BackgroundEmergency department (ED) overcrowding remains a significant national issue in Canada. To address this issue, SurgeCon, a quality improvement program, was implemented to enhance patient flow, improve communication, and reduce wait times. Despite their potential, interventions like SurgeCon lack evidence on real-world implementation and sustainability in high-pressure, resource-limited ED settings.ObjectiveThis study explores the factors influencing the implementation of SurgeCon in four Canadian EDs using the Consolidated Framework for Implementation Research (CFIR) to identify facilitators and barriers.MethodsData were collected over 2.5 years–before, during, and after SurgeCon implementation—in two rural and two urban EDs in Canada using a longitudinal qualitative research (LQR) design. Forty-two semi-structured interviews with physicians, nurses, and hospital managers were analyzed through inductive and deductive thematic analysis, guided by the CFIR framework.ResultsFacilitators were predominantly associated with CFIR’s Innovation Characteristics, particularly the perceived benefits of real-time data collection, workflow optimization, and enhanced communication. However, barriers—mainly linked to outer setting (COVID-19 disruptions), inner setting (resource constraints and fragmented communication), and individual characteristics (leadership engagement and motivation)—outweighed these advantages.ConclusionTo strengthen adoption, this study proposes eight strategic action plans focusing on leadership commitment, automation, cross-departmental collaboration, feedback loops and change management strategies to maximize facilitators and address implementation barriers.Trial registrationClinicalTrials.gov. NCT04789902. 10/03/2021.

Oral cancer is a significant worldwide public health issue in nations with low levels of awareness and restricted access to healthcare. Despite advancements in diagnostic and treatment methods, its prevalence and mortality rates remain high. The purpose of this bibliometric study is to evaluate global research trends, key contributors, and emerging directions for oral cancer research between 2000 and 2025 using data from the Scopus database. A total of 570 publications were obtained using keywords related to the research of oral cancer. Bibliometric features including total publications, citation counts, and h-index were examined using Biblioshiny with R-studio and VOS viewer. Results indicate that China, the United States, and the United Kingdom were the most frequently named countries, while the National Institute of Biomedical Genomics, the University of London, and Fujian Medical University were the top contributing institutions. Professor Warnakulasuriya S. was the most prolific author. "Oral Oncology" was determined to be the most popular journal based on the quantity of publications. Publication activity peaked in 2021. Saliva-based diagnostics, optical imaging devices, and autofluorescence spectroscopy were mentioned as important technological advancements in early detection. This study offers valuable insights into the current status and future directions of research on oral cancer. It highlights areas for more study and identifies significant authors, institutions, and countries that are advancing the field. These results highlight the need for increased international collaboration and the continuous development of early diagnostic tools.

El clásico (the classic) is the name given to any football match between rival clubs FC Barcelona and Real Madrid. It is a global event full of drama that reflects sporting rivalry, politics, and identity. This article analyses the treatment of 2090 journalistic pieces covering 34 clásicos published by leading sports newspapers Marca and Mundo Deportivo from the 2003-2004 season to the 2020-2021 season. We use content analysis and the framing theory to capture when journalistic biases link sports with politics and identity. Concretely, we search for signs of language that might fuel conflict. The results indicate that the dominant frame presents matches from an athletic and competitive point of view. However, there is also a significant number of journalistic pieces in which confrontation arises from national identity issues and political strife around the Catalan question. Sometimes, war-like language is used to describe football. This is a relevant issue since several studies point to a connection between conflict around sports and physical, psychological, and symbolic violence outside the stadium. The study concludes that sports journalism relies on a limited set of sources and spectacular reporting.

This article explores the manner in which the underdevelopment of Zimbabwean Sign Language (ZSL) has prevented ZSL from developing into an equally developed language in Zimbabwe. The investigation is grounded on Zimbabwe's lack of ZSL in postsecondary and higher education, along with the absence of foreign sign languages like American, British, or French, leading to marginalization and hindering the deaf community's full potential. The study utilized document analysis, focus group discussions with deaf vendors in Harare, Zimbabwe's Market Square and Copa Cabana bus termini, and semi-structured interviews with executive directors of organisations for the Deaf. The chapter highlights the negative impact of nonstandard sign language in Zimbabwe, highlighting the lack of foreign sign language teaching and standardized sign language on the Deaf community's participation in national development issues. Despite Zimbabwe's Constitution recognizing 16 official languages, including ZSL, deaf individuals still face prejudice and discrimination. Inclusive education forces signers to adopt spoken languages, while schools often deny deaf students, hindering their future contributions. The lack of international sign language training also makes it difficult for Deaf individuals to find jobs abroad and transfer money home.

