Factors influencing the continuity of evidence-based practice in perioperative airway management for elderly patients with fractures:A qualitative study

BACKGROUND More and more evidence-based practices are emerging,but researchers mostly focus on short-term effects,resulting in evidence-based practices not being applied in the clinic in the long term.In this study,we took the evidence-based practice of perioperative airway management in elderly fracture patients as an example and adopted a descriptive phenomenological approach to understand the influencing factors of its sustainability to provide a reference basis for promoting the continuity of evidence-based practice in the clinic.AIM To explore factors influencing the persistence of evidence-based practice in perioperative airway management in elderly patients with fractures.METHODS This study was qualitative research.Nine nurses who implemented evidencebased practice in the orthopedic ward of a tertiary comprehensive hospital in Shanghai from September 2023 to October 2023 were selected using purposive sampling as research subjects.Semi-structured interviews were conducted with them,and the data were analyzed using the Colaizzi phenomenological analysis method based on the three dimensions and ten factors of the NHS sustainability model.RESULTS Three main themes and ten subthemes were identified:Process aspects(benefits to patients,benefits to nurses,lack of follow-up,complex processes);staff aspects(insufficient human resources,inadequate training and education,lack of leadership support);and organizational environment aspects(inadequate infrastructure,poor patient compliance,poor doctor cooperation).CONCLUSION Human resources,training and education,leadership support,infrastructure,and patient-physician collaboration are important factors influencing the sustainability of evidence-based practice for perioperative airway management in older patients with fractures.

Youth’s Perspectives on a Sustainable Model for the Provision of Youth Friendly Sexual and Reproductive Health Services in Kenya: A Quantitative Approach

Nearly half of the world’s population comprise youths. However, addressing their Sexual and Reproductive Health (SRH) remains a challenge. Globally countries are mandated to continually provide Youth Friendly Sexual and Reproductive Health services (YFSRHs) to the youth. The objective of this study was to assess and describe youth’s perspectives on a sustainable model for the provision of YFSRHs in Kenya. Data was collected among 400 youths aged 18 - 24 years in Embu and Kirinyaga counties, Kenya. A structured questionnaire was utilized as the data collection tool. Collected data was analyzed using SAS statistical software version 9.4. Statistical threshold of P ≤ 0.05 was used. Overall the mean age of the study participants was ±standard deviation (SD) 21.2 ± 1.86 years. Majority of the participants’ perspective on the health care system sustainability was that the waiting time at the facility should be less than an hour, accessible geographically (less than a kilometre), affordable (≤20 Ksh.), and convenient working hours (weekday and weekends ratio 1:1). Advocacy was on health care provider’s attributes of politeness, welcoming, confidential and non-judgmental. The most preferred locations for the youth friendly centres by the participants were community and school based locations. Similarly, parental and community support was reported to highly contribute to sustained utilization and provision of the YFSRHs (P < 0.001). Unlike popular belief, 99.8% did not see the need for recreational facilities at the youth centres to ensure sustainability of the model. To ensure a sustainable model for the provision of YFSRHs, there is need for a multi-sectoral and stakeholder involvement that is;youth, health care system structure, health care service providers, parents and community. Further research is needed on parents and health care service provider’s perspectives on how to sustain the provision of YFSRH services.

Basic Structures and Political Implications of a Sustainable Welfare Model

A synopsis of political welfare concepts, which are currently discussed under labels such as ＂green growth＂, ＂zero growth＂ and ＂degrowth＂, has identified fundamental shortcomings concerning the informational bases of the complex links between ecological, social and economic systems, which were taken into account in the creation of the concept. In the development of a concept for political action, a rationally acting environmental policy cannot neglect reflecting on which economic, ecological and social contexts have to be taken into account and on which normative statements its decisions should be grounded. The proposed sustainable welfare model consists of a positive impact and a normative decision model. The positive model provides a description of the ＂world＂ with which the effects of the various options for action on the environmental, social and the economic systems can be assessed. The normative model is a tool for selecting and assessing the options for action in pursuing the desired goal of sustainable welfare development. Principally the key environmental goals are prearranged to socio-economic goals. The model at hand provides the reference points for the development of a sustainable welfare concept, which can be used as a political action plan in the context of environmental policy.

Population Ageing and Sustainable Development Research in China

According to the United Nations population projections, the population of the elderly is expected to roughly triple in China from 2000 to 2050, particularly when the generations who were born between the 1950s and 1970s move through the age structure, and also because people are living longer and fertility rates have fallen, population aging is expected to put pressure on government's fiscal balance through higher old-age security benefits and health-care expenditures. This work draws together the broad range of elements involved within a consistent framework, based on a computable dynamic general equilibrium model with an overlapping generation structure. Further analysis using model simulation illustrates that the alternative schemes for the benefit rate, retirement age and technological progress are likely to be beneficial, and that an obvious slow-down in the growth of living standards is likely to be avoided.

