Complex Factors Research Articles

Reviewing the process intensification landscape through the introduction of a novel, multitiered classification for downstream processing.

A demand for process intensification in biomanufacturing has increased over the past decade due to the ever-expanding market for biopharmaceuticals. This is largely driven by factors such as a surge in biosimilars as patents expire, an aging population, and a rise in chronic diseases. With these market demands, pressure upon biomanufacturers to produce quality products with rapid turnaround escalates proportionally. Process intensification in biomanufacturing has been well received and accepted across industry based on the demonstration of its benefits of improved productivity and efficiency, while also reducing the cost of goods. However, while these benefits have been shown empirically, the challenges of adopting process intensification into industry remain, from smaller independent start-up to big pharma. Traditionally, moving from batch to a process intensification scheme has been viewed as an "all or nothing" approach involving continuous bioprocessing, in which the factors of complexity and significant capital costs hinder its adoption. In addition, the literature is crowded with a variety of terms used to describe process intensification (continuous, periodic counter-current, connected, intensified, steady-state, etc.). Often, these terms are used inappropriately or as synonyms, which generates confusion in the field. Through a detailed review of current state-of-the-art systems, consumables, and process intensification case studies, we herein propose a defined approach in the implementation of downstream process intensification through a standardized nomenclature and viewing it as distinct independent levels. These can function separately as intensified single-unit operations or be built upon by integration with other process steps allowing for simple, incremental, cost-effective implementation of process intensification in the manufacturing of biopharmaceuticals.

Interpretable machine learning models for predicting in-hospital and 30 days adverse events in acute coronary syndrome patients in Kuwait

The relationships between acute coronary syndromes (ACS) adverse events and the associated risk factors are typically complicated and nonlinear, which poses significant challenges to clinicians' attempts at risk stratification. Here, we aim to explore the implementation of modern risk stratification tools to untangle how these complex factors shape the risk of adverse events in patients with ACS. We used an interpretable multi-algorithm machine learning (ML) approach and clinical features to fit predictive models to 1,976 patients with ACS in Kuwait. We demonstrated that random forest (RF) and extreme gradient boosting (XGB) algorithms, remarkably outperform traditional logistic regression model (AUCs = 0.84 & 0.79 for RF and XGB, respectively). Our in-hospital adverse events model identified left ventricular ejection fraction as the most important predictor with the highest interaction strength with other factors. However, using the 30-days adverse events model, we found that performing an urgent coronary artery bypass graft was the most important predictor, with creatinine levels having the strongest overall interaction with other related factors. Our ML models not only untangled the non-linear relationships that shape the clinical epidemiology of ACS adverse events but also elucidated their risk in individual patients based on their unique features.

Sustainable Practices in the Textile Industry of Pakistan: Challenges and Opportunities

In an era where sustainability is paramount, this study ventures into assessing the complex factors influencing sustainability in Pakistan's textile industry. Given its economic significance and environmental impact, the research focuses on unraveling how governmental policies, technological innovations, management practices, and consumer awareness collectively shape sustainability outcomes. Central to this exploration is the mediating role of organizational commitment. Employing a structured survey among diverse industry stakeholders, the study uncovers that while external factors significantly drive sustainability performance, it is the depth of organizational commitment to sustainability that amplifies these effects. This intersection of various elements highlights the need for a multi-dimensional approach in steering the textile sector towards greater sustainability. The findings offer practical insights for policymakers and industry leaders, advocating for integrated strategies that marry regulatory frameworks, technological advancement, and internal cultural shifts towards sustainability. However, the study acknowledges its limitations and paves the way for future research, calling for broader, longitudinal explorations to deepen our understanding of sustainable practices in diverse economic contexts.