This article examines the history of computer-based technologies for children and adults with disabilities. Using Switzerland as an example, it demonstrates how special hardware and software for people with disabilities became a national policy issue in the last decades of the twentieth century. The focus is on private and public actors, and the historical sources are publications, newspapers, magazines and archival documents. Starting with early regional efforts to develop specialised electronic devices in the French-speaking part of Switzerland, the article first shows the enthusiasm that accompanied the development of new tools for people with disabilities in the 1980s. From the late 1980s, experts in special education and technology development began to network with national stakeholders in computer education. However, this did not generate significant momentum, highlighting the limits of ambitious educational policies in the so-called post-liberal welfare state.

This study examines the pivotal role of social media in mobilising young people, specifically Gen-Z, during the anti-government protests against Kenya’s Finance Bill 2024. Triggered by pressing socio-economic issues, the protests saw the youth demand accountability and radical reforms. The study employed a desk review of 28 media reports and 10 key informant interviews drawn through purposive sampling to examine how young adults organised themselves while evading government detection. Social Action Theory was used to explore the power of social media in political power dynamics. Findings reveal that social media facilitated coordination, mobilisation and raised awareness on societal problems. Gen-Z used digital platforms to mobilise and create practical tools such as Finance Bill GPT for public inquiries and a USSD code for legal support. The eventual withdrawal of the Finance Bill highlights the effectiveness of digitally driven collective action. Despite the movements’ emphasis on nonviolence, over 60 fatalities and hundreds of injuries were reported, underscoring that nonviolent action can still meet violent state responses. The Gen-Z movement demonstrates the power of grassroots mobilisation and its ability to amplify the voices of young citizens. Kenyan youth are often underrated in civic processes, and they effectively use social media in organising for social action for change in society. This study recommends involvement of young adults in socio-economic issues, enhancement of digital platforms to address critical national issues and sensitisation of diverse issues.

BackgroundIn the contemporary era, the role of nurses in safeguarding and advancing environmental and human health has assumed heightened significance, particularly in light of the deteriorating environmental conditions. The objective of this descriptive study was to ascertain the extent of environmental health literacy among student nurses.MethodsThe study was conducted with 299 undergraduate nursing students from a foundation university in Northern Cyprus during the spring semester of the 2023–2024 academic year. The data collection instrument included the Descriptive Information Form and the Environmental Health Literacy Scale (EHLS).ResultsThe mean EHLS score for the nursing students was found to be 80.47 ± 22.96. The mean scores obtained from the knowledge, awareness of health effects, perception of environmental exposure, and behavior dimensions of the EHLS were 23.87 ± 7.49, 19.83 ± 6.27, 9.27 ± 4.83, and 27.50 ± 8.95, respectively. A positive and statistically significant correlation was observed between the scores obtained from the EHLS and its dimensions of knowledge, awareness of health effects, perception of environmental exposure and behavior. The independent variables that significantly contributed to an increase in the EHLS scores were residing with friends, always or sometimes warning people who pollute environment, holding the belief that nurses should be sensitive to the environmental issues and being a third-year nursing student.ConclusionThe study revealed that the environmental health literacy levels of the participants were above the moderate level. Based on these findings, it can be proposed that compulsory environment-related courses be incorporated into the nursing curriculum. Furthermore, active learning methodologies should be employed, and existing environment-related courses should be revised to encompass national and global environmental issues, environmental risks, and their potential consequences. Further studies can be conducted with the aim of enhancing environmental health literacy.

