Search Results (683)

Maritime transportation accounts for approximately 80 percent of global trade volume, with modern vessels increasingly reliant on Software-Defined Radio (SDR) technologies for communication and navigation. However, the very flexibility and reconfigurability that make SDRs advantageous also introduce complex radio frequency vulnerabilities exposing ships to threats that jeopardize vessel security, and this disrupts global supply chains. This survey paper systematically examines the security landscape of maritime SDR systems through a threat modeling lens. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we analyzed 84 peer-reviewed publications (from 2002 to 2025) and applied the STRIDE framework to identify and categorize maritime SDR threats. We identified 44 distinct threat types, with tampering attacks being most prevalent (36 instances), followed by Denial of Service (33 instances), Repudiation (30 instances), Spoofing (23 instances), Information Disclosure (24 instances), and Elevation of Privilege (28 instances). These threats exploit vulnerabilities across device, software, network, message, and user layers, targeting critical systems including Global Navigation Satellite Systems, Automatic Identification Systems, Very High Frequency or Digital Selective Calling systems, Electronic Chart Display and Information Systems, and National Marine Electronics Association 2000 networks. Our analysis reveals that maritime SDR threats are multidimensional and interdependent, with compromises at any layer potentially cascading through entire maritime operations. Significant gaps remain in authentication mechanisms for core protocols, supply chain assurance, regulatory frameworks, multi-layer security implementations, awareness training, and standardized forensic procedures. Further analysis highlights that securing maritime SDRs requires a proactive security engineering that integrates secured hardware architectural designs, cryptographic authentications, adaptive spectrum management, strengthened international regulations, awareness education, and standardized forensic procedures to ensure resilience and trustworthiness. Full article

In the fields of geographic information science and location-based services, the fusion of multisource Point-of-Interest (POI) data is of remarkable importance but faces several challenges. Existing matching methods, including those based on single non-spatial attributes, single spatial geometric features, and traditional hybrid methods with fixed rules, suffer from limitations such as reliance on a single feature and inadequate consideration of spatial context. This study takes Dongcheng District, Beijing, as the research area and proposes a POI-matching method based on multi-feature value calculation and a deep neural network (DNN) model. The method comprehensively incorporates multidimensional features such as names, addresses, and spatial distances. Additionally, the approach also incorporates an improved multilevel name association strategy, an address similarity calculation using weighted edit distance, and a spatial distance model that accounts for spatial density and regional functional types. Furthermore, the method utilizes a deep learning model to automatically learn POI entity features and optimize the matching rules. Experimental results show that the precision, recall, and F1 value of the proposed method achieved 97.2%, 97.0%, and 0.971, respectively, notably outperforming traditional methods. Overall, this method provides an efficient and reliable solution for geospatial data integration and POI applications, and offers strong support for GIS optimization, smart city construction, and scientific urban/town planning. However, this method still has room for improvement in terms of data source quality and algorithm optimization. Full article

Background: This study seeks to evaluate the 23 year experience of the İnonu University Liver Transplantation Institute from a public health perspective by examining demographic patterns, etiological factors, and transplantation trends between 2002 and 2025. Aims: This analysis aims to provide insights into the epidemiological landscape of liver transplantation in Türkiye from a public health perspective. Methods: In this retrospective cross sectional study, we analyzed 4011 liver transplant procedures performed between March 2002 and March 2025. Recipient demographics, disease etiologies, donor characteristics, and patients geographic distribution were assessed to delineate regional health needs and service utilization patterns. Results: A total of 4011 patients were included. The cohort comprised 2618 males (65.3%) and 1393 females (34.7%). Recipients were classified as adult (n = 3232, 80.9%) or pediatric (n = 779, 19.1%). Among adults, infectious etiologies were the most prevalent (35.5%), followed by cryptogenic liver cirrhosis (24.7%). In contrast, pediatric patients most commonly presented with toxic etiologies (29.4%), metabolic disorders (22.6%) and bile duct diseases (15.9%). Most liver transplantations were performed using living donors (n = 3481, 86.8%), while deceased donors accounted for 530 procedures (13.2%). Additionally, 244 living donor liver transplantations were performed via liver paired exchange (LPE). Conclusions: These findings may inform resource allocation, health policy development, and the optimization of transplantation services. This center-based model offers a useful framework for characterizing regional health needs and strengthening community health, particularly through prevention, screening, and early intervention strategies for liver diseases. Full article

