Conceptual Model Research Articles

Patient-related experience measurement scales for endoscopy procedures - A systematic review, COSMIN and conceptual model evaluation.

Patient experience is a quality indicator in gastrointestinal endoscopy, as recognized by the European Society of Gastrointestinal Endoscopy (ESGE). Despite this, no standardized tools or metrics have been formally endorsed for routine use. To identify and evaluate patient-reported experience measures (PREM) used in endoscopic procedures, assessing their psychometric properties and conceptual completeness, and to explore gaps for future development. A systematic literature review was conducted up to March 2023, including studies involving adults (>18 years) who underwent endoscopic procedures and completed PREM. Instruments were assessed using the COSMIN risk of bias tool and a patient experience conceptual model. Of 1.911 articles screened, 10 studies met the inclusion criteria. The Colonoscopy Experience Score Tool (CEST) proved the strongest psychometric performance, while the Endoscopic Patient-Reported Experience Measure (ENDOPREM) showed superior conceptual coverage. However, no single instrument met both psychometric and conceptual standards. A critical gap identified across all tools was the absence of items related to patient health motivation. CEST is psychometrically superior and ENDOPREM is conceptually robust. Future PREM should adopt a hybrid approach-combining the psychometric strengths of CEST with the conceptual complexity of ENDOPREM-while also incorporating domains such as patient motivation to improve relevance and impact. Measuring patient experience requires tools that are currently both scientifically rigorous and patient-centered. Developing a Hybrid PREM is an essential next step to support quality improvement in endoscopic care.

Towards sustainability and circular economy: conceptual design model for the water-energy-food nexus in Ferdaws Village, Western Desert, Egypt

Abstract Sustainable management of natural resources is a pressing global challenge that requires the prevention of loss and waste. Egypt is facing an acute water crisis due to insufficient water supplies throughout the country. To address this issue, it is essential to implement a range of solutions to improve the situation. This study aims to alleviate the stress on multiple resources and environmental impacts in one of Egypt's earliest reclaimed areas (Wadi El-Natrun, Western Desert), by applying systematic modeling to achieve sustainable development objectives and mitigate resource stress. To promote a more sustainable and resilient future, a pilot model ecovillage has been designed for a community of three thousand inhabitants, promoting integrated resource management and considering the Water-Energy-Food (WEF) nexus concept. The ecovillage design incorporates collaborative engagement of groundwater reservoirs for water supply, agricultural production for food demands, power generation, and community sensitivity. Evaluating key aspects related to water supply, power generation, agricultural production, and environmental impact within the proposed pilot design aims to provide insights into the complex interactions among these systems. A four-step methodology for evaluating and implementing the nexus at a local level, which includes identifying linkages, mapping interconnections, focusing on core foundations, and applying the findings to improve project execution was investigated. An understanding of the WEF nexus, demonstrating how such frameworks can enhance the management of scarce resources was provided. The “TORAY DS2” design is employed to analyze model parameters and quantify their values. The study’s findings aim to support decision-makers and stakeholders in developing effective strategies to navigate the complexities of the WEF Nexus, promoting optimal resource management. These findings are promising, indicating a low environmental risk while aligning with both the WEF Nexus and the Sustainable Development Goals.

Examining the impact of organisational leadership on pay satisfaction through self-esteem and locus of control: insights from the chemical industry

