Search Results (3,483)

Background/Objectives: Perinatal care is essential for the health and well-being of women and adolescent girls from conception through the first year postpartum. The World Health Organization (WHO) provides evidence-based recommendations aimed at improving the quality of antenatal, intrapartum, and postnatal care. This study mapped 51 WHO perinatal care recommendations against Zambian guidelines to identify areas of alignment, as well as gaps and challenges related to their implementation. Methods: The review was conducted following Joanna Briggs Institute (JBI) guidance. Published recommendations and relevant documents issued from 2016 onwards were included. National guidelines, policy documents, professional standards, and literature related to perinatal care in Zambia were identified through searches of PubMed, Google Scholar, WHO resources, and relevant institutional websites. WHO recommendations were mapped against Zambian guidelines and classified according to their level of alignment. Results: The findings demonstrated significant alignment between WHO recommendations and Zambian guidelines in perinatal healthcare. However, important implementation gaps remain; for example, only 4.7% of pregnant women attended all eight recommended antenatal care visits. Intrapartum care largely aligns with WHO standards, though there are differences in pain-relief choices. Furthermore, difficulties in adopting WHO recommendations are mostly due to health system constraints. Conclusions: Most of the Zambian guidelines align with the WHO recommendations. However, ten were classified as partly aligned, and one did not align. This small proportion of non-alignment may reflect adaptation for a national context and require further evidence-based evaluation. In addition, consolidating existing recommendations, strengthening health-system capacity, and addressing implementation gaps may support the delivery of standardized, high-quality perinatal care and contribute to improved maternal and newborn health outcomes. Full article

Bioinformatics courses are widely available at US institutions of higher learning. These courses meet the high demand for experiential learning and provide training in relevant job skills for biology students. However, courses based on the biology of genomes, the findings of high-throughput approaches and the potential for future discovery have not been studied separately from informatics. Because of the pervasiveness of genomic research in science, medicine, and multiple other fields, the lack of genome biology courses could represent a significant barrier to the future success of the nation’s biology majors. We therefore performed an audit of genome biology courses provided at 297 US colleges and universities offering at least one bachelor’s degree in biology. Four researchers independently searched course catalogs and department websites of each institution for descriptions of courses focused on genome biology. The results showed that there are significant disparities in genome biology course offerings across the US. Specifically, highly funded institutions are most likely to offer such courses, whereas less-funded, minority-serving, and historically black institutions offer far fewer such opportunities. Full article

The increasing demand for scalable digital learning environments has created a need for cloud-based educational content delivery systems that support efficient resource management, platform accessibility, and quality-assured learning experiences. While low-code web development platforms have enabled rapid deployment of educational websites, many implementations remain content-centric and lack systematic architectural design, deployment frameworks, and software quality evaluation mechanisms. This study proposes a modular architecture for cloud-based educational content delivery systems that integrates content management, user access, resource delivery, platform administration, and quality monitoring components within a unified web-based environment. The proposed architecture adopts a structured development framework consisting of requirements analysis, system architecture design, prototype development, deployment configuration, performance testing, and quality evaluation. The framework is designed to support the rapid development of lightweight educational platforms using low-code technologies while maintaining software engineering principles related to reliability, usability, accessibility, compatibility, and performance efficiency. The architecture further incorporates cloud-hosted deployment strategies that facilitate scalable content distribution and cross-platform accessibility for technology-enhanced learning environments. To demonstrate the feasibility of the proposed architecture, a prototype implementation was developed using a low-code web platform and deployed as a cloud-based educational content delivery system. The prototype was evaluated by expert validators using selected software product quality characteristics derived from the ISO/IEC 25010 standard. The evaluation results indicated a high level of technical acceptability across multiple quality dimensions, including performance efficiency, reliability, usability, compatibility, accessibility, and capacity. The findings support the effectiveness of the proposed architecture as a practical framework for developing quality-assured educational delivery platforms. The study contributes a replicable systems architecture and implementation framework for educational content delivery applications. The proposed model provides guidance for the design, deployment, and evaluation of cloud-based learning platforms and offers a foundation for future integration with learning analytics, adaptive content delivery mechanisms, and intelligent educational support systems. Full article

