Geriatric oncology in 2040: Exploring potential realities and challenges. A diverse perspective.

The Connecting Adolescents to Comprehensive Healthcare (CATCH) program built upon existing infrastructure for school nurses and physicians to provide limited reproductive health services to New York City public high school students. We evaluated CATCH reach, service delivery, and impacts on contraceptive use and pregnancy among female teens over the period 2011-2019. Our evaluation incorporated data from school rosters and CATCH patient records; the NYC Youth Risk Behavior Survey, to estimate contraceptive use among students without CATCH access for comparison with students with access; and NYC vital statistics, to estimate the pregnancies, abortions, and births averted by CATCH. CATCH grew from piloting on five campuses to operating on 61 campuses with more than 80,000 students, reaching an estimated 53.7% of sexually active female students on those campuses by the 2018-19 school year. Use of most or moderately effective contraception (IUD, implant, pills, patch, ring, or Depo-Provera) among CATCH patients increased over time and was consistently higher than estimates for those same students if they had not had CATCH access. We estimate the program averted 3526 pregnancies among NYC teens. By supporting access to reproductive health care, CATCH contributed to contraceptive uptake and reduced pregnancies among NYC teens.

This study aims to analyze consumer preferences for parcel delivery services in Batam City, focusing on JNT Express, JNE, J&T Cargo, and SiCepat as the primary service choices. The research examines key factors influencing consumer decision-making and the impact of tax regulations on the distribution of goods from Batam. A quantitative method was employed by distributing an online questionnaire to 200 respondents who had used parcel delivery services and met the research criteria. The variables investigated include information, atmosphere, convenience, enjoyment, uncertainty, service, consumer attitude, and purchase intention, selected based on prior studies demonstrating their relevance in e-commerce and logistics contexts. The findings reveal that information, enjoyment, and service significantly influence consumer attitude, while atmosphere, convenience, and uncertainty show no significant effects. Consumer attitude is also proven to significantly affect purchase intention. SmartPLS analysis indicates that the data are free from Common Method Bias (CMB) and meet the required validity and reliability criteria, including outer loadings, AVE, Cronbach’s Alpha, and Composite Reliability. Despite a decline in parcel shipment volume from Batam over the past three years due to tax regulations, information availability and service quality remain the primary determinants of consumer purchase intention. These results highlight the need for delivery service providers to prioritize information accessibility, convenience, and service excellence to strengthen consumer attitudes and encourage purchase intention.

Smart ride and delivery services with electric vehicles: Leveraging bidirectional charging for profit optimisation

Introduction: Nursing competence is a cornerstone of highquality patient care, yet there is limited empirical evidence from rural regions of Northeast India, particularly Meghalaya. These areas face unique systemic challenges, including workforce shortages, high patient loads and limited resources, which may further impede the delivery of effective healthcare services. Aim: To assess the level of nursing competence among nurses employed in secondary healthcare centres in the Garo Hills region of Meghalaya and to examine whether selected workplace factors predict variations in competence. Materials and Methods: A cross-sectional study was carried out in 16 Secondary Healthcare Centres (District Hospitals and Community Health Centres) across the Garo Hills region of Meghalaya, from 11th July 2023 to 19th August 2023. Using purposive sampling facilitated by Institutional gatekeepers, 226 nurses were approached, with 222 responding to the questionnaire. Data were collected using the validated Nurse Professional Competence Scale – Short Form (NPC-SF), which assesses multiple domains of nursing competence. Prior to data collection, ethical approval was obtained, and written informed consent was secured from all the participants. Descriptive statistics summarised demographic, workplace characteristics and competence data, while multiple linear regression analysis was applied to identify predictors of competence. Results: The mean overall competence score was 5.34±1.28, indicating a moderate level of nursing competence. Among the competence domains, documentation and administration of nursing care scored highest (5.51±1.27), while nursing care scored lowest (5.03±1.16). The majority of nurses (96.85%) reported working more than 50 hours a week, with 82.88% frequently involved in overtime duties. Regression analysis revealed that workplace factors such as overtime involvement and departmental distribution did not significantly predict competence {(R²=0.018, F (4,217)=0.99, p-value=0.413)}. Conclusion: Nurses in the Garo Hills, Meghalaya, demonstrated a moderate level of competence across all assessed domains. The findings suggested that nursing competence may be influenced by broader organisational, educational, and psychosocial factors not captured in the present study.

