PurposeThis study provides a systematic analysis of key literature in healthcare Operations Management (OM), examining its evolution from manufacturing-based approaches to modern healthcare applications. It addresses two main questions: the insights gained from a bibliometric review, such as publication trends, influential authors and institutions, and emerging themes; and how OM has developed over time within healthcare, identifying key thematic shifts.MethodUsing a hybrid method that combines bibliometric and content analysis, the authors examined 604 English-language research papers from the Web of Science Core Collection™, focusing on healthcare and operations research journals. The analysis followed three steps: (1) using the histograph method to trace citation patterns and identify influential publications; (2) applying thematic evolution mapping to explore how research themes have developed across time; and (3) conducting content analysis to understand thematic clusters more deeply.ResultsResults show that early OM research emphasized strategic decision-making and efficiency in clinical areas like operating rooms and emergency departments. Over time, the field incorporated practical tools such as Lean, Six Sigma, and simulation models. More recently, the focus has shifted toward patient-centered care, with growing use of big data and artificial intelligence. These findings contribute to a theoretical framework and offer guidance for future research, healthcare managers, and policymakers.
Introduction. Sanger sequencing-based emm typing has traditionally been used in England to assess case relatedness when managing invasive group A Streptococcus (iGAS) outbreaks.Gap statement. While timely, emm typing can lack resolution. Whole-genome sequencing (WGS), offering greater strain discrimination, is increasingly used, but its comparative value for public health response has not been assessed.Aim. This study evaluates the added value of WGS over Sanger emm typing for group A Streptococcus (GAS) surveillance and outbreak detection, investigation and management in England.Methodology. The evaluation followed the Pathogen Genomics in Public Health Surveillance Evaluation (PG-PHASE) framework (full description in Appendix 1, Table S1). Interviews with laboratory staff and bioinformaticians, and a survey of UK Health Security Agency (UKHSA) health protection and epidemiology iGAS leads, provided insights into emm typing and WGS data use, utility, acceptability and appropriateness. Typing data from outbreak isolates collected between February 2018 and February 2024 were analysed to evaluate the concordance between Sanger emm typing and WGS-based single-nucleotide polymorphism (SNP) clusters. WGS strain diversity and SNP distances within emm types were assessed, using a five-SNP threshold for WGS clusters. The number of cases excluded from outbreaks by emm typing vs. WGS was compared.Results. Laboratory staff indicated that transitioning from a Sanger- to a WGS-based GAS typing service would result in more granular information to inform public health action. Survey participants acknowledged WGS benefits for relatedness resolution but raised concerns about longer turnaround times (a maximum of 14 vs. 5 days for WGS and the Sanger method, respectively) and highlighted the need for training in interpreting WGS data. Suggestions included more standardized, regular, cumulative WGS reports to improve clarity and usefulness. We analysed 178 epidemiologically linked GAS outbreaks, including 1,142 isolates. Emm typing excluded 217 unrelated isolates from 58 outbreaks, while WGS excluded a further 224 isolates (n=44 total) from 114 outbreaks.Conclusion. WGS improves outbreak management, particularly for protracted outbreaks and those with common emm types. WGS better automates and integrates reference laboratory services; however, current turnaround times reduce its benefits for immediate public health action. Our findings suggest that strengthening the timeliness of WGS reporting, co-designing reporting processes with data users and providing training in data interpretation will enhance WGS utility.