Despite nationwide transparency mandates and expanding digital infrastructure, Chinese local governments adopted online budget disclosure at markedly different times. This study explains this staggered diffusion by integrating the Technology–Organization–Environment (TOE) framework with policy diffusion theory and analyzing 290 prefecture-level governments in China from 2002 to 2023 using discrete-time event history models. The results show that government website development, central government mandates, and peer-city adoption are positively and robustly associated with the likelihood of adoption. By contrast, provincial government disclosure, regional economic development, fiscal pressure, and internet penetration show no stable independent effects in the full models. Interaction analyses reveal, however, that economic development and internet penetration strengthen the association between website development and adoption, while fiscal pressure does not. These findings indicate that local environmental conditions function primarily as enabling conditions that amplify technological capacity rather than as autonomous drivers. The study advances research on fiscal transparency and public-sector innovation by shifting attention from whether governments disclose to when adoption occurs, offering a conditional interpretation of the TOE framework, and demonstrating how vertical authority, horizontal peer dynamics, and digital readiness jointly shape policy diffusion in a unitary governance system. Full article

The post-pandemic acceleration of digital tools has reshaped how small and medium-sized enterprises (SMEs) in Latin America compete, yet the resulting maturity gains remain poorly understood in individual emerging-market economies. Ecuador exemplifies this gap: SMEs account for over ninety per cent of the formal business register but appear in few econometric studies, most based on convenience samples. This study asks how strongly digital adoption is associated with the digital maturity of Ecuadorian SMEs and which tools best predict e-commerce engagement. The analysis draws on the National Digital Skills Survey (ENHD, Encuesta Nacional de Habilidades Digitales), administered by Ecuador’s Ministry of Telecommunications (MINTEL), covering 847 SMEs in 2021. A ten-indicator Digital Adoption Index (DAI) is related to the ENHD maturity score through least squares regression with robust standard errors, and a binary logit model with multicollinearity diagnostics identifies the tools that predict e-commerce adoption. The DAI explains over half of the variance in digital maturity, robust to firm-size and sector controls. Website presence exerts the largest marginal effect on e-commerce adoption, followed by cloud services. Top adopters score twice as high as non-adopters, consistent with cumulative advantage. Policy implications include subsidised digital-foundations bundles for laggard micro-enterprises. Full article

In submitting conference proceedings to Environmental and Earth Sciences Proceedings, the Volume Editors of the proceedings would like to certify to the publisher that all papers published in this volume have been subjected to peer review by the designated expert referees and were administered by the Volume Editors strictly following the policies announced on the conference website [...] Full article

Regenerative agriculture is increasingly promoted as a pathway towards sustainable food production, climate resilience, and the restoration of soil ecosystem functions. However, evidence on the actual uptake of regenerative practices and the factors influencing their adoption remains limited. This study compared the self-reported prevalence of 17 soil-health-oriented regenerative practices among farmers in Poland, Germany, and Belarus using a questionnaire survey conducted in 2025 (N = 150). The survey also examined farmers’ motivations, perceived barriers, knowledge sources, and definitions of regenerative agriculture. Adoption frequencies were assessed using a five-point Likert scale and analysed using non-parametric statistical methods. Several practices, including crop rotation and soil pH management, were widely implemented across all three countries and showed only slight variation. In contrast, more complex, system-based practices, such as agroforestry, biological soil monitoring, and crop–livestock integration, showed lower and more variable levels of adoption. Additional subgroup analyses were conducted to assess the robustness of the observed cross-country patterns. Although some associations weakened after stratification, many significant differences persisted. Across all countries, improving soil health was the primary motivation for adopting regenerative agriculture, whereas financial constraints and limited equipment access were the main barriers. Digital media served as the primary source of knowledge about regenerative agriculture across the surveyed countries, although in Belarus, peers and neighbours also represented a highly important source of information. Farmers in all three countries expressed a preference for online communication channels for further learning about regenerative agriculture; however, Polish and Belarusian farmers prefer social media, whereas German farmers preferred webinars and dedicated websites. In-person training sessions also attracted considerable interest among Polish and Belarusian farmers, but were the least preferred information source among German respondents. On the basis of these results, targeted investment support and direct financial incentives appear to be key priorities for promoting the further uptake of regenerative agriculture across all surveyed countries. However, communication and knowledge-transfer strategies are likely to require greater adaptation to country-specific preferences, although digital media are likely to represent the most effective primary channel for disseminating information on regenerative agriculture. Full article

