Search Results (7,379)

Household waste systems are a frontline test of Australia’s circular economy transition, yet progress remains highly uneven and structurally constrained. Despite strong national targets for resource recovery and emissions reduction, local governments are expected to deliver circular outcomes without uniform access to infrastructure, funding, or technical capability. This study assesses the status, implementation, and progress of household waste management, energy recovery, and circular economy initiatives at the local government level in Australia. Using content analysis of data from 520 local government areas across six states, the study maps differences in service provision (e.g., general waste, mixed recycling, and food organics and garden organics [FOGO] collection), policy instruments, public-facing education, and participation in circular economy programs. The findings reveal that while a majority (92.5%) of councils provide general waste bins, 47% offer FOGO bins, and 78% supply mixed recyclable bins, only a small fraction (2.6%) offers a separate glass bin stream. Fewer than one in ten councils reference any form of energy recovery or waste-to-energy initiative, indicating that resource–energy integration remains emergent and geographically concentrated. Despite national policies such as the National Waste Policy Action Plan, significant regional disparities persist, particularly between metropolitan and rural councils. Guided by environmental governance theory and systems thinking, the study shows how policy fragmentation, funding limitations, and infrastructure inequities create systemic barriers to circularity. The study concludes by recommending targeted co-funding for rural councils, stronger policy support for organics and energy recovery infrastructure, and more coherent multi-level governance to achieve Australia’s 2030 waste and circular economy targets. This research contributes an evidence-based framework for understanding how governance structures and resource asymmetries shape local progress toward a circular economy. Full article

Background: Superior semicircular canal dehiscence (SSCD) is characterized by a bony defect of the superior semicircular canal (SSC), leading to vestibular and auditory symptoms. A process of spontaneous “auto-plugging,” in which the overlying dura mater progressively occludes the SSC, may replicate the effects of surgical canal plugging but remains under-recognized. The present study reports diverse clinical, instrumental, and 3d High Resolution MRI findings in patients with SSCD and subsequently confirmed to present with spontaneous complete or partial auto-plugging. Methods: We retrospectively reviewed 11 patients with SSCD diagnosed on high-resolution CT and suspected auto-plugging based on clinical atypia and large dehiscence (>4 mm). Patients underwent comprehensive neurotological assessment, including pure-tone audiometry, vestibular testing, and HR MRI with 3D labyrinthine reconstructions to identify partial or complete auto-plugging. Auto-plugging was classified as partial (Canalis semicircularis superior depressus) or complete (absence of endolymph fluid signal; Canalis semicircularis superior obturatus). Results: Among 13 ears with auto-plugging, 6 were partial and 7 complete. The mean SSCD size in auto-plugged ears was 5.5 mm. Most ears had normal or near-normal vestibular function on VHIT, with minimal air-bone gaps and preserved VEMP responses. Imaging demonstrated varying degrees of dural contact with the SSC, confirming partial or complete canal occlusion. Conclusions: Spontaneous auto-plugging of the SSC is a plausible, under-recognized phenomenon that may reproduce functional effects of surgical plugging. Dedicated 3D labyrinthine MRI enhances detection and characterization. Prospective multimodal studies are needed to clarify the pathophysiology, progression, and clinical implications, optimizing patient selection for surgical versus conservative management. Full article