The imminent transition from low Earth orbit operations to sustained deep-space exploration introduces significant demands upon crew health systems that extend well beyond the physiological and psychological domains traditionally addressed in aerospace medicine. Despite growing recognition that sexuality and reproductive health represent fundamental dimensions of human well-being, these domains have remained conspicuously absent from official mission planning, crew training curricula, and habitat design specifications. This narrative review was therefore undertaken to appraise and synthesize existing evidence on the biological, psychological, ethical, and technological dimensions of human sexuality relevant to long-duration spaceflight and to identify critical knowledge gaps and operational vulnerabilities. A structured literature search was performed across multiple academic repositories, including PubMed, PsycINFO, Web of Science, and Google Scholar, targeting English-language studies published from 1990 to 2026. The scope of the review comprised reproductive physiology within microgravity and high-radiation environments; the psychosocial and psychosexual dynamics of isolated, confined, and extreme settings; the intersection of habitat design, privacy, and ethical-regulatory frameworks; and the emergence of erotic technologies with potential aerospace applications. Eligible studies were thematically analyzed to construct a five-pillar operational framework. The narrative synthesis identified five operational pillars that require systematic integration into mission architecture. Reproductive risk assessment emerged as a foundational concern, encompassing radiation- and microgravity-induced impairment of gonadal function, gametogenesis, and embryonic development; however, the evidence base remains predominantly derived from animal models and in vitro studies. Psychosexual crew preparedness was identified as equally critical, necessitating the development of consent training, healthy intimacy education, and relationship management strategies. The review further highlighted the need for habitat design standards that incorporate spatial, acoustic, and hygiene requirements for intimate behavior in reduced-gravity environments. Regulatory and ethical governance represents an additional imperative, requiring the establishment of relationship policies, pregnancy contingency protocols, and sexual misconduct reporting mechanisms adapted to the jurisdictional complexities of extraterrestrial operations. Finally, a prioritized research agenda is proposed, targeting systematic reproductive health surveillance, analog-based psychosexual studies, stakeholder consultation, and erobotic technology evaluation. We conclude that the systematic neglect of sexuality and reproductive health in current mission planning may compromise crew well-being, interpersonal dynamics, and ultimately mission success as the duration and remoteness of human spaceflight increase. The proposed framework offers a structured conceptual roadmap for translating space sexology from academic discourse into actionable components of mission architecture but requires empirical validation through analog-based pilot studies and stakeholder engagement. This integration should be prioritized in parallel with the technological development of deep-space transportation systems.
Mental health disorders are on the rise globally, with policies promoting programmes that aim to enhance mental wellbeing across various population domains. This scoping review aims to examine the literature to identify and map the mental health programmes in Singapore, while identifying critical knowledge gaps and scope for future systematic reviews. A systematic search was conducted across multiple databases including Medline, PsycINFO, CINAHL, OpenGrey and ProQuest, complemented by hand and bibliography searches. Articles published from 2000 onwards in English language were included. Independent parallel reviews were conducted by multiple reviewer pairs. Data was extracted into standardised, pre-piloted templates that incorporated the Template for Intervention Description and Replication (TIDieR) checklist. One hundred and six studies were included in the review, demonstrating diverse programmes targeting different age groups, with particular focus on older adults in hospital and community settings. The programmes addressed mental health outcomes in individuals with mental disorders, physical conditions, neurodevelopmental and learning disabilities, and among healthy individuals. Implemented by trained care teams or multidisciplinary professionals, these programmes generally showed positive outcomes. However, significant gaps were identified in the literature regarding user experiences, with minimal focus on implementation barriers and enablers. Notably, there was limited evidence of successful community-level implementation beyond the experimental phase, raising questions about programme sustainability and real-world effectiveness. Critical gaps were also identified in youth-specific suicide prevention programmes, despite suicide being a leading cause of death among youths, and programmes targeting the impact of built environment on mental health outcomes and workplace wellbeing. These areas represent important opportunities for future research and intervention development in Singapore's mental health landscape. Singapore has developed an active research network over the past decade to design and implement programmes aimed at improving mental health across different populations and settings. However, stronger collaborative approaches between academics and policymakers are needed to better utilise research findings and understand which programmes add value to the public health domain. Future research should focus on implementation science, long-term sustainability, and cost-effectiveness of these programmes in real-world settings.
The same dataset can be analysed in different justifiable ways to answer the same research question, potentially challenging the robustness of empirical science1-3. In this crowd initiative, we investigated the degree to which research findings in the social and behavioural sciences are contingent on analysts' choices. We examined a stratified random sample of 100 studies published between 2009 and 2018, in which, for one claim per study, at least five reanalysts independently reanalysed the original data. The statistical appropriateness of the reanalyses was assessed in peer evaluations, and the robustness indicators were inspected along a range of research characteristics and study designs. We found that 34% of the independent reanalyses yielded the same result (within a tolerance region of ±0.05 Cohen's d) as the original report; with a four times broader tolerance region, this indicator increased to 57%. Of the reanalyses conducted, 74% reached the same conclusion as the original investigation, 24% yielded no effects or inconclusive results and 2% reported the opposite effect. This exploratory study indicates that the common single-path analyses in social and behavioural research should not be simply assumed to be robust to alternative analyses4. Therefore, we recommend the development and use of practices to explore and communicate this neglected source of uncertainty.