Purpose This study aims to investigate the influence of organisational leadership (OL) on pay satisfaction (PS), examining the mediating roles of self-esteem (SE) and locus of control (LC) within the chemical industry, where safety and leadership dynamics are critically important. Design/methodology/approach Structural equation modelling was used to test the proposed conceptual model. Data were collected through a survey administered to middle and senior managers from 86 chemical companies in Istanbul, Türkiye, yielding 741 responses. After addressing validity concerns, 709 responses were analysed using SmartPLS 4. Findings The analysis demonstrates that OL has a significant and positive effect on SE and LC, both of which, in turn, enhance PS. Furthermore, leadership directly impacts PS, emphasising its multifaceted role in fostering positive employee outcomes. Research limitations/implications The study is limited to the chemical industry in Istanbul, which may affect the generalisability of the findings. Future research could examine these dynamics across various industries and geographical regions to validate and extend the results. Practical implications The results underscore the importance of cultivating strong leadership practices to enhance employees’ SE and LC, thereby improving PS. Organisations may benefit from leadership development programmes that target these psychological constructs. Social implications The findings contribute to the literature on leadership and PS by elucidating the mediating roles of SE and LC. The study supports the view that effective OL positively shapes individual self-perception and job satisfaction outcomes. Originality/value This study uniquely explores the interrelationship between leadership, SE, LC and PS in a high-risk industry. It offers empirical evidence of the pivotal role psychological mediators play in the leadership–employee satisfaction nexus.

Managing ambidexterity tensions in transferring innovation projects to mainstream units

PurposeIn a high-tech environment with unsatisfactory innovation results, this research investigates how strategic innovations can be more effectively transferred into the core business, considering the integration challenges within an ambidexterity context.Design/methodology/approachResearch was conducted in a major Brazilian public biopharmaceutical laboratory using mixed methods: a process-oriented methodology accounting for the significance of project stages and timeline and a grounded theory approach for inductive analysis of discourses during the project transfer to the core business.FindingsThe primary outcome is a conceptual model focused on the innovation transfer process and its redefinition throughout new product development phases. The results demonstrate the organizational and project-level integration practices that enabled the flow of innovation projects into mainstream operations. Mechanisms facilitating access to crucial resources significantly promoted the integration and the transfer.Research limitations/implicationsThe company faces the challenges and constraints of the public sector. Including diverse contexts would enhance the results.Practical implicationsThe study indicates that stimulating an ambidextrous orientation and leveraging the flexibility of resource exchange processes can significantly promote innovation transfer.Originality/valueThe research shows how a process view affects the transfer of innovations to regular operations, offering a novel approach to managing innovation projects in ambidextrous organizations. It revisits the concept of innovation transfer as an ongoing process rather than a singular event at the end of an innovation project. Finally, the results highlight resource exchange mechanisms essential to balancing exploration and exploitation.

Analysis of the Projected Climate Impacts on the Interlinkages of Water, Energy, and Food Nexus Resources in Narok County, Kenya, and Vhembe District Municipality, South Africa

The current changing climate requires the development of water–energy–food (WEF) nexus-oriented systems capable of mainstreaming climate-smart innovations into resource management. This study demonstrates the cross-sectoral impacts of climate change on interlinked sectors of water, energy, and food in Narok County, Kenya, and Vhembe District, South Africa. This study used projected hydroclimatic extremes across past, present, and future scenarios to examine potential effects on the availability and accessibility of these essential resources. The projected temperature and rainfall are based on nine dynamically downscaled Coupled Model Intercomparison Project Phase 5 (CMIP 5) of the Global Climate Models (GCMs). The model outputs were derived from two IPCC “Representative Concentration Pathways (RCPs)’’, the RCP 4.5 “moderate scenario”, and RCP 8.5 “business as usual scenario”, also defined as the addition of 4.5 W/m2 and 8.5 W/m2 radiative forcing in the atmosphere, respectively, by the year 2100. For the climate change projections, outputs from the historical period (1976–2005) and projected time intervals spanning the near future, defined as the period starting from 2036 to 2065, and the far future, spanning from 2066 to 2095, were considered. An ensemble model to increase the skill, reliability, and consistency of output was formulated from the nine models. The statistical bias correction based on quantile mapping using seven ground-based observation data from the South African Weather Services (SAWS) for Limpopo province and nine ground-based observation data acquired from the Trans-African Hydro-Meteorological Observatory (TAHMO) for Narok were used to correct the systematic biases. Results indicate downscaled climate change scenarios and integrate a modelling framework designed to depict the perceptions of future climate change impacts on communities based on questionnaires and first-hand accounts. Furthermore, the analysis points to concerted efforts of multi-stakeholder engagement, the access and use of technology, understanding the changing business environment, integrated government and private sector partnerships, and the co-development of community resilience options, including climate change adaptation and mitigation in the changing climate. The conceptual climate and WEF resource modelling framework confirmed that future climate change will have noticeable interlinked impacts on WEF resources that will impact the livelihoods of vulnerable communities. Building the resilience of communities can be achieved through transformative WEF nexus solutions that are inclusive, sustainable, equitable, and balance adaptation and mitigation goals to ensure a just and sustainable future for all.

