Search Results (5,066)

Pharmaceutical waste is a challenge for the environment and public health in the European Union (EU). Although EU legislation requires Member States to establish collection systems for unwanted household pharmaceutical products, there is no common legal framework governing the application of extended producer responsibility (EPR) in this area, which has led to differences in the financing, organization, and effectiveness of national waste collection systems. Against this background, the aim of this work was to critically examine the role of EPR in the management of household pharmaceutical waste in the EU by analyzing its legal foundations, comparing selected national take-back systems, identifying the barriers to its implementation and indicating the key elements of a future EU regulatory framework. The analysis indicates that key elements of the future EPR framework for pharmaceutical products should include financing for producers through producer responsibility organizations (PROs), free and accessible collection of medicinal products from patients through community pharmacies, full cost compensation for collection point operators, common reporting requirements, environmentally differentiated producer contributions, consumer education, and independent public oversight. The future EU framework could build on good practices developed in Member States with established EPR systems and on the regulatory solutions adopted in EU environmental legislation. Full article

Objective: To examine the reliability, construct validity, and discriminative capacity of the Spanish version of the Economic Living Standards Index Short Form (ELSI_SF) in a sample of older adults in Spain. Methods: This analysis was conducted using baseline data from 133 participants (mean age = 66.2 years, SD = 5.6; 53.8% women) recruited from community health and social centers in the provinces of Cuenca, Albacete, and Toledo within the PEPE cohort. Participants completed the ELSI_SF (25 items), sociodemographic measures, the SF-12 Health Survey, and the International Fitness Scale (IFIS). Internal consistency was assessed using Cronbach’s alpha. Convergent validity was examined through correlations between ELSI_SF scores and education, occupation, physical and mental health, and perceived fitness. Discriminative ability for health-related variables was analyzed using ANOVA and partial η². The internal structure was explored using exploratory factor analysis (EFA) and subsequently examined against the original four-factor theoretical model using confirmatory factor analysis (CFA), based on polychoric correlations and estimation methods appropriate for ordinal data. Results: The mean ELSI_SF score was 23.0 ± 3.9, with most participants classified as having comfortable or good living standards. Internal consistency was acceptable for the total scale (α = 0.779), whereas the ownership restrictions (α = 0.441) and self-rating (α = 0.319) subscales showed low reliability. Significant associations were observed between the ELSI_SF total score and selected socioeconomic and health-related measures. Factor-analytic findings provided only partial support for the original four-domain structure. Although CFA showed favorable CFI, TLI, and RMSEA values, the elevated SRMR and instability of the self-rating factor warrant cautious interpretation of the factorial solution. Conclusions: The Spanish ELSI_SF provides preliminary psychometric evidence supporting the use of its total score among relatively socioeconomically advantaged older adults. However, limitations in subscale reliability, factorial stability, and the restricted socioeconomic variability of the sample preclude definitive validation across the full spectrum of material living standards. Further evaluation in larger, independent, and more socioeconomically heterogeneous samples, particularly including older adults experiencing material deprivation, is required. Full article

The core predicament of energy transition lies not in the availability of clean technologies, but in whether an economy possesses the institutional capacity and social foundation to systematically regulate its carbon-energy metabolic processes. Drawing upon co-evolutionary theory from evolutionary economics, this paper constructs a composite indicator of Low-Carbon Green Energy Eco-Co-evolution (LCEE) encompassing three functional dimensions: efficiency advancement, kinetic energy replacement, and boundary adherence. Concurrently, by integrating innovation ecosystem theory with inclusive development theory, we propose the concept of “Inclusive Potential of Regional Innovation Ecosystems” (IEP), characterizing the systemic potential for transforming innovation outcomes into social welfare across four dimensions: Knowledge Matrix Abundance (KMF), Cultural Capillary Permeation (CCP), Technological Community Succession (TCS), and Social Root Nourishment (SRN). Taking China’s 2016 intellectual property (IP) powerhouse construction pilot as the institutional prototype of Industrial Intellectual Property Upgrading Reform (IPR), we incorporate IPR, IEP, and LCEE into a unified causal analytical framework, proposing a testable transmission logic of ‘institutional supply → ecological development → co-evolutionary synergy. Using panel data from 30 Chinese provincial-level administrative regions over 2010–2022, we employ a Spatial Durbin Difference-in-Differences (SDM-DID) model to identify the direct and spatial spillover effects of IPR on LCEE, and embed a Double Machine Learning (DML) framework to test the mediating mechanism of IEP while controlling for high-dimensional nonlinear interference. The findings reveal that IPR exerts a significant and robust direct promoting effect on LCEE, generating positive spatial spillovers to neighboring regions through the public disclosure of patent information. IEP significantly promotes local LCEE, yet its spatial spillover lacks statistical support due to structural conflicts in inter-dimensional transmission attributes. IEP plays a significant partial mediating role between IPR and LCEE, with the indirect effect accounting for over one-third of the total effect, a finding robust to alternative machine learning algorithms, sample split adjustments, and exclusion of contemporaneous competing policies. Sub-path tests reveal that KMF bears the strongest mediating efficacy, serving as the primary transmission channel, while CCP exhibits full mediation—the institutional effect on LCEE in the cultural dimension depends almost entirely on the mediating transformation through the public cultural service system. Heterogeneity analysis further demonstrates full mediation in the Low-Carbon Green Energy Eco-Kinetic Replacement (KER) dimension, indicating that the institutional catalytic effect on clean energy substitution must be realized through IEP transformation. This paper provides empirical evidence for the proposed causal pathway through which institutional public goods indirectly enhance the synergistic quality of carbon-energy transition via the inclusive potential of innovation ecosystems, providing theoretical foundations and policy implications that, while grounded in China’s institutional context, may offer valuable reference points for emerging market economies facing similar dual pressures of technological constraints and green transition. Full article