Based on the analysis of the works of European researchers on the use of Latinisms, it has been established that the modern Latinization of the legal sphere is a transnational legal phenomenon. Within the European legal space, this trend has affected both national legal systems and supranational integration entities. Among the supranational legal instruments containing Latinisms, the authors analyse legal acts of the Council of Europe, soft law instruments, case law of the European Court of Human Rights, and the acquis communautaire, particularly the case law of the Court of Justice of the European Union. According to the authors, the trend of Latinization in the legal sphere, both within national legal systems and at the level of integration entities, demonstrates that Latinization today serves as an integration factor within the European legal space and as a tool to facilitate the resolution of national legal issues. It is demonstrated that further integration of states within the EU necessitates the search for new instruments to harmonise legal practices and concepts. Latinisms have the potential to create a common communicative platform for lawyers from different legal systems. Furthermore, it is argued that written Latin can either convey specialised legal meanings of certain concepts that cannot otherwise be expressed in some national languages, or more precisely communicate the essence of a concept than its equivalents in national languages. The authors note that, at the present stage, there is no need for comprehensive Latinization of the legal sphere across Europe. The selective use of Latinisms in legal language serves to preserve tradition and can contribute to the universalization of legal concepts and principles, as well as to the unification of legal terminology and practice amid processes of convergence and cross-fertilization among European legal systems. Special attention is also given to scholarly remarks concerning the use of Latinisms in national legal systems. It is emphasized that although the principles of using Latin in many countries are very similar, not all Latinisms are equally popular and have identical formulations, even in the legal systems of European countries.

The area of the Balkan Peninsula has been a zone of conflicting geopolitical interests for centuries. For centuries, influences from the West, East, North and South have shaped this area. The past three turbulent decades have brought great changes to this area. From changing borders and state structures, ideological changes, restructuring the economy, to international sanctions, ethnic and religious conflicts with tens of thousands of victims and war crimes. The collapse of the economic and political systems of the communist countries resulted in these societies falling into a state of complete social and value confusion. Continuity of national issues and frozen conflicts in Southeast Europe came to the fore again - due to the historical heritage, which created numerous ethnic and religious mixtures in this area, which again represents a fertile ground for geopolitical interference and foreign influences. The states created by the dissolution of the SFRY became to a greater or lesser extent subject to the influence of foreign factors, both in the regulation of internal policy and in the tracing of foreign policy directions. Such a factual state of limited sovereignty created a kind of: protectorates, semi-protectorates, ambassadorships. The turbulent geo-economic and geo-political movements of the past decades, the movement from a unipolar to a multi-polar global order, with more economic, military and political centers of power - has a significant impact on the areas located on the periphery of the capitalist system and vulgarized neoliberalism. The ex-YU space represents a typical syndrome of emphasizing small differences, and on the other hand - there is much more that unites, mutual respect, solidarity during natural disasters, floods, earthquakes, fires and during pandemics. There is an ongoing geopolitical struggle, in which, in order to realize certain political and economic interests, various means are used against the targeted states, from hybrid war, sanctions, armed conflicts based on the model of „controlled chaos“. The effort of the Great Powers to achieve stability in the world is often wrong, because the international environment is an excellent example of a chaotic system. The world is destined to be chaotic, because geopolitical players have different goals and values. Therefore, the great powers see chaos as a source of opportunity and pursue the illusory goal of global stability. The geopolitical strategy of „controlled chaos“ produced an adequate reaction, which is also reflected in the media field. The wide use of mass media and new technologies in such complex international relations, with multiple crisis hotspots (Middle East, Ukraine, Afghanistan, Iran, Venezuela, North Korea, islands in the South China Sea, neuralgic hotspots in Africa) is evident. So, even though a deceptive peace reigns at the global level, „below the surface“, the conflicting geopolitical interests of leading but also regional states intersect in the mediasphere through special services. At the beginning of the new millennium, the world is facing numerous challenges. The challenges are of a security, political, economic, ecological, cultural, technological nature, with the enormous power and use of mass media. The economic rise of China, the military and political rise of Russia, the creation of the BRICS economic alliance, the rise of South American economies striving for independence from the influence of the USA - represent new factors on the geopolitical map of the world. New, economic-political organizations are trying to reduce the power of the IMF and reduce the use of petro-dollars, while international political relations are moving towards the tendency of creating a new multipolar world, with more economic, political and military power centers. A multipolar world, the emergence of which can be seen during the second decade of the new millennium, global hotspots in the Middle East, the migrant crisis, the struggle over the deposits and flows of energy sources and water sources, the struggle for the influence of the Great Powers through the so-called hybrid wars - have their consequences on the territory of Southeast Europe.Small countries, like the Balkan ones, cannot allow themselves some foreign political freedom and strategy and geopolitical games. Therefore, they act towards the Great Powers - primarily with tactics of survival and short-term gains.

