Patient Safety Culture (PSC) is key to healthcare quality. While widely studied in hospitals, evidence on PSC in Hospital at Home (HaH)-a growing model delivering hospital-level care at home-remains scarce. This study evaluated PSC among professionals in Spanish public HaH units. A descriptive, cross-sectional survey was conducted using the Spanish-validated Hospital Survey on Patient Safety Culture 2.0. Participants were physicians, nurses, and other HaH professionals with ≥ 3 months' experience. A total of 199 responses were analyzed using non-parametric tests. Positive response rates identified strengths (≥ 75%) and improvement areas (≤ 50%). Teamwork Within Units achieved the highest positive responses, indicating strong collaboration, while Staffing and Work Pace scored lowest, reflecting workload concerns. Most rated unit safety as "good" or "very good," though few as "excellent." Nurses reported more favorable perceptions than other professionals. Significant differences appeared in teamwork, communication, and leadership support. Comments highlighted commitment despite workforce shortages and limited institutional recognition. HaH services demonstrate a generally positive PSC. Addressing staffing and workload challenges through stronger institutional support and safety protocols is crucial for sustainable, safe home-based care.

Water security and its implications for sanitation and hygiene remain a critical global challenge and are the focus of the United Nations' Sustainable Development Goal 6 (SDG 6). Acknowledging the diversity and rapid growth of research on SDG 6—and more broadly on water and sanitation—this study conducts a science mapping analysis of the literature in this domain. The purpose of this type of analysis, in the context of a substantial and rapidly expanding body of research, is to assess the range of issues addressed within this multidisciplinary domain and to identify areas that remain underexplored or have received comparatively limited scholarly attention. Drawing on a corpus of 3,068 articles published between 1993 and 2024 and indexed in Scopus, we applied the SPAR-4-SLR protocol to perform a thematic evolution analysis over the entire period, alongside a bibliographic coupling analysis focused on the 2020–2024 period to capture recent research trends. Both analyses were triangulated with author keyword co-occurrence analyses. In this respect, our analysis shows that several issues still lack dedicated investigation. Our findings highlight a persistent research gap in the financial dimensions of SDG 6, with limited attention to funding mechanisms for equitable and sustainable access and a fragmentation of research efforts on these issues. These results suggest that future research should prioritize innovative financing models, inclusive governance frameworks, and data-driven strategies to improve infrastructure investment and policy effectiveness, as well as stronger collaboration within the scientific community on these specific issues.

Optimizing hospice care: A scoping review of staffing strategies to enhance practice.

ABSTRACT Nature-based solutions (NbS) and grey infrastructure have traditionally been implemented separately to address environmental and societal challenges in vulnerable regions like the northern coast of Java, Indonesia. This research examines the extent to which the integration of NbS and grey infrastructure can be sustainably operationalized to promote coastal resilience in the northern coast of Wonokerto District. It focuses on stakeholder collaboration in implementation, the influence of community engagement and local knowledge, and the governance and institutional conditions that shape their sustainability. Using a qualitative approach, the research findings highlight the need for strong cross-sectoral collaboration and multi-level coordination to operationalize these solutions sustainably.

BackgroundChronic obstructive pulmonary disease (COPD) often coexists with sarcopenia, contributing to poorer exercise tolerance, quality of life, and prognosis. Although interest in this topic has increased, a comprehensive bibliometric overview is still lacking.MethodsEnglish-language articles and reviews on COPD complicated with sarcopenia published between 2005 and 2025 were retrieved from the Web of Science Core Collection and Scopus. After screening and deduplication, bibliometric and visualisation analyses were conducted using bibliometrix/biblioshiny, VOSviewer, and CiteSpace to evaluate publication trends, major contributors, collaboration networks, co-citation patterns, and keyword evolution.ResultsA total of 922 publications from 421 journals were included. Output increased markedly over time, especially after 2018, peaking in 2025. The United States and China were the main contributors and major collaboration hubs, while several European countries showed strong international collaboration and high citation impact. Core journals included International Journal of Chronic Obstructive Pulmonary Disease, Journal of Cachexia, Sarcopenia and Muscle, and Clinical Nutrition. Co-citation analysis showed that the knowledge base was mainly supported by studies on COPD systemic effects and body composition, together with consensus documents on sarcopenia definition and grading. Research hotspots evolved from early work on weight loss, malnutrition, and muscle wasting to functional assessment and clinical outcomes, and more recently to interventions such as nutrition support, resistance training, and pulmonary rehabilitation, alongside emerging mechanistic themes including inflammation, oxidative stress, and metabolic abnormalities.ConclusionResearch on COPD complicated with sarcopenia has shifted from descriptive phenotypes to standardised assessment, functional outcomes, and clinical management. Future studies should strengthen multicentre longitudinal designs and multidisciplinary collaboration to better integrate mechanisms with clinical assessment and intervention.