Groundwater in coastal aquifers is highly vulnerable to contamination driven by intensive anthropogenic activities and hydrogeochemical processes such as seawater intrusion. This study investigated the occurrence, source apportionment, and health risks of heavy metals (Cd, Pb, and Ni) and inorganic nitrogen species (NO3 --N, NO2 --N, and NH₃-N) in groundwater from the Qinhuangdao coastal plain, North China. A total of 46 groundwater samples were collected and analyzed. Positive matrix factorization (PMF) and absolute principal component scores-multiple linear regression (APCS-MLR) were jointly applied to identify pollution sources, and a probabilistic human health risk assessment incorporating Monte Carlo simulation was conducted to quantify uncertainty. Results indicated that the mean concentrations of Cd, Pb, and Ni complied with Chinese groundwater quality standards, whereas NO₃--N and NH₃-N exceeded the Class V threshold at several sites, suggesting localized nitrogen contamination. PMF resolved three primary sources: industrial discharge (dominated by NO2 --N), domestic sewage (NH₃-N), and agricultural activities (NO₃--N and heavy metals). Health risk assessment showed that Cd posed a potential carcinogenic risk through ingestion and dermal exposure, whereas the noncarcinogenic risks of Pb and Ni remained within acceptable limits. Monte Carlo simulation confirmed the robustness of the deterministic estimates and identified the Cd carcinogenic slope factor and ingestion rate as the most sensitive parameters. Source-oriented risk apportionment further indicated that agricultural activities contributed the largest share of carcinogenic risk. These findings highlight the importance of controlling agricultural nonpoint pollution and provide a scientific basis for groundwater protection and risk management in coastal plain aquifers.
Despite the critical role that feeding and feed bunk management practices play in dairy herd performance, limited information is available on how these practices are implemented across different production levels in Brazilian confined dairy systems. We aimed to gather information on the producers 'reported feeding practices used on confined dairy operations and identify their relationship with average herd milk production. An electronic survey of 38 questions was emailed to 500 Brazilian dairy producers. Out of the 135 responses received, answers from 82 producers were included, and herds were ranked according to their 305-d milk production (kg) as low (LP; < 7,000; n = 27), medium (MP; 7,000-10,000; n = 35), and high production (HP; > 10,000; n = 20). The HP and MP herds had greater odds of evaluating particle size distribution, forage DM, TMR physically effective fiber NDF (peNDF), corn kernel processing, and having a water trough wash protocol and cooling system than LP herds. The HP herds had greater odds of grouping primiparous separated than LP herds. The feed refusals and frequencies of feed efficiency, feed bunk clean-up, and TMR peNDF were similar among herds. The HP producers reported a greater feeding frequency, feed push-up, and cleaning water troughs than MP and LP, respectively. Producers reported evaluating forage DM monthly and when a new silo was opened, regardless of milk production level. In conclusion, this survey demonstrates that producers of HP and MP herds showed a greater frequency of use of feeding management practices than those of LP herds. Furthermore, survey results can be used to develop and disseminate target information on feeding practices and feed bunk management in dairy operations.
