Search Results (40)

The transition toward sustainability in the construction industry requires integrated tools that align with circular economy principles. This study introduces the Interactive Stakeholder Journey Map in Construction (ISJMC), an innovative visual and systemic tool that supports waste management and circularity throughout the life cycle of construction assets. Although the sector is economically significant, it remains one of the main contributors to environmental degradation due to high resource consumption and low waste recovery rates. Developed according to EN 15643-3:2012, a European standard that provides a framework for assessing the social sustainability of construction works, focusing on aspects such as accessibility, health, and comfort and grounded in the Design Thinking methodology, ISJMC enables mapping stakeholder interactions, touchpoints, and responsibilities across all life cycle stages, including initiative, design, procurement, construction, use, and end of life. A systematic literature review and collaborative workshops guided the tool’s development and validation. The application in a real case involving a medium-sized Brazilian construction company helped identify significant pain points and opportunities for implementing circular practices. The results demonstrate that ISJMC (i) facilitates a systemic and visual understanding of material and information flows, (ii) promotes transparent mapping of resource value to support better decision-making, and (iii) encourages the identification of circularity opportunities while fostering collaboration among stakeholders. The tool revealed critical challenges related to waste generation and management. It supported co-creating sustainable strategies, including improved material selection, lean construction practices, and stronger supplier engagement. By translating complex standards into accessible visual formats, ISJMC contributes to the academic field, supports practical applications, and offers a foundation for expanding circular approaches in construction projects. Full article

The aetiology and pathophysiology of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) have not yet been clarified. Its exact diagnosis is also difficult because it has no biomarkers. This lack of knowledge leads to difficulties in treating the disease. In our work, we are attempting to counteract this problem by analysing the central cellular mechanisms in ME/CFS patients and comparing them with those of healthy individuals. This pilot study provides a small glimpse into the journey of nine people with ME/CFS—more specifically, how their peripheral blood mononuclear cells (PBMCs) responded immediately after a session of whole-body hyperthermia (WBH). The clinical effect of WBH has already been investigated in other studies on the treatment of ME/CFS, and these studies have provided valuable insights into its potential benefits. The present study is concerned with the investigation of cellular parameters, namely autophagy, mitochondrial function and mRNA expression, before and after WBH. The results suggest that ME/CFS patients may have higher autophagy-related protein light chain 3 (LC3)-II levels and increased mitochondrial function compared with healthy individuals. A whole-body hyperthermia session could lead to a reduction in LC3-II levels, resulting in a reversion to the levels observed in healthy donors. In the case of mitochondrial parameters, hyperthermia could lead to an increase in the measured parameters. This pilot study is a continuation of a previously published study in which only the isolated cells of ME/CFS patients and a healthy control group were treated with hyperthermia. Full article

The increasing digitalization of the world underscores the critical importance of both social and technical aspects in software engineering practice. While prior research links socio-technical congruence (STC) to positive workstream outcomes, the current convergence of digital products, technologies, and social systems introduces novel and often unpredictable results, driven by the complex interplay of leadership, organizational culture, and software engineering practices operating as a complex adaptive system (CAS). This paper proposes a novel model for adopting socio-cultural practices to bridge the social and technical divide through the lens of STC. The innovation of the model lies in its socio-technical evolutionary journey, built upon dual systems: (1) an analytical System-I focused on enhancing robustness via compliance with Lean and Agile socio-cultural practices, and (2) a holistic System-II emphasizing resilience through an acceptance of interdependence of system actors that requires sense-making techniques. A methodology based on this model was piloted across six case studies: three in an Enterprise IT organization and three in two business units undergoing transformations on Lean and Agile plus DevOps adoption. System-I’s robustness was evaluated through surveys and structured STC maturity assessments (self and guided ones). System-II employed sense-making techniques to foster resilience within the system of work (SoW), laying the groundwork for their evolutionary journeys. The findings reveal a significant need for greater alignment between management (as transformation agents) and software engineering practices. However, the study suggests actionable guidelines, grounded in new principles and mental models for operating within a CAS, to cultivate enhanced resilience and robustness in a VUCA world. Full article

