Search Results (17,247)

Although organizational resilience is well established, refining the systematic quantitative evaluation of health systems resilience (HSR) remains an ongoing opportunity for advancement. Research either focuses on individual HSR indicators, such as social welfare policy, public expenditure, health insurance, healthcare quality, and technology, or broadly examines socio-economic factors, highlighting the need for a more comprehensive methodological approach. This study employed the Slacks-Based Measure (SBM) within Data Envelopment Analysis (DEA) to analyze efficiency by maximizing outputs. It systematically examined key HSR factors across countries, providing insights for improved policymaking and resource allocation. Taking a five-year (2016–2020) dataset that covered 55 to 56 countries and evaluating 17 indicators across governance, health systems, and economic aspects, the paper presents that all sixteen top-ranked countries with a perfect efficiency score of 1 belonged to the high-income group, with ten in Europe, highlighting regional HSR differences. This paper concludes that adequate economic resources form the foundation of HSR and ensure stability and sustained progress. A properly supported healthcare workforce is essential for significantly enhancing health systems and delivering quality care. Last, effective governance and the equitable allocation of resources are crucial for fostering sustainable development and strengthening HSR. Full article

Soil testing has long been used to optimize fertilization and crop production. More recently, soil health testing has emerged to reflect the growing interest in soil multifunctionality and ecosystem services. Soil health encompasses physical, chemical, and biological properties that support ecosystem functions and sustainable agriculture. Despite its relevance to several United Nations Sustainable Development Goals (SDGs 1, 2, 3, 6, 12, 13, and 15), comprehensive soil health testing is not widely practiced due to complexity and cost. The aim of the study presented here was to contribute to the further development, implementation, and testing of an integrated procedure for soil health assessment in practice. We developed and tested a rapid, standardized soil health assessment tool that combines near-infrared spectroscopy (NIRS) and multi-nutrient 0.01 M CaCl₂ extraction with Inductive Coupled Plasma Mass Spectroscopy analysis. The tool evaluates a wide range of soil characteristics with high accuracy (R² ≥ 0.88 for most parameters) and has been evaluated across more than 15 countries, including those in Europe, China, New Zealand, and Vietnam. The results are compiled into a soil health indicator report with tailored management advice and a five-level ABCDE score. In a Dutch test set, 6% of soils scored A (optimal), while 2% scored E (degraded). This scalable tool supports land users, agrifood industries, and policymakers in advancing sustainable soil management and evidence-based environmental policy. Full article

Background: Breast cancer is the most prevalent malignancy among women globally. In Romania, it is the most frequent form of cancer affecting women, with approximately 12,000 new cases diagnosed annually, and the second most common cause of cancer-related mortality, second only to lung cancer. Methods: This study looked at 79 breast cancer patients from Oltenia, concentrating on epidemiology, histology, diagnostic features, and treatments. Patients were chosen based on inclusion criteria such as histopathologically verified diagnosis, availability of clinical and treatment data, and follow-up information. The analyzed biological material consisted of tissue samples taken from the breast parenchyma and axillary lymph nodes. Even though not the primary subject of this paper, all patients underwent immunohistochemical (IHC) evaluation both preoperatively and postoperatively. Results: We found invasive ductal carcinoma to be the predominant type, while ductal carcinoma in situ (DCIS) and mixed types were rare. We performed cross-tabulations of metastasis versus nodal status and age versus therapy type; none reached significance (all p > 0.05), suggesting observed differences were likely due to chance. A chi-square test comparing surgical interventions (breast-conserving vs. mastectomy) in patients who did or did not receive chemotherapy showed, χ² = 3.17, p = 0.367, indicating that chemotherapy did not significantly influence surgical choice. Importantly, adjuvant chemotherapy and radiotherapy were used at similar rates across age groups, whereas neoadjuvant hormonal (endocrine) therapy was more common in older patients (but without statistical significance). Conclusions: Finally, we discussed the consequences of individualized care and early detection. Romania’s shockingly low screening rate, which contributes to delayed diagnosis, emphasizes the importance of improved population medical examination and tailored treatment options. Also, the country has one of the lowest rates of mammography uptake in Europe and no systematic population screening program. Full article