Research on a Two-Dimensional Model of Customer Satisfaction

Background and Aim： Important topics in service management theory research include customer orientation, reducing customer complaints, and pursuing customer satisfaction. The majority of customer satisfaction surveys and analyses overlook the effect of the discrete distribution of each evaluation item on the overall uncertainty of customer satisfaction evaluation, which makes it challenging to provide thorough and accurate information. Currently, customer satisfaction surveys are widely used to quantitatively evaluate service quality. Simultaneously, the quality of service provided by college student apartments will impact social and campus stability, so analyzing satisfaction metrics is crucial. This paper aims to (1) establish a two-dimensional indicator model for customer satisfaction and perceived quality standard deviation, expanding the single dimension into two dimensions, and (2) improve the service of college student apartments to avoid the occurrence of crisis events. Methodology: The study employs a rigorous quantitative approach, supported by theoretical analysis and validated through iterative testing of the questionnaire. This ensures the conceptual model is robust, and the final survey instrument is both reliable and valid for comprehensive data collection. Results: This study identifies current issues, presents the concept of standard deviation based on accepted theories of customer satisfaction and service quality, and summarizes research findings in customer satisfaction, service quality, customer complaints, etc. Customer satisfaction (CS) is the first dimension in a two-dimensional model of customer satisfaction, and perceived quality standard deviation (SD) is the second dimension. For a more thorough assessment of customer satisfaction, a "four-interval" chart is suggested. This study developed a two-dimensional model of customer satisfaction for college student apartments using expert interviews and statistical analysis. This study simultaneously screened and processed the actual survey questionnaire data, developed a data processing program, and proposed a mathematical model. Conclusion: In addition to conducting a correlation analysis between customer satisfaction, quality standard deviation, and the number of student complaints in college student apartments, this study shows how effective a two-dimensional model for customer satisfaction is in these settings.

A Model of Long-Term Conflict Resolution and Cooperation

The formal end of a political conflict does not always create lasting peace, as interpersonal violence can persist for years or decades after large-scale hostility ends. A key question for policymakers and peace builders, then, is how interventions into situations of low social capital might resolve persistent interpersonal conflicts sustained through complex networks of interaction. Existing approaches to this question generally focus on the small-scale effects of interventions like peace education that seek to change the attitudes of a few individuals at a time. Less focus has been paid to how such programs could leverage social networks to have broader effects on society as a whole. This paper explores this scale effect by building a conceptual agent-based model of conflict resolution and cooperation to examine when new ideas introduced by peace builders might spread throughout a population. We find significant benefits to layering different kinds of programs on the same populations, with the goal of leveraging the structure of society to maximize intervention impact.

The impact of digital transformation on E-recruitment performance: An empirical study

This study investigates the impact of digital transformation on the performance of e-recruitment in companies based in the northern region of Morocco. The purpose of the research is to understand how factors such as digital maturity, stakeholder influence, and data analytics contribute to the effectiveness of digital recruitment processes. A quantitative research design was employed, involving the distribution of a structured questionnaire to 117 companies, and data were analyzed using structural equation modeling (SEM) to test the proposed conceptual model and hypotheses. The findings reveal that digital transformation significantly enhances e-recruitment performance, with digital maturity and the use of social media emerging as key drivers. The study concludes that digital tools and competencies are essential for optimizing recruitment outcomes in a digital context. In terms of practical implications, the results offer valuable insights for HR managers and decision-makers aiming to improve recruitment efficiency through digital strategies, highlighting the need to invest in digital capabilities and stakeholder engagement to remain competitive in talent acquisition.

