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Response to animal disease has importance for domestic supply and demand, trade implications, and other economic factors. Stamping out is effective at eradicating disease but requires resource investments that may be prohibitive in large-scale animal production systems. Alternative management strategies in a 50,000-head cattle feedlot are examined. Sample feedlot and epidemiological data are utilized for a discrete programming model. We analyze 14 scenarios across five management strategies under stochastic cattle prices and static disease management costs. Results show that targeted depopulation is a preferred method for the overall feedlot. [ABSTRACT FROM AUTHOR]

This research was conducted with the aim of providing a chicken supply chain model based on challenges, success factors and human resource limitations. The information required for the research was collected from 15 experts and managers of poultry farms of Behparvor Group in the whole country and their opinions were obtained through interpretive structural modeling (ISM) interviews with a qualitative approach. In this research, using interpretive structural modeling, an integrated model for the chicken supply chain based on challenges, success factors and human resource limitations was designed. The results of interpretative structural modeling in this research showed the challenges of human resources with the dimensions of not paying attention to employee training, competitors' attempts to attract the company's experts, the nature of hard work, the inability to retain the company's experts, employees' resistance to change and leaving the job. Expert employees of the company as negative factors of the optimal supply chain of chicken production and also, the success factors of human resources with the dimensions of employee training, employee empowerment, employee welfare, job justice, financial justice and attracting and retaining employees as positive factors of the optimal supply chain of chicken production, along with the limitations of human resources with the dimensions of the lack of specialized labor in the labor market, the supply of labor by non-specialists and the lack of financial resources to attract specialized labor as negative factors of the optimal supply chain of chicken production constitute the integrated model of the chicken supply chain based on human resources. [ABSTRACT FROM AUTHOR]

Abstract Nutrient and water limitations contribute to yield losses in semi-arid regions. Therefore, crop rotations incorporating nitrogen-fixing legumes and drought-tolerant sorghum varieties offer a strategy to improve the utilization of scarce soil resources. Under semi-arid, field-like conditions, sorghum crop rotations with either cowpea pre-crop or fallow, including two early and three late maturing genotypes, were tested to identify stress adaptation traits of sorghum to water and phosphorus limitations. Morphological and physiological parameters were evaluated on a single-plant basis. Lower soil P content significantly delayed flowering compared to higher P levels. However, improved P availability arising from pre-crop residues reduced this effect. Mycorrhizal infection rates and root-to-shoot ratios were positively correlated with panicle N and P content at anthesis under low P conditions. Although drought significantly impacted yield, early maturing genotypes with the highest reduction in shoot biomass and reduced water use before flowering, could sustain yield production. Early-maturing genotypes characterized by high root-to-shoot ratios, rapid AMF establishment, and reduced water use before flowering exhibit a strong potential for maintaining yield and biomass production on nutrient-poor soils in semi-arid regions. Such genotypes conserve water before flowering and thus can alleviate post-flowering water stress, ensuring adequate P uptake despite low soil P availability.

Background/Objectives: Few studies have assessed barriers to providing care from the perspective of interprofessional healthcare providers. Despite Idaho's predominantly rural geography, limited research exists assessing barriers to providing care within the state. This study sought to assess barriers to providing optimal healthcare using a sample of 400 healthcare providers at 22 clinic sites across the state. Methods: A barriers to providing optimal care 9-factor, 41-item survey was modified from an existing survey. Healthcare providers rated barrier items using an 11-point Likert scale. The survey was distributed to a convenience sample of healthcare providers in 22 different clinic sites in rural Idaho. Results: Four hundred interprofessional healthcare providers in Idaho across 13 professional disciplines completed surveys. Items in the Service Access (mean = 7.14), Patient Complexity (mean = 6.59), and Resource Limitations (mean = 6.18) factors were reported as the most commonly perceived barriers to providing optimal care. Conclusions: Few studies have assessed rural interprofessional providers' perceived barriers to providing optimal, high-quality, care, specifically in the rural state of Idaho, where healthcare services are often not equitable compared to urban regions. The results suggest that commonly perceived barriers exist throughout the state, particularly Service Access, Patient Complexity, and Resource Limitations. Further research is needed to develop data-driven decisions to address these concerns. [ABSTRACT FROM AUTHOR]