Trends and developments in marine debris studies: A bibliometric review over two decades (2004-2024).

Cognitive dysfunction is a major nonmotor feature of Parkinson's disease (PD) that impairs quality of life and increases caregiver burden. Its intellectual structure and thematic development remain underexplored. This bibliometric and scientometric study analyzed English-language publications on PD-related cognitive dysfunction indexed in Web of Science, Scopus, and PubMed (2000-May 2025). After screening and duplicate removal, 8721 articles were included. VOSviewer 1.6.20, Python, and Microsoft Excel were used for co-authorship, bibliographic coupling, co-word, and citation analyses. Results showed 8721 publications authored by 34,311 researchers, with the United States, China, and the United Kingdom leading in output and international collaboration (collaboration index 8.02). Four thematic clusters were identified: diagnostic criteria and staging, neurobiological mechanisms, nonmotor symptoms and quality of life, and therapeutic interventions. Findings highlight a mature but evolving research field, emphasizing multidisciplinary integration, stronger collaboration, and the need to explore biomarkers, neuroinflammation, and novel therapeutic approaches.

Since 2019, Dutch hospitals have been developing approaches aiming to bridge the gap between hospital care and community-based lifestyle support. This has led to the introduction of the so called 'Lifestyle Front Office" (LFO) in 2022. The LFO enables healthcare professionals to refer patients for lifestyle and (psycho)social support adjacent to medical treatment in the context of specialist medical care. After a consultation at the LFO, patients are referred to the appropriate community-based lifestyle interventions. LFOs have been quickly adopted in Dutch hospitals, leading to conceptual differences. This study aimed to evaluate similarities, differences and future needs of LFOs in the Netherlands, striving for a more unified concept. A cross-sectional survey was sent out between December 2023 and September 2024 to all Dutch hospitals with an operational LFO (n = 17 hospitals). The survey focused on referral processes, patient eligibility criteria, departmental involvement, screening methods, consultation practices, follow-up procedures, financing, and capacity. The collected data were analyzed quantitatively and qualitatively to identify common practice, challenges, and opportunities for improvement. The survey response rate was 82% (14/17). Primary referral groups were patients with lifestyle-related conditions such as obesity, type 2 diabetes mellitus and cardiovascular diseases. Most LFOs conducted pre-visit screenings by using questionnaires, employed lifestyle care coordinators with diverse professional backgrounds, utilized structured tools during consultations and used the electronic patient records for screening and communication. Future needs included the need for (long-term) funding, which was only secured in 21% of the LFOs. Furthermore, inconsistent eligibility criteria, limited capacity, and follow-up procedures were seen as priorities for future attention. This study highlights the similarities, differences and future needs of LFOs in the Netherlands. To achieve a more unified concept, LFOs need to better align patient-related eligibility criteria, use of structured tools, referral to community-based support, follow-up strategies and long-term funding. While the LFO concept emphasizes strong inter-organizational collaboration, further research is needed to assess its impact by investigating success rate of referrals and (long-term) health outcomes after referral. Additionally, for maintaining LFOs in the Dutch healthcare system, additional research is required to better understand the barriers and facilitators regarding structural implementation.

Nursing programs face challenges finding clinical sites for education due to increased enrollment. Expanding beyond traditional acute care placements is essential to providing learning experiences aimed at meeting AACN Essentials competencies. In response to increased enrollment, one rural baccalaureate nursing program used assisted living facilities as clinical sites for a Foundations course. Clinical faculty collaborated with five assisted living facilities to establish placements, defining expectations and ensuring appropriate student-to-faculty ratios. Students completed a combination of hospital-based and assisted living facility clinical hours. At the end of the rotation, students and faculty completed written evaluations assessing skill development and learning experiences. Students reported increased confidence in communication and assessment skills, appreciation for holistic care, and positive engagement with residents. Faculty observed growth in student competence and strong collaboration with facility staff. Assisted living facilities provide viable, effective clinical placements in nontraditional settings with positive experiences reported by students and faculty.