A robust audit services market is essential for ensuring financial transparency, regulatory compliance, and investor confidence. As a dimension of organizational sustainability, the capacity of audit firms to remain competitive and resilient under market pressures is increasingly relevant. However, existing research has paid insufficient attention to the stability of audit firms and the survival dynamics of mid-sized players. The present study addresses this gap by examining the volatility of the U.S. audit services market and the sustained dominance of the Big Four firms over the 2019–2023 period. Based on data from Accounting Today’s annual rankings, the study employs Kaplan–Meier survival analysis to assess the probability of audit firms remaining in the Top 100 over time. Furthermore, K-means clustering is used to identify structural factors contributing to firm exit, including revenue, number of employees, branches, and partners. The results indicate that, while the Big Four retained stable leadership, 19 firms exited the rankings, with revenue and number of specialists being the most influential exit factors. These findings provide insights for enhancing risk assessment, strategic planning, and regulatory design. Moreover, the study contributes to broader discussions on organizational sustainability and long-term competitiveness within the context of the U.S. audit sector, while offering insights that may be informative for understanding similar dynamics in other markets rather than aiming for direct global generalization. Full article

Background/Objectives: Vaccination programs are highly effective public health interventions, yet parental hesitancy toward combination vaccines has led to growing demand for alternative vaccination schedules, defined in this study as parental requests to split or replace recommended combination vaccines with single-antigen vaccines for non-clinical reasons. While parental attitudes have been widely studied, little empirical evidence exists on the real-world use of single-antigen vaccines and their public health implications in countries with otherwise high coverage. This study examined the prevalence patterns and parental motivations for requesting such alternative vaccination schedules in Israel, where national guidelines recommend specific combination vaccines, including measles-mumps-rubella-varicella (MMRV) and the pentavalent diphtheria-tetanus-pertussis–inactivated polio–Haemophilus influenzae type b (DTaP+IPV+Hib) vaccines, but informal accommodations exist. Methods: A mixed-methods design was employed: a retrospective cohort analysis of vaccination data from 2018 to 2021 (before and during the COVID-19 pandemic) focused on measles (first dose at 12 months) and pertussis (four-dose primary series), followed by semi-structured interviews with Maternal and Child Health clinic providers, policymakers, and parents. Results: Alternative vaccination schedules involving single-antigen measles or pertussis vaccines are occasionally used despite official policy, accounting for less than 1% of vaccinations overall. Outcomes include delayed administration, lower uptake of combination vaccines, and incomplete protection in certain groups. Parents cited safety concerns, fear of immune overload, and mistrust of authorities. These concerns were often amplified by misinformation, while providers described balancing parental preferences with the need for adequate coverage. Conclusions: This study provides new evidence on how vaccine hesitancy translates into service utilization, highlights the tension between individualized parental decision-making and contribution to collective health, and underscores the need for communication, policy strategies and service designs that sustain high coverage while addressing community-specific concerns. Full article