Legal Pluralism and Cultural Legitimacy: Reframing Sasak Customary Law to Prevent Child Marriage in Lombok

Child marriage remains a deeply rooted socio-cultural issue in Lombok, West Nusa Tenggara, where traditional customs, religious authority, and economic hardship intersect. This study investigates how Sasak customary law (awiq-awiq) and the roles of local religious figures, Kyai and Tuan Guru, contribute to both the persistence and potential transformation of early marriage practices. Using a qualitative approach involving interviews, participant observation, and document analysis across three regencies, Central Lombok, West Lombok, and East Lombok, the research finds that cultural traditions such as merarik kodeq (a customary elopement practice) are still widely accepted as mechanisms to preserve family honor and reduce economic burden. Although national legal frameworks, specifically Law No. 16 of 2019 on Marriage and West Nusa Tenggara Regional Regulation No. 5 of 2021 on the Prevention of Child Marriage, set a minimum legal age of 19, implementation remains weak due to widespread use of religious court dispensations and cultural resistance. Findings show that while some customary and religious leaders continue to legitimize child marriage, an increasing number have begun to reinterpret awiq-awiq in line with contemporary health, educational, and religious considerations. Village-level forums (musyawarah desa) are emerging as strategic spaces for negotiating alignment between formal legal norms and local wisdom. This study develops a culturally embedded integration model that emphasizes participatory governance, moral legitimacy, and the co-production of legal norms. It offers empirical insight into the resilience of early marriage in culturally entrenched settings. It contributes a conceptual model for rethinking legal pluralism as a framework for reform through collaboration, not confrontation. These findings expand current scholarship by repositioning customary and religious authority as key agents in adaptive and community-driven legal transformation.

Why established collaborative networks fail to drive organizational innovation efficiency – from an internal knowledge network perspective

PurposeInterorganizational research and development (R&D) networking encounters obstructions, due mainly to inefficient resource utilization and necessary breakthroughs are not achieved. We aim to explore the interplay between a firm’s internal knowledge network and subsequent resource consumption efficiency.Design/methodology/approachWe build collaborative and knowledge networks through screening patent data for 2007–2019 in the aerospace industry. By integrating social network analysis (SNA) with data envelopment analysis (DEA), we measure organizations’ resource transformation efficiency in collaborative networks (RTECN). Through regression analysis, we further investigate the impact of internal knowledge network invulnerability, agility and knowledge positions on RTECN.FindingsThe results show that organizations’ internal knowledge network invulnerability has a positive effect on their RTECN. Agility has an inverted U-shaped effect, whereas organizational knowledge element position has no obvious effect on RTECN.Practical implicationsManagers must rework their internal knowledge infrastructure by encouraging deep cooperation among interdisciplinary research talent. Organizations must establish a more comprehensive and scientific evaluation system for new R&D projects through collective intelligence and data support. Organizations can achieve learning efficiency comparable to that of organizations in other fields and should not blindly pursue crowded technology fields without careful examination. Managers must avoid massive networks rather than opt for networks with fewer occupants to achieve learning efficiency.Originality/valueFirst, we propose a new indicator to measure organizational efficiency when studying networked partners. Second, we advance social network theory to multilayered network examination through incorporating knowledge and collaborative networks into a conceptual model from a new perspective. Third, our research enables us to understand the efficiency gap and explore means of filling it from a knowledge standpoint. Fourth, our findings highlight limitations in SNA in terms of the position of knowledge (elements) such that it does not contribute to a firm’s efficiency in collaborative resource transformation.

Understanding Complex Care ThroughNarrative Medicine: AQualitative Study.

