Systematic Integration Research Articles

Follow the user: Taking advantage of Internet users as methodological resources

In this article, I introduce a novel epistemological approach meant to re-adapt the digital methods paradigm to a fast changing digital landscape. This change was mostly brought about by the transformation of Web 2.0 into a platformized social media environment and the advent of the post-API and platform surveillance era. This approach is premised on the idea of considering the Internet user as a source of methods, rather than an object of study. To this purpose I suggest to ‘ follow the user’, meaning to take advantage of the natively digital methods that Internet users employ to gather, organise, manage and create their own digital data throughout their everyday digital practices. In order to illustrate my approach, I show how to practically follow the users in each of the key phases of a digital research project within social media platforms: keywords selection, data collection, data sampling, data analysis. In doing so, I mean to contribute to an emerging strand of research within the digital methods tradition which is trying to: (a) update digital methods, given the continuous mutations of the digital landscape; (b) seek a more organic and systematic integration of digital and qualitative methods; (c) go beyond the classical quali-quanti dichotomy.

When It’s Worth the Effort: User Perceptions of AR-enhanced News Reports on Television

ABSTRACT In the past years, news media organizations have explored Extended Reality (XR) for immersive storytelling in news. Despite the initial interest, XR has not been systematically integrated into TV news storytelling, raising questions about its value to news consumers. Additionally, there is no successful business model for Augmented Reality (AR) in news media, possibly due to the limited understanding of audience reception. Therefore, this study aims to explore the potential of Augmented Reality (AR) in television news through the lens of its audience. An online survey was conducted among Flemish media users (N = 894) involved viewing two AR-enhanced news reports by the French commercial broadcaster TF1. One depicted the 1918 Armistice signing in a virtual train wagon; the other discussed car taxation with a virtual vehicle in the studio. Results showed positive viewer perceptions and evaluations of both AR applications. The use of AR did not negatively affect news credibility, and most respondents favored AR's systematic integration into Flemish broadcasts. Our findings confirmed that respondents emphasized the importance of informativeness and comprehensibility, suggesting that AR adds value to TV news not because it is a technological novelty, but because—and only if—it makes the news more accessible.

METHODOLOGICAL APPROACHES TO ASSESSING AND REALIZING THE INVESTMENT POTENTIAL OF THE COUNTRY’S ECONOMY IN THE CONTEXT OF SUSTAINABLE DEVELOPMENT

THE PURPOSE OF THE ARTICLE is to study methodological approaches to assessing and realizing the investment potential of the country’s economy in the context of sustainable development. RESEARCH METHODS. In writing the article, the following research methods were used: analytical method – to study the indicators of the country’s investment potential, study trends and previous studies in this area; theoretical analysis – in analyzing modern theoretical approaches to assessing and realizing investment potential in the context of sustainable development; method of empirical research and comparative analysis – to identify advantages and disadvantages; case study – to identify factors of successful realization of investment potential, taking into account the principles of sustainable development. PRESENTING MAIN MATERIAL. In the context of globalization and increasing environmental risks, the issue of rational use of investment potential in the context of sustainable development is of particular relevance, where investments are becoming a key element that ensures economic growth, improvement of social welfare and environmental protection. The investment potential of a national economy is a set of resources and conditions that enable the attraction and efficient use of investments in various sectors of the economy, including: economic resources; social resources; natural resources; and institutional resources. Among the methodological approaches to assessing investment potential, the most popular is the classical approach, where the assessment of investment potential is based on the analysis of such indicators as the level of domestic and foreign investment, GDP structure, level of savings and investment activity of enterprises. In the context of sustainable development, the assessment of investment potential takes into account additional factors such as environmental risks, the level of social responsibility, and the availability of green investment projects. Innovations and the introduction of green technologies are key elements in the context of sustainable development, where government support is directed to funding research and supporting green investments. Countries that have succeeded in realizing their investment potential in the context of sustainable development are characterized by: a developed institutional framework (availability of effective institutions that support investment activities), a high level of innovation activity (active implementation of innovations in various sectors of the economy), and effective environmental policy (active state support for environmentally friendly technologies and projects). Therefore, approaches to assessing and realizing investment potential take into account the main aspects of innovative development and the introduction of green technologies, where the state helps to create a favorable investment climate and support sustainable development by stimulating investment, developing infrastructure and supporting innovation. CONCLUSIONS. In today’s world, the concept of sustainable development is central to the economic development strategies of countries, where one of the key aspects is the effective use of investment potential to ensure sustainable economic growth. The main approaches to realizing investment potential include: creating a favorable investment climate (legislative regulation that stimulates investment in low-carbon sectors; reducing bureaucratic barriers for foreign and domestic investors; developing infrastructure that supports sustainable production and consumption); integrating sustainable development principles into investment projects (assessing the impact of projects on the environment and social aspects; implementing investments in energy efficiency and renewable energy). It has been established that the realization of the country’s investment potential in the context of sustainable development requires an integrated approach and systematic integration of economic, social and environmental requirements, which requires active cooperation between government, business, academia and the public to achieve common goals of sustainable development and provide future generations with a stable and environmentally friendly living environment. KEYWORDS: investment potential; national economy; sustainable development; methodological approaches; economic development of the country; economic growth; assessment and implementation; investment climate; investment projects; financing; infrastructure.