Medication adherence is a critical determinant of treatment effectiveness; however, its measurement and integration into routine healthcare practice remain challenging in many healthcare systems. This study aimed to compare medication adherence measurement methods and examine the legal and regulatory frameworks governing adherence-related tools in North Macedonia, Romania, Serbia, and Bulgaria. A structured comparative, two-phase document review was conducted between January and April 2026. The first phase identified and compared medication adherence measurement methods reported in research and recognized within national healthcare systems. The second phase analyzed legislation, regulatory documents, and policy frameworks relevant to adherence-related tools, including digital technologies. Searches were performed in PubMed, Scopus, and Web of Science, together with official governmental, regulatory, and institutional websites. The final evidence base comprised 84 documents, including scientific publications, official legal and policy documents, and regulatory and institutional sources. Across North Macedonia, Romania, and Bulgaria, medication adherence monitoring was not systematically integrated into routine clinical practice, despite differences in digital health infrastructure and regulatory maturity. Traditional indirect methods, particularly prescription refill data and clinician assessment, were more consistently reported, whereas validated direct and digital adherence measurement approaches remained unevenly implemented. Regulatory frameworks differed substantially in scope, specificity, and formal recognition of adherence-related tools, reflecting varying levels of alignment with European digital health policies and contributing to fragmented implementation across healthcare systems. Although existing digital health infrastructure provides a foundation for systematic medication adherence monitoring, implementation remains fragmented because of limited interoperability, inconsistent regulatory support, and the absence of standardized national approaches. Strengthening regulatory guidance, harmonizing adherence measurement standards, integrating adherence indicators into routine healthcare information systems, and formally supporting pharmacist-led adherence services could support more consistent medication adherence monitoring and improve medication management across the healthcare systems of the four analyzed countries. Full article

Airports face increasing pressure to reduce their climate impacts while maintaining mobility, connectivity, operational capacity, and service quality. However, many airport sustainability assessments rely on expert judgments, narrow environmental indicators, or conventional multi-criteria decision-making models that treat heterogeneous public data as equally reliable. This study evaluates the sustainable mobility and climate-transition performance of 20 European airports using 18 criteria across six dimensions: airport access sustainability, low-carbon mobility, carbon transition, energy and resource efficiency, circularity, and operational pressure. Data from sustainability, annual, and integrated reports; Airport Carbon Accreditation records; official airport websites; public transport sources; and traffic statistics were integrated through a standardized airport–criterion data structure recording the source type, reporting year, unit, organizational boundary, calculation status, and assurance level of each observation. The data were then harmonized to common definitions and units before analysis. A Z-number fuzzy WENSLO–ALWAS framework was applied to represent each airport–criterion observation through two components: a fuzzy performance value and a fuzzy reliability value. This mechanism allows airport-specific, externally assured observations to exert stronger evidential influence than calculated, group-level, incomplete, or proxy-based values, thereby avoiding the equal treatment of data with different levels of credibility. The results provide reliability-adjusted airport rankings, dimension-level performance profiles, sensitivity analyses, robustness comparisons, and airport clusters. The findings indicate that airport sustainability performance depends not only on carbon reduction and accreditation maturity, but also on public transport accessibility, low-carbon mobility, resource efficiency, circularity, operational pressure, and reporting reliability. The empirical findings are specific to the selected European airports, while the proposed framework is transferable to other regions, subject to the recalibration of criteria, benchmarks, reporting conventions, and reliability rules. The study demonstrates how heterogeneous public sustainability data can be converted into transparent and defensible, reliability-aware inputs for airport benchmarking. Full article