Assessing project complexity factors for railway megaprojects: a Delphi-BWM approach

Purpose Project complexity (PC) governs project success, but the project management literature primarily focuses on performance measures and rarely examines the complexity factors, especially for megaprojects. This paper aims to determine the most significant complexity factors for the railway megaprojects in India. Design/methodology/approach A mixed approach using the Delphi and best–worst method (BWM) helped to identify, validate and determine the most critical factors that require intervention to diminish variance from project performance. Findings The BWM resulted in stakeholder management, followed by organizational and technological complexity as significant complexity factors, and the varied interests of the stakeholder as the most important among the 40 subfactors. Practical implications The finding indicates the necessity for strategic, tactical and operational-level interventions to effectively manage the complexity affecting project efficiency because of the varied stakeholders. This paper will guide the project and general managers to prioritize their resources to handle complexity for effective project performance measured in terms of time, cost and quality and help them make strategic decisions. The research findings of this study are expected to help researchers and practitioners in better planning and smoother execution of projects. In addition, this study would help the researchers formulate policies and strategies for better handling of the projects. Originality/value This study adds significant value to the body of knowledge related to PC in megaprojects in developing countries. The result of the investigation underlined that nine complexity factors and seven unique subfactors, namely, the sustainable environment, timely availability of information, communication in both directions, interdepartmental dependency and coordination, design, statutory norms, site challenges, socioeconomic conditions, the tendency of staff to accept new technology and the frequent changes in the requirements of stakeholders are significant in railway megaprojects. The BWM is applied to rank the complexity factors and subfactors in the case area.

The intrinsic coagulation pathway plays a dominant role in driving hypercoagulability in ANCA-associated vasculitis

AbstractThe risk of a venous thrombotic event (VTE) is increased in patients with antineutrophil cytoplasmic antibody (ANCA)–associated vasculitis (AAV); however, a detailed understanding of the underlying mechanisms of hypercoagulability is limited. We assessed prospectively different coagulation parameters in 71 patients with active AAV at baseline and after 6 months of follow-up. D-dimers and fibrinogen were increased in most patients at presentation and remained elevated in half of the patients. Particularly, thrombin-antithrombin (T:AT) complex and activated coagulation factors in complex with their natural inhibitors of the intrinsic coagulation pathway (ie, activated FXII:C1 esterase inhibitor [FXIIa:C1Inh], FXIa:AT, and FXIa:alpha1-antitrypsin [FXIa:α1AT]) were profoundly elevated in patients at baseline. Thrombin formation was dominantly correlated with coagulation factors of the intrinsic pathway (ie, FXIIa:AT, FXIa:AT, FXIa:α1AT, and FXIa:C1Inh) compared to the extrinsic pathway (ie, FVIIa:AT). Hypercoagulability correlated with higher disease activity, ANCA levels, C-reactive protein, serum creatinine, and proteinuria. VTEs were observed in 5 out of 71 (7%) patients within 1 month (interquartile range, 1-5) after inclusion. Baseline T:AT levels were significantly higher in patients with VTE than in those without VTE (P = .044), but other clinical or laboratory markers were comparable between both groups. Hypercoagulability is dominantly characterized by activation of the intrinsic coagulation pathway and elevated D-dimers in active AAV. The driving factors of hypercoagulability are yet to be studied but are most likely related to an interplay of increased disease activity, vascular inflammation, and endothelial damage. Future targets for intervention could include inhibitors of the intrinsic coagulation pathway and compounds specifically reducing the hyperinflammatory state.

Compact stellar model with vanishing complexity under Vaidya–Tikekar background geometry

We make use of the condition of vanishing complexity, based on the current definition proposed by Herrera (Phys Rev D 97:044010, 2018), to find exact interior solutions to the Einstein equations for describing compact stellar objects. In the framework of general relativity, the complexity factor is an outcome of the orthogonal splitting of the Riemann tensor from which structure scalars are obtained. By using the Vaidya–Tikekar (V–T) metric ansatz (J Astrophys Astron 3:325, 1982) for the spacetime of a static spherically symmetric matter distribution, we model superdense, relativistic stars. The interior spacetime is matched to the exterior Schwarzschild solution across the boundary of the star where the radial pressure vanishes. The physical viability of the model has been tested following the current data corresponding to the pulsar 4U1820-30\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$ 4U 1820-30 $$\\end{document}. The stability of the model fulfilled the given criteria, namely the Tolman–Oppenheimer–Volkoff equation, the adiabatic index and the causality conditions.