Background: Immunization plays a substantial role in reducing the under-five mortality rate. However, Tanzania still has a significant number of zero-dose and under-vaccinated children and was ranked among the top ten African countries with the highest numbers of zero-dose children in 2022. The human-centered design (HCD) approach is more ethical and effective at addressing public health challenges in complex sociocultural settings. This study aimed to use the HCD approach to aid in identifying, prioritizing, and implementing community-centric interventions in Tanzania, particularly in the Ilala District of Dar es Salaam, to increase vaccine demand and close the zero-dose gap by at least 50%. Methods: The study involved co-creation workshops with 483 participants to identify, design, and test solutions. The study followed the UNICEF Journey to Health and Immunization framework to identify barriers and enablers influencing stakeholders in adopting and sustaining health- and immunization-related actions. Results: The study identified the causes of under-five defaulting and the zero-dose gap, i.e., the inadequate support of local community leaders in under-five vaccination sensitization and surveillance; poor infrastructure to new settlement areas; hesitancy and unwillingness of parents/guardians; absence of house numbers; limited/time-constrained availability of resources to facilitate mobile immunization services, etc. The participants were able to come up with 309 ideas, which were refined through multiple iterations using the impact–-effort matrix and skimmed down to three (3) solutions: (i) having health facilities to notify and alert local leaders about vaccination dates; (ii) using parents, kids, and grownups who got vaccinated to influence others; (iii) using local government leaders and house representatives for vaccine advocacy. Of these, the solution involving local government leaders and house representatives for vaccine advocacy was implemented. An advocacy strategy was used to enhance the collaboration of the District Commissioner, Council leaders, and community leaders. A home-to-home interpersonal sensitization approach accompanied by the household delivery of vaccination services was employed. The findings reveal that the HCD framework was impactful in increasing collaborations/cooperation with local government leaders and community ownership of the under-five vaccination initiative. As a result, 67,145 houses, equal to 104%, were reached, surpassing the initial target of 64,800 houses, and 131,088 families, equal to 83% of the targeted 156,995 households, were sensitized through a home-to-home campaign approach. This study demonstrates the effectiveness of the approach. Researchers and practitioners are encouraged to adopt the HCD approach when addressing public health challenges, especially in complex sociocultural settings. Full article

Total knee arthroplasty (TKA) is a commonly performed surgery aimed at alleviating pain and improving functionality. However, patients often face uncertainties in selecting the timing, location, and type of TKA implant that best meets their needs. This study aims to comprehensively compare various variables, explore trends, and identify factors potentially influencing TKA outcomes. A cohort of 40 TKA subjects received either unilateral posterior stabilized (Persona) TKA or bi-cruciate stabilized (Journey II) TKA. Additionally, 20 healthy controls matched for age, gender, and BMI were included. Participants underwent patient-reported outcome assessments, range of motion evaluations, balance assessments, proprioception tests, and biomechanical analyses. These analyses covered motion, loading, and electromyography during five daily activities and two clinical tests. Multifactor ANOVA was utilized to compare 283 variables and assess their impact on TKA outcomes. A knee biomechanics index was formulated to evaluate deviations from healthy norms. Significant differences were observed in EMG varus/valgus rotation during both ramp-up and ramp-down phases between the two implant groups. Although significant improvements were noted post-TKA for both implants, the results remained below those of the control group. Gender, age, and BMI exhibited noticeable effects on TKA outcomes across several biomechanical variables and demonstrated significant disparities compared to the controls. Full article