Current training models do not adequately prepare pediatricians to care for children with medical complexity (CMC) as part of a team. Narrative medicine may foster mutual understanding between clinicians and families with colearning as a foundation for collaborative care. In this study, we implemented family-led interprofessional narrative medicine training and explored participants' perspectives in complex care. We performed a qualitative study of narrative medicine training grounded in entrustable professional activities (EPAs) in complex care. We recruited clinicians and families who care for CMC to participate in a series of 6 workshops. Each workshop involved close reading of a text and discussion related to a clinical activity in complex care. Participants defined the EPA before and after each workshop. We performed thematic analysis of EPA definitions and workshop transcripts and synthesized findings into a conceptual model. We recruited 3 interprofessional cohorts (35 total participants) with a mean participation rate of 80%. Each cohort included at least 2 family partners. We analyzed EPA definitions and transcripts from 18 workshops across all cohorts. Four themes emerged involving shifts in perspective about complex care: fragmented to holistic care, intractable to navigable complexity, transactional to relational connection, and caring in isolation to caring in community. Findings aligned with elements of patient- and family-centered care. Clinician and family participants in narrative medicine training described changes in their perspectives on key clinical activities in complex care. Further research should explore colearning models for pediatricians and families that foster team-based patient- and family-centered care.

Longitudinal Impact of Peer Support on Self-Compassion, Self-Stigma, and Mental Health Among Individuals with Mental Disorders

Abstract Objectives The present study examined a conceptual model regarding the longitudinal impact of peer support on the mental health of individuals with mental disorders. Specifically, it tested whether greater peer support would be longitudinally associated with higher levels of self-compassion and lower levels of self-stigma, leading to reduced psychological distress, more positive perceptions of recovery, and greater life satisfaction. Method Participants were 235 individuals with mental disorders recruited from four non-governmental organizations providing mental health services in Hong Kong. They completed questionnaire measures of peer support at baseline (Time 1; T1) and measures of self-compassion, self-stigma, psychological distress, perceptions of recovery, and life satisfaction 1 year later (Time 2; T2). The interrelations of these variables were investigated using path analyses and bootstrap analyses. Results Path analyses revealed that greater peer support at T1 was associated with higher levels of self-compassion and lower levels of self-stigma, which, in turn, were linked to reduced psychological distress, more positive perceptions of recovery, and greater life satisfaction at T2. Bootstrap analyses further showed that peer support had indirect effects on psychological distress, perceptions of recovery, and life satisfaction through self-compassion and self-stigma. Conclusions This study demonstrates the beneficial effects of peer support in enhancing self-compassion, reducing self-stigma, and promoting mental health outcomes among individuals with mental disorders. Given the psychological benefits of peer support, mental health service providers should make concerted efforts to promote peer support for their service users. Preregistration This study is not preregistered.

Antimicrobial Resistance (AMR) Development Map: A Conceptual Map and a Tool to Support Economic Evaluation of AMR Interventions.

Antimicrobial resistance (AMR) is a complex, inter-sectoral and international problem. Economic evaluation (EE) methods offer systematic, evidence-driven approaches to inform policy decisions about which AMR interventions to fund. EE of AMR interventions is complicated owing to diffuse effects, complex mechanics of the problem and high levels of uncertainty. Current AMR EE literature restricts the analytical scope, potentially resulting in omissions of effects that may limit the utility of EE to inform policy decisions. We aimed to systemise the key evolutionary and ecological processes of AMR to elucidate the paths through which AMR interventions impact population health and healthcare costs to support EE design and to support decision makers in understanding the limitations of EE evidence for decision-making. A conceptual map and a corresponding tool were developed on the basis of a literature review in consultation with experts across the relevant disciplines of molecular biology, infectious disease modelling, health economics and ecology. The AMR development map: (1) distils the key AMR processes and process drivers behind AMR development and maps the available types of AMR interventions to AMR process drivers; (2) proposes a way to conceptualise the spatial scope of analysis through considering the connectivity of the wider ecosystem and (3) outlines the key dimensions that AMR burden and intervention effects could be measured across. An AMR development map tool was developed to support conceptual modelling, with the focus on the choice of scope in the EE of AMR interventions, and an illustrative case study was provided. This work summarises the key underlying biological principles of AMR development to provide mechanistical grounding for considering the scope of effects of AMR interventions and the appropriate system of analysis to support conceptual modelling in EE of AMR interventions. In addition, this map can facilitate the identification of effects that cannot be considered or quantified, thus enabling transparency about these omissions within decision-making.