Efficient allocation of nursing human resources (NHR) is critical for optimizing care quality in integrated medical-nursing elderly care institutions. However, standardized tools for assessing NHR efficiency remain underdeveloped. This study aimed to develop and validate a data envelopment analysis (DEA)-based evaluation system for nursing human resource efficiency in integrated elderly care institutions, with empirical application in clinical settings. Employing a cross-sectional design, the research evaluated NHR efficiency in integrated medical-nursing elderly care institutions. A preliminary indicator system was developed through comprehensive literature review and field investigations, followed by two rounds of Delphi consultations with 17 multidisciplinary experts specializing in nursing management, elderly care administration, integrated medical-nursing operations, health economics, and public health. Expert reliability was determined by assessing response rates, authority levels (qualifications and experience), consensus (agreement rates), and coordination (Kendall's W test). Based on this established indicator system, the DEA model was employed to evaluate the operational efficiency of 12 integrated medical-nursing elderly care institutions in Hainan Province, China. The constructed evaluation system featured a three-level hierarchical structure totaling 68 indicators (9 first-level, 19 second-level, and 40 third-level indicators). Two rounds of expert consultation demonstrated strong participation (response rates: 100% and 94.1%, respectively) and high reliability (authority coefficients: 0.88 and 0.92). Expert consensus was confirmed through statistical analysis (Kendall's W: 0.471 and 0.348; average coefficient of variation: 0.16 and 0.12; all p < 0.001). Subsequent DEA implementation across 12 institutions revealed 5 were fully efficient (OE = TE = SE = 1.000), while the remaining 7 showed varying inefficiency patterns: 4 exhibited pure technical efficiency (TE = 1.000) with scale inefficiency (SE < 1.000), and 3 demonstrated both technical and scale inefficiency (TE < 1.000, SE < 1.000). The nursing human resource efficiency evaluation system developed in this study demonstrated strong validity through a rigorous Delphi expert consultation process, showing high expert engagement and authoritative consensus. The comprehensive three-level indicator system exhibits well-organized structure with strong specialty-specific relevance for integrated medical-nursing care settings. DEA application confirmed the system's effectiveness in objectively evaluating nursing efficiency, supporting its practical utility for healthcare management in elderly care institutions.
Chronic diseases are the largest contributor to overall morbidity and mortality. The workplace lifestyle interventions have shown improvements in anthropometric, and cardiometabolic parameters. However, data related to workplace wellness programs in the United Arab Emirates (UAE) are scarce. The aim of this study was to evaluate the effectiveness of a workplace wellness intervention on anthropometric measures, functional capacity and cardiovascular fitness. We conducted a 12-week workplace wellness intervention among employees of a leading UAE healthcare organization. The program included physical activity challenges targeting step count and calorie expenditure, with assessments conducted at baseline, day 45, and day 90. We used adjusted linear mixed-effects models to analyse the data. A total of 116 participants were included in the analysis [mean age 39.2 (SD 8.4) years, female sex 49.1%]. Compared with baseline values, we observed a significant improvement in weight, body mass index, and waist circumference both at day 45 [-0.52 (95% CI, -0.96 to -0.08) kg, -0.18 (-0.32 to -0.03) kg/m2, -2.53 (-3.93 to -1.14) cm, respectively], and at day 90 [-1.16 (-1.81 to -0.51) kg, -0.40 (-0.62 to -0.18) kg/m2, -3.73 (-5.84 to -1.59) cm, respectively]. The total functional movement score increased by 2.76 (2.23-3.30) and 4.99 (4.50-5.49) at day 45 and day 90, respectively. The systolic blood pressure was decreased by -2.58 (-5.09 to -0.07) mmHg and -4.76 (-7.09 to -2.43) mmHg, and Rockport 1-mile walking time was decreased by -2.06 (-2.57 to -1.55) minutes and -2.46 (-3.11 to -1.82) minutes at day 45 and day 90, respectively, compared with the baseline values. The predicted cardiorespiratory fitness (VO2) increased by 9.00 (7.28-10.73) mL·kg-1·min-1 at day 45, and by 7.24 (5.34-9.13) mL·kg-1·min-1 at day 90. Compared with week-1 levels, the activity wearable parameters of steps and calories per day showed reductions mid-intervention [-1,392 steps/day, (-2,233 to -550); -248 calories/day, (-404 to -92)], and by day 90 [-1,008 steps/day (-2,164 to 148); -157 calories/day (-310 to -5). The wearable-derived resting heart rate showed a modest decline with mean reductions of -1.41 bpm (-2.52 to -0.30) at mid-intervention, and -0.57 bpm (-1.79 to 0.66) by day 90. Our findings show significant improvements in anthropometry, functional movement scores, and selected parameters of cardiovascular fitness associated with workplace wellness program. These results contribute important preliminary data for the UAE healthcare workforce, and suggest that incorporating workplace interventions into organizational health policies could play a crucial role in improving employee health.