Peran Saksi dalam Persidangan sebagai Pendorong Keadilan: Studi Kasus Pencurian Sepeda Motor

This research examines the role of witnesses in motorbike theft cases which ended in peaceful resolution through a restorative justice approach. The main focus lies on how witnesses can influence the trial and mediation process in an effort to achieve balanced justice between the perpetrator and the victim. The method used is a normative juridical approach, which refers to legal studies and related documents to understand the role of witnesses as evidence and promoters of justice. The research results show that witness testimony plays an important role in revealing facts, supporting the mediation process, and preventing decision-making errors in court. Witnesses also function as moral monitors who ensure that restorative justice is carried out transparently and protects the rights of victims. This research suggests the need for systematic integration of restorative justice in the legal system, better witness protection, and public education regarding the importance of the role of witnesses in the judicial process.

OS EFEITOS DA FISIOTERAPIA RESPIRATÓRIA EM PACIENTES COM CÂNCER DE PULMÃO: REVISÃO DE LITERATURA

Introduction: Lung cancer is one of the most lethal neoplasms, with 2.2 million cases and 1.8 million deaths in 2020. Respiratory complications affect up to 75% of patients. Respiratory physiotherapy is effective in improving lung function and quality of life, reducing readmissions by up to 30% and postoperative complications. This study reviews literature to highlight the benefits of physiotherapy on the quality of life of patients with lung cancer. Objective: To conduct a literature review to investigate the impact of respiratory physiotherapy on the quality of life of patients with lung cancer, focusing on statistical data that demonstrates the benefits of this intervention. Materials and method: This study consists of a literature review in the following databases: SciELO, LILACS and BVS. Among them, a total of 47 studies were identified. Results: The search results indicated that only 4 studies met the eligibility criteria, while the others were excluded for not meeting the established requirements. The distribution of the 47 identified studies was as follows: 11 in SciELO, 20 in LILACS and 16 in BVS. Conclusion: The systematic integration of respiratory physiotherapy into treatment protocols for patients with lung cancer is essential to improve physical condition and quality of life, with personalized programs and regular assessments that ensure the effectiveness of interventions.

Single-cell integration reveals metaplasia in inflammatory gut diseases

The gastrointestinal tract is a multi-organ system crucial for efficient nutrient uptake and barrier immunity. Advances in genomics and a surge in gastrointestinal diseases1,2 has fuelled efforts to catalogue cells constituting gastrointestinal tissues in health and disease3. Here we present systematic integration of 25 single-cell RNA sequencing datasets spanning the entire healthy gastrointestinal tract in development and in adulthood. We uniformly processed 385 samples from 189 healthy controls using a newly developed automated quality control approach (scAutoQC), leading to a healthy reference atlas with approximately 1.1 million cells and 136 fine-grained cell states. We anchor 12 gastrointestinal disease datasets spanning gastrointestinal cancers, coeliac disease, ulcerative colitis and Crohn’s disease to this reference. Utilizing this 1.6 million cell resource (gutcellatlas.org), we discover epithelial cell metaplasia originating from stem cells in intestinal inflammatory diseases with transcriptional similarity to cells found in pyloric and Brunner’s glands. Although previously linked to mucosal healing4, we now implicate pyloric gland metaplastic cells in inflammation through recruitment of immune cells including T cells and neutrophils. Overall, we describe inflammation-induced changes in stem cells that alter mucosal tissue architecture and promote further inflammation, a concept applicable to other tissues and diseases.