Positive youth development as a pathway to climate engagement: testing a conceptual model

Positive youth development as a pathway to climate engagement: testing a conceptual model

THE CONTRIBUTION OF CONTENT MARKETING TO BUILDING THE BRAND IMAGE OF TOURIST DESTINATIONS

The objective of our article is to highlight the role of content marketing in building brand image and increasing awareness of tourist destinations, to advance the tourism sector. To achieve our objective, we reviewed the literature, building on previous studies, in order to define our conceptual model and hypotheses. Next, we tested these hypotheses with a quantitative study, based on an ad hoc questionnaire of 500 Internet users (tourists), and the results obtained were analyzed through structural equation modeling Pls approach.The study concluded that the dimensions of content marketing (relevance, credibility, and attractiveness) have a positive and direct impact in building the brand image and increasing awareness among tourists, while brand awareness is considered a real mediator between content marketing and the brand image of the tourist destination.

Conceptual Model on the Effect of Axial Load on Shallow Isolated Footings Resting on Clay Soil

This study investigates the geotechnical behavior and bearing capacity of clay soils at the Polo Ground in Maiduguri, Nigeria, with a focus on their suitability for building and shallow structural foundation design. Laboratory tests were conducted on soil samples collected at a depth of 2.0 meters to determine key index properties such as moisture content, specific gravity, Atterberg limits, grain size distribution and shear strength parameters. The results indicated high plasticity indices (PI > 17), classifying the soils as highly plastic clays (CL and CH) under the Unified Soil Classification System (USCS). Specific gravity values ranged from 1.32 to 2.60, suggesting the presence of organic material and further raising concerns regarding the soil's load-bearing capability. The computed safe bearing capacities for the soil samples ranged from 136.9 to 166.4 kN/m2, with an average design value of 152 kN/m2. These results reflect moderate bearing strength, typical of soft clay soils, which necessitate careful foundation design. The settlement analysis conducted for samples A, B, and C revealed settlement values of 196 mm, 291 mm, and 186 mm, respectively. These values are considered significantly high and may pose serious risks to the structural integrity of buildings supported by isolated footings. Excessive settlement of this magnitude can lead to differential movement, cracking, and potential failure of foundation elements, particularly in structures with limited load redistribution capacity. To validate the structural performance on such soils, STAAD Pro Connect software was used to model and analyze isolated footing system under various load conditions. The analysis confirmed that the footing design complies with BS 8110-97 standards, offering adequate load distribution and structural stability under the evaluated geotechnical conditions. This integrated geotechnical and structural analysis approach provides a reliable framework for safe and optimized foundation design in clay-rich soils.

Reshaping roles and value logics among distributed system operators for future electricity systems

BackgroundThis paper seeks to explore the roles of distribution system operators (DSOs) in future energy systems. Measures to combat climate change have led to a transition in the energy sector, where old system fundamentals are becoming obsolete, which results in changing rules for incumbent actors, such as DSOs. These actors must uphold heavily regulated operations within their distribution networks, while landscape trends are changing with a growing number of prosumers and distributed energy resources. To understand these future roles and increase the preparedness for future scenarios and facilitate thinking beyond current lock-ins, action-oriented workshops were held with two Swedish DSOs, departing from pre-developed future imaginaries, structured through transition theory. Researchers were actively involved in the workshops, to guide the participants in the discussions and to provide additional knowledge from transition processes. This was structured through transition theory, mainly in terms of linking transition management fundamentals to the topics in the workshops and basing the workshop discussions on an imagined future socio-technical system-wide approach using four focus areas.ResultsResults included descriptions of roles within future energy systems and their connection to specified value logics from different target groups which would, from the DSO perspective, create value in a future energy system. Roles included sustainable developer, facilitator for increased collaboration, balancing actor, and communicator. In addition, competence requirements were outlined concerning the described roles. The future logic was also described in a conceptual value model for an active DSO in a prosumer-oriented energy system, creating value in all different value logics. Moreover, it provided the steps necessary to develop a pathway aimed at the transformation of DSOs.ConclusionsThe study provided a constructive approach for DSOs to prepare for a future, more prosumer-oriented and flexible energy system, avoiding being locked in current system thinking and focusing on necessary roles and competencies suitable for a DSO. In addition, the utilization of the value logics approach helped place the prosumers in a differentiated manner, which can have implications for strategies among DSOs to create the necessary relations and collaborations for an efficient and value-creating future energy system.