Background: Psychological services within hospitals are essential to delivering integrated, patient-centred care, yet in many health systems they remain fragmented, variably organised, or confined to specific medical specialties. The Clinical Psychology Unit of the Fondazione Policlinico Universitario Agostino Gemelli, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), represents one of the few examples of a hospital-wide psychological governance model in Italy, but its organisational structure and longitudinal activity have not previously been systematically described. Objective: This study (I) describes the organisational design and operational components of the Gemelli Unit; (II) compares it with international organisational models using a typological framework; and (III) examines its resilience and adaptive capacity during the coronavirus disease 2019 (COVID-19) pandemic. Methods: A descriptive–narrative approach was adopted, integrating institutional documentation, routinely collected service data (2019–2024), anonymised case vignettes, and a structured comparison with national and international psychological care structures. The analysis was informed by theoretical models of integrated health-care delivery and by Donabedian’s structure–process–outcome framework. Results: Between 2019 and 2024, psychological interventions increased from 28,878 to 47,076 (+63%), with a post-pandemic average of 41,868 annual interventions. In 2024, the Unit supported 2150 patients and 340 healthcare professionals, with psycho-oncology accounting for approximately one-third of all activities. The model integrates clinical activity, staff support, conflict management, research, and training under a centralised governance structure, ensuring hospital-wide coverage and coordinated referral pathways. The comparative analysis identified four international organisational types—department-based, liaison/specialty-based, structured health-system, and academic–clinical hybrid—highlighting the hybrid and transversal nature of the Gemelli Unit and its capacity to maintain and adapt services during the COVID-19 emergency. Conclusions: The Gemelli Unit represents a distinctive hospital-wide organisational model that combines centralised governance, transversal deployment, personalised care, and structured support for healthcare professionals. These characteristics position it as a potentially transferable benchmark for health systems seeking to integrate psychological care into core organisational and clinical processes. Future work should prioritise the development of standardised outcome indicators and national frameworks to support the evaluation and harmonisation of hospital-based psychological services. Full article

The loss of urban nature and declining biodiversity pose significant challenges to the sustainability of cities and the well-being of their inhabitants. Existing initiatives such as the Taskforce on Nature-related Financial Disclosures (TNFD) have begun to address ecological risks in real estate, but they still address mental health, biodiversity, and social equity only partially as non-financial values. This article adopts an integrative review and conceptual framework approach. It develops a nature-based accounting framework for urban real estate that combines principles of traditional Chinese architecture with contemporary sustainability metrics. The study reviews ecological theory, nature-related accounting, and evidence on biodiversity and mental health, and then undertakes an operational mapping from classical site planning, courtyard design, water management, and community structures to measurable indicators that remain compatible with TNFD-aligned reporting. The framework groups indicators into three main domains: nature-related conditions, ecosystem service pathways, and human well-being outcomes. It also outlines simple procedures for normalising and combining these indicators at the project scale to support assessments of biodiversity, microclimate, mental health, and basic aspects of cost-effectiveness and social accessibility in urban real estate projects. The paper provides a structured, heritage-informed basis for future applications and empirical testing, helping to incorporate biodiversity, mental health, and equity into urban real estate assessment. Full article

Background: Carpal tunnel syndrome (CTS) is a common peripheral neuropathy with increasing prevalence and economic burden. This study aimed to analyze recent trends in CTS treatment patterns, healthcare utilization, and costs within the dualized healthcare system in Korea, using nationwide claim data. Methods: This cross-sectional study used data from the Korean Health Insurance Review and Assessment Service National Patient Sample (HIRA-NPS) between 2010 and 2017. Patients with a primary diagnosis of CTS (KCD-10: G56.0) were included. Descriptive analyses were performed to examine trends in patient characteristics, healthcare utilization, treatment patterns, and medical costs in Western and Korean medicine. Results: A total of 29,112 patients with CTS were analyzed. In Western medicine, diagnostic tests accounted for the highest expenditure, particularly X-ray, nerve conduction studies, and electromyography. Over time, X-ray utilization increased, while nerve conduction and electromyography tests decreased. The proportion of surgical treatment declined from 11.28% in 2010 to 8.55% in 2017, whereas Korean medicine use increased from 9.41% to 15.08%, mainly consisting of acupuncture and related procedures. Conclusions: Korea exhibited a lower CTS surgery rate than other countries, alongside a rising trend in Korean medicine utilization. These findings underscore the distinctive dual healthcare system in Korea and highlight the need for prospective studies to assess the long-term effectiveness of Korean medicine-based conservative treatments. Additionally, the results may inform national health policy decisions, including insurance coverage and resource allocation for CTS management. Full article