EU peace capacities: An analysis of the EU's integration of the youth, peace and security agenda

AbstractThis contribution examines the integration of the youth, peace and security (YPS) agenda within the European Union (EU). This integration has evolved from initial recognition to a stronger implementation phase. Key milestones include the Young Med Voices Plus Initiative and the recent Youth Action Plan for 2022–2027. However, challenges remain. These include inconsistent support and the need for more specific strategies for youth in conflict settings. Recent developments such as the inclusion of the YPS agenda in EU Peace Mediation Guidelines signal progress towards a more systematic integration.

Using Case Scenarios to Foster Critical Thinking Skills among Graduate Students

In a rapidly evolving professional landscape, critical thinking is paramount for success. This study investigated the transformative impact of case scenarios on enhancing critical thinking skills among graduate students at Gulu University. The purpose was to examine how these scenarios facilitated the practical application of theoretical concepts, fostering a deeper understanding of complex issues. Utilizing a qualitative research methodology, the researchers conducted interviews and focus group discussions with recent graduates, current graduate students, and lecturers, providing comprehensive insights into participants’ perceptions and experiences regarding case scenarios. Results indicated that participants viewed critical thinking as essential for both academic achievement and professional competence. Case scenarios emerged as instrumental in promoting analytical thinking, problem-solving abilities, and the synthesis of diverse perspectives. Graduates reported significant improvements in their capacity to deconstruct complex issues, critically evaluate evidence, and generate innovative solutions. The study also highlighted the importance of incorporating culturally diverse scenarios, which enriched students' understanding of various socio-economic contexts crucial for their professional development. However, it identified gaps in the systematic integration of case scenarios into the curriculum, suggesting a need for more consistent application and institutional support. In conclusion, the findings emphasized the critical role of case scenarios in cultivating the skills necessary to navigate the complexities of modern professional environments. By effectively bridging the gap between theoretical knowledge and practical application, these scenarios enhanced students’ analytical and creative capabilities, preparing them to tackle multifaceted problems. Educational stakeholders were urged to prioritize the integration of diverse, contemporary case scenarios into curricula, while future research should focus on longitudinal studies assessing the long-term impact of these scenarios on students' critical thinking skills

Reflecting Uses and Gratification 2.0 Perspective into Over-the-Top (OTT) Consumption: Role of Collaboration Design and Cross Platform Navigability

A discernible trend within Over-the-top (OTT) platforms is the systematic integration of gamification elements into their marketing endeavors. While existing research has established the positive effects of gamification on customer satisfaction and engagement, there remains a significant gap in understanding how GMA contributes to enduring brand associations. Particularly, the role of strategic factors such as collaboration design and cross-platform navigability in amplifying the effectiveness of gamification has yet to be explored. This study utilizes Uses and Gratifications Theory 2.0 and Consumption Value Theory to investigate these nuances of modern media consumption by delineating the role of gamification in facilitating OTT brand stickiness. This combines PLS-SEM and fsQCA to analyze 590 responses from active subscribers of OTT. The study’s findings draw significant boundary conditions for the base model envisaging brand stickiness.

Comparing the effectiveness of five traditional Chinese exercises in improving balance function in older adults: a systematic review and Bayesian network meta-analysis.

