Bellevue University

This conceptual paper examines the interplay between Digital Leadership, Knowledge Sharing, and Emotional Intelligence, with Cultural Sensitivity and Capacity Building as contextual enablers, in the context of Cambodian secondary schools undergoing digital transformation. Drawing on recent literature from 2018–2025, the paper proposes a framework where Digital Leadership and Emotional Intelligence independently foster Knowledge Sharing, while Emotional Intelligence also moderates the Digital Leadership–Knowledge Sharing relationship by enhancing trust, motivation, and openness. Cultural Sensitivity and Capacity Building are positioned as cross-cutting factors that strengthen these relationships by addressing cultural norms, infrastructural disparities, and professional development needs. The framework responds to Cambodia’s leadership gap in digital readiness by emphasizing both technology-oriented and human-centric leadership capabilities. The proposed model contributes to theory by integrating socio-emotional and contextual dimensions into digital leadership research and offers practical guidance for school leaders and policy-makers seeking to cultivate collaborative, innovative educational environments. This conceptualisation invites future empirical studies to validate the relationships and mechanisms proposed.

BackgroundA healthy gut microbiome offers protection against pathogenic bacteria, such as multidrug-resistant organisms (MDROs), Enterococcus and Enterobacterales. Expansion of these organisms is a harbinger for invasive infection and could contribute to the spread of MDROs. Acute care hospitals account for the majority of MDRO infections nationally. To test whether hospitalized patients develop pathogenic expansion within the microbiome, we examined the gut microbiome and metabolome of hospitalized patients and compared them to post-discharge infection.MethodsIn a prospective, observational study we collected stool samples from hospitalized patients on a single unit that approximates a general inpatient population. We performed shotgun metagenomic sequencing and quantitative GC and LC-MS metabolite measurement on each sample. We examined the differences in microbiota diversity and composition to healthy donors and compared discharge microbiome composition to post-discharge infection.ResultsA total of 71 samples were collected from 46 hospitalized patients (Table 1). Compared to 32 healthy donors, hospitalized patients had lower diversity, compositional changes and expansion of both Enterobacterales and Enterococcus in 17 (23%) and 6 (8%) samples, respectively (Figure 1). Beneficial microbe-derived short chain fatty acids and secondary bile acids were also reduced (Figure 2). Among hospitalized patients that developed post-discharge infection, the discharge microbiome had 9 (64%) of the infecting organisms (Figure 3). For infections caused by Enterobacterales, 7 (88%) were detected in the discharge microbiome. E.coli expanded >2.5% in 5 (71%) patients with E.coli infection. Candida was found in 2 (66%) discharge stool samples that developed a Candida infection.ConclusionHospitalized patients have a reduction in microbiome diversity, beneficial microbial metabolites, and pathologic expansion of Enterobacterales and Enterococcus species. Expansion at the time of discharge was associated with post-discharge infection. Gut microbiome expansion in this population could be responsible for the rise of MDROs. Therapies to restore microbiome composition and function could be used to combat MDRO infections.DisclosuresAll Authors: No reported disclosures

Cross-border B2B trade relies heavily on trust, verification, and timely settlement, yet traditional mechanisms such as letters of credit and centralized escrow services remain slow, costly, and vulnerable to disputes and documentation errors. Blockchain-enabled digital escrow introduces a programmable, transparent, and automated alternative that strengthens payment security while reducing dependency on intermediaries. This study proposes a blockchain-backed digital escrow and conditional payment framework designed to streamline global trade settlement by leveraging smart contracts, oracle-based verification, and decentralized audit trails. In the proposed model, conditional payment logic—such as delivery confirmation, document compliance, IoT shipment tracking, and multi-party approval—executes autonomously on-chain, releasing escrow funds only when verifiable conditions are met. The architecture integrates permissioned distributed ledgers, cryptographic hashing, and regulatory compliance modules to ensure legal enforceability, privacy protection, and resilience against fraud or manipulation. By automating verification events and embedding trade rules directly into smart contracts, the system reduces settlement latency, minimizes operational risk, and enhances transparency among buyers, sellers, logistics providers, and regulators. The paper concludes that blockchain-based escrow can significantly transform B2B cross-border trade, while also highlighting challenges related to oracle trust models, global regulatory harmonization, interoperability, and digital identity integration.