Cancer remains a major health issue globally, with increasing incidence and mortality rates. While immunotherapy has revolutionized cancer treatment, not all patients benefit, urging the identification of predictive biomarkers. This study utilized public datasets and tumor samples to examine the expression and promoter hypermethylation of DLEC1 in normal and tumor tissues, to evaluate its potential as prognostic and immunotherapy marker. In vitro and in vivo experiments on breast cancer (BrCa) cell lines were conducted to explore the functions and mechanisms of DLEC1. The prognostic significance of DLEC1 downregulation and its impact on immune cell infiltration and immunotherapy efficacy were analyzed using the GEO and TCGA databases. DLEC1 was frequently downregulated and methylated across multiple cancers. In BrCa, expression of DLEC1 inhibited tumor cell proliferation, induced apoptosis, and activated the interferon lambda1 signaling pathway, indicating its important role as a bona fide tumor suppressor and immunoregulator. High DLEC1 expression correlated with better prognosis in several cancer types and with increased immune cell infiltration. Cancer patients with high DLEC1 expression showed improved overall and progression-free survival under immune checkpoint inhibitor therapies, such as anti-CTLA4, anti-PD1 and anti-PDL1. DLEC1 promoter hypermethylation is a promising biomarker for cancer prognosis and potential immunotherapy response prediction. Its expression and promoter hypermethylation status could thus help to guide clinical treatment strategies for cancer patients, particularly of breast cancer. The online version contains supplementary material available at 10.1007/s00439-026-02828-3.
The development of autonomous aerial robots capable of safely navigating complex real-world environments without or with little human intervention represents a major milestone in robotics and artificial intelligence (AI). While rapid advances in AI-enabled decision-making, sensing, and control systems are unlocking new capabilities for unmanned aerial vehicles (UAVs), their translation into safe and scalable real-life applications remains a major challenge. In this Perspective, we examine key AI technologies relevant to aerial autonomy and discuss early application scenarios in unmanned aviation and airspace management, with a focus on their assurance-relevant properties. We analyze regulatory obstacles that limit deployment, particularly for AI-enabled and beyond visual line of sight (BVLOS) operations, and highlight why traditional risk assessment and certification approaches are need to be updated to account for adaptive, data-driven systems. Building on this analysis, we argue that testing infrastructure must be understood as a core scientific instrument, enabling systematic evidence generation under realistic and safety-critical conditions, validating autonomous functions, ensuring safety, and building trust among regulators and the public. As a concrete example, we introduce LINA, a scientifically-grounded, integrated experimentation and validation platform in Switzerland designed to support iterative, regulator-aware development of autonomous systems across technology readiness levels. We highlight how LINA function as sandbox for system-level science, regulatory learning, and trust building, thereby enabling the responsible and societally acceptable integration of autonomous aerial systems and strengthening Switzerland's role in advancing aerial robotics research and innovation.
Commercial processing of quails has been less studied than broiler processing, despite the food safety relevance of hygienic control in poultry slaughter operations. This study characterized hygiene indicator bacteria in quail carcasses pre- and post-chlorinated water immersion chilling (CWIC), in finished packaged products, and in selected processing-environment matrices across three independent trials in a commercial facility. In each trial, whole-carcass rinse samples were collected from pre-CWIC (n = 5) and post-CWIC (n = 5) carcasses, with technical triplicate plating for each carcass. The finished packaged products (n = 15 per trial) and environmental samples (gloves, precooling chamber floor, aspiration inlet opening, wash water, and CWIC water) were also evaluated. Aerobic plate counts (APC), coliforms, and Escherichia coli were enumerated and expressed as log colony forming units (CFU)/mL. Qualitative screening for Salmonella was performed using enrichment. Across trials, CWIC reduced APC; however, the magnitude varied (Trial 1: 2.75-2.28 log CFU/mL; Trial 2: 4.60-2.35 log CFU/mL; and Trial 3: 3.21-3.08 log CFU/mL). Coliforms and E. coli were not detected in Trial 1 carcass-stage samples. Trial 2 showed decreased coliforms post-CWIC, with E. coli not detected in the post-CWIC group. Trial 3 showed detectable coliforms and E. coli both pre- and post-CWIC. In all trials, packaged finished products exhibited higher indicator levels than post-CWIC carcasses, including higher APC (4.05-4.88 log CFU/mL across trials). Gloves consistently showed the highest indicator counts among the environmental matrices, whereas wash water and CWIC water were negative in Trial 1 but showed detectable APC in Trials 2 and 3, indicating variability in process hygiene. Salmonella was not detected in any of the carcass stages, packaged products, or environmental samples tested. Overall, the data identified post-wash handling points and water/disinfectant management as practical targets for verification to improve hygiene consistency during commercial quail processing.