Temporal and regional associations between fentanyl concentrations in the unregulated drug supply and drug-related mortality in British Columbia, Canada.

• DAPSI(W)R(M) is a problem structuring framework, here applied to offshore energy structures. • Oil and gas platforms and wind farms are linked to ecosystem service delivery and the production of societal benefits. • The life stage of a structure heavily influences the species present, along with the ecosystem services delivered. The marine environment provides a wealth of ecosystem services, which can deliver human benefit when combined with built, human or social capital. Through the expansion of offshore energy infrastructure, human intervention has reshaped marine ecosystems on a global scale. Yet, the changes that these structures induce in the environment and the knock-on effects on ecosystem services remains poorly understood. This study aims to first provide a comprehensive review on the role of offshore energy structures in ecosystem service delivery, synthesising findings from 18 countries over a 42-year period. These findings are then structured under the DAPSI(W)R(M) framework, to draw links between human activity, environmental effects and ecosystem services. The findings are discussed in the context of UK energy transitions in the North Sea. The life stage of the structure and the specific marine environment were the biggest driving forces behind how a structure affected ecosystem services. The initial construction stage created many pressures within the environment, which in turn negatively affected how people engaged with the marine environment through the displacement of commercial fishing, local tourism and visual enjoyment of the seascape. Conversely, structures in place for several years fostered reef-like habitats, leading to enhanced tourism, increased fish stocks and improved nutrient cycling by benthic species. Existing research has focused primarily on the construction and operation periods, with limited research available which addresses how different decommissioning approaches will affect associated communities and ecosystem services. By improving knowledge around the role that offshore structures have in the delivery of ecosystem services and the tools used to assess a structures value, such findings could support informed decision-making for decommissioning on a global scale.

Services and supports for child-welfare involved children with medical complexity: Data from a national survey of child welfare agencies.

Continuity of care prioritizes patient-centered approaches. Effective continuity of care is essential for ensuring high-quality service delivery and benefits for patients in the end-of-life phase. Although continuity of care has been well-established, few studies have focused on promoting continuity of care in big cities. The purpose of this action research was to develop a model for continuity of care during the end-of-life phase in Bangkok. Key participants were 8 nurses involved in continuity of care services. The data collection consisted of in-depth interviews, focus group discussions, observation, and document reviews. The research process followed the action research cycle. Content analysis was employed. The 3 emerging domains of continuity of care during the end-of-life included (1) comprehensive patient information; (2) collaborative care management; and (3) technology-supported care. The participants indicated that the key factors to successful continuity of care during the end-of-life involved: (1) clear goals; (2) effective communication; (3) proactive coordination; and (4) good health care provider-client relationships. The model motivated nurses and other providers in the hospital to change practices associated with continuity of care for palliative care patients. This study's findings provide a foundation for future research to strengthen sustainable care continuity and develop palliative care networks in urban Thailand.

Perceived Barriers and Facilitators to Radiology Examinations Among Patients with Parkinson's Disease in Ireland.

Nursing students' attitudes on sexuality in later life and ageism: A cross sectional study.

This study aims to analyze the influence of apparatus competence, public service ethos, technology adaptation, and internal communication on the success of police transformation. Police transformation requires strengthening human resources, technological innovation, and effective internal communication to ensure professional public service delivery. This study employs a literature review method, gathering data from journals, books, and research reports published in the last 10 years. Findings indicate that apparatus competence significantly enhances transformation effectiveness, as competent personnel are able to perform tasks professionally. Public service ethos also contributes positively, as a work culture emphasizing integrity and responsibility strengthens the police’s public image. Adaptation to modern technology accelerates reform processes, including management information systems and online services. Effective internal communication supports coordination and quick decision-making, facilitating smooth reform implementation. The study highlights the importance of HR development, technological innovation, and internal communication as pillars of successful police transformation. These findings are expected to serve as a reference for internal policy-making within the police organization to strengthen reform and organizational modernization, while improving public service quality.