High-value payment transactions (HVTs) face heightened exposure to money laundering risks due to their large monetary volumes, cross-jurisdictional nature, and the increasing complexity of financial networks. Traditional Anti-Money Laundering (AML) procedures rely heavily on sharing customer identities, transactional attributes, and risk-model outputs across institutions and regulators—creating substantial privacy, security, and data-handling risks. Zero-Knowledge Proofs (ZKPs) offer a transformative alternative by enabling financial institutions to prove compliance with AML requirements without revealing the underlying sensitive information. This paper examines the design and application of ZKP-based compliance frameworks for HVT ecosystems, detailing how AML checks—including KYC verification, sanctions screening, transaction-amount threshold validation, behavioral-risk scoring, and source-of-funds assessment—can be cryptographically attested through privacy-preserving proofs. We propose a hybrid architecture that combines off-chain AML computation with an on-chain ZKP verification and audit layer supported by secure regulatory nodes. Through structured workflows and proof types such as range proofs, list membership proofs, and rule-compliance circuits, the model ensures regulatory oversight while maintaining strict confidentiality. The study also evaluates the performance implications of ZKP systems in high-volume transaction environments and addresses security, interoperability, and oracle-reliability concerns. Ultimately, ZKP-enabled AML frameworks demonstrate significant potential to enhance compliance efficiency, reduce data-exposure risk, and strengthen trust across global payment networks. The paper concludes by outlining future research opportunities, including AI-driven AML circuits, cross-border ZKP interoperability standards, and integration with decentralized identity solutions.

Understanding actual field conditions is important in construction projects, where various in situ devices are used for subsurface characterisation. However, limited research has been conducted on the relative soil disturbance caused by device insertion. This study investigates soil disturbance induced by device penetration using discrete element method-based modelling. Commonly used devices that have different sizes and geometries, including the cone penetrometer, dilatometer blade, and Ko stepped blade, are inserted into model soil specimens, and the stress and strain responses of the soil to assess relative soil–device interactions are quantified. The results show that larger-width devices generate higher stress concentrations and greater permanent strains, while smaller-width devices and geometrical transitions associated with the devices redistribute stress more gradually, reducing overall stress and strain. In addition, geometric transitions are seen to induce closed-loop hysteresis in particle movement, effectively behaving like multi-tip devices. These findings confirm that soil disturbance occurs regardless of device size and shape, emphasising the importance of considering the device geometrical effects in interpreting in situ testing results.

Background: The Ross procedure has favorable outcomes in young and middle-aged patients with aortic valve disease. However, one challenge is early-onset pulmonary homograft stenosis. Perivascular leukocytic infiltration on histology indicates an inflammatory etiology. Homograft upsizing has been shown to reduce the need for reintervention, but remains imperfect. Hypothesis: We hypothesized that a prophylactic anti-inflammatory regimen in addition to homograft upsizing would reduce the incidence of homograft stenosis following the Ross procedure. Methods: Data were collected retrospectively from patients who underwent the Ross procedure at our institution between 6/2020-10/2024. Patients who had surgery 12/2022 or later were prescribed a methylprednisolone taper and a non-steroidal anti-inflammatory drug (NSAID) for 6 months. Outcomes included at least moderate pulmonic stenosis (PS), defined as peak gradient 36 mmHg or higher, and need for re-intervention. Results: A total of 103 patients were included, with 55 in the standard group and 48 patients in the NSAID group. Baseline characteristics were similar between groups. Pulmonary homograft size was higher in the NSAID group (30 mm [IQR 28,31] vs 27 mm [IQR 26,27], p<0.001). There were no major bleeding events. Two patients discontinued NSAIDs due to side effects. The incidence of at least moderate PS was significantly higher in the standard group at 20.0% versus 6.25% in the NSAID group (p=0.042). Among those who completed 6 months of NSAIDs, only 1 patient had moderate PS (2.8%). Logistic regression demonstrated NSAID use was significantly associated with a lower likelihood of PS during follow-up (OR 0.171, CI 0.018, 0.749, p=0.016). Multivariate analysis was limited by study size. Reduction in incidence of PS persisted when patients were stratified by homograft size (Figure 1). In the standard group, 3 patients (5.4%) required pulmonic valve re-intervention. No patients in the NSAID group required re-intervention, although the difference was not significant (p=0.197, Figure 2). No patients in either group died or required aortic valve re-intervention. Conclusion: Implementation of an anti-inflammatory regimen in combination with pulmonary homograft upsizing was associated with a significantly lower incidence of homograft stenosis following the Ross procedure. No patients treated with the NSAID regimen have required pulmonic re-intervention, although longer follow-up will be needed to see if the difference persists.

