the effects of NB60 E on the cell viability and downstream signaling pathway of Trop2 via MTT assay and Western blotting were determined. Lastly, we also examined whether NB60 E treatment in Jurkat T cells affects IL-6, TNF-α, and IL-2 cytokine production by enzyme-linked immunosorbent assay (ELISA). Results: Results revealed treatment with NB60 E significantly reduced surface Trop2 expression across both cell lines by 23.5 ± 1.5% in MDA-MB-468, and 61.5 ± 1.5% in LTLT-Ca, relative to the HEK293T-derived control EVs (HEK293T E). NB60 E treatment resulted in a marked reduction in LTLT-Ca cell viability by 52.8 ± 0.9% at 48 h post-treatment. This was accompanied by downregulation of key oncogenic signaling molecules: phosphorylated ERK1/2 (p-ERK 1/2) decreased by 30 ± 4%, cyclin D1 by 67 ± 11%, phosphorylated STAT3 (p-STAT3) by 71.8 ± 1.6%, and vimentin by 40.8 ± 1.4%. ELISA analysis revealed significant decreases in IL-6 (−57.5 ± 1.5%, 7.4 ± 0.35 pg/mL) and TNF-α (−32.1 ± 0.3%, 6.1 ± 1.2 pg/mL) levels, coordinated by an increase in IL-2 secretion (22.1 ± 2.7%, 49.2 ± 1.1 pg/mL). Quantitative analysis showed marked reductions in the number of nodes (−45 ± 4.4%), junctions (−55 ± 3.5%), and branch points (−38 ± 1.2%), indicating suppression of angiogenic capacity. In vivo experiment using near-infrared Cy7 imaging demonstrated rapid and tumor-selective accumulation of NB60 E within 4 h post-administration, followed by efficient systemic clearance by 24 h. The in vivo results demonstrate the effectiveness of NB60 E in targeting Trop2-enriched tumors while being efficiently cleared from the system, thus minimizing off-target interactions with normal cells. Lastly, Trop2 expression in LTLT-Ca tumor xenografts revealed a significant reduction of 41.0 ± 4% following NB60 E treatment, confirming efficient targeted delivery. Conclusions: We present a first-in-field NB60 E-grafted EV therapy that precisely homes to Trop2-enriched breast cancers, silences multiple growth-and-invasion pathways, blocks angiogenesis, and rewires cytokine crosstalk, achieving potent antitumor effects with self-clearing, biomimetic carriers. Our results here show promising potential for the use of NB60 E as anti-cancer agents, not only for letrozole-resistant breast cancer but also for other Trop2-expressing cancers. Full article

Background: hearing loss represents, today, one of the most significant health problems affecting the world’s population. This clinical condition, particularly manifest in adulthood, can arise or be aggravated by both the presence of specific pathologies and by taking multiple classes of drugs at the same time. Methods: to understand this relationship, the present non-interventional observational study aimed to investigate the relationship between worsening hearing abilities in 1651 patients aged between 18 and 99 years. In particular, the thorough history of patients allowed us to evaluate the pathological profiles, pharmacological profiles, and therapeutic regimens adopted. This allowed us to evaluate its association with self-reported hearing loss, assessed through the administration of the HHIE-S-It questionnaire. Furthermore, given the presence of multimorbidity, the possible correlation between self-reported hearing loss and the specific classes of drugs, categorized using the Anatomical Therapeutic Classification (ATC) system, was evaluated. Results: the results highlighted how patients taking drugs, both in mono- and polytherapy regimens, had higher hearing deficits than patients not taking drugs. Furthermore, an apparent dose–response effect, in which the risk of moderate to severe impairment progressively increased with the number of drugs taken, was also observed. Different classes of drugs, particularly those used for the treatment of diseases of the cardiovascular system, as well as drugs for acid-related disorders, were significantly linked to an increased risk of perceived hearing impairment. On the contrary, agents belonging to the antidiabetic category have proven to be drugs capable of offering a potential protective effect. Conclusion: this study highlighted how both the number of drugs taken and some specific categories of drugs can contribute to perceived hearing impairment. While this evidence highlights the importance of integrating audiological evaluation into the management of patients in polypharmacy, the cross-sectional nature of the design precludes the inference of causality. This evidence still favors safer and more personalized therapeutic strategies. Full article

Background: Authentic leadership is characterized by the authenticity and self-awareness of the leader, who acts with transparency and promotes positive outcomes in clinical practice and team management. In Portugal, there isn’t a tool available to assess nurses’ perceptions of authentic leadership in nursing. This study aimed to translate and cross-culturally adapt the Authentic Nurse Leadership Questionnaire (ANLQ) for the Portuguese context and to evaluate its psychometric properties. This instrument assesses nurses’ perceptions of the authentic leadership exercised by their leader. Methods: A methodological, descriptive, cross-sectional study with a quantitative approach was conducted. The translation and cross-cultural adaptation process followed the recommendations of internationally recognized guidelines. The Authentic Nurse Leadership Scale—Portuguese version (ANLS-PT) was administered to a sample of 406 nurses from various functional units in three primary healthcare centers. Exploratory and confirmatory factor analysis techniques were used. Reliability was established through a test–retest administration to 22 nurses at two different times, with a two-week interval. The internal consistency of the scale was assessed using Cronbach’s Alpha. Results: An instrument with 29 items and 3 dimensions was obtained, explaining 68.3% of the total variance. The identified dimensions were Caring and Decision-Making, Self-Awareness, and Relational Integrity and Ethics. The overall instrument showed an internal consistency of 0.97. Conclusions: The ANLS-PT proved to be a valid, reliable, and robust tool for assessing authentic leadership in the Portuguese cultural context and can be used in various nursing practice contexts. Full article