Diabetes poses a major global public health challenge, carrying significant economic implications worldwide. In China, the ongoing implementation of Diagnosis Related Groups (DRG) payment reforms, especially within Traditional Chinese Medicine (TCM) contexts, is critical in improving diabetes patient care and alleviating associated economic burdens. We examined 2,804 hospitalized diabetes patients at Qingyang City Hospital of Chinese Medicine in Gansu Province from 2017 to 2022. Using univariate and interrupted time-series (ITS) analyses, we compared patient visit data, healthcare-related costs, and length of stay pre- and post-DRG reform. Following DRG reform at Qingyang City Hospital of Chinese Medicine, significant differences were noted in patients' age, visit times, type of diabetes, complications and comorbidities, use of Chinese medicine diagnostic and therapeutic equipment, and surgeries and operations, compared with the pre-reform period (p < 0.05). Post-reform, there was a noteworthy decrease in hospitalization cost and Western medicine cost, and TCM treatment cost (p < 0.05), while Chinese medicine cost remained stable but the overall cost level increased (p > 0.05). Additionally, there was a slight reduction in length of stay after the reform, although this change did not reach statistical significance (p > 0.05). DRG reform significantly reduces hospitalization cost, TCM treatment cost, and Western medicine cost for diabetes patients in TCM hospitals. However, its impact on Chinese medicine cost and length of stay is limited. Future reforms should capitalize on the unique strengths of TCM treatment, enhance cost management strategies, and focus on minimizing length of stay and medical expenses while ensuring effective patient care.
Inhaled medications are the mainstay of chronic obstructive pulmonary disease (COPD) management. While consensus guidelines for pharmacological management in COPD are well-established, few guidelines exist regarding inhaled medication delivery systems. The COPD Foundation Nebulizer Consortium conducted a cross-sectional survey of patients with COPD and healthcare providers to understand their perceptions and utilization of nebulized medications. An online survey was conducted from February 7 through April 9, 2024. Patients completed a 42-question survey, including demographic information, tobacco use, symptoms severity, and the role of nebulizers in their treatment. Healthcare providers responded to a 17-question survey about their clinical experience with nebulized medications. We analyzed responses from 347 patients and 39 healthcare providers. Among patients, 76.4% (265/347) were ≥65 years old, 72.0% (250/347) were female, 93.4% (324/347) were white, 90.5% (314/347) had a current or former smoking history, 77.6% (263/339) reported at least one exacerbation in the past year, and 70.8% (240/339) used some form of supplemental oxygen. Nebulizer use was reported by 84.1% (292/347) of patients. Among nebulizer users, 94.5% (276/292) used short-acting while only 22.3% (65/292) used long-acting nebulized medications. Patients reported that hand-held inhaler devices were easier to use (69.8%, 171/245), but nebulized therapy led to better symptom control (64.9%, 159/245) and had lower copays (67.8%, 166/245). Among prescribers surveyed, most (82.1%, 32/39) believed nebulizers were preferable for patients experiencing exacerbations. Impediments to wider use of nebulizers included difficulties with insurance coverage (69.2%, 27/39), cost (53.8%, 21/39), and lack of combination nebulized drugs (46.2%, 18/39). Two-thirds of providers thought that nebulizers were underused. We demonstrate that while patients and providers both perceive nebulizers as preferred in clinical management of COPD, there is discordance between patient and provider perception of nebulizer use on the basis of cost and feasibility of use.
Amid growing global concern about the impact of marine plastic debris on the marine environment, fishers are expected to remove debris from their fishing gear during day-to-day fishing, and bring it back to land for proper disposal. However, a comprehensive survey of stranded, drifting, and benthic marine debris removed by fishers across Japan has not yet been undertaken. This study aims to analyze fishers' removal activities and the challenges they encounter. Nominal variables-such as ocean currents, the size of Fisheries Cooperative Association (FCA), and fishing types-were selected as external factors to examine their statistical significance and contribution to removal efforts using inferential statistical analysis. Correspondence analysis was applied to illustrate the relationship between currents and types of debris. Nearly 90% of FCAs across Japan experienced at least one of the three categories of marine debris at the same time and carried out removal operations for at least one of them. Significant relationships were identified between ocean currents and the presence or absence of removal activities for all types of marine debris. FCAs engaged in small-scale trawl fisheries were more likely to carry out benthic debris removal. Correspondence analysis showed that plastic products were removed by fishers across nearly all areas. This study contributes to the policy implications of reducing plastic pollution and promoting sustainable marine management by highlighting the role of coastal fishers in the removal of stranded, drifting, and benthic marine debris.