The growing number of publications on Operating Room Scheduling (ORS) in recent years reflects the rapid advancements in the field. This review aims to comprehensively analyze the historical developments and evolving trends in operating room scheduling by systematically examining the literature from 2000 to 2023. A multi-database search, including Scopus, Web of Science, PubMed, ProQuest and IEEE Xplore was employed to ensure the inclusion of key studies. This paper presents a review of the factors, descriptive fields, and key issues in operating room scheduling. It also focuses on optimization techniques and solution approaches for both deterministic and uncertain conditions. Special attention is given to real-world constraints, such as resource limitations, staff availability and patient variability which significantly impact scheduling. The review identifies that ORS research covers a broad spectrum of problems and solutions, with no singular research trend dominating the field. This indicates that researchers are tackling diverse challenges across various contexts. The final section outlines the significant pitfalls and proposes future research directions, including the integration of emerging technologies and sustainability considerations. This review is a valuable resource for researchers, practitioners, and academicians in healthcare operations and hospital management, offering insights into current practices and future opportunities for innovation in ORS. [ABSTRACT FROM AUTHOR]

Orchardgrass (Dactylis glomerata L.), a widely cultivated cool-season perennial, is an important forage crop due to its adaptability, high nutritional value, and substantial biomass. Understanding its genetic diversity and population structure is crucial for developing resilient cultivars that can withstand climate change, diseases, and resource limitations. Despite its global significance in fodder production, the genetic potential of many regional accessions remains unexplored, limiting breeding efforts. This study investigates the genetic diversity (GD) and population structure of 91 accessions of D. glomerata from Turkey and Iran using genotyping-by-sequencing based single nucleotide polymorphism (SNP) markers. A total of 2913 high-quality SNP markers revealed substantial genetic variability across provinces. Notably, accessions from Erzurum exhibited the highest GD (mean GD: 0.26; He: 0.5328), while provinces such as Bursa and Muğla demonstrated lower GD (mean GD: 0.15; He < 0.22), suggesting potential genetic bottlenecks. Population structure analysis using Bayesian clustering, PCoA and UPGMA dendrograms divided the accessions into three distinct clusters, with cluster membership largely reflecting geographical origins, and dry biomass content. Cluster II revealed higher GD, associated with enhanced biomass production (128 g/plant), the most important agronomic trait in forage species, supporting the notion of heterosis in breeding programs. The majority of the genetic variation (85.8%) was observed within clusters, with minimal differentiation among clusters (FST = 0.007). Genome-wide association studies (GWAS) identified significant marker-trait associations for dry biomass weight, a critical agronomic trait, with markers DArT-100715788, DArT-101043591, and DArT-101171265 and DArT-101090822 located on Chromosomes 1, 6, and 7 respectively. These findings highlight the importance of regional diversity for maintaining adaptive potential in future breeding programs. [ABSTRACT FROM AUTHOR]

Recent research has explored combining large language models (LLMs) with speech recognition for various services, but such applications require a strong network environment for quality service delivery. For on-device services, which do not rely on networks, resource limitations must be considered. This study proposes HYLR-FO, an efficient model that integrates a smaller language model (LM) and a rule-based system (RBS) to enable fast and reliable voice-based order processing in resource-constrained environments, approximating the performance of LLMs. By considering potential error scenarios and leveraging flexible natural language processing (NLP) and inference validation, this approach ensures both efficiency and robustness in order execution. Smaller LMs are used instead of LLMs to reduce resource usage. The LM transforms speech input, received via automatic speech recognition (ASR), into a consistent form that can be processed by the RBS. The RBS then extracts the order and validates the extracted information. The experimental results show that HYLR-FO, trained and tested on 5000 order data samples, achieves up to 86% accuracy, comparable to the 90% accuracy of LLMs. Additionally, HYLR-FO achieves a processing speed of up to 55 orders per second, significantly outperforming LLM-based approaches, which handle only 1.14 orders per second. This results in a 48.25-fold improvement in processing speed in resource-constrained environments. This study demonstrates that HYLR-FO provides faster processing and achieves accuracy similar to LLMs in resource-constrained on-device environments. This finding has theoretical implications for optimizing LM efficiency in constrained settings and practical implications for real-time low-resource AI applications. Specifically, the design of HYLR-FO suggests its potential for efficient deployment in various commercial environments, achieving fast response times and low resource consumption with smaller models. [ABSTRACT FROM AUTHOR]