Television series enhance the social visibility of their content, as is the case with Queen Elizabeth II and The Crown. Netflix is the streaming television platform that has turned Peter Morgan’s successful series (2016) into a television icon where the monarch is the main protagonist, taking us on a biographical journey that mixes the historical and the political with fiction. The main character is made to seem more humane and is brought closer to the general public, all of which leads to a transmedia narrative. This research aims to analyze the content of the messages published on Twitter during the days surrounding the Queen’s State funeral in September 2022 and their connection with the series through the hashtag #TheCrown. The topics that have become trends worldwide are quantitatively analyzed, using different digital tools. The sample collected 1,489,279 tweets published during the days from the announcement of the death of Elizabeth II to the day of her funeral (from 8 to 19 September 2022). The results show nodes of connection between different players and linked communities to #TheCrown while offering the traffic generated by the hashtag with different nodes and edges. Full article

The field of audiology as a collection of auditory science knowledge, research, and clinical methods, technologies, and practices has seen great changes. A deeper understanding of psychological, cognitive, and behavioural interactions has led to a growing range of variables of interest to measure and track in diagnostic and rehabilitative processes. Technology-led changes to clinical practices, including teleaudiology, have heralded a call to action in order to recognise the role and impact of autonomy and agency on clinical practice, engagement, and outcomes. Advances in and new information on loudness models, tinnitus, psychoacoustics, deep neural networks, machine learning, predictive and adaptive algorithms, and PREMs/PROMs have enabled innovations in technology to revolutionise clinical principles and practices for the following: (i) assessment, (ii) fitting and programming of hearing devices, and (iii) rehabilitation. This narrative review will consider how the rise of teleaudiology as a growing and increasingly fundamental element of contemporary adult audiological practice has affected the principles and practices of audiology based on a new era of knowledge and capability. What areas of knowledge have grown? How has new knowledge shifted the priorities in clinical audiology? What technological innovations have been combined with these to change clinical practices? Above all, where is hearing loss now consequently positioned in its journey as a field of health and medicine? Full article

The journey of drug discovery (DD) has evolved from ancient practices to modern technology-driven approaches, with Artificial Intelligence (AI) emerging as a pivotal force in streamlining and accelerating the process. Despite the vital importance of DD, it faces challenges such as high costs and lengthy timelines. This review examines the historical progression and current market of DD alongside the development and integration of AI technologies. We analyse the challenges encountered in applying AI to DD, focusing on drug design and protein–protein interactions. The discussion is enriched by presenting models that put forward the application of AI in DD. Three case studies are highlighted to demonstrate the successful application of AI in DD, including the discovery of a novel class of antibiotics and a small-molecule inhibitor that has progressed to phase II clinical trials. These cases underscore the potential of AI to identify new drug candidates and optimise the development process. The convergence of DD and AI embodies a transformative shift in the field, offering a path to overcome traditional obstacles. By leveraging AI, the future of DD promises enhanced efficiency and novel breakthroughs, heralding a new era of medical innovation even though there is still a long way to go. Full article

This paper sheds light on the manufacturing processes, techniques, and materials used in the splendid illuminations of the oldest surviving copy of De Balneis Puteolanis, preserved at the Angelica Library in Rome (Ms. 1474). The codex is one of the masterpieces of mid-13th-century Italian-Southern illumination, traditionally referred to as the commission of Manfredi, son of Frederick II. The findings reported in the article result from the interdisciplinary study conducted in 2021–2023 in the framework of “Codex 4D: journey in four dimensions into the manuscript”, a multidisciplinary project involving many competences and dealing with art-historical studies on manuscripts, diagnostic and conservative analyses, scientific dissemination, storytelling, and public engagement. The considerations we present aims at increasing the knowledge of book artefacts while respecting their extraordinary complexity; data from non-invasive diagnostic investigations (X-ray fluorescence, Vis-NIR reflectance and Raman spectroscopies, hyperspectral imaging, and multi-band imaging techniques as ultraviolet, reflectography, and thermography), carried out in situ with portable instruments on the book, have been integrated with observations resulting from the historical-artistic study, and the reading of some ancient treatises on the production and use of the pigments and dyes employed in illumination. Full article