Establishing a mechanism for ecological product value realizing (EPVR) is a critical component of China’s ecological civilization strategy, aimed at translating the concept that “lucid waters and lush mountains are invaluable assets” into actionable economic policies. Although central government investments in the form of project for EPVR have increased significantly, surpassing CNY 700 billion by 2024, studies rarely focus on these projects and how to evaluate them. Evaluating the performance of EPVR projects is essential for optimizing resource allocation, enhancing project accountability, and ensuring the sustainable realization of ecological, economic, and social values. This study innovatively defines the conceptual connotation of EPVR projects and constructs a comprehensive performance evaluation system based on a “benefit-cost” analysis, comprising a multi-dimensional indicator system, quantifiable calculation methods, and explicit evaluation criteria. As water source protection projects are typical EPVR projects, the comprehensive water environment management project of Hongfeng Lake is selected for an in-depth empirical study. The results reveal that (1) the total annual benefits amount to CNY 923.66 million, dominated by ecological benefits (84.04%); (2) with an investment of CNY 1194.66 million, the project yields a net loss and a moderate performance index (PCPI = 0.77); (3) the project performance is primarily affected by weak economic value conversion stemming from restrictive zoning policies and underdeveloped market mechanisms for ecological services; and (4) integrated development pathways—such as ecotourism, eco-aquaculture, and ecological branding—are proposed to enhance the long-term sustainability of the project. The Hongfeng Lake case establishes a replicable framework for global assessment of analogous projects and delivers actionable insights for enhancing benefit–cost ratios in public ecological initiatives, with costs confined to data collection, modeling, and validation. Therefore, this study contributes a quantifiable and reproducible tool for the full lifecycle management of EPVR projects, thereby facilitating more informed government decision-making. Key findings reveal the following: (1) A comprehensive “Benefit-Cost” performance evaluation framework, pioneered in this study and tailored specifically for individual EPVR projects, surpasses regional-scale accounting methodologies like Gross Ecosystem Product (GEP). (2) A novel consolidated metric (PCPI) is introduced to integrate ecological, economic, and social dimensions with cost input, thus enabling direct cross-project comparison and classification. (3) The framework operationalizes evaluation by providing a detailed, adaptable indicator system with explicit monetization methods for 26 distinct benefits, thereby bridging the gap between theoretical value accounting and practical project assessment. (4) The empirical application to a drinking water source protection project addresses a critical yet understudied category of EPVR projects, offering insights into “protection-oriented” models. Full article

The integration of IT services is a critical challenge for public organizations that seek to modernize their operational ecosystems and strengthen mission-oriented processes. In the field of fiscal oversight, supreme audit institutions (SAIs) increasingly require systematized and interoperable service architectures to ensure transparency, accountability, and effective public resource control. However, existing literature reveals persistent gaps concerning how service integration models can be deployed and validated within complex government environments. This study describes an enterprise architecture-driven service integration model designed and evaluated within the Office of the General Comptroller of the Republic of Colombia (Contraloría General de la República, CGR). The study tests the hypothesis that an Enterprise Architecture-driven integration model provides the necessary structural coupling to align technical IT performance with the legal requirements of fiscal oversight, which is an alignment that typically does not appear in generic governance frameworks. The methodological approach followed in this study combines an IT service management maturity assessment, process analysis, architecture repository review, and iterative validation sessions with institutional stakeholders. The model integrates ITILv4 (Information Technology Infrastructure Library), TOGAF (The Open Group Architecture Framework), COBIT (Control Objectives for Information and Related Technologies), and ISO20000 into a coherent framework tailored to the operational and regulatory requirements of an SAI. Results show that the proposed model reduces service fragmentation, improves process standardization, strengthens information governance, and enables a unified service catalog aligned with fiscal oversight functions. The empirical validation demonstrates measurable improvements in service delivery, transparency, and organizational responsiveness. The study contributes to the field of applied system innovation by: (i) providing an integration model, which is scientifically grounded and evidence-based, (ii) demonstrating how hybrid governance and architecture frameworks can be adapted to complex public-sector environments, and (iii) offering a replicable approach for SAIs that seek to modernize their technological service ecosystems through enterprise architecture principles. Future research directions are also discussed to provide guidelines to advance integrated governance and digital transformation in oversight institutions. Full article