Despite numerous studies affirming the potential of traditional Chinese exercises (TCEs) in enhancing balance in older adults, systematic integration is lacking. This study evaluated the effectiveness of five TCEs-Baduanjin, Liuzijue, Tai Chi, Wuqinxi, and Yijinjing-in improving balance among older adults using network meta-analysis. This meta-analysis was registered in PROSPERO with the registration number CRD42023481450. Related articles indexed by Web of Science, Cochrane, PubMed, Embase, China National Knowledge Infrastructure (CNKI), Wanfang, and VIP databases before October 2023 were searched. Randomized controlled trials (RCTs) involving TCEs interventions to improve balance function conducted in older adults who aged ≥60 years were included. Two researchers used Review Manager to assess the quality of the studies, and analyzed the data using Stata and R. In total, 46 RCTs and 3,333 older adults were included. The aforementioned TCEs had positive effects on improving balance in older adults. Tai Chi revealed significant intervention effects in performing the Single-Leg Stand with eyes Closed (SLSC), 6-Min Walk Test (6MWT), and Short Form 36-Item Physical Component Summary (SF-36PCS). Liuzijue significantly improved performance in the Timed Up and Go Test (TUGT), 6MWT, SF-36PCS, and Berg Balance Scale (BBS). Baduanjin, Wuqinxi, and Yijinjing showed noteworthy intervention effects on the BBS. Tai Chi ranked highest in the SLSC, 6MWT, and SF-36PCS in the surface under the cumulative ranking, while Liuzijue and Yijinjing ranked highest in the TUGT and BBS, respectively. Tai Chi, Liuzijue, and Yijinjing improved the static, dynamic, and overall balance outcomes, respectively. Older adults can make a reasonable choice among these TCEs based on their needs.

Primary healthcare as a strategy for eliminating hepatitis C: the METRIC toolkit.

This paper presents the development of the METRIC toolkit, aimed at enhancing primary healthcare interventions in the context of hepatitis C control, thus contributing to the World Health Organization's global strategy to achieve the elimination of the disease by 2030. At the global level, most people living with hepatitis C are unaware of their condition. As such, the eradication of hepatitis C necessitates comprehensive strategies within primary healthcare settings, as it provides an opportunity to reach the general population, facilitates the identification of potential patients who may be unfamiliar with hepatitis C, and guides them toward adequate care. Herein, we propose the METRIC toolkit as a means to optimize the efficiency and efficacy of healthcare services dedicated to hepatitis C control. The development of the METRIC toolkit was guided by a thorough review of pertinent literature, focusing on primary healthcare interventions in hepatitis C control. Key components were identified, encompassing systematic problem identification, solution formulation, outcome evaluation, and feedback integration. The METRIC toolkit represents a valuable resource for strengthening primary healthcare interventions in hepatitis C control. By fostering a culture of continuous improvement and data-driven decision-making, this framework holds promise in advancing the global agenda towards hepatitis C elimination. However, its successful application requires careful consideration of contextual factors and ongoing adaptation to local needs and circumstances.

Topographic complexity drives trait composition as well as functional and phylogenetic diversity of understory plant communities in microrefugia: new insights for conservation

Topographic complexity supports the maintenance of a high diversity of microhabitats that may act as important ‘safe havens’ – or microrefugia – for biodiversity. Microrefugia are sites with specific environmental conditions that facilitate the persistence of species during environmental changes and exhibit unique eco-evolutionary dynamics. However, our knowledge about how topographic complexity and related eco-evolutionary selective forces influence the functional and phylogenetic signatures of species assemblages in microrefugia is very limited. Although the conceptual framework on the systematic integration of plant functional traits into the study of refugia is well established, more empirical studies on functional trait composition and functional diversity in refugia are urgently needed for more effective conservation. Here we analyzed the distribution of various plant functional traits and phylogenetic patterns in microhabitats (south- and north-facing slopes, and bottoms) of 30 large topographic depressions (i.e. doline microrefugia) and microhabitats of the surrounding plateaus in two distant forested karst regions. We found that plant assemblages in the understory of dolines and their surroundings are characterized by unique functional values and combinations of traits. Doline bottoms had the highest functional diversity among doline microhabitats and supported plant assemblages with considerably different trait compositions from the plateaus. Bottoms also had the highest phylogenetic diversity. These results suggest that topographic complexity in forested dolines has a significant effect on the distribution of plant functional traits in the understory. High functional and phylogenetic diversity in doline bottoms can have important consequences for the long-term survival of plant populations, highlighting that these microhabitats may provide a higher resilience and support an adaptive community-level response to natural and anthropogenic stressors. Understanding mechanisms that drive the survival of species within microrefugia is required to determine the best conservation and management strategies.