Background: Palliative care (PC) can alleviate suffering and improve quality of life. Yet, disparities persist, particularly in Honduras. Training efforts in PC for non-health caregivers have proven to reduce burnout and stress while enhancing the quality of life for both caregivers and patients. Purpose: This study aimed to explore the feasibility of a PC training program for non-health caregivers in Honduras. Methods: This exploratory study utilized latent content analysis within an interpretivist paradigm. Data was collected through individual semi-structured interviews with 25 participants belonging to different key groups: patients diagnosed with cancer, non-health caregivers, PC experts, and health-related decision makers. Interviews were conducted in Honduras' three main cities: Tegucigalpa, San Pedro Sula, and La Ceiba. The sampling technique employed was maximum variation. Results: PC patients and caregivers face significant emotional challenges, often worsened by poverty and resource limitations, which leads to a strain in family dynamics. A lack of education, driven by inadequate healthcare education and policies, contributes to widespread misconceptions about PC. However, progress through various sectors aligned with the same goals proves Honduras is a country with potential. A program with a bottom-up approach, with intersectoral collaboration and training tailored to the needs of caregivers and patients, is urgently needed. Conclusion: It highlights the feasibility, necessity, and potential replicability of implementing a PC training program for non-health caregivers in Honduras, which could offer significant benefits at both individual and national levels. A program that truly accounts for health determinants may help mitigate PC shortages in similar regions. Further research and policy advocacy are essential to empower underserved populations and foster health equity across low- and middle-income settings, to ensure no one is left behind. [ABSTRACT FROM AUTHOR]

Introduction: Pediatric surgery training in Germany faces significant challenges related to structural issues and resource limitations, including variability in training sites and a lack of standardized oversight. This study aims to assess the current state of pediatric surgery training including its structure, quality, and resident satisfaction and identify areas for improvement. Materials and methods: We conducted an online survey between May 2022 and November 2023 using single-choice, multiple-choice and open-ended questions. Additionally, information was gathered via analysis of available statistics and through direct contact with the State Chambers of Physicians. Results: 75 pediatric surgery residents and 15 young specialists participated in the survey. 12 of 17 state medical chambers responded to our inquiry, but only 4 maintain detailed statistics. Training often extends beyond the planned six years, mainly (75%) due to insufficient surgical exposure. Residents reported a predominant role of attendings in surgical training and other residents in clinical training. They desired more involvement from chiefs in their education. A significant proportion (58.9%) noted a lack of dedicated scientific education. Nearly half (44.4%) of the respondents had changed training sites, primarily due to clinical rotations (26,7%) and dissatisfaction with training conditions (30,0%). Conclusion: Pediatric surgery residents in Germany face inconsistent training quality and extended training periods, mainly due to insufficient surgical exposure. They report that some chiefs do not meet their obligations as trainers adequately. To address these issues, there is a need for enhanced oversight, standardized curricula, more surgical exposure and improved collaboration among training institutions. [ABSTRACT FROM AUTHOR]

The understanding of selective forces driving the compartmentalization of microbiota in plants remains limited. In this study, we performed a phenotypic characterization of bacterial endophytes isolated from the medicinal plant Origanum heracleoticum, together with the determination of the antibiotic resistance profiles and the antagonistic interactions of communities within and across different plant organs. Results revealed organ-related differences in the metabolic capabilities of bacteria, with those associated with stems displaying the highest metabolic activity for carbon sources. Contrarily, the patterns of antibiotic resistance appeared closely aligned with the taxonomical classification of the endophytes. The presence of antagonistic interactions, likely spurred by resource limitations, favor bacteria exhibiting greater metabolic plasticity. In conclusion, this research advances our comprehension of the intricate dynamics between plants and their associated microbiota, indicating that its composition is mainly influenced by forces contributing to the selection of distinct functions and phenotypic traits. The relationships existing within the plant holobiont in Origanum heracleoticum are mainly driven by forces contributing to the selection of distinct functions and phenotypic traits, among which antagonism, antibiotic resistance and metabolism. [ABSTRACT FROM AUTHOR]