Sixth-generation (6G) wireless systems aim to integrate terrestrial, aerial, and satellite networks to support large-scale remote sensing and service delivery. In such non-terrestrial networks (NTNs), channels change quickly and the multi-tier architecture is heterogeneous, which makes real-time channel state acquisition and cooperative resource scheduling difficult. This paper proposes an FMA-MADDPG framework that combines a channel prediction module with a constraint-based multi-agent deep deterministic policy gradient scheme. The Fusion of Mamba and Attention (FMA) predictor uses a Mamba state-space backbone and a multi-head self-attention block to learn both long-term channel evolution and short-term fluctuations, and forecasts future CSI. The predicted channel information is added to the agents’ observations so that scheduling decisions can take expected channel variations into account. A constraint-based reward is also designed, with explicit performance thresholds and anti-idle penalties, to encourage fairness, avoid free-riding, and promote cooperation among heterogeneous agents. In a representative NTN uplink scenario, the proposed method achieves higher total reward, efficiency, load balance, and cooperation than several DRL baselines, with relative gains around 10–20% on key metrics. These results indicate that prediction-aware cooperative reinforcement learning is a useful approach for resource optimization in future 6G NTN systems. Full article

Investors use information about companies’ social and environmental performance to make investment decisions, a strategy known as Environmental, Social, and Governance (ESG) investment analysis. ESG screening may offer a mechanism to incentivize corporations to improve their health impact. However, there has been limited investigation of the extent to which ESG investment frameworks capture corporate health impacts in major industries. In this study, we sought to characterize the extent to which ESG frameworks address the health-impacting activities of the food and beverage (F&B) industry. To do this, we conducted a deductive framework analysis during the period of September 2023 to March 2024. Specifically, we identified gaps in existing ESG frameworks by comparing the content of five ESG reporting standards and rating systems to the HEALTH-CORP-FB typology, an evidence-based typology that describes the health-impacting activities of the F&B industry across seven domains (Governance Practices, Political Practices, Preference and Perception Shaping Practices, Economic Practices, Employment Practices, Products and Services, and Environmental Practices). To further assess how ESG frameworks account for the health-impacting activities of the F&B industry, we classified health-focused ESG fields in the packaged foods subindustry by two attributes: relevance to the assigned HEALTH-CORP-FB activity (low, medium, high) and type of business operations addressed (e.g., process, performance). Results indicate that, on average, the ESG fields (n = 1348) covered 39% of the 89 HEALTH-CORP-FB activities (range across frameworks: 27–48%). Higher proportions of activities in the Governance, Environmental, Employment, and Economic Practices domains (range across domains: 43–87%) were represented than activities in the Products and Services, Preference and Perception-Shaping Practices, and Political Practices domains (17–36%). Fields assigned to the latter domains were also less likely to be deemed highly relevant and to measure corporate performance. We conclude that the ESG frameworks included in this study capture some of the activities of the F&B industry that affect population health and health equity; however, critical gaps remain. We discuss how integrating key health-focused ESG indicators (e.g., revenue generation from ultra-processed foods) into existing frameworks could enable investors, public health organizations, civil society, and shareholder advocates to strengthen the accountability of the F&B sector with respect to health. Full article

This article examines the maternal healthcare experiences of ten Brazilian women during Portugal’s obstetric crisis, focusing on access, use, and quality of care throughout the perinatal and childbirth periods. Using a qualitative approach based on semi-structured interviews, this study explores women’s perceptions of the adequacy and quality of maternal healthcare, contributing to a deeper understanding of their experiences within the Portuguese health system. Thematic analysis revealed persistent barriers to accessing services, linked to limited knowledge of the healthcare system, lack of awareness of legal rights, discrimination, and other structural obstacles. Participants expressed dissatisfaction with the clarity and quality of information provided by healthcare professionals, their communication skills, and the limited access to specialized care. They also described feeling undervalued by healthcare providers and reported an absence of emotional and psychosocial support during pregnancy, childbirth, and the postpartum period. Accounts of disrespectful and abusive practices highlight the vulnerability of migrant women. This study underscores the urgent need to recognize and address migrant women’s needs. Beyond access, policies should promote equity, cultural responsiveness, and intercultural dialogue to ensure respectful, person-centered maternal care. Full article