Background: North Carolina Macular Dystrophy (NCMD) is a non-progressive inherited macular dystrophy characterized by marked phenotypic variability. The genetic etiology of NCMD remains largely unknown, and only a limited number of families have been reported in Europe. Methods: We performed an in-depth investigation of an Italian family affected by NCMD using an integrated approach that combined SNP-array analysis, whole-exome sequencing, and long-read whole-genome sequencing. Additionally, we conducted a comprehensive review of NCMD-related literature. Results: We identified a novel 98 Kb duplication involving both PRDM13 and CCNC genes in a three-generation kindred, where the proband exhibited severe macular alterations, while all other affected family members presented with a milder clinical phenotype. A review of the literature suggests different genotype–phenotype correlations and similar penetrance for duplications and single-nucleotide variants (SNVs) in described families. Specifically, smaller duplications may be associated with more severe phenotypes, while SNVs exhibit high phenotypic variability. Conclusions: In this study, we describe the first NCMD Italian family, in which the integration of second- and third-generation sequencing methods enabled the identification of a novel pathogenic PRDM13 and CCNC duplication, thereby expanding the mutational spectrum of NCMD. Overall, these findings, together with the literature review, highlight the importance of selecting appropriate genetic testing approaches that allow the detection of non-coding variants and CNVs and thus enable accurate diagnosis and effective clinical management of patients and their families. Full article

Water governance in Europe faces mounting challenges from climate change, demographic pressures, and aging infrastructure—especially in Southern regions increasingly affected by drought and institutional fragmentation. In contrast, Nordic countries such as Denmark and Sweden exhibit coherent, integrated governance systems with strong regulatory oversight. This study introduces the Water Governance Maturity Index (WGMI), a document-based assessment tool designed to evaluate national water governance across five dimensions: institutional capacity, operational effectiveness, environmental ambition, equity, and climate adaptation. Applying the WGMI to eight EU countries—four Nordic and four Southern—reveals a persistent North–South divide in governance maturity. Nordic countries consistently score in the “advanced” or “model” range, while Southern countries face systemic gaps in implementation, climate integration, and territorial inclusion. Based on these findings, the study offers actionable policy recommendations, including the establishment of independent regulators, strengthening of river basin coordination, mainstreaming of climate-water strategies, and expansion of affordability and participation mechanisms. By translating complex governance principles into measurable indicators, the WGMI provides a practical tool for benchmarking reform progress and supporting the EU’s broader agenda for just resilience and climate adaptation. Unlike broader frameworks like SDG 6.5.1, the WGMI’s document-based, dimension-specific approach provides granular, actionable insights for governance reform, enhancing its utility for EU and global policymakers. Full article

This article investigates the macroeconomic and labor market conditions that shape the adoption of artificial intelligence (AI) technologies among large firms in Europe. Based on panel data econometrics and supervised machine learning techniques, we estimate how public health spending, access to credit, export activity, gross capital formation, inflation, openness to trade, and labor market structure influence the share of firms that adopt at least one AI technology. The research covers all 28 EU members between 2018 and 2023. We employ a set of robustness checks using a combination of fixed-effects, random-effects, and dynamic panel data specifications supported by Clustering and supervised learning techniques. We find that AI adoption is linked to higher GDP per capita, healthcare spending, inflation, and openness to trade but lower levels of credit, exports, and capital formation. Labor markets with higher proportions of salaried work, service occupations, and self-employment are linked to AI diffusion, while unemployment and vulnerable work are detractors. Cluster analysis identifies groups of EU members with similar adoption patterns that are usually underpinned by stronger economic and institutional fundamentals. The results collectively suggest that AI diffusion is shaped not only by technological preparedness and capabilities to invest but by inclusive macroeconomic conditions and equitable labor institutions. Targeted policy measures can accelerate the equitable adoption of AI technologies within the European industrial economy. Full article