Oral administration remains the most patient-friendly drug delivery route, yet its efficacy is limited by physiological barriers including gastric degradation and inefficient cellular uptake. pH-responsive nanogels have shown promise for gastrointestinal drug delivery, though their effectiveness is often constrained by poor membrane interaction. Inspired by natural membrane-anchoring mechanisms, a series of comb-like anionic polymers were designed via grafting alkylamines of different chain lengths (C₁₀, C₁₄, C₁₈) at varying densities (10–30%) onto a biodegradable poly(L-lysine isophthalamide) (PLP) backbone. These pH-responsive comb-like polymers self-assembled into nanogels for loading the hydrophobic chemotherapeutic agent camptothecin. The alkyl length and grafting density significantly influenced pH-responsive behavior, membrane disruption, and drug release profiles. The optimal formulation—the nanogel prepared with PLP grafted 30% C₁₄—achieved a high drug-loading capacity, ideal particle size and stability, and offered superior protection in acidic conditions (only 7 ± 5% release at pH 1.2 over 24 h), while enabling rapid intestinal release (78 ± 2% at pH 7.4 within 24 h). The nanogels significantly enhanced cellular uptake, cytoplasmic delivery, and cytotoxicity against colorectal carcinoma cells. This study demonstrates the key role of hydrophobic modification in designing effective oral nanocarriers, providing a promising platform for the treatment of intestinal diseases. Full article

Objectives: Multidisciplinary management of chronic pain benefits many patients, although some continue to experience refractory pain. Administration of lidocaine infusions (LI) to manage certain chronic pain conditions has been reported in adults, but evidence is limited for its utility in managing pediatric chronic pain. We reviewed LIs for refractory pain in children to (1) describe the patient population that received LI and (2) evaluate the response to LI. Methods: With IRB approval, a retrospective review of patients receiving LI for refractory pain between 2016 and 2021 was conducted at Boston Children’s Hospital. Demographic, medical, pain, sleep, and school function information was collected through self-report and from the electronic medical record. Longitudinal outcomes for a subset of these patients were analyzed using the Chronic Pain Repository database. Results: During the study period, 3959 patients presented for management of chronic pain. Among this population, 184 (5%) patients aged 22 years or younger ultimately received LI as part of their pain management. A total of 350 LIs were administered and were well tolerated. During approximately 42% of the infusions, patients experienced an immediate statistically significant decrease in pain scores. Among the patients with follow-up data, pain improvement was not sustained. Discussion: LI for the treatment of chronic pain appears safe and may be useful for managing refractory pain in pediatrics. Although approximately half of the patients who received LI reported an immediate positive response, the small follow-up sample did not show a continued response. Study limitations preclude demonstrating long-term efficacy of LI; therefore, a prospective study is critical. Full article

Corporate greenwashing has emerged as a pervasive and systemic threat to global sustainability efforts, undermining regulatory effectiveness and obstructing progress toward multiple United Nations Sustainable Development Goals. As environmental opportunism increasingly diffuses across interconnected industrial supply networks, it evolves from isolated corporate misconduct into a chain-level governance challenge with significant systemic risks. Traditional governance mechanisms—whether market-based self-regulation or top-down administrative control—have proven insufficient, while the effectiveness of hybrid approaches integrating administrative coordination with market dynamics remains largely unexplored. This study investigates China’s Chain Leader Policy, a novel hybrid governance model that combines formal administrative authority with market coordination mechanisms to systematically address environmental opportunism across industrial supply networks, and its impact on mitigating greenwashing. Employing a multi-period difference-in-differences design on 12,334 firm-year observations of Chinese A-share listed companies from 2011 to 2023, we find that the policy reduces corporate greenwashing by 10.8% through four pathways: stabilizing supply–demand relationships, reducing coordination costs, fostering green collaborative innovation, and enhancing external scrutiny via social networks. Coercive isomorphism strengthens these effects, while mimetic isomorphism weakens them; impacts are more pronounced in state-owned enterprises, firms with stronger green awareness and higher levels of internationalization, and in more concentrated industries. By operationalizing embedded autonomy theory in an environmental governance context, this research extends theoretical understanding of hybrid governance mechanisms, offers robust empirical evidence for designing policies to curb greenwashing, and provides a replicable framework for achieving corporate environmental sustainability worldwide. Full article

Background: The 4CMenB vaccine (Bexsero^®) contains surface proteins from Neisseria meningitidis serogroup B and is recommended from 2 months of age. The most frequently reported adverse events are fever, injection site pain, and fatigue. Thus, this study aimed to estimate the incidence of local and systemic adverse events associated with the administration of the 4CMenB (Bexsero^®) vaccine. Methods: A systematic review and meta-analysis of clinical trials published up to 28 February 2025 were conducted using PubMed, ScienceDirect, and Web of Science. Human studies available in English, Spanish, French, German, or Italian were exclusively included. Adverse events following the first dose of the vaccine were analyzed. Pooled proportions with 95% confidence intervals were calculated, and heterogeneity across studies was assessed using the I² statistics. Results: Ten clinical trials comprising 13,345 participants were included. The most common adverse event was local pain (occurring in up to 94% of cases), followed by induration, erythema, and edema, with frequencies ranging from 25% to 45%. The most frequently reported systemic events were irritability (up to 75%), fatigue (51–59%), fever (up to 60%), headache (42–49%), and persistent crying (50–65%). Most adverse events were mild and self-limiting. Conclusions: The 4CMenB (Bexsero) vaccine exhibits a favorable safety profile, characterized by a predominance of mild and transient local adverse events. Although several systemic events were reported, their overall frequency was generally low. These findings support the continued inclusion of Bexsero^® in routine childhood immunization programs. Full article