Background/Objectives: Vitamin D deficiency contributes to pathological vertebral fragility (path-VF), including fragility fractures and early pedicle screw loosening after posterior instrumented spinal fusion (PISF). Supplementation practices remain inconsistent. This retrospective study evaluated whether patients with path-VF receive appropriate vitamin D3 (Vit.D3) supplementation and assessed the dose–response relationship between daily intake and path-VF risk, particularly in older adults. Methods: A total of 210 patients treated with kyphoplasty or PISF (2022–2023) were classified into a path-VF or control group. Daily oral Vit.D3 intake was categorised as Zero- (0 IU), Low- (<2000 IU), or High-Dose (≥2000 IU). Statistical analyses were performed for each dosage group, including subgroup analyses for patients aged ≥67.5 years. Vertebral BMD was estimated using mean Hounsfield Units (HU) from T11–L5. Results: Patients in the path-VF group received significantly lower Vit.D3 doses than controls (1431.4 ± 1055.7 vs. 2366.7 ± 1186.7 IU/day, p < 0.001). Low-dose supplementation was associated with a markedly increased risk of path-VF compared with high-dose in the overall cohort (OR = 6.5, p = 0.003) and in patients aged ≥67.5 years (OR = 8.6, p = 0.008). Logistic regression identified a threshold of 1900 IU/day (AUC = 0.805). Mean vertebral HU values were significantly lower in the path-VF group than in controls (71.9 ± 29.1 vs. 133.5 ± 52.6, p < 0.001), and no consistent HU gains were observed with increasing Vit.D3 dosage. Conclusions: Low-dose Vit.D3 supplementation was associated with increased path-VF risk, especially in patients aged >67.5 years. Patients without path-VF had received significantly higher doses, suggesting broader benefits of adequate Vit.D3 beyond bone density. A daily intake above 1900 IU may serve as a practical threshold for at-risk elderly patients. Full article

Existing observation instruments to measure differentiated instruction often lack insight into the degree to which teachers’ decisions match the actual needs of their students, and neglect the importance of preparation and evaluation. This article describes the psychometric evaluation of a comprehensive instrument (Assessing Differentiation in All Phases of Teaching; ADAPT) that does not suffer from these shortcomings. To assess its quality, 41 raters used it to score videos of lessons and interviews of 86 primary school teachers. A 5-dimensional item-response model showed good fit and high internal consistency, and a decision study was conducted to determine the reliability and agreement coefficients for different numbers of raters. For the intended low-stakes use, a single rater would be enough to provide a reliable estimate of a teacher’s overall score. Finally, rater experiences showed that ADAPT has high practical value due to the comprehensive manual and detailed score descriptions and examples. The instrument can therefore not only be used for research purposes, but can also serve as a valuable resource for teachers and teacher educators in practice. Full article

The primary goal of the present study was to assess the efficacy of the inflation-targeting framework (ITF) within the Egyptian economy. This was achieved by scrutinizing the monetary policy framework (MPF) from 2005 to 2022 and measuring its effectiveness in realizing monetary policy objectives (MPs). The approach involved constructing a macroeconomic model that captures the interconnections among macroeconomic variables (real and monetary), whether they serve as targets or instruments of MP or are otherwise closely associated variables. The model also helps to estimate the sensitivity coefficients of macroeconomic variables (real and monetary) related to changes in interest rate, exchange rate, money supply, and real output and then to identify how the impact transfers between monetary variables and related macroeconomic variables, as well as the amount of that impact. Using a quarterly series constructed from the original annual data via a Bayesian temporal disaggregation procedure (2005Q1–2022Q4), our findings conclude that there is a mechanism in the Egyptian economy to transfer the impact to and from the basic macroeconomic variables (household and investment expenditure, net exports, money demand, interest rate, and real output). This reflects the responses of the household and business sectors in their decisions on changes in both the real interest rate and the level of output. However, the extent to which the impact of monetary policy instruments was transmitted to the main monetary target value (money supply) and subsequently to real output (or economic growth) was significantly low, indicating the weak effectiveness of the ITF in the Egyptian economy. Full article

Background: Nurses experience substantial anxiety and depression; robust, validated instruments are needed. We aimed to identify tools used to assess these conditions in nurses. Methods: A systematic review was conducted in December 2024 and registered in OSF and PROSPERO. MEDLINE, Embase, CINAHL, and PsycINFO were searched for quantitative studies (2014–2024) in English/Spanish that included nurses only and used standardized measures. Two reviewers screened and extracted the data; quality was appraised with JBI checklists, narrative synthesis only. Results: Twenty-two studies (n = 10,710 nurses) met the criteria. Most were cross-sectional with non-probability sampling; the overall risk of bias was moderate in 19 studies and high in 3. The most frequently used instruments were PHQ-9, GAD-7, GHQ-28, and BDI; across versions, PHQ (PHQ-2/PHQ-9) predominated. Heterogeneity precluded meta-analysis. Discussion: The available tools support routine screening in nursing populations, but reliance on self-reports and scarce formal cross-cultural validation in practicing nurses limit inference and generalizability. Conclusions: Screening programs in nursing should pair brief self-report instruments with objective indicators and standardized protocols; future studies should prioritize contextualized validation and robust longitudinal designs. Full article