The novel application of Virtual Twins (VT) in PBPK (VT-PBPK) presents the opportunity to advance precision dosing and accelerate the shift from one-size-fits-all to targeted, individualized treatments. This review aims to: (1) critically evaluate existing research on the use of VTs in PBPK, (2) develop a conceptual definition of VT-PBPK, (3) describe and evaluate VT methodological diversity, (4) examine existing regulatory frameworks and guidance governing the integration of VT-PBPK, and (5) identify opportunities and challenges for advancing next-generation VTs. A structured literature search was conducted to identify studies describing VT-PBPK of a whole human body for the purpose of predicting drug concentration and/or effect. Details of the VT-PBPK models and VT design were extracted from each study. A framework assessing and categorizing methods of simulation and virtualization was applied to the extracted data. Twenty-two (22) studies were included which demonstrated the application of VT-PBPK across a range of populations, disease states, and drug classes. All studies applied VT-PBPK to real-world patient-specific covariate data retrospectively for the purpose of PBPK model development and evaluation, or model-informed precision dosing (MIPD). In the VT approaches, three levels of virtualization were identified; low, medium, and high, as determined by the number of covariates integrated into the model. To date there is no specific regulatory guidance on the appropriate use of VT-PBPK. A shift in application of PBPK modeling from population-based to specific, individualized predictions is required to advance VTs toward clinical implementation. Achieving rigorous design and evaluation of VT models will require strong interdisciplinary collaboration.

Sustainability has become an increasingly important concept in marina management due to the growing impacts of global warming, climate change, and marine pollution. In recent years, sustainability has gained a central place on the global agenda, particularly with the identification of 17 Sustainable Development Goals by the United Nations, emphasizing the importance of sustainable practices in business management and environmental governance. The primary aim of this research is to identify and systematically present sustainable marina management practices in a scientific, concrete, and objective manner. To achieve this objective, a Sustainable Marina Management Scale was developed through a field-based scale development study. Australia stands out as a country with a highly developed marina industry and a strong environmental awareness that has become integrated into business practices and social values. The country hosts a total of 296 marinas. Australia’s yachting industry has been experiencing rapid growth, supported by strong collaboration among marina operators, yacht tourism stakeholders, and non-governmental organizations working on sustainability and marina management. Furthermore, Australia represents one of the largest yacht markets outside Europe and North America. Within this framework, the study explores the question: “How should sustainable marina management be implemented?” by examining the perspectives and participation of marina stakeholders in Australia. The findings are expected to contribute not only to the economic development of the marina sector but also to the sustainable management of marine tourism resources, ensuring their protection and transfer to future generations. In this context, Australia’s functional and sustainability-oriented marina management approach offers a valuable model that may serve as an example for both local and global marina industries.

One critical measure of success in workplaces is an employees’ ability to use competently the knowledge, skills and values that meet the needs of his job, satisfy the demands of the employer, and contribute to the overall achievement of institutional goals. The paper seeks to describe the employability of the graduates of Mindoro State University in consonance with the CMO 75, s.2017. The research utilized descriptive research design. The questionnaire enables the employers to express their feedback and satisfaction on the five areas of employability enumerated as professionalism and work ethic, communication and collaboration, critical thinking and problem solving, adaptability and flexibility, technological savvy and digital literacy. The research findings underline the graduates' commendable performance in demonstrating professionalism and work ethic, a vital aspect for success in the teaching profession. Additionally, the graduates exhibit strong communication and collaboration skills, an essential competency for educators who need to engage with colleagues, superiors, and stakeholders effectively. However, the feedback indicates room for growth in conflict resolution and creative problem-solving within collaborative settings. While the graduates excel in adaptability and flexibility, their aptitude in using technology, although strong, could be enhanced. Furthermore, the graduates' demonstrated strengths in critical thinking and problem-solving are accompanied by a readiness to embrace new challenges. Research's holistic evaluation of graduates' attributes showcases their preparedness for the demands of the educational sector. While the strengths are evident, tailored interventions to address areas of growth, like conflict resolution, creative problem-solving, and technology integration, can contribute to well-rounded and adaptable educators.