This paper proposes an intelligent power adaptation framework for Free-Space Optics (FSO) communication systems operating under different weather conditions exploiting a deep learning (DL) analysis of received eye diagram images. The system incorporates two Convolutional Neural Network (CNN) architectures, LeNet and Wide Residual Network (Wide ResNet) algorithms to perform regression tasks that predict received signal quality metrics such as the Quality Factor (Q-factor) and Bit Error Rate (BER) from the received eye diagram. These models are evaluated using Mean Squared Error (MSE) and the coefficient of determination (${\mathrm{R}}^2$ score) to assess prediction accuracy. Additionally, a custom CNN-based classifier is trained to determine whether the BER reading from the eye diagram exceeds a critical threshold of ${10}^{-4}$; this classifier achieves an overall accuracy of 99%, correctly detecting 194/195 “acceptable” and 4/5 “unacceptable” instances. Based on the predicted signal quality, the framework activates a dual-amplifier configuration comprising a pre-channel amplifier with a maximum gain of 25 dB and a post-channel amplifier with a maximum gain of 10 dB. The total gain of the amplifiers is adjusted to support the operation of the FSO system under all-weather conditions. The FSO system uses a 15 dBm laser source at 1550 nm. The DL models are tested on both internal and external datasets to validate their generalization capability. The results show that the regression models achieve strong predictive performance, and the classifier reliably detects degraded signal conditions, enabling the real-time gain control of the amplifiers to achieve the quality of transmission. The proposed solution supports robust FSO communication under challenging atmospheric conditions including dry snow, making it suitable for deployment in regions like Northern Europe, Canada, and Northern Japan. Full article

The study investigates the contribution of technology (TECH), quantified by Internet penetration, in influencing tourism performance (TP) among the top ten touristic nations in Europe: France, Spain, Italy, Turkey, the United Kingdom, Germany, Greece, Austria, Portugal, and the Netherlands. Using panel data from 2000–2022, the study includes additional structural controls like environment quality, gross domestic production (GDP) per capita, exchange rate (ER), and safety index (SI). The Method of Moments Quantile Regression (MMQR) is employed to capture heterogeneous effects at different levels of TP, and Driscoll–Kraay standard error (DKSE) correction is employed to make the analysis robust against autocorrelation as well as cross-sectional dependence. Spectral–Granger causality tests are also conducted to check short- and long-run dynamics in the relationships. Empirical results are that TECH and SI are important in TP at all quantiles, but with stronger effects for lower-performing countries. Environmental quality (EQ) and GDP per capita (GDPPC) exert increasing impacts at upper quantiles, suggesting their importance in sustaining high-level tourism economies. ER effects are limited and primarily short-term. The findings highlight the need for integrated digital, environmental, and economic policies to achieve sustainable tourism development. The paper contributes to tourism research by providing a comprehensive, frequency-sensitive, and distributional analysis of macroeconomic determinants of tourism in highly developed European tourist destinations. Full article

Background: Increasing regulatory pressure for maritime decarbonization (e.g., IMO CII, FuelEU) drives adoption of low-carbon fuels and prompts reassessment of regional ports’ competitiveness. This study aims to evaluate the economic and environmental viability of rerouting deep-sea container services to regional ports in a decarbonizing world. Methods: A scenario-based analysis is used to evaluate total costs and CO₂ emissions across the entire container shipping supply chain, incorporating deep-sea shipping, port operations, feeder services, and inland rail/road transport. The Port of Liverpool serves as the primary case study for rerouting Asia–Europe services from major ports. Results: Analysis indicates Liverpool’s competitiveness improves with shipping lines’ slow steaming, growth in hinterland shipment volume, reductions in the emission factors of alternative low-carbon fuels, and an increased modal shift to rail matching that of competitor ports (e.g., Southampton). A dual-port strategy, rerouting services to call at both Liverpool and Southampton, shows potential for both economic and environmental benefits. Conclusions: The study concludes that rerouting deep-sea services to regional ports can offer cost and emission advantages under specific operational and market conditions. Findings on factors and conditions influencing competitiveness and the dual-port strategy provide insights for shippers, ports, shipping lines, logistics agents, and policymakers navigating maritime decarbonization. Full article