Introduction: Recovery-oriented approaches in mental health emphasize personal growth, agency, and meaningful community integration. While endorsed by policies and reforms, the practical implementation of such approaches remains challenging, particularly in settings like Denmark, where structural fragmentation, professional hierarchies, and resource constraints may limit the adoption of holistic recovery principles. Methods: This qualitative study employed focus group interviews with 21 health professionals from inpatient units and Assertive Community Treatment (ACT) teams in Danish mental health services. Using inductive content analysis, we examined participants' perceptions, understandings, and experiences in implementing personal recovery-oriented practices. Results: Four categories emerged: (1) "Creating New Control in Recovery" highlighted the importance of personal agency and collaborative care involving patients, families, and community stakeholders; (2) "Recovery-Oriented Practice within Professional Parameters" underscored efforts to balance patient preferences with clinical responsibilities; (3) "Barriers to Implementing Recovery-Oriented Practice" revealed systemic constraints, resource limitations, and emotional strain on staff; and (4) "Advocating for a Paradigm Shift towards Recovery-Oriented Approaches" emphasized the desire for interprofessional collaboration, the inclusion of peer workers, and structural reforms. Discussion/Conclusion: The findings demonstrate that while Danish health professionals recognize the value of personal recovery-oriented care, their capacity to realize this approach is constrained by organizational structures, professional hierarchies, and limited resources. Strengthening systemic support, enhancing interprofessional collaboration, and integrating peer expertise are critical to fostering more equitable, person-centered mental health services. These insights contribute to a nuanced understanding of recovery-oriented implementation in European contexts and may inform strategies that better support professionals and service users in achieving sustained, meaningful recovery. [ABSTRACT FROM AUTHOR]

Simple Summary: In this study, we explored how the position of flowers and the connection between plant parts affect the development of individual flowers in water hyacinth (Eichhornia crassipes). This plant is known for its invasive ability and unique clonal growth, where new plants form from parts of the parent. We aimed to understand if this clonal connection helps stabilize flower traits when resources are limited. We found that flowers at the bottom of the plant receive more resources, making them larger and more attractive for pollinators. When this clonal connection was removed or the plants were stressed, flower size and pollinator-attracting traits decreased, especially in flowers located higher on the plant. These findings suggest that clonal integration helps water hyacinths maintain reproductive traits even in challenging conditions, possibly aiding their spread. This research offers insights into how plants adapt to varying environments, which could help in managing invasive species like water hyacinth. Intra-individual variation in floral traits is linked to plant fitness, playing a central role in sexual selection. This variation can arise from architectural constraints, such as flower position on the inflorescence axis, and from environmental factors. In relation to the environmental influences on floral traits, the most common causes of variation are linked to the presence of pollinators, to plant resource acquisition strategies and to the availability of local resource pools. We investigated how clonal integration and resource depletion through defoliation affect floral trait stability in Eichhornia crassipes, testing whether clonal integration buffer floral traits against resource limitations. Using greenhouse experiments, we manipulated clonal structure and resource availability. We assessed the effects of floral position and clonal integration on floral traits through model selection. Our results showed that basal flowers generally had larger traits, more attractive to pollinators, and isolated or defoliated ramets exhibited significant reductions in floral traits, especially at distal flowers. Clonal integration stabilized floral traits across positions by mitigating the effects of resource variability. Clonal integration in E. crassipes enhances resilience to resource depletion, likely contributing to this species invasiveness. These findings highlight the significance of clonal and architectural integration in sustaining reproductive traits under environmental stress. [ABSTRACT FROM AUTHOR]

Soil enzyme activities serve as the key indicators of microbial nutrient limitations. Vegetation types after farmland is returned modify both the biological and abiotic properties of the soil, thereby impacting the soil nutrient cycle and the stability of forest ecosystems. However, soil enzyme activities and microbial nutrient limitations in degraded karst forests under different vegetation types after farmland return remain unclear. Therefore, this study investigated the soil physicochemical properties, enzyme activities, and microbial resource limitations in different vegetation types (grasslands (G), transitional grass–shrub (SG), shrubland (S), and secondary forest (F)) after returning farmland on dip and anti-dip slopes in a karst trough valley. The relationships among the factors influencing soil enzyme activities were analyzed to identify the drivers of microbial nutrient limitation. The results revealed that soil enzyme activities and physicochemical properties were significantly greater on anti-dip slopes than on dip slopes. Total nitrogen (27.4%) and bulk density (24.4%) influenced mainly soil enzyme activity and its stoichiometric ratio, whereas carbon and phosphorus limitations impacted soil microorganisms on the dip slopes of the F and G vegetation types. The soil physicochemical properties and enzyme characteristics accounted for 85.5% and 75.6%, respectively, of the observed influence. Notably, the total phosphorus content (36.8%) on the anti-dip erosion slope was significantly greater than that on the other slopes. These factors, especially bedrock strata dip and vegetation type, significantly affect soil enzyme activity. This study confirms that vegetation type enhances soil enzyme activities on anti-dip erosion slopes, providing a scientific basis for karst ecosystem restoration. [ABSTRACT FROM AUTHOR]