Translational science and related disciplines.

Translational research moves scientific discoveries and innovations across the development spectrum for a particular target or disease, trying to bridge in a multidisciplinary fashion the gap between laboratory scientific discoveries and practical, real-world applications in medicine and in healthcare. Translational research aims to move research findings across settings, specific languages, methodologies, and study designs, from laboratory to clinical practice and ultimately into community- and population-level health benefits. In contrast, translational science is a distinct field, which evolved over time toward a systematic study and practice of operationalizing the translation of content from one language, ecosystem, environment, contextual landscape, culture, discipline, area, or domain into another. It involves systematic and transdisciplinary integration of knowledge from basic science, clinical research and population science to improve human health, better longevity, and to ensure disease- and disability-free lives. Translational science often uses knowledge, operational frameworks, and specific capabilities borrowed from other specialties, disciplines, and fields such as operations management, implementation and dissemination science, quality improvement and management, project management, public health, intervention science, change management and leadership, decision science, design thinking, functional design, data science, communication and marketing science, etc. The main goal of this article is to open a series of thematic reviews in this journal, introducing the reader to the main definitions, contingencies, touchpoints, and overlapping areas between translational science and these related specialties, disciplines, and fields of study. Transdisciplinary capabilities borrowing from these related specialties can create a robust translational science machinery for health systems, research organizations, and innovation hubs.

7.O. Skills building seminar: Initiating change: Mainstreaming equity and diversity in public health

Abstract Background Consideration of the increasing population cultural and ethnic diversity and the widening of social gaps is essential for narrowing health inequities. While tailored and targeted measures for populations at risk of social disadvantage are needed, mainstreaming and integration of diversity and inclusion perspectives in all public health measures are required. To our knowledge, the EU Joint Action for Cardiovascular diseases and diabetes (JACARDI) is the first large-scale program to apply a systematic and harmonized approach for integrating equity and diversity perspectives. Objectives The main objective of the workshop is skills building in integration of equity and diversity perspectives in practice through: 1) Introducing the key requirements for achieving EU-wide programme change, drawing from several decades of experience in projects conducted in over 30 countries, including those partnered with the World Health Organization, governments and industry. 2) Outlining a practical tool in the format of an equity and diversity matrix designed for integrating equity and diversity perspectives developed within the JACARDI project to support implementation of 142 sub-projects in 21 partner countries. 3) A practical participatory group work based on the JACARDI equity and diversity maturity matrix, followed by a moderated discussion. The workshop acts as a valuable platform for sharing and building collaborative knowledge across European countries and empowering participants as initiators for sustainable, more equitable, and diversity inclusive public health actions. It provides practical and concrete skills on equity and diversity that participants can apply in their work and disseminate within their organizations. The presentations will build knowledge, while group work and the moderated discussion will build skills among participants on the workshop topic. Format of the workshop Two presentations followed by participatory group work and a moderated discussion among workshop participants and presenters. Key messages • Population diversity should be systematically mainstreamed in public health to effectively and sustainably narrow persisting health inequities. • An equity and diversity maturity matrix can be used as a practical tool for systematic integration and monitoring of diversity perspectives in practice.

Cross-cutting integration of equity and diversity lens in public health: a novel approach of JACARDI