Background: Patients with complex proximal tibial plateau fractures (TPFs) tend to overestimate the prognosis of their injury, potentially due to factors such as a limited understanding, optimism, and the influence of the pain intensity. Understanding the reasons behind this misperception is crucial for healthcare providers to effectively communicate with patients and establish realistic expectations for treatment outcomes. The purpose of this study was to analyze the outcomes of TPFs, with a particular focus on patient-reported outcome measures concerning functional recovery, pain levels, and overall satisfaction with treatment. The authors aim to provide valuable insights into the realistic expectations and potential limitations that patients may encounter during their recovery journey. Methods: In this retrospective single-center study, all surgically treated TPFs between January 2014 and December 2019 with a minimum follow-up of 12 months were included. Several patient-reported outcome measures were obtained, including the International Knee documentation Committee Score (IKDC), Lyholm score, Tegner score, and visual analog scale (VAS) for pain. Fractures were classified according to Schatzker, and then subgrouped into simple (Schatzker I–III) and complex (Schatzker IV–VI) fractures. Results: A total of 54 patients (mean age 51.1 ± 11.9 years, 59.3% female) with a mean follow-up time of 3.9 years were included. Schatzker II fractures were present in 48% (n = 26) of the cases, with Schatzker III in 6% (n = 3), Schatzker IV fractures in 6% (n = 3), and Schatker VI fractures in 41% (n = 22) of the cases. All outcome scores showed a significant improvement between the first year after surgery and the last follow-up (mean: 3.9 years). Simple fractures showed significantly lower patient-reported outcomes when compared to the preinjury state; however, good to excellent results were observed. Patient-reported outcomes of complex fractures showed no significant changes in the study period with good to excellent results. When it comes to the Lysholm score, there were no significant differences in the outcome between simple and complex fractures. Furthermore, there was a return-to-sports rate of 100%, with high rates of changing sporting activity in 25% (simple fractures) and 45% in complex fractures. Conclusions: The data from this study showed that both simple and complex tibial plateau fractures show favorable outcomes at the midterm follow-up, and that injury severity does not correlate with worse results. While patients may tend to overestimate the recovery speed, this research highlights the importance of long-term follow-up, demonstrating a substantial improvement between one year post-surgery and the final evaluation. Return-to-sports rates were high, with adjustments needed for certain activities. However, patients should recognize the need to shift to lower-impact sports and the lengthy recovery process. Full article

Background: Glutaric aciduria type II (GA II), also known as multiple acyl-CoA dehydrogenase deficiency (MADD), is a rare autosomal recessive metabolic disorder with varied manifestations and onset ages. Case Report: This study presents a distinctive case of a 10-year-old girl who experienced episodic, intermittent vomiting and epigastric pain, particularly aggravated by high-fat and sweet foods. Despite inconclusive physical examinations and routine laboratory tests, and an initial suspicion of cyclic vomiting syndrome, the persistence of recurrent symptoms and metabolic abnormalities (metabolic acidosis and hypoglycemia) during her third hospital admission necessitated further investigation. Advanced diagnostic tests, including urinary organic acid analysis and genetic testing, identified heterozygous pathogenic variants in the ETFDH gene, confirming a diagnosis of GA IIc. The patient showed a positive response to a custom low-protein, low-fat diet supplemented with carnitine and riboflavin. Significance: This case emphasizes the diagnostic challenges associated with recurrent, nonspecific gastrointestinal symptoms in pediatric patients, particularly in differentiating between common gastrointestinal disorders and rare metabolic disorders like GA II. It highlights the importance of considering a broad differential diagnosis to enhance understanding and guide future medical approaches in similar cases. Full article