In the context of global carbon emissions and climate change, identifying context-specific low-carbon pathways for urban areas is critical for achieving socio-environmental sustainability. This study applies the technology–organization–environment (TOE) framework to examine the driving mechanisms and the diversity in carbon reduction pathways across 81 cities in China. Utilizing partial least squares structural equation modeling (PLS-SEM) and necessary condition analysis (NCA), this research assesses the roles of technological, organizational, and environmental drivers in urban carbon reduction. Fuzzy-set qualitative comparative analysis (fsQCA) is employed to uncover distinct carbon reduction pathways and causal asymmetries between cities. The findings reveal that technological, organizational, and environmental factors significantly drive carbon reduction, with technological and organizational factors playing the central roles. Environmental factors exert primarily indirect effects, interacting with technological and organizational drivers. This study categorizes cities into three distinct carbon reduction models: cities with high carbon-neutral potential primarily leverage technological innovation and energy efficiency optimization; cities with moderate potential integrate technology and policy, emphasizing green landscape planning to achieve balanced development; and cities with lower carbon reduction potential are mainly policy-driven, constrained by technological and resource limitations. This study underscores the role of computational modeling in providing valuable insights for the development of context-tailored carbon reduction strategies. It highlights the synergetic interactions among technological, organizational, and environmental factors, offering essential guidance for advancing sustainable development planning and facilitating the low-carbon transition of cities and communities. [ABSTRACT FROM AUTHOR]

Human biomonitoring (HBM) is a critical tool for assessing chemical exposure in populations and informing public health policies. This study aimed to prioritize chemical substances for the development of a national HBM program in Latvia, addressing the need for systematic evaluation of chemicals in the local context. Initially, 318 chemical substances were reviewed, of which 130 were shortlisted and assessed using an adapted Hanlon methodology. Substances were assessed based on their health significance, hazardous properties, exposure characteristics, national relevance, and public interest. The results identified 30 high-priority substances across various categories, providing a foundation for the HBM4LV program. This prioritization process highlighted the challenges of data gaps, resource limitations, and the need to balance national priorities with alignment to European frameworks. Despite addressing key methodological challenges, the study highlights the importance for ongoing refinement, robust data collection, and strengthened international collaboration to enhance the program's scope and long-term sustainability. While the methodology addressed key challenges, further refinement and international collaboration are essential to enhance the program's scope and sustainability. [ABSTRACT FROM AUTHOR]

Purpose: Traumatic brain injury (TBI) disproportionately affects asylum-seekers and refugees (ASR), although underdiagnosed and undertreated. Our study assesses clinicians' perspectives on characteristics and management of TBI among ASR, with the hope of improving TBI management in this population. Materials and Methods: We conducted six focus groups of 16 clinicians across two academic medical centers in Boston, Massachusetts, United States. Clinicians in our sample included primary care clinicians, nurse practitioners, social workers, psychologists, neurologists, psychiatrists, and neuropsychologists. We analyzed the qualitative data following a hybrid inductive-deductive thematic analytic approach. Results: Clinicians characterized TBI among ASR as mostly mild and remote, involving head strikes, perpetrated predominantly by interpersonal violence and strangulation-related brain injury, and involving symptom overlap with mental health diagnoses, challenging diagnosis. Clinicians also described inadequate screening, the importance of connecting the physical and psychological symptoms of the brain injury rather than viewing them as distinct, and addressing diagnosis-related stigma and shame. Finally, they discussed lack of TBI-specific knowledge among providers and patients alike, and resource limitations affecting the continuum of care for this population. Conclusion: Integrating clinicians' perspectives in caring for this population allows us to best meet their needs, including in TBI recovery. IMPLICATIONS FOR REHABILITATION: Traumatic Brain Injury (TBI) disproportionately affects asylum-seekers and refugees (ASR). ASR predominantly sustain TBI through head strikes, but strangulation-related brain injury is under-recognized and must be assessed alongside common TBI mechanisms of injury. Current challenges in assessing TBI in ASR include mild and remote presentation of TBI, perpetration in contexts of interpersonal violence, and symptom overlap with mental health diagnoses. Rehabilitation professionals can enhance TBI-related assessment, care, and communication by enhancing education of ASR patients and clinicians who serve them. This includes implementing use of, and improving, existing screening tools. [ABSTRACT FROM AUTHOR]