Oral health is fundamental to overall well-being, as it influences physical health, social confidence, mental stability, and daily functioning. Public Health Dentistry (PHD) addresses oral health at the population level by developing strategies to improve access and outcomes. This narrative review examines the current state, challenges, and opportunities in PHD in India. It incorporates peerreviewed literature as well as policy documents and strategic reports from relevant government health agencies and professional dental organisations to ensure contextual relevance and completeness. The review highlights key areas, including workforce distribution, oral health awareness, mobile dental services, and community outreach. However, persistent challenges such as insufficient manpower, limited funding and a lack of integrated policies continue to pose significant obstacles. Disparities in access to dental care between urban and rural areas underscore the need for targeted interventions to address these inequities. The review emphasises the importance of a robust national oral health policy, integrating oral health care into general health services, and fostering interdisciplinary collaboration. Newer techniques, such as teledentistry and mobile health applications, have the potential to address service deficiencies, particularly in remote or isolated areas. Enhancing community-based oral health education and targeted prevention can lead to lasting improvements in population oral health. Coordinated action among government agencies, academic institutions, and local health systems is crucial to maintain service delivery that is reliable, accessible, and sustainable. A community-centered and equitable approach is essential for reducing the prevalence of oral illnesses in India. Overall, aligning public health priorities with oral health needs can contribute to meaningful and long-term improvements in national health outcomes.

In Estonia, Latvia, and Lithuania, the push for care integration has gained momentum, being seen as an innovative approach to allocate resources more efficiently and improve patient outcomes. This study investigates the progress of integrating care in the Baltic countries from 2019 to 2024 to detail key learnings. We undertook a cross-country study to better understand the progress in care integration in the Baltics with a two-round, 21-item questionnaire on the adoption of integrated care reforms in 2019 and 2024. Responses were analyzed to capture countries' policy environments and their conduciveness to the uptake of integrated care. Country-specific experiences with implementation of care were further explored via case studies of pilot programmes. The pace of implementing integrating care varied. Existing barriers, workforce challenges and payment schemes have impeded integration across health and social care. Despite this, political commitment across successive governments to new and innovative service delivery and collaboration for chronic care management underscores an important prerequisite toward achieving more integrated and person-centred healthcare. The three case studies illustrate hurdles that come with shifting care settings and expanding roles for some workers. Integrating care across providers and the social and health sectors is an incremental process that needs long-term political support to address persistent barriers. The Baltic countries' experiences indicate challenges in bringing together stakeholders in areas such as data interoperability, new financing models and reorganization of workforce and skills mixing. Further work should advance evidence on patient-centred solutions for evolving needs.

Genome sequencing (GS) has emerged as the gold standard for diagnosing patients with rare diseases. As with many emerging technologies, equitable access remains a concern. To evaluate the feasibility and diagnostic impact of expanding access to GS, we report our experience implementing CincyKidsSeq, a prospective study offering GS as a "proband-first" test. Participants of all ages with at least one symptom were referred by genetics or non-genetics healthcare providers, or alternatively, were self-referred from February 2024 to February 2025. This diverse referral structure was evaluated for diagnostic yield while maintaining clinical oversight through a hybrid model in which reportable variants are delivered through genetic providers. The overall diagnostic yield of GS on 313 participants was 22% in the unstratified cohort. Self-referred patients had a higher diagnostic yield (11/33; 33%), compared with patients referred by a non-genetics provider (27/98; 27%), or genetics provider (32/182; 18%). Self-referred individuals were older, more likely to be female, frequently test-naïve, and utilized fewer human phenotype ontology (HPO) terms (p value = 0.0016). Self-referral may serve as an effective and complementary pathway for improving access to GS. Empowering families to initiate GS may be a reasonable pathway for an alternative model for genetic service delivery.

Drone food delivery services adoption and consumer well-being: A dual-method approach

The article examines marketing logistics as an integrated management system within transport enterprises, emphasizing its role in creating sustainable competitive advantages through the effective management of flows and delivery of services that preserve consumer value. In modern economic conditions, traditional isolated application of marketing and logistics tools often fails to ensure the achievement of strategic objectives, particularly under circumstances of high uncertainty, resource limitations, and disruptions in supply chains, such as those experienced during martial law. Marketing logistics emerges as an integrative mechanism that combines market-oriented approaches with process- and flow-oriented logistics, aligning demand generation with the enterprise’s operational capabilities. A critical review of domestic and international literature reveals a lack of unified conceptual understanding of marketing logistics. Foreign studies tend to interpret it from a logistics perspective, emphasizing operational efficiency and physical distribution, while domestic research increasingly views it as a comprehensive, integrative system that coordinates marketing and logistics decisions to achieve long-term competitive advantages. The article classifies approaches to marketing logistics into three groups: functional-distributional, integration-oriented, and value-oriented (synthetic), reflecting its evolution from a narrowly operational function to a strategic management concept. The study offers a conceptual generalization of marketing logistics as an integrated management system under conditions of high uncertainty. The study identifies key objectives and tactical tasks of marketing logistics, including ensuring full and timely satisfaction of consumer demand, optimizing logistics costs, maintaining service quality, enhancing resilience, and supporting sustainable development and digital transformation. The article further delineates the core functions of marketing logistics — analytical, planning, organizational, coordination, control, and value-oriented — demonstrating their integrative nature in harmonizing marketing and logistics processes. Comparative analysis highlights that marketing logistics not only delivers physical products but also generates additional value for the consumer by balancing service levels with operational efficiency. The findings underscore the relevance of marketing logistics as a holistic management tool for transport enterprises operating in dynamic and uncertain environments. Prospects for further research include the development of digital, data-driven, and adaptive approaches to enhance efficiency, resilience, and sustainability in marketing logistics processes.