Introduction/Purpose Carotid webs are an underrecognized cause of embolic ischemic stroke, typically presenting in younger patients and often identified by their characteristic shelf‐like morphology and minimal associated stenosis on angiography. However, non‐calcified atherosclerotic plaques can mimic this appearance, leading to diagnostic uncertainty. We report a case of presumed carotid web based on classic imaging features that was found to be an atherosclerotic plaque on histopathologic examination after carotid endarterectomy (CEA). Materials/Methods Single‐patient case report. Results A 58‐year‐old man with hypertension, hyperlipidemia, type II diabetes, and a 10‐pack‐year smoking history presented with acute left hemiparesis, hemispatial neglect, and dysarthria. Last known normal was eight hours before arrival; NIH Stroke Scale score was 18. Non‐contrast head CT demonstrated right M1 segment hyperdensity, mild right insular region hypodensity, and no acute hemorrhage. CT angiography revealed right M1 occlusion. The patient underwent mechanical thrombectomy with complete reperfusion (TICI 3). Digital subtraction angiography (DSA) confirmed a proximal right M1 occlusion and revealed an intraluminal, shelf‐like filling defect arising from the posterior wall of the right internal carotid artery (ICA) at the level of the carotid bulb, with contrast stasis posterior to the lesion, suspicious for carotid web. In retrospect, the abnormality was also visible on initial CTA, with only 30% luminal stenosis by NASCET criteria.Brain MRI demonstrated infarcts in the right MCA territory, specifically involving the right insula, basal ganglia, and frontal and parietal lobes, with no chronic infarcts in other vascular territories. Routine coagulation panels were normal, LDL was 60 mg/dL, HbA1c was 11.0%, transthoracic echocardiography was unremarkable, and non‐invasive ambulatory cardiac monitor detected no episodes of atrial fibrillation or atrial tachycardia within two weeks of recording. CT of the chest was negative for malignancy. Given the patient's relatively young age, the presence of an embolic‐appearing ischemic stroke without an obvious cardioembolic source or underlying hypercoagulable state, and the classic shelf‐like morphology with minimal stenosis, artery‐to‐artery embolization from carotid web was considered the most likely stroke etiology. The patient was discharged to acute inpatient rehabilitation. One month later, he underwent elective right CEA for secondary stroke prevention. Intraoperatively, the suspected web was visualized and resected en bloc. Histopathological analysis revealed the lesion to be a non‐calcified atherosclerotic plaque rather than a fibrous intimal web.Following this unexpected diagnosis, the patient's medical management was adjusted to emphasize aggressive atherosclerosis risk reduction. At one‐year follow‐up, the patient remained neurologically intact with no recurrent cerebrovascular events. He was adherent to prescribed medications with improved glycemic control and LDL cholesterol < 70 mg/dL. Conclusion This case illustrates that even lesions with classic radiographic features of carotid webs may represent non‐calcified atherosclerotic plaques, particularly in patients with vascular risk factors. As imaging alone may be insufficient for definitive diagnosis, CEA not only restores ICA patency but also provides diagnostic tissue, enabling accurate etiologic classification and appropriate long‐term secondary stroke prevention. In cases of embolic stroke with equivocal imaging findings, particularly when the clinical context raises concern for both carotid web and atherosclerosis, histopathologic confirmation can be essential.