The Sustainable Development of Resource Environment and Economy

At first, this article gives the calculating formulas about the mutual-motive mechanism of the economy development and its resource, environmental influence. And then it gives out relevant ideas about the sustainable development＇s realizing means, motive force and economic model.

Why Becoming a B Corp?A Discussion and Some Reflections

In the late 1980s,the prevailing corporate model usually depicted companies as economic entities pursuing shareholders’profit maximisation interests without a thought for the consequences of this behaviour on the local community and environment.However,over the last decades,corporate scandals challenged that corporate model’s validity and paved the way for a sustainable corporate model.The latter emphasises a triple bottom line approach that incorporates social,economic,and environmental objectives.By implementing a sustainable corporate model,companies achieve both economic and social goals in a balanced approach.This research investigates the B Corporation(B Corp)certification system,which helps companies implement a sustainable corporate model voluntarily.B Corp certification is a badge signal that companies’business model adheres to ethical standards and meets socially conscious stakeholders’expectations.Our research aims to provide a deep contextual understanding of the determinants and implications of the B Corp certification’s adoption.We adopt a semantic approach to review and systematise management and accounting literature on Certified B Corporations(B Corps)through institutional theory’s lenses,which help us explain why firms decide voluntarily to become B Corps.

Hepatitis C virus induced insulin resistance impairs response to anti viral therapy

Hepatitis C virus (HCV) infection is an important risk factor for insulin resistance (IR). The latter is the pathogenic foundation underlying metabolic syndrome, steatosis and cirrhosis, and possibly hepatocellular carcinoma (HCC). The interplay between genetic and environmental risk factors ultimately leads to the development of IR. Obesity is considered a major risk factor, with dysregulation of levels of secreted adipokines from distended adipose tissue playing a major role in IR. HCV-induced IR may be due to the HCV core protein inducing proteasomal degradation of insulin receptor substrates 1 and 2, blocking intracellular insulin signaling. The latter is mediated by increased levels of both tumour necrosis factor-α (TNF-α) and suppressor of cytokine signaling 3 (SOC-3). IR, through different mechanisms, plays a role in the development of steatosis and its progression to steatohepatitis, cirrhosis and even HCC. In addition, IR has a role in impairing TNF signaling cascade, which in turn blocks STAT-1 translocation and interferon stimulated genes production avoiding the antiviral effect of interferon.

Water sustainability model for estimation of groundwater availability in Kemuning district,Riau-Indonesia

There are rising interests in the utility of groundwater in various aspects,which is capable of triggering problematic issues.The excessive exploitation for anthropologic uses,without regards to aquifer capacity,will decreases the water table as well as capacity of groundwater in the aquifer.This research was aimed to provide aquifer model of underground water by consideration of various environmental factors,with the propensity of being modeled,in an attempt to predict groundwater conditions in subsequent years.The purpose of this research was to forecast water requirements,availability,as well as three-dimensional model of groundwater depth in Kemuning,Indragiri Hilir Regency-Indonesia between 2015 and 2022.Furthermore,various environmental factors,from aquifer profiles to anthropologic demand,are taken into account in the evaluated model,including water requirements,encompassing recharge and aquifer parameters,which consists of storativity and transmissivity.From anthropologic side are domestic requirements,trade,public facilities,agriculture,and livestock.The results show that groundwater availability in Kemuning is to be safe condition,and average difference is 1.06×108 m3/yr.The coefficient of storativity and transmissivity are 16.514 m2/day and 9897.26 m2/day,respectively,while the average depth was recorded as 2.8965 m to 10.4927 m.

Theoretical and exploratory research on sustainability mental model of the public in China:based on a typical survey in Guangdong province

This article aims to investigate the public's sustainability mental model(SMM), which can reveal the sustainability dilemma from the public respective, other than enterprise or government. In this article, SMM is defined as one's cognitive structure, thinking mode, and behavior tendency when someone deals with sustainability issues. After theoretical analysis, the authors developed reliable and valid measures systematically and conducted a typical survey with 581 participants from college students' families in Guangdong province in China. Based on those samples, the author used the exploratory factor analysis and confirmatory factor analysis to construct a measurement model of SMM, which includes three dimensions, i.e. sustainable cognition, sustainable thinking, and sustainable behavior intention. According to SMM survey and clustering analysis, the results indicate that SMM of those participants is inactive. Even though those samples do not represent the whole country comprehensively, but this survey was sampled typically and they came from around China. So, the authors consider the SMM scores can reflect Chinese people to some extent, leading to the assumption that SMM of Chinese people is not active presently.