Cardiovascular disease (CVD) remains Europe’s leading cause of mortality, responsible for >45% of deaths. Beyond established risk factors (hypertension, diabetes, dyslipidaemia, smoking, obesity), psychosocial elements—depression, anxiety, financial stress, personality traits, and trauma—significantly influence CVD development and progression. Behavioural Cardiology addresses this connection by systematically incorporating psychosocial factors into prevention and rehabilitation protocols. This review examines the HEARTBEAT model, developed by Greece’s first Behavioural Cardiology Unit, which aligns with current European guidelines. The model serves dual purposes: primary prevention (targeting at-risk individuals) and secondary prevention (treating established CVD patients). It is a personalised medicine approach that integrates psychosocial profiling with traditional risk assessment, utilising tailored evaluation tools, caregiver input, and multidisciplinary collaboration to address personality traits, emotional states, socioeconomic circumstances, and cultural contexts. The model emphasises three critical implementation aspects: (1) digital health integration, (2) cost-effectiveness analysis, and (3) healthcare system adaptability. Compared to international approaches, it highlights research gaps in psychosocial interventions and advocates for culturally sensitive adaptations, particularly in resource-limited settings. Special consideration is given to older populations requiring tailored care strategies. Ultimately, Behavioural Cardiology represents a transformative systems-based approach bridging psychology, lifestyle medicine, and cardiovascular treatment. This integration may prove pivotal for optimising chronic disease management through personalised interventions that address both biological and psychosocial determinants of cardiovascular health. Full article

In comparative analyses, specific features of the Spanish welfare and housing systems have often been emphasized. The case of Barcelona illustrates the extent to which these features are the result of a long-standing historical trajectory and the decisive impact of the challenges and policy responses adopted during Franco’s lengthy, dark, and gloomy regime. This period marked a significant shift, not only due to the persistent shortage of social rental housing, but also because of the early consolidation of a homeownership culture and its dominance in working-class suburban areas—a legacy that is completely different from that of the welfare states of Western Europe. Through a review of the literature and the analysis of primary sources, ongoing research on Barcelona seeks to clarify the factors and processes that led to this transformation, as well as its evolution during the democratic period, within an international context of economic liberalization and the dismantling of the welfare state. Full article

The biopharmaceutical industry is undergoing a fundamental transformation from traditional batch manufacturing to continuous manufacturing (CM) for recombinant drugs and biosimilars, driven by regulatory support through the International Council for Harmonization (ICH) Q13 guidance and compelling economic advantages. This comprehensive review examines the technical, economic, and regulatory aspects of implementing continuous manufacturing specifically for recombinant protein production and biosimilar development, synthesizing validated data from peer-reviewed research, regulatory sources, and global implementation case studies. The analysis demonstrates that continuous manufacturing offers substantial benefits, including a reduced equipment footprint of up to 70%, a 3- to 5-fold increase in volumetric productivity, enhanced product quality consistency, and facility cost reductions of 30–50% compared to traditional batch processes. Leading biomanufacturers across North America, Europe, and the Asia–Pacific region are successfully integrating perfusion upstream processes with connected downstream bioprocesses, enabling the fully end-to-end continuous manufacture of biopharmaceuticals with demonstrated commercial viability. The regulatory framework has been comprehensively established through ICH Q13 guidance and region-specific implementations across the FDA, EMA, PMDA, and emerging market authorities. This review provides a critical analysis of advanced technologies, including single-use perfusion bioreactors, continuous chromatography systems, real-time process analytical technology, and Industry 4.0 integration strategies. The economic modeling presents favorable return-on-investment profiles, accompanied by a detailed analysis of global market dynamics, regional implementation patterns, and supply chain integration opportunities. Full article