Access to in-laboratory polysomnography (PSG) is restricted by prolonged waiting lists, and first-night effects can distort typical sleep architecture. This study evaluates the PneumoWave biosensor as a scalable, unobtrusive alternative for longitudinal single-channel home sleep apnea monitoring. Over three nights in an uncontrolled home environment, the biosensor’s respiratory rate agreement was evaluated against smartwatch-derived respiratory rate estimates, whilst apnea/hypopnea detection was compared with concurrent pulse oximetry. PneumoWave and smartwatch devices demonstrated good correlation (r = 0.870; p < 0.001). The PneumoWave device showed strong measurement agreement and provided a highly predictive screening pathway for patients with intermediate-to-high obstructive sleep apnea (OSA) risk. Longitudinal analysis confirmed consistent multi-night performance without first-night effect biases (ICC = 0.956, p < 0.001). Furthermore, its intuitive design yielded zero patient-induced setup errors, highlighting its operational robustness for self-administered use. Combining this continuous chest wall monitor with the STOP-Bang clinical questionnaire has the potential to provide an effective predictive screening pathway, improving community OSA screening and assisting clinical triage. Further validation against full polysomnography is warranted before clinical adoption. Full article

Maritime routes ensure connectivity between nations, carrying a vast flow of goods across borders, while ports serve as the critical junctions within this network, managing a wide spectrum of commodities from raw materials to finished goods. Ports also generate employment across numerous sectors and underpin a broad range of allied industries. A seaport is a maritime facility equipped with docks, cranes, and storage infrastructure for international trade, where ships load and unload cargo, containers, and passengers. Key functions of seaports include customs processing, warehousing, and vessel services, with major global hubs such as Shanghai, PSA Singapore, DP World, and Rotterdam handling immense volumes of cargo each year. In contrast, Bangladesh’s ports, Chittagong, Mongla, and Payra, play a vital role in sustaining regional commerce. Today, ports are widely recognized as essential capital infrastructure and prime movers of economic activity. Smart ports are automated facilities that leverage advanced digital technologies, including sensors, big data analytics, artificial intelligence (AI), machine learning (ML), deep learning (DL), augmented reality (AR), digital twins, the Internet of Things (IoT), and various automation systems, to optimize overall operational efficiency. These tools streamline cargo movement while embedding sustainable practices to protect the environment. Beyond operational gains, smart ports deliver faster, more advanced services to all stakeholders involved in port operations, including shipping companies, customs agencies, local communities, and other relevant parties. Renewable energy sources, electric vehicle charging stations, onshore power supply, and smart logistics infrastructure are among the defining sustainability features of smart ports in the present-day context. This study examines the current status and future development trajectory of Bangladesh’s sea ports in relation to the broader global imperative toward smart port transformation. Full article