Fine-grained grid computing model for Wi-Fi indoor localization in complex environments

The fingerprinting-based approach using the wireless local area network (WLAN) is widely used for indoor localization. However, the construction of the fingerprint database is quite time-consuming. Especially when the position of the access point (AP) or wall changes, updating the fingerprint database in real-time is difficult. An appropriate indoor localization approach, which has a low implementation cost, excellent real-time performance, and high localization accuracy and fully considers complex indoor environment factors, is preferred in location-based services (LBSs) applications. In this paper, we proposed a fine-grained grid computing (FGGC) model to achieve decimeter-level localization accuracy. Reference points (RPs) are generated in the grid by the FGGC model. Then, the received signal strength (RSS) values at each RP are calculated with the attenuation factors, such as the frequency band, three-dimensional propagation distance, and walls in complex environments. As a result, the fingerprint database can be established automatically without manual measurement, and the efficiency and cost that the FGGC model takes for the fingerprint database are superior to previous methods. The proposed indoor localization approach, which estimates the position step by step from the approximate grid location to the fine-grained location, can achieve higher real-time performance and localization accuracy simultaneously. The mean error of the proposed model is 0.36 ​m, far lower than that of previous approaches. Thus, the proposed model is feasible to improve the efficiency and accuracy of Wi-Fi indoor localization. It also shows high-accuracy performance with a fast running speed even under a large-size grid. The results indicate that the proposed method can also be suitable for precise marketing, indoor navigation, and emergency rescue.

Benchmarking and Analysis of Unsupervised Object Segmentation from Real-World Single Images

AbstractIn this paper, we study the problem of unsupervised object segmentation from single images. We do not introduce a new algorithm, but systematically investigate the effectiveness of existing unsupervised models on challenging real-world images. We first introduce seven complexity factors to quantitatively measure the distributions of background and foreground object biases in appearance and geometry for datasets with human annotations. With the aid of these factors, we empirically find that, not surprisingly, existing unsupervised models fail to segment generic objects in real-world images, although they can easily achieve excellent performance on numerous simple synthetic datasets, due to the vast gap in objectness biases between synthetic and real images. By conducting extensive experiments on multiple groups of ablated real-world datasets, we ultimately find that the key factors underlying the failure of existing unsupervised models on real-world images are the challenging distributions of background and foreground object biases in appearance and geometry. Because of this, the inductive biases introduced in existing unsupervised models can hardly capture the diverse object distributions. Our research results suggest that future work should exploit more explicit objectness biases in the network design.

Isotropization and complexity shift of gravitationally decoupled charged anisotropic sources

This article focuses on investigating the role of decoupling in isotropizing anisotropic, self-gravitational charged sources with spherical symmetry through a well-known gravitational technique, known as minimal geometric deformation (MGD). This technique separates the given system into two gravitational systems: the Einstein-Maxwell system and the gravitational system governed by additional source. We employ novel approaches, including the zero complexity factor and isotropization techniques, to construct various charged compact star models using the Tolman IV as the seed source within the framework of the MGD scheme. The term complexity factor emerges as one of the structure-defining scalar quantities resulting from the orthogonal splitting of the Riemann–Christoffel curvature tensor, as proposed by Herrera (Phys Rev D 97(4):044010, 2018). This scalar function, denoted as YTF\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$Y_{TF}$$\\end{document}, is associated with the fundamental structural characteristics of self-gravitational compact configurations. Our approach is innovative in that it derives the deformation functions by imposing the requirement of YTF=0\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$Y_{TF}=0$$\\end{document} and employs isotropization techniques for electrically charged anisotropic configurations.

A mosaic variant in CTNNB1/β-catenin as a novel cause for osteopathia striata with cranial sclerosis.