Background/Objectives: Ear, nose, and throat (ENT) presentations are common across the UK healthcare system and are often managed initially by junior doctors on call. Short, structured teaching interventions (e.g., boot camps and simulation workshops) have been introduced to improve confidence and preparedness. This review evaluated evidence published since 2015 on such ENT teaching interventions for junior doctors, examining effectiveness, study design, and outcome measures. Methods: Five databases were searched (January 2015–July 2025). Eligible studies assessed ENT-specific courses for junior doctors and reported outcomes on confidence, preparedness, knowledge, or performance. Study quality was appraised using the Medical Education Research Study Instrument (MERSQI). Owing to heterogeneity, findings were narratively synthesised in line with Synthesis Without Meta-analysis (SWiM) guidance. Results: Eleven studies (n = 591) met inclusion criteria: nine single-group pre–post studies, one two-group comparative study, and one randomised controlled trial (RCT). Most studies reported increased confidence after the interventions, while three also showed gains in knowledge. A minority reported improvement using blinded performance assessments. Overall methodological quality assessed using MERSQI scores was moderate (mean 10.0/18). Limitations included reliance on self-reported outcomes, limited use of control groups, and generally short follow-up periods. Conclusions: Short, structured ENT courses for junior doctors are associated with immediate improvements in confidence and knowledge, with some evidence of objective performance gains. However, the predominance of single-arm designs and brief follow-up limits causal inference and conclusions regarding retention, workplace behaviour, and patient outcomes. More robust comparative studies with blinded assessment and longitudinal follow-up are needed to determine sustained impact. Full article

Türkiye’s forest governance exhibits a persistent policy–implementation gap rooted in a governance paradox: while the Ecosystem-Based Functional Planning (EBFP) system promotes ecological integrity and adaptive management, the foundational Forest Law No. 6831 (1956) still legitimizes extractive uses under a broad “public interest” doctrine. This contradiction has enabled 94,148 permits covering 654,833 ha of forest conversion, while marginalizing nearly seven million forest-dependent villagers from decision-making. The study applies a doctrinal and qualitative document-analysis approach, integrating legal, institutional, and socio-economic dimensions. It employs a comparative design with five EU transition countries—Poland, Romania, Bulgaria, Czechia, and Greece—selected for their shared post-socialist administrative legacies and diverse pathways of forest-governance reform. The analysis synthesizes legal norms, policy instruments, and institutional practices to identify drivers of reform inertia and regulatory capture. Findings reveal three interlinked failures: (1) institutional and ministerial conflicts that entrench centralized decision-making and weaken environmental oversight—illustrated by the fact that only 0.97% of Environmental Impact Assessments receive negative opinions; (2) economic and ecological losses, with foregone ecosystem-service values exceeding EUR 200 million annually and limited access to carbon markets; and (3) participatory deficits and social contestation, exemplified by local forest conflicts such as the Akbelen case. A comparative SWOT analysis indicates that Poland’s confrontational policy reforms triggered EU infringement penalties, Romania’s fragmented legal restitution fostered illegal logging networks, and Greece’s recent modernization offers lessons for gradual legal harmonization. Drawing on these insights, the paper recommends comprehensive Forest Law reform that integrates ecosystem-service valuation, climate adaptation, and transparent participatory mechanisms. Alignment with the EU Nature Restoration Regulation (2024/1991) and Biodiversity Strategy 2030 is proposed as a phased transition pathway for Türkiye’s candidate-country obligations. The study concludes that partial reforms reproduce systemic contradictions: bridging the policy–law divide requires confronting entrenched political-economy dynamics where state actors and extractive-industry interests remain institutionally intertwined. Full article