The purpose of the local government system is to provide essential public services to the local communities as per their needs and ensure community participation in the planning and decision-making process. The idea of a local government system (LGS) is adopted worldwide for the social and economic development of the local communities through a community participation approach, but it works in different structures and sustains in a different framework. In Pakistan, South Africa, and New Zealand, the local government system has been introduced to empower the local communities and work for their well-being and development through a community engagement and participation approach. However, the local government bodies have more power and authority in New Zealand and South Africa than in Pakistan, as it is very systematic and organized. Local bodies enjoy power but are simultaneously under the control of the central government through a legal framework. LGS provides effective service delivery at the grassroots level if it is developed in a very systematic way, either regulated or managed through the constitution or the central government. Moreover, the capacity of local bodies is always a remaining issue, and the central government mostly hires private actors to combat the inability and inefficiency of the local elected officials. Lastly, the essence of local government systems all over the world lies in the “community engagement/participation”, as it cannot serve its holy purpose of local service delivery with the practice of community disengagement.

Telerehabilitation is an innovative, technology-supported approach that enables the delivery of rehabilitation services remotely through information and communication technologies. It serves as a modern extension of conventional face-to-face rehabilitation, aiming to provide continued care for individuals of all ages following hospital discharge or in settings where access to in-person rehabilitation is limited. Telerehabilitation has been applied across a wide range of clinical conditions, including musculoskeletal and neuromuscular disorders, cerebrovascular accidents, pulmonary diseases, dermatological conditions, and sports-related injuries. The rapid expansion of telerehabilitation during the COVID-19 pandemic highlighted its potential to overcome geographical, temporal, and financial barriers to healthcare delivery. Technological advancements such as wearable sensors, digital health platforms, virtual reality, and artificial intelligence have further strengthened the role of telerehabilitation in clinical practice, sports physiotherapy, and physiotherapy education by enabling remote assessment, monitoring, and intervention. Community-based telerehabilitation programs have demonstrated the ability to improve equity in healthcare access, particularly in densely populated and underserved regions, while supporting sustainable health systems and addressing shortages of rehabilitation professionals. Despite these advantages, several barriers limit widespread implementation, including restricted physical examination, inadequate internet infrastructure, data privacy and security concerns, evolving regulatory frameworks, and the potential risk of misdiagnosis. Addressing these challenges requires the development of robust regulatory policies, legal protections, professional training programs, and public awareness initiatives. In Pakistan, strengthening digital infrastructure, expanding internet accessibility, and establishing clear national telerehabilitation guidelines are essential to promote trust and effective adoption. Telerehabilitation should be recognized as an integral component of rehabilitation services, with significant potential to improve patient outcomes and transform the future of rehabilitation care.

Online Food Delivery Services (OFDS) platforms are growing rapidly in Indonesia. However, when compared to neighboring countries such as Malaysia, OFDS user penetration in Indonesia is still very minimal despite the high level of user consumption. The level of user penetration is directly related to customer retention, where product presentation is an important part of customer retention. Previous studies focusing on product presentation factors are still rare. The product presentation factors studied in this research include the combination of product color and background, social presence, and calorie information. These three factors can be directly managed by restaurant partners and have been proven to be important in previous studies related to their relationship with product evaluation. This study uses an experimental design and Structural Evaluation Modeling (SEM) approach. A total of 240 respondents participated in this study. Of the eight hypotheses, four were accepted. Social presence and calorie information were found to significantly affect product attitude negatively. In addition, product attitude (β = 0.733, p = 0.001) and brand trust (β = 0.338, p = 0.001) had a significant positive effect on purchase intention. The discussion and managerial implications are further discussed in this study.