Osteopathia striata with cranial sclerosis (OSCS) is a rare bone disorder with X-linked dominant inheritance, characterized by a generalized hyperostosis in the skull and long bones and typical metaphyseal striations in the long bones. So far, loss-of-function variants in AMER1 (also known as WTX or FAM123B), encoding the APC membrane recruitment protein 1 (AMER1), have been described as the only molecular cause for OSCS. AMER1 promotes the degradation of β-catenin via AXIN stabilization, acting as a negative regulator of the WNT/β-catenin signaling pathway, a central pathway in bone formation. In this study, we describe a Dutch adult woman with an OSCS-like phenotype, i.e. generalized high bone mass and characteristic metaphyseal striations, but no genetic variant affecting AMER1. Whole exome sequencing led to the identification of a mosaic missense variant (c.876A>C; p.Lys292Asn) in CTNNB1, coding for β-catenin. The variant disrupts an amino acid known to be crucial for interaction with AXIN, a key factor in the β-catenin destruction complex. Western blotting experiments demonstrate that the p.Lys292Asn variant does not significantly affect the β-catenin phosphorylation status, and hence stability in the cytoplasm. Additionally, luciferase reporter assays were performed to investigate the effect of p.Lys292Asn β-catenin on canonical WNT signaling. These studies indicate an average 70-fold increase in canonical WNT signaling activity by p.Lys292Asn β-catenin. In conclusion, this study indicates that somatic variants in the CTNNB1 gene could explain the pathogenesis of unsolved cases of osteopathia striata.

Metabolic dysfunctions in polycystic ovary syndrome

Polycystic Ovary Syndrome (PCOS) is a condition that involves various metabolic dysfunctions such as insulin resistance (IR), hyperandrogenemia, obesity, dyslipidemia, and steroid hormone irregularities. Although the exact cause of PCOS is still unknown, it is known to cause several hormonal disturbances, including hyperandrogenemia, IR, and hyperinsulinemia. Insulin appears to disrupt all components of the hypothalamic-pituitary-ovarian (HPO) axis, and ovarian tissue insulin resistance results in impaired metabolic signaling. This causes hyperandrogenemia, which is one of the primary causes of the symptoms of PCOS. Androgens may also lead to IR by modifying muscle tissue composition and functionality and increasing levels of free fatty acids, perpetuating the IR-hyperinsulinemia-hyperandrogenemia cycle. Obesity exacerbates hormonal imbalances, and in combination with dyslipidemia, amplifies cardiovascular and cerebrovascular risks. This review discusses the complex risk factors of PCOS, including genetic, epigenetic, and environmental factors. It also discusses the interconnected etiologies of metabolic dysfunctions of PCOS, its effective management, and metabolic consequences such as cardiovascular and cerebrovascular diseases. J MEDICINE 2024; 25: 68-77

Complexity of dynamical spherical system in [formula omitted] gravity

This paper presents complexity measure of a dynamical spherical configuration with anisotropic distribution in energy–momentum squared gravity. The self-gravitating bodies become complex due to non-uniform energy density, asymmetrical pressure, heat loss and contribution of modified terms. By orthogonally decomposing the Riemann tensor, we analyze the structure scalars and obtain the complexity factor that accounts for all the fundamental characteristics of the system. Furthermore, by using the homologous mode as the simplest pattern of evolution, we study the dynamics of the celestial configuration. We also discuss dissipative/non-dissipative fluids in the context of homologous and complexity-free cases. Finally, we investigate a criterion for which the complexity-free condition remains stable throughout evolutionary process. It is concluded that the contribution of product as well as squared components of the considered framework leads to a more complex system.

Elevated atmospheric CO2 combined with Epichloë endophyte may improve growth and Cd phytoremediation potential of tall fescue (Festuca arundinacea L.).