Post-donation care is variable in Canada. A virtual workshop including donors and health providers was conducted to advance recommendations for a new national standard of living donor follow-up. Attendees participated in facilitated breakout groups to deliberate pre-set questions on a draft care model informed by a survey of 685 previous donors. Deliberations were audio-recorded, transcribed, and imported into HyperRESEARCH software to facilitate inductive, systematic and auditable coding of the data. Final meeting recommendations were approved by attendees and then presented for consideration of endorsement by all Canadian programs. We identified four themes: (1) Establishing a donor centric long-term follow-up plan; (2) Generating data to optimize donor outcomes; (3) Safeguarding donors and (4) Partnership to strengthen care (transplant centers enacting duty of care, setting expectations with donors for follow up, supporting a collaborative model with primary care doctors, harnessing technology, ensuring consistency, regularity, and feasibility). Post-donation care should be donor-centric, flexible and based on a strong collaboration between primary care providers and transplant programs. The new model should include a "safety net" to provide specialist care when needed, as well as donor consent for capture of long-term health outcomes in a national registry. The recommendations are endorsed by all Canadian living donor programs. Although necessary, the provision of universal health care coverage alone is insufficient to ensure long-term donor health and inform future practice. A new national model of long-term donor follow-up informed by the lived experience of past donors and input from primary care and transplant providers was proposed.

Volleyball plays a crucial role in maintaining physical and mental health while contributing to the overall quality of life. Internationally, volleyball is governed by the Fédération Internationale de Volleyball (FIVB), and nationally by the Indonesian Volleyball Federation (PBVSI). The FIVB Women’s U-21 Volleyball World Championship 2025, held in Surabaya from August 7 to 17, involved 24 countries and served as a platform for young athletes to demonstrate their abilities, strengthen athlete development pathways, and determine global rankings. This study aims to analyze the overall performance of the Indonesian Women’s U-21 National Volleyball Team throughout the tournament, from the preliminary round to the play-off phase, by identifying playing patterns, factors contributing to wins and losses, and Indonesia’s global position when competing against strong teams such as Italy and China. The research employed a descriptive quantitative analytical approach using document analysis. Data were collected from match results, point statistics, and final rankings. The findings indicate that Indonesia, competing in Pool A, finished 16th in the world ranking, 5th in Asia, and 2nd in Southeast Asia, achieving two wins and seven losses. Italy emerged as the world champion, while Japan secured the runner-up position. The discussion highlights that mental resilience, technical mastery, and tactical execution are key determinants of competitive performance at the international level. Therefore, sustained high-quality training programs and multidimensional support, along with strong collaboration among stakeholders, are essential to enhance the future performance of the Indonesian national team, in line with FIVB’s vision of “Volleyball for All.”

Infection prevention and control (IPC) is essential in healthcare education, including medical imaging disciplines such as computed tomography (CT) and nuclear medicine (NM). Drug administration, including contrast media (CM) and radiopharmaceuticals, poses an increased infection risk. The aim of this study was to explore IPC curricula related to drug administration in medical imaging programs. An online cross-sectional survey was distributed to program directors from universities offering medical imaging programs in Australia, the United Kingdom (UK), New Zealand, and Ireland. The survey explored curriculum content, teaching approaches, resource utilisation, and challenges in delivering IPC education. Data were analysed using descriptive statistics, non-parametric tests, and qualitative content analysis. Twenty participants from Australia and the UK completed the survey. Most programs include practical activities, simulations, and multimedia resources. IPC curricula are routinely reviewed and aligned with national guidelines. Key challenges include limited resources and restricted clinical access. Participants highlighted collaboration with healthcare professionals, regular curriculum updates, and innovative teaching technologies as effective strategies to address these issues. Experiential learning through case studies and simulations was viewed as essential for developing practical IPC skills and supporting knowledge retention. Medical imaging programs demonstrate a strong commitment to IPC education through diverse active learning strategies. Addressing resource limitations and ensuring ongoing curriculum updates via collaboration, innovation, and experiential learning are crucial for sustainable IPC training that protects both patients and healthcare professionals. The findings emphasize the need for medical imaging departments to prioritise ongoing IPC training, incorporating simulation, case-based learning, and regular alignment with national standards. Stronger collaboration between universities and clinical sites can improve student preparedness for drug administration and enhance patient safety.

High concentration subcutaneous biological drug products: challenges and advancements.