Online toxicity has become a defining feature of contemporary digital discourse, permeating all forms of online discussion, from news websites and discussion forums to social media platforms. While prior research has examined toxic behaviour across these domains, less attention has been paid to the interplay among broader socio-political polarization, platform architectures, and psychological mechanisms that jointly sustain this discursive paradigm. This literature review proposes a multi-level integrative framework to conceptualize the toxicity lifecycle. At the macro level, affective polarization fosters societal antagonism, reinforcing entrenched in-group and out-group dynamics. However, the intensity and expression of these societal cleavages are shaped by distinct media–political system configurations, including varying degrees of political parallelism, and journalistic professionalization. At the meso level, platform affordances such as algorithmic amplification and engagement-based metrics promote emotionally charged, conflict-driven content. At the micro level, disinhibition lowers normative constraints on expression, often leading to verbal aggression that undermines the principles of healthy public deliberation. Addressing these challenges requires a comprehensive response that brings together users, platforms, and policymakers to safeguard the normative democratic values of constructive public deliberation. Full article

Rationale: This research explores the connections between shelter and rescue revenues and expenses and live release outcomes, specifically focusing on the implications of a nonprofit having a government contract to provide animal control and welfare services. Methods: Two data sources were used for the project: nonprofit I990s as reported to the Internal Revenue Service (for financial data) and live release data from Shelter Animals Count (to measure shelter outcomes). The project focuses on financing for nonprofit shelters and rescues and 252 organizations from the Shelter Animals Count database, classified as nonprofits with and without government contracts, were used in the analysis. Data on revenue and expenditures were pulled from the nonprofit 990s using the GuideStar website. Results: Two variables—relinquishment rate and diversification of revenue—account for 40% of the variation in live release rates. Organizations with greater diversification of revenue have significantly higher live release rates and those with higher numbers of relinquished animals have lower ones. Conclusions: The study concludes that: a more even distribution of revenue between donations, programs, and government contracts for service is related to better outcomes; it is not so much whether a shelter or rescue has a government contract, but the portion of its revenue provided by the contract that is related to live release rates; and, overall, there are few significant relationships between revenue, expenditures, and outcomes. Full article

Background/Objectives: Romania’s National Health Insurance House (CNAS) reimbursement basket is the principal public financial-protection mechanism, yet whether it reflects the therapeutic services patients actually seek has not been tested against private-market offerings. This study compared the public basket with the private dental service portfolio, using the latter as an indirect, supply-side signal of expressed need rather than a direct measure of demand. Methods: In this cross-sectional study (November 2024–February 2025), the publicly listed portfolios of 420 private dental practices in Bucharest (n = 256), Cluj-Napoca (n = 104), and Iași (n = 60) were analyzed, stratified by size (0–3 vs. >3 employees). Practices were identified from CAEN 8623 records on listafirme.ro; portfolios were extracted from official websites displaying prices. Services were classified as functional or aesthetic by two independent raters (Cohen’s κ = 0.91), with disagreements resolved by consensus. Results: Across all municipalities and strata, approximately 53–68% of private services fell outside the CNAS basket. Critically, about 95–96% of private services were functional rather than aesthetic (4–5%), indicating that the gap reflects functional treatments patients seek and providers offer yet that remain unfunded—not elective demand. No statistically significant geographic differences emerged. Geographic location was not associated with portfolio breadth, whereas in multivariable models larger practices (>3 employees) independently offered approximately 33% more services. Conclusions: Because the analysis reflects advertised portfolio breadth rather than utilization, and a documented Romanian orientation toward reactive over preventive care, these hypothesis-generating findings make private supply a pragmatic, supply-side reference point for evidence-based revision of the CNAS basket, pointing to two directions directly supported by the data—aligning coverage with observed demand and administrative simplification of contracting. To our knowledge, this is the first benchmarking of the CNAS basket against private supply, relevant to other predominantly private European dental systems. Full article