Abstract Issue/Problem Health inequities persist across European countries, impacting the distribution, prevention, and management of non-communicable diseases. With increasing population diversity and improved understanding of the intersectional nature of drivers of health inequities, narrowing inequities calls for systematic integration of diversity perspectives into equity-driven policy and practice. Description of the problem The EU-co-funded Joint Action on CVDs and diabetes (JACARDI, 11/2023-10/2027) project with 76 partners from 21 countries and 142 national-level projects (later pilots), applies a structured approach for integrating equity and diversity perspectives within all project structures. This is achieved through design of a common methodological framework and terminology glossary for all thematic work packages (WPs) and their pilots, which are further supported through capacity building sessions and consultations. Results The “4Cs” framework (Critical reflection; Context and data; Co-design; and inclusive and accessible Communications) for integrating equity and diversity principles in JACARDI was developed based on results of focus group interviews with WP leaders (n = 24) and review of previous literature. This framework was applied as a lens to be applied in the planned activities by WPs and pilots, elaborated in an equity and diversity maturity matrix aligned with the XV methodological steps for pilot implementation. Additionally, equity and diversity indicators were integrated into harmonized context analysis questionnaires for national focal points of each partner country, as well as into the methodology for pilot assessment and reporting. Lessons Equity and diversity perspectives should be integrated into the core structures of project implementation, supported by practical tools, trainings and practical consultations to improve adherence and collaborative understanding across project partners. Key messages • Equity and diversity integration into core structures are essential for tackling health inequities and the NCD-related social gradient in Europe. • Encouraging critical reflection among JACARDI partners is pivotal for initiating a paradigm shift towards equity and diversity inclusion.

Equity and diversity maturity matrix for structured diversity inclusion in the EU JACARDI project

Abstract Issue There is increasing awareness on the importance of integration of cultural and ethnic diversity perspectives to reduce prevailing health inequities effectively and sustainably. There is, however, limited experience and practical tools for systematic integration of these perspectives in public health. Description of the problem The EU Joint Action for Cardiovascular Diseases and Diabetes (JACARDI) project, conducted 11/2023-10/2027 has developed a structured and systematic approach for integrating equity and diversity perspectives in all its 142 pilots across 21 European countries. Results Equity and diversity perspectives are embedded in the harmonized stepwise methodology for pilots, supported with a practical Equity and diversity maturity matrix. The maturity matrix is based on the JACARDI 4Cs Equity and diversity explanatory framework (Critical reflection; Context and data; Co-design; inclusive and accessible Communications). The content of the matrix is divided into concrete steps related to pilot’s planning and implementation, each with three levels of maturity that aim at gauging how equity and diversity perspectives are applied in practice: Approaching, Meeting, Exceeding. Pilots are encouraged to strive for any of these three levels, considering their available resources and previous experiences in diversity inclusion. Lessons Effective and sustainable change toward more equitable and diversity inclusive practice requires seamless integration of these perspectives in other routine activities. Training and continued practical and motivational support are key for adherence to novel approaches. In addition to being a practical tool, the Equity and diversity matrix acts as a structured self-evaluation tool to monitor how equity and diversity principles are translated into practice.

Cybersecurity Transformation: Cyber-Resilient IT Project Management Framework

In response to the escalating threats of cybersecurity attacks and breaches, ensuring the development and deployment of secure IT products has become paramount for organizations in their cybersecurity transformation. This work emphasizes the critical need for a comprehensive and secure IT project management life cycle that safeguards products from their initial development stages through decommissioning. The primary objective is to seamlessly integrate security considerations into every facet of IT project management life cycles. This work embraces a cyber-resilient IT project management framework and advocates the inclusion of cybersecurity measures in IT projects and their strategic, organized, continuous, and systematic integration throughout the entire product life cycle. It introduces a pioneering framework that harmonizes the cybersecurity risk management process with the IT project management life cycle. This framework delineates a methodical sequence of steps, each encompassing a distinct set of activities. The effectiveness and practical applicability of the proposed framework were validated through a comprehensive case study focused on the Personal Health Record (PHR) system. The PHR case study served as a real-world scenario to assess the framework’s ability to address cybersecurity challenges in a specific domain. The results of the experiment demonstrated the framework’s efficacy in enhancing the security posture of IT projects, showcasing its adaptability and scalability across diverse applications.