(1) Background: Unicompartmental knee arthroplasty (UKA) provides a viable alternative to total knee arthroplasty (TKA) in patients with isolated medial osteoarthritis (OA). From 2007 to 2021, 23% of all primary knee arthroplasties in Italy were UKAs. We retrospectively evaluated clinical outcomes and satisfaction in patients implanted with a new oxinium metal-backed fixed-bearing medial unicompartmental prosthesis at a 24-month follow-up. (2) Methods: From December 2020 to December 2021, 145 patients were treated by a single surgeon at a single institution using the hypoallergenic Journey II prosthesis. Clinical outcome measures included the Knee Society Knee Score (KSKS), Knee Society Function Score (KSFS), Oxford Knee Society (OKS) score, University of California Los Angeles Activity Score (UCLA), the Physical Component Summary (PCS), and the Mental Component Summary (MCS), and were calculated preoperatively and at 12 and 24 months. The Forgotten Joint Score-12 (FJS-12) was calculated at 12 and 24 months. Patient satisfaction was collected at 24 months. The scores were compared using the Friedman test. (3) Results: All clinical scores improved significantly from baseline to 24 months (p < 0.0001), except for the FJS-12, which from 12 to 24 months did not improve significantly (p = 0.041). Patient satisfaction was 9.32 ± 0.74 out of 10. No patient experienced complications or required revision surgery. (4) Conclusions: The Journey II unicompartmental prosthesis is a valuable treatment option for end-stage medial OA, improving knee function, providing pain relief, and ensuring high patient satisfaction at 24 months. Full article

Breast cancer (BC) significantly impacts the quality of life (QoL) of affected individuals. This study, conducted at Colțea Clinical Hospital, Bucharest, aimed to assess the impact of organ failures and metastases on QoL in breast cancer patients using EORTC QLQ-C30 and EORTC QLQ-BR45 questionnaires and the survival rate to understand the clinical journey and the quality of life status in breast cancer patients. From January 2019 to October 2022, a prospective, observational study surveyed 874 patients, revealing 201 fatalities, 66 refusals, and 607 eligible participants. Results indicated statistically significant differences in various QoL aspects for patients experiencing heart failure, including physical functioning, pain, insomnia, global health status, and overall summary score. Kidney failure exhibited significance in physical functioning for QLQ-C30 and body image, sexual functioning, and endocrine sexual symptoms for QLQ-BR45. Respiratory failure demonstrated significant differences across multiple QoL domains. Patients with bone metastases reported lower physical functioning (p = 0.006) and increased pain (p = 0.002). This study has revealed an overall 5-year life expectancy of 68.8%, with survival rates of 93.8% for Stage I, 86.3% for Stage II, and 77.2% for Stage III breast cancer. Metastatic cancer patients have shown a 35.6% survival rate over 45 months, with a median survival duration of 36 months. A significant limitation of our study was the administration of the questionnaire only once, preventing us from quantifying the impact of specific treatment types on quality of life. This study emphasizes the necessity of using standardized QoL assessments in clinical practice from the initial presentation to ongoing follow-up. Full article

Since the first discovery in 1989, the β3-adrenoceptor (β3-AR) has gained great attention because it showed the ability to regulate many physiologic and metabolic activities, such as thermogenesis and lipolysis in brown and white adipose tissue, respectively (BAT, WAT), negative inotropic effects in cardiomyocytes, and relaxation of the blood vessels and the urinary bladder. The β3-AR has been suggested as a potential target for cancer treatment, both in adult and pediatric tumors, since under hypoxia its upregulation in the tumor microenvironment (TME) regulates stromal cell differentiation, tumor growth and metastases, signifying that its agonism/antagonism could be useful for clinical benefits. Promising results in cancer research have proposed the β3-AR being targeted for the treatment of many conditions, with some drugs, at present, undergoing phase II and III clinical trials. In this review, we report the scientific journey followed by the research from the β3-Ars’ discovery, with focus on the β3-Ars’ role in cancer initiation and progression that elects it an intriguing target for novel antineoplastic approaches. The overview highlights the great potential of the β3-AR, both in physiologic and pathologic conditions, with the intention to display the possible benefits of β3-AR modulation in cancer reality. Full article