Global nursing shortages require innovative care delivery models. Virtual nursing is a cutting-edge model being explored. This study aimed to examine the perspectives of clinical and administrative staff involved in a virtual nursing pilot on a medical-surgical unit and to identify best practices for future adoption. We conducted a qualitative evaluation using individual semistructured interviews with virtual and bedside nurses, nurse executives, and IT project managers implementing a virtual nursing pilot program at a medical-surgical unit with 35 private and semiprivate beds at the Mount Sinai Hospital, a 1110-bed acute care hospital in New York, NY. Interviews took place in the spring of 2024 and were completed via phone or Zoom, audio recorded, and professionally transcribed. Participants were selected using purposive sampling. The authors applied an iterative thematic analysis to transcripts using Dedoose. Claude.ai was used to generate code summaries for select codes. Of 33 individuals approached, 16 (48.5%) consented to participate. Nine participants were clinical staff (virtual and bedside nurses and nurse managers), and 7 were executive leaders or managers in nursing and informatics. Our analysis identified the following themes: (1) staff attitudes toward virtual nursing shifted from resistance to acceptance over time, (2) direct communication channels between virtual and bedside nurses were critical for efficient care coordination and model adoption, (3) admission and discharge processes evolved throughout the pilot implementation, and (4) adaptable staffing allocations were necessary to accommodate fluctuating patient census and unit demands. The main beneficiaries of this intervention, bedside nurses, found their virtual counterparts helpful following a few adjustments. Participants reported a perceived reduction in administrative burden, uninterrupted completion of clinical tasks, and they felt their overtime was reduced, which all increased their buy-in for this care model. There are several opportunities for improvement, such as real-time communication, unit-specific virtual nurse training, and flexible staffing for high-volume units. Our findings suggest that virtual nursing can address staffing challenges. Calculating the true return on investment for virtual nursing programs will require comprehensive mixed methods evaluations of such outcomes as care team and patient satisfaction, length of stay, readmission prevention, completion of nursing tasks, and reduction in overtime.
Source-specific probabilistic ecological risk assessment (PERA) of heavy metals (HMs) enhances risk management strategies. However, conventional methods, relied on total concentrations and deterministic parameters, may introduce considerable bias due to ignoring bioavailability and uncertainty. To address these limitations, this study conducted both concentration- and source-specific PERAs for HMs in Poyang Lake sediments using their bioavailable fractions and two-dimensional Monte Carlo simulation. Results reveled significant Cd pollution in sediments. Chemical speciation analyses indicated Cd (58.45% acid-soluble fraction) and As (36.96% specifically adsorbed fraction) exhibited high bioavailability, whereas Cr, Cu, Ni, Pb, and Zn were predominantly associated with residual fraction (48.55%-89.07%). Source apportionment identified three primary sources: mining/smelting, mixed sources, and industrial activities, with contribution of 26.87%, 34.55%, and 38.58%, respectively. Notably, mining/smelting was identified as the primary sources (77.68%), and As, Cd, and Pb emerged as targeted elements of concern. Incorporating bioavailable HMs into PERA reduced overall ecological risks by 38.09% compared to total concentration-based PERA. Corresponding source-specific ecological risk reductions were 39.21%, 42.11%, and 47.47% for mining/smelting, mixed sources, and industrial activities, respectively. This study highlights the importance of incorporating HM bioavailability and probabilistic analysis into ecological risk assessment framework for achieving accurate and realistic evaluation.