The discussion surrounding contemporary history didactics faces numerous challenges related to effectively conveying historical knowledge and developing various skills in the context of a changing society and dynamic transformations in education. Questionsarise about teaching methods and tools, the role of technology, and the understanding of the past in the context of national identity and global issues. One significant issue is the evolving role and new functions of the history textbook. It is still the basic teaching medium, but in the light of the concepts of constructivism and connectivism, it is one of many sources helpful in constructing school knowledge. New forms of it are emerging (multibooks, educational platforms). Teaching methods are also changing. Increasingly, educators are turning to unconventional approaches, such as historical games. These games allow for the analysis of various scenarios, decision-making, and evaluating their consequences. They foster critical thinking and an understanding of cause-and-effect relationships in history. Moreover, they can serve as excellent tools for developing interpersonal skills, which are crucial in the context of professional work and solving everyday problems.

Stunting is a chronic nutritional problem that affects children's physical growth and cognitive development, and it remains a national priority issue in Indonesia. One of the key strategies for preventing stunting is to provide education to adolescent girls as future mothers, considering that their nutritional status greatly influences pregnancy outcomes and fetal growth. This community service activity aims to increase adolescent girls’ awareness of the importance of balanced nutrition and anemia prevention as a means of reducing stunting in future generations. The method used was socialization through interactive counseling sessions at several senior high schools in East Lombok Regency, targeting adolescents aged 14–18 years. The activities included material preparation, logistical arrangements, implementation of health education, and final reporting. The topics delivered covered balanced nutrition, anemia in adolescents, and the distribution of Iron-Folic Acid (IFA) tablets. The results showed that the counseling sessions effectively improved adolescents’ knowledge about stunting and the importance of adopting healthy lifestyle habits early on. Health education on stunting has proven to be a strategic approach to raising awareness and preparing adolescents for a healthy reproductive future. This activity is expected to serve as a model for involving adolescents in stunting prevention efforts, especially in East Lombok.

ABSTRACT Radical right nativist parties have gained ground across Europe in recent decades. However, a key unanswered question is how these parties adapt in contexts marked by the centre–periphery cleavage and competing national attachments. This paper addresses that question by examining the case of Catalonia and the emergence of Vox, a Spanish nationalist radical right party, and Aliança Catalana, a pro-independence, anti-immigration, and Catalan nationalist party. Although both parties align on immigration and economic concerns, they diverge on gender, climate change, LGBT + rights, and – most notably – the national cleavage and territorial issues. Voters from both parties exhibit similar socioeconomic characteristics and share concerns related to immigration, but their national attachment primarily influences their choice between AC and Vox.

Backround: Undertreatment of elevated LDL-Cholesterol (LDL-C) is a national public health issue. The Collaborative Approach to Reach Everyone with Familial Hypercholesterolemia (CARE-FH) is a clinical trial within an integrated health system to foster the application of FH screening guidance in primary care, to identify and to improve early initiation of treatment of individuals with FH and/or elevated LDL-C. We hypothesized that primary care providers would be more likely to initiate lipid lowering therapy in those with LDL-C > 190 mg/dl after an educational intervention regarding FH, and might also be more likely to treat those not at goal as defined by the 2018 multi-society lipid guidelines. Methods: Stepped-wedge cluster randomized design was employed to implement the intervention across participating clinics. From the electronic health record we identified all adult patients at Geisinger with a lipid profile obtained during the study time window. Data collected included LDL-C levels, new lipid prescriptions, referrals to cardiology/lipid specialist/pharmacy treatment program, and achievement of treatment goal. Providers who received the intervention were compared to those who had not to assess impact of the intervention on lipid treatment outcomes. Results: Overall, there were 57,277 patients with an LDL-C value (22,539 (39%) in intervention practices; 24,614 male (43%)). The Table shows key results stratified by sex. Overall, slightly more than half of those with an LDL-C > 190 mg/dl had a lipid lowering medication started, with about 20% being referred for further evaluation. The educational intervention did not appear to impact these rates (Chi-square test, p = 0.13 for new meds; p = 0.60 for achieved goal). For the cohort at large, about 10% overall had a new medication started and about 10% got to goal at follow up, with women less likely than men to have a medication started (OR = 0.66 [0.61, 0.70], p < 0.001) or get to goal (OR = 0.72 [0.65, 0.79], p < 0.001). Conclusion: These results are disappointing. Overall, lipid lowering medication initiation rates for extreme elevations in LDL-C were low and an educational intervention to improve FH diagnosis had no impact on outcomes. For all those with actionable lipid profiles, women were less likely to receive treatment than men.