This study presents a comprehensive bibliometric analysis of federated learning within distributed computing, aiming to explore research trends, intellectual structures, and emerging themes in the field. Data were retrieved from the Scopus database covering publications from 2010 to 2025. The analysis employs performance metrics and science mapping techniques, including co-authorship, keyword co-occurrence, citation, and density visualization using VOSviewer. The results reveal a significant increase in research output, particularly after 2018, driven by the growing demand for privacy-preserving machine learning and the expansion of edge computing and Internet of Things (IoT) ecosystems. Key research clusters focus on data privacy, system optimization, distributed machine learning, and real-world applications such as healthcare and industrial systems. The findings also highlight strong global collaboration networks and the dominance of contributions from leading countries such as China and the United States. Furthermore, recent trends indicate a shift toward integrating federated learning with advanced technologies such as blockchain, reinforcement learning, and energy-efficient systems. This study provides a structured overview of the field and offers valuable insights for researchers and practitioners in identifying research gaps and future directions in federated learning within distributed computing.

This study explores the evolution of knowledge graph research within the field of information systems through a comprehensive bibliometric analysis. Data were collected from Scopus and analyzed using quantitative techniques, including performance analysis and science mapping. Visualization was conducted using VOSviewer to examine co-authorship networks, citation structures, and keyword co-occurrence patterns. The results indicate a significant growth in publications, particularly after 2012, reflecting the increasing importance of knowledge graphs in data-driven environments. Co-authorship analysis reveals strong global collaboration, with dominant contributions from countries such as China and the United States. Citation analysis highlights foundational studies in bioinformatics, semantic networks, and graph-based learning as key drivers of the field. Meanwhile, keyword analysis shows a clear thematic shift from ontology and information management toward artificial intelligence, machine learning, natural language processing, and recommender systems. The overlay and density visualizations further confirm the emergence of application-oriented and AI-integrated research trends. Overall, this study provides a structured overview of the intellectual landscape of knowledge graph research and identifies future directions, particularly in the integration of knowledge graphs with advanced artificial intelligence technologies.

This study investigates global trends and collaboration patterns in Community-Based Learning (CBL) and Civic Engagement (CE) research in higher education between 2015 and 2025, focusing on fragmented civic engagement practices, limited student participation, and weak university–community partnerships as the central rationale. Employing a bibliometric approach, 110 Scopus-indexed publications were examined using VOSviewer and Publish or Perish to identify publication trajectories, influential authors, productive institutions, and emerging thematic clusters. Results indicate steady growth in research outputs, with peaks in 2023–2024, and journal articles as the primary dissemination medium. The United States emerges as the largest contributor, followed by India, South Africa, and the United Kingdom. Keyword analysis highlights five thematic clusters: civic engagement, interdisciplinarity, health, sustainability, and community capacity building. These findings reveal regional disparities and emphasize the importance of digital integration and stronger collaboration among universities, communities, and students to advance inclusive and transformative civic learning.

Despite advancements in critical care medicine, moral challenges in end-of-life care persist. Approximately 80% of ICU deaths occur after decisions are made to limit or withdraw life-sustaining treatments. ICU nurses frequently experience moral dilemma when their professional judgment conflicts with clinical realities or institutional constraints. This meta-synthesis systematically integrated qualitative evidence to explore ICU nurses' experiences, alongside the sources and impacts of this dilemma. We conducted a comprehensive search of PubMed, Web of Science, Embase, CINAHL, CNKI, and Wanfang databases from inception to May 2025, ultimately including six qualitative studies from six countries. The analysis identified three core themes: (1) Sources of moral dilemmas; (2) Impacts of moral dilemmas on nurses; (3) Coping with moral dilemmas. The sources of moral dilemmas comprise five sub-themes: (1)Conflict between futile treatment and dignity preservation; (2) Infringement of patients' right to informed consent and autonomy; (3) Lack of nursing voice in clinical decision-making; (4) Insufficient family involvement in end-of-life care; and (5) Inadequate organizational support. The impact of moral dilemmas includes two sub-themes: (1) Distress experience and emotional exhaustion and (2) Professional burnout. These findings highlight the critical importance of recognizing that ICU nurses operate within a complex moral environment shaped by interwoven institutional structures, cultural norms, and relational dynamics. Therefore, providing effective support requires the implementation of systematic interventions, which should encompass comprehensive moral training, strong interdisciplinary collaboration, and the formulation of organizational policies that clearly prioritize nurses' autonomy and the maintenance of patients' dignity. This review highlights the urgent need to foster supportive moral environments globally to alleviate moral dilemma and improve the quality of end-of-life care in ICUs.