Complex environmental conditions like heavy metal contamination and elevated CO2 concentration may cause numerous plant stresses and lead to considerable crop losses worldwide. Cadmium is a non-essential element and potentially highly toxic soil metal pollution, causing oxidative stress in plants and human toxicity. In order to assess a combination of complex factors on the responses of two genotypes of Festuca arundinacea (75B and 75C), a greenhouse experiment was conducted on plants grown in two Cd-contaminated soil conditions and two soil textures under combined effects of elevated ambient CO2 (700ppm) and Epichloë endophyte infection. Plant biomass, Cd, Fe, Cu, Zn, and Mn concentrations in the plant shoots and roots, Fv/Fm, chlorophyll (a & b), and carotenoid contents were measured after 7months of growth in pots. Our results showed that endophyte-infected plants (E+) grown in elevated CO2 atmosphere (CO2+), clay-loam soil texture (H) with no Cd amendment (Cd-) in the genotype 75B had significantly greater shoot and root biomass than non-infected plants (E-) grown in ambient CO2 concentration (CO2-), sandy-loam soil texture (L) with amended Cd (Cd+) in the genotype 75C. Increased CO2 concentration and endophyte infection, especially in the genotype 75B, enabled Festuca for greater phytoremediation of Cd because of higher tolerance to Cd stress and higher biomass accumulation in the plant genotype. However, CO2 enrichment negatively influenced the plant mineral absorption due to the inhibitory effects of high Cd concentration in shoots and roots. It is concluded that Cd phytoremediation can be positively affected by the increased atmospheric CO2 concentration, tolerant plant genotype, heavy soil texture, and Epichloë endophyte. Using Taguchi and AIC design methodologies, it was alsopredicted that the most critical factors affecting Cd phytoremediation potential were CO2 concentration and plant genotype.

Research on Guide Star Distribution of Sub-Arcsecond Attitude Determination for Microsatellites Reusing Scientific Cameras

Onboard scientific cameras are reused in attitude determination to meet the sub-arcsecond attitude determination accuracy requirements of microsatellites. This approach does not require an additional payload for microsatellites. It involves reusing high-quality optical lenses from the scientific camera and utilizing the peripheral high-quality imaging areas of its square-shaped detector. Separate detectors are placed within these areas as attitude determination detectors to obtain star patterns for closed-loop attitude determination, thereby achieving high-precision attitude determination for microsatellites. The star patterns obtained using this method may pose specific issues due to the relative positions of stars. Through an analysis of the theoretical model that examines the relationship between attitude determination accuracy and the main influencing factors, it is indicated that guide star distribution is one of the main, complex factors determining attitude determination accuracy. A further simulation analysis was conducted on the specific impact of two guide star distribution characteristics—namely, the coverage of guide stars in the attitude determination areas and the proportion of the average field of view occupied by the guide star triangles to the total field of view of the attitude determination areas—on attitude determination accuracy. This study concludes that when the measurement error of the guide stars is bigger than the attitude determination accuracy requirement for its area configuration, four attitude determination areas should be configured. Four attitude determination areas should be prioritized when the measurement error is equal to or smaller than the attitude determination accuracy requirement, followed by the option to configure three attitude determination areas or two symmetric attitude determination areas. When selecting guide stars for star pattern recognition, the guide stars should cover the attitude determination areas as much as possible, and guide stars with a higher proportion of the average field of view occupied by the guide star triangles to the total field of view should be chosen. Finally, experimental validation was conducted using star patterns from dense star fields and sparse star fields. The research results provide an important reference for the optimization of attitude determination area configuration, navigation star catalog construction, and star pattern recognition algorithm research for microsatellites equipped with scientific cameras.

Qualitative Study of Emergency Medicine Residents' Perspectives of Trauma Leadership Development.

Trauma team leadership is a core skill for the practice of emergency medicine (EM). In this study our goal was to explore EM residents' perception of their trauma leadership skill development through formal and informal processes and to understand factors that may impact the development and implementation of trauma leadership skills. Using qualitative semi-structured interviews, we explored the leadership experiences of 10 EM residents ranging from second to fourth postgraduate year. Interviews were conducted between July 26-October 31, 2019 and were audio-recorded, transcribed, and de-identified. We analyzed data using qualitative content analysis. Residents discussed three main themes: 1)sources of leadership development; 2)challenges with simultaneously assuming a dual leader-learner role; and 3)contextual factors that impact their ability to assume the leadership role, including the professional hierarchy in the clinical environment, limitations in the physical environment, and gender bias. This study describes the complex factors and experiences that contribute to the development and implementation of trauma team leadership skills in EM residents. This includes three primary sources of leadership development, the dual role of leader and learner, and various contextual factors. Research is needed to understand how these factors and experiences can be leveraged or mitigated to improve resident leadership training outcomes.