The PhD journey is a transformative yet complex process that requires candidates to balance intellectual rigor with personal, professional, and logistical challenges. In addition to producing original research, doctoral candidates navigate competing responsibilities, resource limitations, and the nonlinear nature of academic inquiry--factors that contribute to inefficiencies, stress, and delays. This paper proposes integrating project management principles as a structured framework for enhancing doctoral productivity, reducing uncertainty, and fostering resilience. By conceptualizing the PhD as a long-term project, candidates can break research into manageable phases, set clear objectives, and systematically address challenges. Project management tools--such as Work Breakdown Structures (WBS), Gantt charts, and risk registers--enable effective planning, progress tracking, and contingency planning. These tools enhance time management, decision-making, and adaptability, ensuring candidates maintain momentum while responding to inevitable research uncertainties. Beyond technical strategies, this paper highlights the crucial role of emotional resilience in doctoral success. Developing support networks, practicing mindfulness, and maintaining work-life balance are essential for sustaining motivation and well-being. Integrating both technical project management methods and psychological coping mechanisms ensures a holistic approach to doctoral success. Furthermore, this paper calls for future research on optimizing project management applications in PhD studies, exploring methodologies like Agile and Lean tailored to different disciplines. Additionally, institutional factors--including the role of supervisors and structured training in project management--should be examined to enhance doctoral completion rates and academic experiences. By adopting a structured, adaptable, and resilient approach to their research, PhD candidates can overcome challenges, enhance efficiency, and cultivate transferable skills valuable in academia and beyond. [ABSTRACT FROM AUTHOR]

Plant species diversity and spatial distribution patterns are critical for understanding ecosystem dynamics in arid and fragile environments. This study investigates the diversity, spatial distribution, and interspecific associations of shrubs and herbaceous plants in the transition zone of the desert oasis located in the Hexi Corridor and southern edge of the Badanjilin Desert, China. Vegetation data were collected across sample plots spanning three counties in Zhangye City. Important values, diversity indices, and spatial distribution metrics were calculated to evaluate plant species dominance and community structure. Interspecific relationships were analyzed using variance ratio (VR), clumping indicators, and corrected χ2 tests. The shrub community exhibited low species diversity (H′ = 1.754) and was dominated by Reaumuria songarica (Pall.) Maxim (IV = 111.175), reflecting its superior adaptability to arid conditions. In contrast, the herbaceous community displayed higher diversity (H′ = 2.498), with Aristida adscensionis L. (IV = 48.6174) as the dominant species. Both communities showed predominantly aggregative spatial distribution patterns, influenced by localized resource availability and adaptive strategies. Weak interspecific associations characterized the shrub community, with limited competition among dominant species, while the herbaceous community demonstrated significant negative correlations, indicating stronger resource competition. The study highlights the contrasting diversity and ecological roles of shrubs and herbaceous plants in arid ecosystems, shaped by resource limitations and environmental stressors. Effective conservation strategies are needed to protect dominant species and sustain ecosystem resilience in desert regions. Future research should focus on below-ground interactions and long-term monitoring to enhance understanding of species coexistence and community stability. [ABSTRACT FROM AUTHOR]