Sustainable water allocation under climate change: Deep learning approaches to predict drinking water shortages.

Sustainable water allocation under climate change: Deep learning approaches to predict drinking water shortages.

A Systematic Literature Review for Blockchain-Based Healthcare Implementations

Background: Healthcare information systems are hindered by delayed data sharing, privacy breaches, and lack of patient control over data. The growing need for secure, privacy-preserved access control interoperable in health informatics technology (HIT) systems appeals to solutions such as Blockchain (BC), which offers a decentralized, transparent, and immutable ledger architecture. However, its current adoption remains limited to conceptual or proofs-of-concept (PoCs), often relying on simulated datasets rather than validated real-world data or scenarios, necessitating further research into its pragmatic applications and their benchmarking. Objective: This systematic literature review (SLR) aims to analyze BC-based healthcare implementations by benchmarking peer-reviewed studies and turning PoCs or production insights into real-world applications and their evaluation metrics. Unlike prior SLRs focusing on proposed or conceptual models, simulations, or limited-scale deployments, this review focuses on validating practical BC real-world applications in healthcare settings beyond conceptual studies and PoCs. Methods: Adhering to PRISMA-2020 guidelines, we systematically searched five major databases (Scopus, Web of Science, PubMed, IEEE Xplore, and ScienceDirect) for high-precision relevant studies using MeSH terms related to BC in healthcare. The designed review protocol was registered with OSF, ensuring transparency in the review process, including study screening by independent reviewers, eligibility, quality assessment, and data extraction and synthesis. Results: In total, 82 original studies fully met the eligibility criteria and narratively reported BC-based healthcare implementations with validated evaluation outcomes. These studies highlight the current challenges addressed by BC in healthcare settings, providing both qualitative and quantitative data synthesis on its effectiveness. Conclusions: BC-based healthcare implementations show both qualitative and quantitative effectiveness, with advancements in areas such as drug traceability (up to 100%) and fraud prevention (95% reduction). We also discussed the recent challenges of focusing more attention in this area, along with a discussion on the mythological consideration of our own work. Our future research should focus on addressing scalability, privacy-preservation, security, integration, and ethical frameworks for widespread BC adoption for data-driven healthcare.

Urogenital Hiatus Closure: Facts, Fallacies, and Why a Unified Theory of Hiatal Failure is Needed.

An enlarged urogenital hiatus is as important as apical support or fascial attachment failures in the development of prolapse and is strongly related to operative failure, yet we lack a conceptual model for factors responsible for hiatal failure. For a conceptual model to be valid, it cannot be proven false by empirical observation. We present six clinical observations with which future model development must be consistent. (1) Perineal body damage alone does not explain an enlarged urogenital hiatus. Three women have complete 4th degree lacerations but small hiatuses. (2) Levator damage is not a sole causal factor. One woman has bilateral levator avulsion but a normal hiatus, while another has intact muscles and an enlarged hiatus. (3) Hiatal assessment during straining is incomplete. Two women with similar straining urogenital hiatuses of 6-7 cm have respective 1.5 cm and 7 cm resting hiatuses. (4) Urogenital hiatus measurements during straining are confounded by Valsalva effort strength. Urogenital hiatus size increases by 30%, 51%, and 181% in one woman depending on straining strength. (5) Hiatal closure during pelvic muscle contraction differs widely. One woman can close her hiatus from 3.5 cm to 1.5 cm, while another shows no reduction despite evidence of contraction. (6) Prolapse/hiatus interactions occur with advancing age. One woman experiences progressive hiatal enlargement over 31 years. Our clinical observations reveal the complexity of the multiple factors involved in hiatal failure and support the need for a unified disease model consistent with these factors on which to base future research.