Sustainable beef production requires identifying animals with superior feed efficiency to reduce environmental impact and production costs. This study aimed to estimate heritability and genetic correlations between residual gain (RG) and growth, reproductive, carcass and feed efficiency traits in Nellore cattle. A total of 217,333 phenotypic records from animals born between 1980 and 2024, raised in diverse Brazilian regions, were analysed using Bayesian inference with a multi-trait mixed animal model. Heritability estimates for reproductive traits were low, while feed efficiency, growth and carcass traits showed moderate heritabilities. Residual gain exhibited a moderate positive genetic correlation with adjusted weight at 450 days (W450), supporting its potential as a selection criterion for growth efficiency. Genetic correlations between RG and carcass, reproductive and feed efficiency traits were generally low or near zero. However, a negative low genetic correlation and a moderate positive phenotypic correlation with early conception probability indicate complex effects on reproduction. Selection for RG may increase yearling weight and maintenance energy requirements, which can reduce early reproductive performance under restricted nutritional conditions, presenting trade-offs to consider in extensive systems. Conversely, RG may be particularly suitable for intensive systems such as feedlot or finishing operations, where nutritional management can mitigate these limitations. The negative genetic correlation between RG and residual feed intake further highlights RG's ability to identify animals that grow efficiently without increased feed intake. These results confirm that RG is a largely independent trait and shows sufficient genetic variability to respond to selection in Nellore cattle. Using it as a selection criterion can enhance feed efficiency without negatively impacting other economically important traits.
Traditional pediatric internship training for undergraduate medical students is often limited by student passivity and underdevelopment of clinical reasoning and skills. This study aimed to evaluate the effectiveness of the Quality Control Circle (QCC) method, integrated with Mini-Clinical Evaluation Exams (Mini-CEX) and Direct Observation of Procedural Skills (DOPS) assessments, in enhancing clinical competencies and teaching outcomes during pediatric internships. Eighty-four medical students were randomly assigned to a QCC group (traditional teaching plus QCC activities) or a control group (traditional teaching only). Clinical skills were assessed using Mini-CEX and DOPS before and after the 4-week pediatric internship. Final exam results and teaching satisfaction were also compared. Baseline scores showed no significant differences. Post-intervention, both groups improved, but the QCC group demonstrated significantly greater improvement in all Mini-CEX domains (medical history taking, physical examination, professionalism, clinical judgment, communication, efficiency, overall competence) and all 11 DOPS items (e.g., procedural understanding, aseptic technique, communication) (P < 0.05). The QCC group also scored higher in final theoretical exams, skill operations, and medical record writing (P < 0.05). Self-evaluations indicated significant progress in eight comprehensive competencies, notably problem-solving and communication skills (P < 0.05). Teaching satisfaction was significantly higher in the QCC group (92.85%) than in the control group (76.19%) (P = 0.024). The QCC teaching model significantly enhances clinical skills, assessment performance, comprehensive competencies, and teaching satisfaction in pediatric internships compared to traditional methods, proving to be a valuable approach for improving clinical teaching quality. The online version contains supplementary material available at 10.1186/s12909-026-09055-4.
Suboptimal use of preventer inhalers and salbutamol reliever overprescribing are associated with preventable asthma deaths and are a major source of primary care carbon emissions. Audit and feedback produces modest behaviour change by assessing clinical performance and delivering feedback to encourage improvement. Although feedback is increasingly delivered digitally, clinicians may respond more to additional printed feedback reports. We evaluated whether combined digital and paper feedback was more effective than digital-only feedback in promoting safer and greener asthma prescribing at the practice level. In this parallel, cluster randomised controlled trial, all 273 primary care practices in West Yorkshire were assigned within their primary care network clusters by stratified, permuted block randomisation to receive seven bimonthly reports on asthma prescribing either in 'digital and paper' (intervention) or 'digital-only' (control) formats. The primary outcome was the proportion of preventer inhalers prescribed in pressurised metred-dose devices due to their high carbon footprint. Intervention group allocation was concealed. The intention-to-treat population was analysed and adjusted for both potential confounders and preintervention achievement. Final analysis assessed 270 practices in 26 clusters per arm due to practice mergers within the control group. There was no significant difference between the intervention groups based on change in the primary outcome (intervention-0.15%; control-0.19%; risk ratio-1.00; 95% CI 0.98 to 1.03) nor any secondary outcome. Analysis of both interventions combined showed a background trend of mixed improvement following feedback. There was no evidence that combined paper and digital feedback was more effective than digital-only feedback, despite the background of mixed improvements following both interventions. Challenges remain to understanding the barriers to influencing the prescribing of preventer inhalers and transitioning inhaler devices towards low-carbon 'green' alternatives; however, this study demonstrated the value of an efficient 'real-world' trial embedded within an existing quality improvement initiative. NCT05761873.