Background/Objectives: The external validity of sarcopenia screening questionnaires in the elderly has been examined in several conditions but rarely evaluated in patients with rheumatoid arthritis (RA). This study aimed to determine the performance of five Thai versions of sarcopenia screening questionnaires (SARC-F [Strength, Assistance with walking, Rising from a chair, Climbing stairs, and Falls], SARC-CalF [SARC-F plus calf circumference], MSRA [Mini Sarcopenia Risk Assessment]-7, MSRA-5, and modified MSRA-5 questionnaires) in Thai RA patients, and evaluate the correlations among these instruments. Methods: In this cross-sectional study, consecutive adult RA patients (aged ≥20 years) from an outpatient rheumatology clinic completed the five sarcopenia screening questionnaires listed above. Sarcopenia was defined according to criteria of the 2019 Asian Working Group for Sarcopenia (AWGS). Appendicular skeletal muscle mass, grip strength, and physical performance were assessed using bioelectrical impedance analysis, a hand dynamometer, and a 6 m gait speed test, respectively. The cut-off values used for each sarcopenia screening questionnaire were pre-specified according to their respective established thresholds. Results: Of 299 RA patients (89.0% female, mean age of 61.3 ± 11.6 years, median [interquartile range] disease duration of 12.8 [8.2, 20.0] years), 37.5% and 27.4% of them had sarcopenia and severe sarcopenia, respectively. The areas under the receiver operating characteristic (ROC) curve for the SARC-F, SARC-CalF, MSRA-7, MSRA-5, and modified MSRA-5 questionnaires were 0.60, 0.74, 0.65, 0.62, and 0.65, respectively, with sensitivities of 34.8%, 73.2%, 77.7%, 68.8%, and 72.3% and specificities of 84.5%, 75.4%, 51.3%, 55.1%, and 58.3%, respectively. SARC-F demonstrated moderate correlations with the other questionnaires: SARC-CalF (r = 0.57), MSRA-7 (r = −0.52), MSRA-5 (r = −0.55), and modified MSRA-5 (r = −0.65), all with a p-value of <0.001. Conclusions: Sarcopenia is common among Thai RA patients. SARC-CalF had the best balance of sensitivity and specificity and is likely the most suitable sarcopenia screening questionnaire for Thai RA patients. Full article

Background/Objectives: The causal role of homocysteine (tHcy) in atrial fibrillation (AF) is unclear. To (re)explore the causal effect of tHcy in non-valvular AF (NVAF). Methods: In a case–control study in overweight/obese adults, cases were patients with NVAF and controls were their peers without AF. They were assessed for clinical, laboratory, and echocardiographic particulars and were genotyped for MTHFR 677C>T (rs1801133), PITX2 C>T (rs2200733), and KCNE1 112A>G (rs1805127) polymorphisms. We employed a conventional case–control, mediation analysis, and one-sample Mendelian randomization (MR) analyses to evaluate forward and reverse tHcy-NVAF associations. Results: We enrolled 180 cases and 179 controls. With an extensive confounder control (i) the MTHFR 677C>T variant allele associated with higher tHcy; (ii) PITX2 C>T variant allele associated with NVAF while KCNE1 112A>G did not; (iii) MTHFR variant associated with NVAF indirectly, through tHcy assuming wild type but not variant genotype (exposure–mediator interaction); (iv) considering all subjects, tHcy associated with NVAF through the effect on renal function and NT-proBNP levels (no exposure–mediator interaction); (v) considering MTHFR wild-type subjects (n = 160), tHcy “directly” strongly associated with NVAF, and considering variant carriers (n = 199), it indirectly associated with NVAF and directly tended to associate with a lower probability of NVAF; (vi) in MR analysis (MTHFR SNP instrument), tHcy associated with NVAF; and vii) mediation and MR analyses [PITX2 SNP (exposure/instrument)—NVAF, (mediator/exposure)—tHcy outcome] excluded the reverse tHcy-NVAF association. Conclusions: Data strongly support the causal role of tHcy in NVAF in overweight/obese patients and suggest that the effect might be modified by the MTHFR 677C>T variant allele. Full article