International distribution compels global value chain members to demand highly innovative and technological advancements in their products and processes. The members include small, medium, and large enterprises from both the manufacturing and service categories. Due to short product lifecycles and resource limitations, SMEs are unable to fulfill global value chain requirements in terms of new product development, consequently struggling to sustain manufacturing. In Saudi Arabia, more than 10% of SMEs currently belong to the manufacturing sector, and the majority continue to use conventional manufacturing technologies. Against this backdrop, and to strengthen existing SMEs and enhance their growth, the author conducted a comprehensive literature review on the applicability of additive manufacturing technologies in the manufacturing of various products. The review indicated that the implementation of additive manufacturing technologies faces several difficulties; thus, the author selected two manufacturing SMEs to obtain information on the necessary requirements to implement additive manufacturing technologies. The author interacted with executives from two manufacturing companies, one located in Sudair Industrial City and the other in the industrial center of Dammam. These interactions revealed that better financing, industry–academia collaborations, and stronger inter-company ties boost the adoption of additive manufacturing and support SME growth. Optimizing the use of resources, minimizing the use of materials during the production process through the use of 3D printing technologies, and optimizing time and labor costs help to enhance the economy, which is one of the main components of sustainability. [ABSTRACT FROM AUTHOR]

Background: Heart failure is a major public health concern, affecting 6.7 million Americans. An estimated 16% of emergency department (ED) patients with acute heart failure (AHF) are discharged home. Our Get with the Guidelines in Emergency Department Patients with Heart Failure (GUIDED-HF) toolkit aims to improve AHF self-care and facilitate safer transitions in care for these patients. We describe implementation barriers and facilitators, and the selection and refinement of implementation strategies, to facilitate future GUIDED-HF implementation. Methods: A mixed-methods cross-sectional observational study was conducted in four United States EDs in two diverse healthcare systems in the Pacific West and Midwest. Data were collected using a survey and interviews with ED providers, nurses, and leaders. The survey assessed the ED context using the context scale of the Organizational Readiness to Change Assessment (ORCA). The Consolidated Framework for Implementation Research informed interviews. Quantitative data were summarized using medians (interquartile ranges) or percentages (frequencies). Wilcoxon rank-sum tests and Kruskal–Wallis tests were used to assess differences in the healthcare system and profession. Qualitative data were analyzed and summarized using rapid qualitative analysis. Convergence of quantitative and qualitative data was used to inform specific refining of implementation strategies to the local context (e.g., who should serve as champions, how best practice alerts should be implemented). Results: Participants were predominately white (76%) with median (IQR) age 37.0 (32.0, 41.0). ED leaders/administrators, providers, and nurses comprised 15%, 55%, and 29% of participants, respectively. Sites reported an ORCA context scale score of 3.7 [3.4, 4.0] (scale of 1 = strongly disagree to 5 = strongly agree). Comparison of scores by profession showed a significant difference in the context score among providers (3.9 [3.5, 4.0]), leaders (3.7 [3.5, 4.0]), and nurses (3.6 [3.0, 3.9]) (p = 0.048). Qualitative data indicated implementation barriers (e.g., resource limitations, patient health literacy), facilitators (e.g., GUIDED-HF is patient-centric; site and intervention congruent values, norms, and goals), and site-specific needs due to contextual factors (e.g., education needs, feedback mechanisms, champions). Conclusions: Specific determinants of implementation exist in ED settings and require the refining of implementation strategies to overcome site-specific barriers and enhance facilitators. Trial registration: n/a. [ABSTRACT FROM AUTHOR]

Introduction: Resilience in the face of educational barriers refers to faculty members' ability to effectively navigate, overcome, and adapt to challenges encountered in the educational environment. These challenges may include curriculum changes, transitions to online instruction, resource limitations, or disruptions caused by external factors, such as a pandemic. This study aims to explore the relationship between medical educators' attitudes toward change and their resilience in overcoming these educational barriers. Methods: This survey was conducted on 130 medical teachers of Shiraz University of Medical Sciences (SUMS) in 2021-2022. A standard questionnaire with 18 items was used to assess the teachers' attitudes to change. A researcher-made questionnaire, including 36 items in eight components, was designed to assess the teachers' resilience to educational barriers. Results: Based on findings, teachers' attitudes towards change were moderate in the affective and behavioral aspects but strongly positive in the cognitive aspect (p < 0.001). Teachers with more positive attitudes, compared to those with weaker attitudes, reported significantly fewer barriers in areas such as previous readiness (p = 0.025) and technical support (p = 0.005). Faculty members with better computer skills (p < 0.001) not only perceived fewer barriers but also exhibited more positive attitudes toward change (p = 0.002). Conclusion: Attitudinal barriers are influenced by a person's knowledge and skills, affecting their attitude toward change and willingness to face challenges. Involving teachers in diverse online education experiences and improving their competencies can enhance their acceptance of technological changes. [ABSTRACT FROM AUTHOR]