Background: Optimal nutritional care is essential to improving outcomes in hemodialysis, yet translation of evidence into routine practice remains uneven across settings. To inform health system planning and implementation priorities, we mapped global research on hemodialysis-related nutrition. Methods: We searched the Web of Science Core Collection for English-language original articles on nutrition and hemodialysis from 1 January 2006 to 13 October 2025. Publication trends, productivity by country and institution, influential journals and authors, citation impact, and conceptual structure via Keyword Plus co-occurrence, trend, and thematic evolution analyses were assessed using the bibliometrix package (version 5.0) in R. Results: A total of 332 articles from 115 journals were identified, with substantial growth and multidisciplinary authorship, though international collaboration remains limited. The United States contributed 21.4% of publications and achieved the highest citation impact, while China, Japan, Iran, and Brazil formed the next tier of contributors. The Journal of Renal Nutrition accounted for 16.6% of papers. Highly cited studies established links between dietary intake, mineral and electrolyte management, and survival, while supporting the use of intradialytic oral nutritional supplements. Thematic evolution showed a shift from biochemical markers toward patient-centered priorities, including diet quality, adherence, body composition, mental health, and quality of life. Emerging directions point to whole-diet approaches and microbiome-modulating strategies. Conclusions: Global research on diet and hemodialysis has progressed from foundational nutrient studies to multidimensional, patient-focused approaches. Our findings suggest opportunities for health systems to strengthen dietitian-led models of care, integrate patient-reported outcomes, and prioritize scalable nutrition interventions within routine dialysis services. Full article

Background: Non-communicable diseases (NCDs) such as cardiovascular diseases, diabetes, obesity, and cancer are the leading cause of mortality globally and in Saudi Arabia, accounting for more than 70% of all deaths. Despite national initiatives offering free preventive services, screening uptake remains low. This study aimed to describe the demographic and clinical characteristics of individuals participating in community-based NCD screening campaigns in the Eastern Province of Saudi Arabia and to evaluate screening uptake, compliance, and diagnostic outcomes. Methods: A retrospective cross-sectional analysis was conducted among 3106 adults screened at volunteer-driven community campaigns held between January 2023 and December 2024. Screening included anthropometric measurements, blood pressure assessment, and glucose testing, followed by eligibility evaluation for osteoporosis and cancer screening. Uptake and compliance were verified using electronic health records. Descriptive and inferential statistical analyses were applied. Results: Participants were 64% male and 36% female, with a mean age of 41.4 ± SD years. Obesity, hypertension, and diabetes were identified in 32%, 31%, and 12% of participants overall. Gender-stratified prevalence showed higher obesity among females at 36% (95% CI 32.3 to 38.1) and higher hypertension and diabetes among males at 36% (95% CI 34.0 to 38.2) and 14% (95% CI 12.1 to 15.2), respectively. Uptake among eligible individuals was 51% for dual-energy X-ray absorptiometry (DEXA), 47% for fecal immunochemical testing (FIT), 43% for Pap smear, and 39% for mammography. Diagnostic findings demonstrated substantial undetected disease burden, including osteoporosis in 41% (95% CI 26.0 to 56.8) of DEXA scans, a FIT positivity rate of 5% (95% CI 1.5 to 10.3), abnormal Pap cytology in 3% (95% CI 1.1 to 7.5), and BI-RADS 0 mammograms in 19% (95% CI 11.9 to 29.5), reflecting incomplete assessments requiring further evaluation. Conclusions: Community-based campaigns can effectively resolve limited engagement in health promotional activities and detect substantial burdens of undiagnosed NCDs. However, improvements in referral tracking, follow-up systems, and culturally tailored health education are essential to enhance screening compliance and early detection outcomes. These results can be utilized to inform public policies by extending screening services to additional areas, increasing investment in preventive health campaigns, and enhancing the capacity of the health system. Full article