Objective: It is commonly believed in the public health community that the mRNA vaccines from Pfizer and Moderna were broadly similar in preventing COVID-19 mortality, with perhaps a small advantage for Moderna. We revisit this question, using a research design that controls for healthy-vaccinee bias. Methods: We studied deaths among persons aged 15 years or greater from January 2021 through December 2022 in Indiana, linked to vaccination records, using an outcome measure, namely COVID-19 Excess Mortality Percentage (CEMP), which uses non-COVID natural mortality to control for HVB. Results: We find both large healthy-vaccinee bias for both vaccines, and larger bias for Pfizervaccinees: Pfizer recipients were healthier and thus would have faced lower COVID-19 mortality without vaccination. For ages 60+, we find almost 50% higher COVID-19 remaining mortality risk (RMR) for Pfizer vaccinees receiving primary vaccination over a “core period” from 2Q2021 through 1Q2022: the average Pfizer/Moderna RMR ratio was 1.49. For ages 15–59, this ratio was 1.25, but was not statistically significant. For booster dose for ages 60+, the average Pfizer/Moderna RMR ratio was 1.34. For 2Q2022 through 4Q2022, after the major Omicron wave, we find much lower vaccine effectiveness and no significant Pfizer–Moderna difference. Conclusions: During the period with both good vaccine availability and high COVID-19 mortality (2Q-2021–1Q2022), the Moderna vaccine was associated with lower COVID-19 mortality, relative to the Pfizer vaccine. A possible explanation is the higher Moderna dose (100 μg vs. 30 for Pfizer). After that period, a high percentage of the population had natural immunity from prior COVID-19 infection; we find only small mortality gains from vaccination, with no significant Pfizer–Moderna difference. Policy Implications: Controlling for healthy-vaccinee bias, Moderna was associated with lower COVID-19 mortality, relative to Pfizer. This difference was not known in real-time due to the failure of the available studies to address healthy-vaccinee bias. Controlling for such bias is vital when making vaccination policy. Full article

In this article, a dual-band frequency-selective surface (FSS) is proposed for wireless communication systems operating in the sub-6 GHz 5G band and emerging upper-mid-band frequencies considered for future wireless applications. The proposed FSS exhibits two passbands centered at 4.8 GHz and 6.9 GHz, with corresponding reflection coefficients of $-33$ dB and $-25$ dB, respectively. The associated $-10$ dB impedance bandwidths extend from 4.6–5.0 GHz and 6.6–7.2 GHz, providing efficient transmission within the desired operating bands. Between these passbands, the proposed structure exhibits a band-stop response centered at 5.5 GHz, where the transmission coefficient ($S_{21}$) reaches a minimum value of $-40$ dB over the frequency range of 5.2–5.8 GHz. This intermediate stopband suppresses unwanted signal transmission, particularly within the Wi-Fi band, thereby improving spectral selectivity and reducing potential interference in multi-band wireless communication environments. Furthermore, the proposed single-layer FSS maintains stable transmission and reflection characteristics under different polarization states and oblique incidence angles up to 60°. The measured results show good agreement with the simulated responses, demonstrating the suitability of the proposed design for applications requiring dual-band transmission and intermediate band-stop filtering in next-generation wireless communication systems. Full article

Nature-based solutions (NBSs) are central to urban climate-neutrality strategies, but their implementation still lags behind policy ambition. One reason is that most NBS benefits are public goods and rarely generate direct revenue, so we know far less about the institutional and financial conditions needed to deliver them than about their ecological performance. This paper develops a business model framework linking NBS interventions to financing and governance configurations, applying established NBS typologies and the Pestoff Triangle of state, market, and community provision to thirteen interventions across eleven sites in the Railway District of Thessaloniki, Greece. The interventions are organised into five business model categories: public space greening, private space upgrades, public–private hybrids, building retrofits, and renewable energy. Their financing logic is shaped less by intervention type than by ownership structure and stakeholder configuration. To address this gap, we followed category-specific blended finance strategies combining grants, private investment, regulatory incentives, and community resources, underpinned by stewardship-oriented governance. The findings suggest that scaling NBSs depends less on technical readiness than on institutional capacity to match financing and governance to local ownership and stakeholder contexts, offering a pathway from climate-neutrality strategy to implementable urban regeneration. Full article