Nigeria's economy holds the largest market in Africa and presents significant opportunities for local and international investors. However, the ease of doing business in Nigeria has become a national issue in the last decade due to the World Bank's ease of doing business index, which has been poor in areas with productive sectors, affecting investment. This study critically examines the contending issues and persistent challenges confronting investment opportunities and the ease of doing business in Nigeria between 2015 and 2025. This study examines the impact of institutional, infrastructural, security, and policy-related factors on Nigeria’s investment environment over the last ten years. The study employs a qualitative approach supported by empirical data, policy reviews, and stakeholder perspectives to examine the challenges related to investment and the ease of doing business in Nigeria. It evaluates the effectiveness of various reforms in the business environment. It analyses how these reforms have resulted in measurable enhancements in the ease of business over the past decade. The results indicate a notable disparity between the objectives of policies and their actual implementation, as numerous enterprises continue to face challenges due to inadequate infrastructure, insecurity, excessive taxation, inconsistencies in regulations and corruption. The study concludes by offering policy recommendations geared towards enhancing transparency, strengthening institutions, and fostering a more enabling and secure environment for sustainable investment and ease of business in Nigeria.

Objectives Coroners in England and Wales have a duty to write Prevention of Future Deaths (PFDs) reports when they believe that action should be taken to prevent similar deaths. We conducted a systematic case series of the reports involving maternal deaths to characterise these deaths in terms of demographics, explore the concerns raised by the coroners and understand what actions were reported by organisations in their responses to the coroner. Methods All coroners’ PFDs published between July 2013 and 1 August 2023 in England and Wales were collected and reviewed (n=4435). Reports were searched for keywords related to maternal deaths. Case information was extracted into pre-specified domains and compared to other data on maternal deaths. Results Twenty nine (n=29) cases were found involving a maternal death. The median age at death was 33.5 years (IQR 29–36 years) and three-quarters (75.9%) of deaths occurred in hospitals. The most common cause of death was haemorrhage. Coroners frequently voiced concerns around the failure to provide appropriate treatment (48.2%) and failure of timely escalation (37.9%). Specific lessons we have highlighted include gaps in national guidance, failure to follow national protocols, communication issues and lack of resources or staff cover. Only 38% of PFDs had published responses from the organisations they were sent to. When organisations did respond to the coroner, 80% reported that they implemented changes, including publishing new local policies, increasing training or committing to increased staffing. Conclusions Poor response rates to PFDs indicate under-utilisation of these reports as a resource for improvement in maternal care. PFDs highlighted gaps in obstetric care and national guidance which, if appropriately addressed and regularly and routinely monitored, could prevent similar deaths.

Given that news media play key roles in shaping public and policy responses to food poverty and insecurity, this study analysed how newspapers frame these issues across the island of Ireland, comparing coverage between jurisdictions (Republic of Ireland and Northern Ireland) and newspaper types (national versus regional/local). Using LexisNexis and Irish Newspaper Archives, we searched for articles containing ‘food poverty’ or ‘food insecurity’ published between January 2018 and January 2023. We used Entman's framing theory to code articles for problem definitions, causal interpretations, solutions, moral evaluations, and social actors. Analysis of 80 articles from 14 newspapers revealed coverage peaked during school holiday periods (December and Summer), reinforcing episodic attention to ‘holiday hunger’. Although structural causes appeared in 66% of articles—including inadequate income, living costs, and welfare failures—proposed solutions were predominantly charitable (79%) rather than structural (39%), with food banks cited most frequently. National newspapers more frequently discussed structural causes and policy solutions, while regional publications focused on charitable responses. Articles predominantly featured voices from charities (88%) and government officials (50%), while only 10% incorporated voices from those experiencing food poverty and insecurity. This disconnect between acknowledged structural causes and proposed charitable solutions perpetuates normalization of food poverty and insecurity, obscuring state responsibility for ensuring the right to adequate food. Such framing impedes recognition that this issue in wealthy nations results from political choices requiring systemic reform, not charitable intervention.