Experimental investigation of CO2 foam flooding-enhanced oil recovery in fractured low-permeability reservoirs: Core-scale to pore-scale

Fractured low-permeability reservoirs are characterized by poor reservoir physical properties, strong interlayer heterogeneity and the existence of natural and artificial fractures, resulting in significant water or gas channeling during flooding development. CO2 foam can effectively control the mobility of CO2 and ensure a more stable flooding front. In this study, taking into account the imbibition effect of the flooding process, the flooding performance under different injection methods and the influencing factors of foam pre-injection volume, back pressure and fracture complexity on CO2 foam flooding were systematically analyzed using fractured low-permeability core flooding experiments. In addition, the mechanism of CO2 foam flooding enhanced oil recovery (EOR) in low-permeability fractured reservoirs was obtained in combination with microscopic flooding experiments. The results show that the maximum recovery of 59.36 % can be obtained by soaking the core samples for 12 h with pre-injection of 0.4 PV CO2 foam followed by CO2 foam flooding, which adequately considers the imbibition effect during the flooding process. The pressure difference and oil recovery increases with increasing foam pre-injection amount, and the oil recovery with back pressure (2 MPa and 4 MPa) is significantly higher than that without back pressure; however, a further increase in back pressure has less impact on the recovery. The oil recovery rate of the fracture-free core is lower than that of the multiple fracture core during CO2 foam flooding but higher than that of the single fracture core, and the fracture complexity of the fractured cores has less impact on the final oil recovery. Microscopic experiments show that CO2 foam can effectively prevent channeling and improve the sweep efficiency. Soaking during the CO2 foam flooding process makes foam enter the matrix through the fracture, and CO2 dissolves after the foam breaks to increase the mobility of the crude oil, while the surfactant solution emulsifies the crude oil and changes the rock wettability. The unbroken foam can increase the sweep range, and the crude oil that flows into the fracture is carried by the subsequent injected foam to be recovered as foamy oil.

Occupational choice, satisfaction and success of PhD graduates in East Asia and the West: A systematic review

AbstractThe globally expanding doctoral education and the diminishing availability of academic job opportunities have prompted an increasing proportion of PhD graduates to seek employment beyond academia, drawing a growing scholarly interest. However, the existing literature on doctoral career pathways tends to be fragmented and dispersed, given the idiosyncratic individual and educational characteristics of doctorates grappling with the complex structural factors. To depict a comprehensive picture of the diversifying employment trajectories of doctorates across various geographical, disciplinary and sectoral contexts, this study conducts a systematic review, scouring 831 pertinent journal articles from the Web of Science. Following a set of inclusion criteria, 31 papers were ultimately selected to identify the key factors shaping employment trajectories of PhD graduates at structural (national supply and demand), institutional (employers' perceptions) and individual (doctorates' characteristics) levels. Drawing on the boundaryless and value‐based career theories, the authors develop a four‐dimension analytical framework, within which the findings of the 31 papers in East Asian and Western contexts are analysed. Overall, stakeholders in Western systems generally recognise the trend of PhD graduates securing non‐academic employment, whereas East Asian nations appear less receptive to this agenda. Meanwhile, due to their strong emphasis on research skills utilisation and employment stability, PhD graduates in certain economies find it challenging to pursue satisfying and successful careers, warranting increased attention. Building on the findings, we propose a four‐quadrat model in an effort to provide a tool for evaluating the capacity to absorb doctoral workforces of specific systems by categorising the doctoral professions. Highlighting shared patterns observed across various higher education systems and distinct trends prevalent in specific economies, this paper addresses key topics in doctoral education and doctorate employment literature such as labour market conditions, employment outcomes, job satisfaction, skills (mis)matches and sustainable careers.

Surgeon views regarding the adoption of a novel surgical innovation into clinical practice: systematic review.