Background: Brain health is a growing public health priority due to the high global burden of neurological and mental disorders. Promoting brain health across the lifespan supports individual and societal well-being, creativity, and productivity. Objective: To address the need for specialized education in this field, the University of Bern developed a Certificate of Advanced Studies (CAS) in Brain Health. This article outlines the program’s rationale, structure, and goals. Program Description: The one-year, 15 ECTS-credit program is primarily online and consists of four modules: (1) Introduction to Brain Health, (2) Brain Disorders, (3) Risk Factors, Protective Factors and Interventions, and (4) Brain Health Implementation. It offers a multidisciplinary, interprofessional, life-course approach, integrating theory with practice through case studies and interactive sessions. Designed for healthcare and allied professionals, the CAS equips participants with skills to promote brain health in clinical, research, and public health contexts. Given the shortage of trained professionals in Europe and globally, the program seeks to build a new generation of brain health advocates. It aims to inspire action and initiatives that support the prevention, early detection, and management of brain disorders. Conclusions: The CAS in Brain Health is an innovative educational response to a pressing global need. By fostering interdisciplinary expertise and practical skills, it enhances professional development and supports improved brain health outcomes at individual and population levels. Full article

This paper investigates the cultural, spiritual, and ecological use and value of fish by-products in the material practices of Alaska Native (Indigenous Peoples are the descendants of the populations who inhabited a geographical region at the time of colonisation and who retain some or all of their own social, economic, cultural, and political institutions. In this paper, I use the terms “Indigenous” and “Native” interchangeably. In some countries, one of these terms may be favoured over the other.) and Greenlandic Inuit women. It aims to uncover how fish remnants—skins, bones, bladders, vertebrae, and otoliths—were transformed through tanning, dyeing, and sewing into garments, containers, tools, oils, glues, and adornments, reflecting sustainable systems of knowledge production rooted in Arctic Indigenous lifeways. Drawing on interdisciplinary methods combining Indigenist research, ethnographic records, and sustainability studies, the research contextualises these practices within broader environmental, spiritual, and social frameworks. The findings demonstrate that fish-based technologies were not merely utilitarian but also carried symbolic meanings, linking wearers to ancestral spirits, animal kin, and the marine environment. These traditions persisted even after European contact and the introduction of glass trade beads, reflecting continuity and cultural adaptability. The paper contributes to academic discourse on Indigenous innovation and environmental humanities by offering a culturally grounded model of zero-waste practice and reciprocal ecology. It argues that such ancestral technologies are directly relevant to contemporary sustainability debates in fashion and material design. By documenting these underexamined histories, the study provides valuable insight into Indigenous resilience and offers a critical framework for integrating Indigenous knowledge systems into current sustainability practices. Full article

The pepper weevil Anthonomus eugenii is a devastating pest native to Central America that can cause severe damage to over 35 pepper varieties. Global trade in peppers has significantly increased the risk of its spread and expansion. Moreover, future climate change may add more uncertainty to its distribution, resulting in considerable ecological and economic damage globally. Therefore, we employed an ensemble model combining Random Forests and CLIMEX to predict the potential global distribution of A. eugenii in historical and future climate scenarios. The results indicated that the maximum temperature of the warmest month is an important variable affecting global A. eugenii distribution. Under the historical climate scenario, the potential global distribution of A. eugenii is concentrated in the Midwestern and Southern United States, Central America, the La Plata Plain, parts of the Brazilian Plateau, the Mediterranean and Black Sea coasts, sub-Saharan Africa, Northern and Southern China, Southern India, Indochina Peninsula, and coastal area in Eastern Australia. Under future climate scenarios, suitable areas in the Northern Hemisphere, including North America, Europe, and China, are projected to expand toward higher latitudes. In China, the number of highly suitable areas is expected to increase significantly, mainly in the south and north. Contrastingly, suitable areas in Central America, northern South America, the Brazilian Plateau, India, and the Indochina Peninsula will become less suitable. The total land area suitable for A. eugenii under historical and future low- and high-emission climate scenarios accounted for 73.12, 66.82, and 75.97% of the global land area (except for Antarctica), respectively. The high-suitability areas identified by both models decreased by 19.05 and 35.02% under low- and high-emission scenarios, respectively. Building on these findings, we inferred the future expansion trends of A. eugenii globally. Furthermore, we provide early warning of A. eugenii invasion and a scientific basis for its spread and outbreak, facilitating the development of effective quarantine and control measures. Full article