Climate change has become a global issue that has serious impacts on biodiversity, including in the Jabodetabek metropolitan area which is experiencing ecological pressure due to massive urbanization and environmental degradation. This study aims to analyze the impact of climate change on the existence and sustainability of local flora and fauna species in Jabodetabek, identify weaknesses in existing policies, and formulate mitigation efforts within the context of national environmental issues. The method used is a legal-sociological approach with data collection techniques through literature studies, field observations, and limited interviews with stakeholders. The results show that rising temperatures, changes in rainfall patterns, and declining habitat quality have caused species migration, local extinction, and ecosystem imbalance. Weaknesses lie in the lack of integration between climate and conservation policies, minimal oversight, and low public participation. Recommended mitigation measures include strengthening conservation regulations, habitat restoration, providing ecological corridors, and multi-stakeholder collaboration between the government, community, and private sector. This study emphasizes that biodiversity protection must be an integral part of climate change adaptation strategies, in line with Indonesia’s commitment to sustainable development.

ABSTRACT While research on disinformation is increasing, there is limited research on gendered disinformation. When gendered disinformation is addressed, it is often framed in policy discussions as a national security issue. This framing raises important questions: What are the implications, both intended and unintended, of framing gendered disinformation as a national security threat, and to what extent can state-centred security responses meaningfully protect those targeted by such disinformation? Relying on feminist security studies literature (FSS) and securitization theory as well as cases from India, Saudi Arabia, Syria, Iraq, Tunisia, and Hungary, I argue that securitizing this issue and relying on the state for protection is problematic. Such an approach assumes that the state is inherently protective of its citizens, overlooking the fact that some states use gendered disinformation as a tool to silence dissenting voices. Additionally, misdiagnosing the issue as an external threat rather than recognizing it as a structural problem rooted in enduring patriarchal norms and institutions within and across societies. A better approach focuses on including civil society, human rights, and combating daily gendered violence women experience from multiple state and non-state actors, both foreign and domestic.

Abstract. As an important infrastructure for the development of intelligent automobile industry, high-definition maps has the characteristics of high precision, high freshness and rich elements. Massive high-definition geographic information data contains not only sub-meter-level location information, but also attribute information such as elevation, slope, and curvature. Once abused, it may involve national security issues. This paper studies the technical route of security compliance on high-definition maps in the process of multi-source updating, by summarizing the status of high-definition maps management in China and other countries of the world, analyzing its potential safety risks , putting forward the technical framework of supervision, and exploring a platform to apply the supervision on high-definition maps multi-source updating. Our research could provide ideas for the security compliance of high-definition maps, and improve healthy and orderly development of intelligent vehicle industry.

The rapid advancement of information technology has enabled the public to openly express their views through social media, including on strategic national issues such as the Draft Law on the Indonesian National Armed Forces (RUU TNI). This study aims to map public sentiment toward the RUU TNI and to compare the effectiveness of two popular sentiment analysis algorithms, Support Vector Machine (SVM) and Random Forest (RF). A total of 525 relevant tweets collected between February and May 2025 were analyzed and classified into three sentiment categories: positive, negative, and neutral. The results reveal that neutral opinions dominate at 81.4%, followed by negative sentiments at 11.1% and positive sentiments at 7.4%. The performance comparison shows that SVM achieved an accuracy of 92%, outperforming RF which obtained 91%. These findings highlight that strategic defense issues tend to generate predominantly informative public opinions, while critical voices show an increasing trend as the discourse evolves. The novelty of this study lies in the application of three-class sentiment classification and the comparative evaluation of SVM and RF within the domain of defense policy. This research contributes to the academic discourse by extending sentiment analysis beyond electoral and marketing topics, while also providing practical insights for policymakers in understanding and responding to public aspirations more effectively.