The haphazard adoption of new surgical technologies into practice has the potential to cause patient harm and there are many misconceptions in the decision-making behind the adoption of new innovations. The aim of this study was to synthesize factors affecting a surgeon's decision to adopt a novel surgical innovation into clinical practice. A systematic literature search was performed to obtain all studies where surgeon views on the adoption of a novel surgical innovation into clinical practice have been collected. The databases screened were MEDLINE, Embase, Science Direct, Scopus, the Web of Science, and the Cochrane Library of Systematic Reviews (last accessed October 2022). Innovations covered multiple specialties, including cardiac, general, urology, and orthopaedics. The quality of the papers was assessed using a 10-question Critical Appraisal Skills Programme (CASP) tool for qualitative research. A total of 26 studies (including 1112 participants, of which 694 were surgeons) from nine countries satisfied the inclusion and exclusion criteria. Types of study included semi-structured interviews and focus groups, for example. Themes and sub-themes that emerged after a thematic synthesis were categorized using five causal factors (structural, organizational, patient-level, provider-level, and innovation-based). These themes were further split into facilitators and barriers. Key facilitators to adoption of an innovation include improved clinical outcomes, cost-effectiveness, and support from internal and external stakeholders. Barriers to adoption include lack of organizational support and views of senior surgeons. There are multiple complex factors that dynamically interact, affecting the adoption of a novel surgical innovation into clinical practice. There is a need to further investigate surgeon and other stakeholder views regarding the strength of clinical evidence required to support the widespread adoption of a surgical innovation into clinical practice.

Influential Factors of Impulsive Buying Behavior: Analyzing Retail Dynamics at Hyperstar Shopping Mall in Pakistan

In the perpetually shifting and dynamic realm of retail, the pivotal elements of differentiation and ensnaring customer trustworthiness stand as paramount imperatives.  The crucial strategy for retailers in steadfast customer retention and captivating is to understand the complex factors behind impulse buying behavior. Henceforth, this study explores the influential factors guiding impulse buying and their dominancy in securing customer loyalty. Our primary goal was to differentiate influential factors of impulse buying behavior and then discover their adeptness potential for customer acquisition. More importantly, our focus gravitated towards dissecting the shopping environment encasing Hyperstar, Karachi, to extract empirical data through a meticulously targeted survey mechanism. A quantitative approach was implemented, surveying 382 respondents within the boundaries of Hyperstar. Employing a 5-point Likert scale questionnaire, the scrutinization leveraged a conventional tool, ensuring an unwavering reliability quotient exceeding 0.7 thresholds for each differentiated factor. The survey questionnaire was borrowed from antecedent researchers to seamlessly align with the context while ensuring robustness.The research culminated in the discernment of distinct factors; sensation cues, promotional approaches, and window displays. Exhibiting a positive correlation with impulse buying bents for retail commodities. Most notably, sensation cues appeared as the foremost catalyst, exerting a strangely profound influence on impulse buying behavior.The research steadfastly emphasizes the pivotal role played by sensory stimuli in direction-finding impulse purchases. By purposefully managing sensation cues line-up promotional strategies and window displays, retailers can efficiently attribute impulse buying behaviors to adoptive customer engagement and customer loyalty, to fortify the market standing in the dynamic retail domain.

Rethinking English in Education: The Paradoxes of Labelling the “Other”

ABSTRACT Research into how to support student teachers to work with diverse school students frequently uses a narrow, Anglocentric lens based on binary language speaker labels. This lens limits understandings of the complex factors impacting any individual’s ability to teach inclusively. Given the increases in diversity in the tertiary sector, we therefore sought to explore four teacher educators' perceptions of two inclusive literacy activities they taught that drew on their students’ rich knowledge in, and of, English to understand multilingual classrooms. An experiential checklist was employed to thematically analyse the psychological and sociocultural classroom experiences together with Bourdieu’s habitus and field theories with key findings revealing key aspects in activity design both affirmed and challenged some participants’ thinking. However, critical in disrupting deficit binaries that position us all as “others” was the need to understand how staff and students see themselves as English language speakers.