Objective: This cross-sectional survey aimed to comprehensively gather data on radial forearm free flap (RFFF) utilization and practices in head and neck reconstructive surgery. Methods: An online questionnaire was organized into seven sections: demographics, surgeon experience, harvesting techniques, microsurgical considerations, postoperative care, flap monitoring, and outcomes. It was distributed by email to 216 head and neck reconstructive surgeons who attended the International Federation of Head and Neck Oncologic Societies (IFHNOS) congress in Rome (21–25 June 2023) using the congress mailing list. Responses were collected from 54 surgeons (25% response rate), representing 15 countries across Europe, Asia, the Americas, and Oceania, underscoring the international scope of the survey between 5 February and 25 March 2024. The questionnaire was not formally piloted or validated. Missing data were managed on a per-question basis. Descriptive statistics were used, and 95% confidence intervals (CIs) were calculated for key surgical outcomes to indicate estimate precision. Associations between categorical variables were analyzed using Pearson’s χ² test with Cramér’s V as an effect size, and relationships between continuous variables were examined using Spearman’s rank correlation (ρ) with 95% confidence intervals (CIs). Given the exploratory design and limited sample size, no correction for multiple comparisons was applied, and the risk of both Type I and Type II errors was acknowledged. Results: Variations were observed in harvesting techniques, microsurgical preferences, and postoperative care protocols. Most surgeons initiated flap harvesting concurrently with tumor resection, primarily preserving superficial sensory nerves. Regarding venous outflow, 50% of respondents preferred the cephalic vein, 19% used comitant veins, and 29% utilized both systems when possible. Perioperative antibiotic use was standard practice, though anticoagulant preferences and flap monitoring methods varied. The study achieved a high success rate for RFFF procedures, exceeding 95%, with venous thrombosis identified as the main cause of flap failure. No significant correlations were found between flap failure rate and training method (p = 0.21), specialty (p = 0.37), annual number of RFFF procedures (p = 0.89), surgeon age (p = 0.42), or hospital type (p = 0.48). Effect sizes were small to moderate, indicating weak or negligible associations. Similarly, perioperative factors such as anticoagulant use (p = 0.84), preoperative antibiotics (p = 0.42), surgical instruments (p = 0.61), suture techniques (p = 0.51), and donor vein selection (p = 0.20) showed no statistically significant associations with flap loss. Patient satisfaction assessments were inconsistent, with only 39% of surgeons routinely performing them. Conclusions: The study provides valuable insights into current RFFF practices and outcomes across an international cohort of head and neck surgeons, highlighting patterns and variability in techniques, perioperative care, and monitoring strategies. Full article

Understanding long-term cloud cover variability is essential for assessing past climate dynamics and human influences on atmospheric conditions. In Padua, instrumental weather records (temperature, precipitation, pressure) and descriptive sky observations date back to 1725, but quantitative cloud cover data, expressed as tenths of the sky covered by clouds, began in 1872 at the Astronomical Observatory. From 1920 to 1989, observations continued under the authority of the Meteorological Observatory of the Water Magistrate, and from 1951 to 1990, additional records by the Italian Air Force expressed in eighths of sky are available. These visual datasets—based on multiple daily observations—are complemented by satellite records (from 1983) and reanalysis such as ERA5 (from 1940) and NOAA 20CRv3 (from 1872 to 2015). The aim of this study is to reconstruct a homogenized, long-term total cloud cover (TCC) time series for Padua from 1872 to 2024, integrating all available observational sources. By comparing overlapping periods across different subseries and nearby ground-based stations, the analysis not only investigates consistency and potential discontinuities across datasets but also quantifies the reliability and limitations of historical visual observations. This work provides one of the few centennial-scale reconstructions of cloud cover in Europe, offering a valuable contribution to historical climatology and climate change studies. Full article