Exploration of Integrating English Courses with Professional Courses in Higher Vocational Colleges

With the acceleration of globalization and the increasing demand for high-quality technical and skilled personnel, the integration of English courses with professional courses in vocational colleges has become an important direction in educational reform. This paper explores the current state and challenges of vocational education, elucidates the importance of English courses in higher vocational education, and emphasizes the significance of curriculum integration in cultivating versatile talents. In the theoretical foundation section, the paper reviews language learning theories and vocational education theories, presents the basic concepts and framework of curriculum integration, and analyzes the theoretical basis for the collaborative development of language and professional education. In terms of practical pathways, the paper proposes specific implementation strategies such as curriculum design and content optimization, innovative teaching methods and approaches, teacher professional development and interdisciplinary collaboration, and student evaluation and feedback mechanisms. The research indicates that systematic curriculum integration can significantly enhance the language skills and professional competencies of vocational students, promoting their overall development.

Constituents over Correlation: Indicators and Arctic Urban Decision-Making

Arctic city mayors influence municipal sustainability outcomes, navigating decisions on waste management, social service funding, and economic development. How do mayors make these decisions and to what extent do they integrate sustainability indicator data? Interviews with the mayors of Fairbanks, Alaska, Yellowknife, Canada, and Luleå, Sweden, revealed indicators are used on a case-by-case basis to track trends but lack systematic integration into decision-making. Constituent concerns drive agendas rather than indicator trends. Based on International Organization for Standardization (ISO) guidelines, 128 indicators grouped into 19 sustainability themes were compiled from 2000 to 2019 for the study cities. Partial Least Squares Structural Equation Modeling (PLS-SEM) was applied to examine the utility of ISO indicators as a guiding factor for sustainability trend tracking, identifying key themes for each city. Results show that indicator trends are too inconsistent and interconnected to be useful as an independent form of guidance for mayors. For Arctic municipalities, sustainability indicator datasets are useful in specific circumstances, but they do not provide the same kind of decision-making heuristic that mayors receive from direct constituent interaction. Findings emphasize the importance of more robust data collection and the development of management frameworks that support sustainability decision-making in Arctic cities.

Impact of an enhanced recovery after surgery program integrating cardiopulmonary rehabilitation on post-operative prognosis of patients treated with CABG: protocol of the ERAS-CaRe randomized controlled trial

BackgroundCoronary artery bypass grafting is associated with a high occurrence of postoperative cardiopulmonary complications. Preliminary evidence suggested that enhanced recovery after surgery can effectively reduce the occurrence of postoperative cardiopulmonary complications. However, enhanced recovery after surgery with systematic integration of cardiopulmonary rehabilitation (ERAS-CaRe) into for Coronary artery bypass grafting has not been evaluated so far. We thus design the ERAS-CaRe randomized-controlled trial to evaluate possible superiority of embedding cardiopulmonary rehabilitation in ERAS over ERAS alone as well as to investigate effects of differential timing of cardiopulmonary rehabilitation within enhanced recovery after surgery (pre-, post-, perio-operative) on post-operative cardiopulmonary complications following Coronary artery bypass grafting surgery.MethodsERAS-CaRe is a pragmatic, randomized-controlled, parallel four-arm, clinical trial. Three hundred sixty patients scheduled for Coronary artery bypass grafting in two Chinese hospitals will be grouped randomly into (i) Standard enhanced recovery after surgery or (ii) pre-operative ERAS-CaRe or (iii) post-operative ERAS-CaRe or (iv) perio-operative ERAS-CaRe. Primary outcome is the occurrence of cardiopulmonary complications at 10 days after Coronary artery bypass grafting. Secondary outcomes include the occurrence of other individual complications including cardiac, pulmonary, stroke, acute kidney injury, gastrointestinal event, ICU delirium rate, reintubation rate, early drainage tube removal rate, unplanned revascularization rate, all-cause mortality, ICU readmission rate, plasma concentration of myocardial infarction-related key biomarkers etc.DiscussionThe trial is designed to evaluate the hypothesis that a cardiopulmonary rehabilitation based enhanced recovery after surgery program reduces the occurrence of cardiopulmonary complications following Coronary artery bypass grafting and to determine optimal timing of cardiopulmonary rehabilitation within enhanced recovery after surgery. The project will contribute to increasing the currently limited knowledge base in the field as well as devising clinical recommendations.Trial registrationThe trial was registered at the Chinese Clinical Trials Registry on 25 August 2023 (ChiCTR2300075125; date recorded: 25/8/2023, https://www.chictr.org.cn/).