A hybrid strategy in selecting diverse combinations of innovative sustainable materials for asphalt pavements

This project integrates recent innovations of recycled materials used in designing and building sustainable pavements. An increasing environmental awareness and the demand for improving economic and construction efficiencies, through measures such as con- struction warrantees and goals to reduce air pollution under the Kyoto Protocol, have increased the efforts to implement sustainable materials in roadways. The objective of this research is to develop a systematic approach toward selecting optimum combinations of sustainable materials for the construction of asphalt pavements. The selected materials, warm mix asphalt （WMA）, recycled asphalt shingles {RAS）I and reclaimed asphalt pave- ment {RAP） were incorporated in this study. The results of this research are intended to serve as guidelines in the selection of the mixed sustainable materials for asphalt pave- ments. The approach developed from this project draws upon previous research efforts integrating graphical modeling with optimizing the amount of sustainable materials based on the performance. With regard to moisture susceptibility and rutting potential test re- suits, as well as the MIM analysis based on a 95% confidence interval, the rutting perfor- mance and moisture susceptibility of asphalt mixtures are not significantly different regardless of the percentages of RAS, RAP, or WMA. The optimum mixture choices could be made by the plant emission rankings with consideration of the optimal WMA types, per- centages of RAS/RAP, and WMA production temperatures. The WMA mixtures prepared with 75% RAP and Advera WMA have produced the lowest CO2 emissions among the investigated mixture types.

Novel data-driven subtypes and stages of brain atrophy in the ALS-FTD spectrum

Background TDP-43 proteinopathies represent a spectrum of neurological disorders,anchored clinically on either end by amyotrophic lateral sclerosis(ALS)and frontotemporal degeneration(FTD).The ALS-FTD spectrum exhibits a diverse range of clinical presentations with overlapping phenotypes,highlighting its heterogeneity.This study was aimed to use disease progression modeling to identify novel data-driven spatial and temporal subtypes of brain atrophy and its progression in the ALS-FTD spectrum.Methods We used a data-driven procedure to identify 13 anatomic clusters of brain volume for 57 behavioral variant FTD(bvFTD;with either autopsy-confirmed TDP-43 or TDP-43 proteinopathy-associated genetic variants),103 ALS,and 47 ALS-FTD patients with likely TDP-43.A Subtype and Stage Inference(SuStaIn)model was trained to identify subtypes of individuals along the ALS-FTD spectrum with distinct brain atrophy patterns,and we related subtypes and stages to clinical,genetic,and neuropathological features of disease.Results SuStaIn identified three novel subtypes:two disease subtypes with predominant brain atrophy in either prefrontal/somatomotor regions or limbic-related regions,and a normal-appearing group without obvious brain atrophy.The limbic-predominant subtype tended to present with more impaired cognition,higher frequencies of pathogenic variants in TBK1 and TARDBP genes,and a higher proportion of TDP-43 types B,E and C.In contrast,the prefrontal/somatomotor-predominant subtype had higher frequencies of pathogenic variants in C9orf72 and GRN genes and higher proportion of TDP-43 type A.The normal-appearing brain group showed higher frequency of ALS relative to ALS-FTD and bvFTD patients,higher cognitive capacity,higher proportion of lower motor neuron onset,milder motor symptoms,and lower frequencies of genetic pathogenic variants.The overall SuStaIn stages also correlated with evidence for clinical progression including longer disease duration,higher King’s stage,and cognitive decline.Additionally,SuStaIn stages differed across clinical phenotypes,genotypes and types of TDP-43 pathology.Conclusions Our findings suggest distinct neurodegenerative subtypes of disease along the ALS-FTD spectrum that can be identified in vivo,each with distinct brain atrophy,clinical,genetic and pathological patterns.

Cultural and creative sectors at a crossroad:from a mainstream process towards an active engagement

The COVID-19 pandemic has led to a current global health crisis with dreadful repercussions all over the world.A global economic recession is anticipated,with strong impacts in all economic and social sectors,including the cultural sector.Although all sub sectors will be impacted(heritage sites,theatres,museums,operas,art galleries),the cultural built heritage is particularly at stake,as it relies on multiple stakeholders through a wide range of heritage-related activities(tourism,recreation,housing,real estate,construction,craftsmanship,etc.).Sites management and heritage conservation have not only been vulnerable to strong economic and social disruptions,like most of other cultural fields,but have been greatly challenged because heritage values and the paradigm of conservation(50 years after adoption of the UNESCO convention)are being themselves revisited in the perspective of the Sustainable Development Goals.The paper aims also to consider cultural heritage as part of the Cultural and Creative Sectors(CCS)and how creativity and innovation contribute to post-COVID recoveries through Schumpeter-related creative destruction process.The current crisis might be perceived in a perspective of long wave theory of innovations and economic growth.The economic history is filled with many examples of such transition period when inventions,innovations,and growth reactivate the economic development in an upward long-term trend.In such framework,crisis can trigger innovation and creativity and can be understood as opportunity to increase the CCS resilience and sustainability,as well as harness the universality and the power of creativity.Finally,the paper aims to describe implications of such situation by providing to the CCS ways to learn and experience cultural entrepreneurship,resilient strategies,new sustainable and circular business models applied to the cultural heritage sector and its conservation.