The aim of this systematic survey was to evaluate the quality of clinical practice guidelines (CPGs) that provide recommendations for the detection, diagnosis, and treatment of oral cavity cancer (OCC). We conducted a systematic search in MEDLINE, EMBASE, Epistemonikos, CPG websites, and scientific societies to identify documents providing recommendations for the detection, diagnosis, and treatment of OCC. Two reviewers independently assessed the included CPGs using the AGREE II instrument. We calculated standardized scores for the six domains and provided a final recommendation for each CPG. We identified twenty-five CPGs published between 2019 and 2024. The mean scores (higher scores indicate better domain assessment) per domain were as follows: scope and purpose, 80.5 ± 11.6%; stakeholder involvement, 55.6 ± 16.7%; rigor of development, 48.3 ± 20.1%; clarity of presentation, 83.8 ± 8.2%; applicability, 33.6 ± 19.1%; and editorial independence, 57.3 ± 22.4%. The overall mean rate was 4.8 ± 0.8, with a maximum score of seven. Reviewers recommended five guidelines for use in practice, twelve were recommended with modifications, and eight were not recommended. The overall quality of CPGs on OCC was suboptimal. CPG developers should strengthen the use of systematic, transparent methodologies and frameworks for evidence synthesis and recommendation formulation, thereby improving the quality of recommendations and facilitating implementation across diverse clinical contexts. Full article

Background/Objectives: Vaccine-preventable disease may generate medico-legal disputes not only after an adverse event following immunization, but also when a clinician is alleged to have failed to mention, recommend, revisit, refer for, or document a clinically relevant vaccine. We examine this “unmentioned vaccine” problem while distinguishing existing law (lex lata) from proposed good practice (lex ferenda). Methods: We conducted a documented purposive narrative and comparative medico-legal review. PubMed/MEDLINE, PubMed Central, structured scholarly web searches, publicly accessible legal repositories, and official policy websites were searched from database inception through 21 July 2026 using combinations of vaccination, informed consent/refusal, failure to recommend or vaccinate, referral, documentation, negligence, causation, and LMIC terms. Authorities were selected for doctrinal relevance and jurisdictional contrast, with citation chaining. Results: In the selected jurisdictions, patient-centered disclosure of material risks and reasonable alternatives is recognized in differing forms. Vaccine-specific cases are sparse and fact-sensitive and do not establish a universal duty to recommend, refer, or revisit every vaccine. Provider recommendation influences uptake, but this behavioral evidence does not itself establish legal duty or causation, and direct empirical evidence linking counselling omissions to claims remains limited. We therefore present ADRR—assess, discuss and disclose, recommend or refer, and record and revisit—as proposed practice guidelines developed by the authors and presented in conceptual form, not as a validated legal or clinical standard. Conclusions: ADRR may support proportionate, system-level preparedness, especially in LMICs, but implementation must account for access, supply, workforce, financing, records, and legal context. Stakeholder co-design and empirical validation are required before routine adoption. Full article

Smart cities have emerged as a strategic approach to enhancing urban sustainability through the integration of digital technologies, intelligent infrastructure, and data-driven governance. However, limited research has comprehensively examined how technological, institutional, governance, and contextual factors interact to influence sustainability outcomes in industrial-city settings, particularly in Saudi Arabia. This study develops an integrated conceptual framework for sustainable smart industrial cities through a qualitative research design based on a systematic screening and synthesis of the literature, complemented by a contextual analysis of the Dammam Metropolitan Area (DMA) as an illustrative urban-industrial case under Saudi Vision 2030. A total of 86 articles, reports, and website materials were identified and screened, of which 49 sources met the inclusion criteria and were synthesized to develop the proposed framework. The analysis examined five interrelated components: smart-city applications, institutional governance, implementation conditions, contextual barriers and opportunities, and sustainability outcomes across three dimensions: environmental, social, and economic. The findings suggest that the effectiveness of smart-city applications depends not only on technological innovation but also on institutional governance, digital readiness, stakeholder participation, integrated planning, and supportive regulatory environments. The study further identifies fragmented governance, limited institutional coordination, cybersecurity risks, and high infrastructure costs as key implementation barriers, while highlighting opportunities associated with Saudi Vision 2030, digital-transformation initiatives, and circular-economy principles. The principal contribution of the study is the development of an integrated conceptual framework that explains the interactions among these five components and provides a theoretical foundation for future empirical validation, as well as conceptually informed guidance for policy development and planning in Saudi Arabia and comparable industrial-city contexts. Full article