Atmospheric electricity measurements are very sensitive to weather conditions. Fair weather for atmospheric electricity in Kamchatka (Russia) was determined by the method of expert assessment at an observatory. After the transition to automated digital methods for measuring meteorological parameters, the necessity to determine the criteria of fair weather appeared. In this paper we developed the criteria for fair weather based on digital measurements in summer and winter observation periods in view of a limited set of meteorological instruments. A database of fair weather since 2009 up to the present was created. We suggest the algorithm to determine fog during a day on the basis of air humidity measurements. The morning convective generator effect occurs sometimes in diurnal variations in atmospheric electricity. The morning convection maximum is determined by the sunrise time. This entails the problems of averaging the electric field diurnal variation over a long time period. We suggest taking into account the days with morning convective generator effect and the days without this effect separately when processing a long series of data. Full article

The northwest of Mexico has important zones for biodiversity conservation, denominated Priority Marine Regions (PMRs), and to study key oceanographic features related to ecological structure, it is necessary to understand environmental variability and observe climatic trends. Sea Surface Temperature (SST) is tightly associated with photosynthesis and serves as a control and driver for biological processes linked to the phytoplankton. Global climatic systems, like El Niño Southern Oscillation (ENSO), are responsible for the interannual and interdecadal variation in SST, since global circulation is modified by them. An important metric to assess phytoplanktonic biomass/photosynthesis is Chlorophyll a (Chl a), constituting the primary basis of the marine trophic web. The present study aims to examine the interannual oceanographic variability across 24 PMRs by employing monthly SST (°C) and Chl a (mg/m³) data derived from remote sensing instruments with spatial resolution of 4 km and 1 km from September 1997 to October 2018. We grouped the Priority Marine Regions into 18 main areas, based on a cluster analysis of Sea Surface Temperature. Significant differences were observed, showing higher SST levels during El Niño phase and higher Chl a concentration during La Niña phase, primarily in winter and spring, which will impact marine ecosystems. Full article

Background/Objectives: Cancer-Related Cognitive Impairment (CRCI) is a frequent and significant complication in cancer patients, involving deficits in memory, attention, and executive functions. Its multifactorial origin includes effects of oncological treatments, psychological factors, and aging—particularly impacting older adults. Early detection through thorough cognitive and psychological evaluation is crucial to optimizing management and maintaining quality of life. Methods: This cross-sectional descriptive-correlational study employed a non-probabilistic convenience sampling technique to recruit cancer patients receiving chemotherapy at the Complejo Asistencial Universitario de Salamanca (Spain) between January 2023 and February 2025. Participants were assessed using validated instruments measuring cognitive function (CFRT), subjective memory failures (MFE-30), anxiety and depression (HADS), and sleep quality (PSQI). Statistical analyses included correlation tests, analysis of variance (ANOVA), and multivariable linear regression models to examine associations among cognitive, psychological, and sleep-related variables. Statistical analyses were performed using IBM SPSS Statistics version 29.0 (IBM Corp., Armonk, NY, USA). Results: Participants (mean age 63.18 years) showed a notable presence of subjective memory complaints and mild anxiety/depression symptoms. Cognitive performance correlated negatively with anxiety/depression (ρ = −0.146, p < 0.05) and sleep disturbances (ρ = −0.583, p < 0.001). Sleep quality worsened with increasing age (ρ = 0.583, p < 0.001), and age itself showed significant associations with cognitive decline and psychological symptoms. No significant link was found between anxiety/depression and sleep quality. Conclusions: Findings confirm CRCI as a multifactorial condition influenced by psychological distress, sleep quality, and aging. The study highlights the importance of early, multidimensional cognitive assessment, especially in older patients, to enable timely interventions. Integrating objective and subjective measures alongside emotional and sleep evaluations enhances understanding and management of CRCI, ultimately improving patient outcomes and quality of life. Full article