Traditional image encryption methods based on static permutation and diffusion are vulnerable to structural cryptanalysis and often exhibit limited robustness under imperfect communication conditions. To address these issues, this paper proposes a robust topology-evolving image encryption algorithm driven by complex hyperchaotic dynamics for secure visual data transmission. First, a two-dimensional Rosenbrock–Schwefel hyperchaotic map is constructed to generate high-quality pseudorandom sequences for both permutation and diffusion. Based on this map, a bidirectional oscillatory spatial permutation mechanism governed by a dynamic linked-list topology is developed. Unlike fixed-path permutation strategies, the proposed topology continuously evolves with the system state during image traversal, thereby increasing nonlinear path complexity and improving resistance to structural attacks. Furthermore, a plaintext-dependent adaptive diffusion mechanism is designed to enhance sensitivity to plaintext variations and produce a strong global avalanche effect. Experimental results demonstrate that the proposed algorithm achieves favorable encryption performance, with an information entropy of up to 7.9994, a Number of Pixels Change Rate (NPCR) of 99.6076%, and a Unified Average Changing Intensity (UACI) of 33.4683%. In addition, the algorithm maintains good recovery performance under cropping attacks and noise interference, indicating its robustness and applicability for secure image transmission in complex communication environments. Full article

Smartphone accelerometry could enable longitudinal home-based balance testing, yet its reliability across tasks and outcome measures must be established. We assessed the test–retest reliability and measurement precision of a custom smartphone balance application. Sixty-nine healthy, community-dwelling middle-aged and older adults (ages 41–76 years) performed a 5 s home-based balance assessment weekly for 3 weeks. The assessment was directed by the application, which generated accelerometer-based sway metrics. Participants performed two 30 s trials each of feet together and tandem stance (eyes open, eyes closed) and single leg stance (eyes open only). Intraclass correlation coefficients (ICCs) and relative standard error of measurement (SEM%) were calculated for time-domain and frequency-domain measures. Outcomes achieved good-to-excellent reliability when averaged across three weekly assessments (ICC = 0.59–0.95), particularly mediolaterally. Time-domain measures, particularly mean acceleration (ICC = 0.84–0.92; SEM% = 11.1–23.5%), were the most reliable and precise outcomes overall, while frequency-domain measures showed lower reliability and precision at higher spectral bands (ICC as low as 0.59; SEM% up to 41.5%). As standing tasks became more difficult, reliability and precision declined correspondingly. We conclude that minimally supervised, home-based balance assessment can produce reliable, precise sway measures in healthy, screened, iPhone-owning middle-aged and older adults. This application carries potential for large-scale, remote balance monitoring for research purposes, though validation in more diverse and higher-risk populations will be needed before clinical application can be recommended. Full article

Objectives: Heart failure (HF) arises from multiple interrelated pathological processes. Among these, lysosomal impairment and loss of autophagic homeostasis are increasingly recognized as important contributors to myocardial damage and ventricular remodeling. This study sought to identify lysophagy-associated signature genes in HF and to define their biological roles, cellular origins, and potential diagnostic relevance. Methods: Bulk myocardial transcriptome datasets, including GSE16499, GSE57338, and GSE76701, were integrated with the human cardiac single-cell dataset GSE145154. Differential expression analysis was first performed to identify lysophagy-related differentially expressed genes (DEGs). Candidate hub genes were then screened using support vector machine-recursive feature elimination (SVM-RFE) and least absolute shrinkage and selection operator (LASSO) regression. Functional enrichment analysis, Gene Set Enrichment Analysis (GSEA), immune infiltration assessment, single-cell transcriptomic mapping, and regulatory network analysis were subsequently conducted. The expression profiles of the selected genes were validated in a murine HF model, and VAMP8 overexpression assays were performed in H9c2 cells. Results: Five hub genes, namely VAMP8, STX2, MCOLN1, DERL1, and PTP4A2, were consistently and markedly decreased in failing myocardial tissue. These genes were mainly linked to SNARE-dependent vesicle trafficking and lysophagy regulation. A diagnostic model incorporating these hub genes demonstrated good discriminatory performance in both the training dataset and a small independent validation cohort, supporting further evaluation of their potential diagnostic value. Single-cell analysis further indicated that these genes were primarily enriched in cardiac FOLR2⁺ tissue-resident macrophages (TRMs). Pseudotime and cell–cell communication analyses associated this module with FOLR2⁺ TRM cell states and predicted interactions with cardiac stromal cells. In the HF mouse model, the mRNA levels of all five hub genes were decreased, with concurrent reductions in VAMP8, MCOLN1 and DERL1 protein expression. In Ang II/LLOMe-induced H9c2 cells, VAMP8 overexpression was associated with reduced cardiomyocyte injury, attenuation of changes in the abundance of lysosome- and autophagy-related proteins, and fewer ultrastructural abnormalities, suggesting a potential cardioprotective effect. Conclusions: VAMP8, STX2, MCOLN1, DERL1, and PTP4A2 were identified as candidate molecular markers of HF that reflect alterations in a lysophagy- and vesicular-transport-related program associated with FOLR2⁺ tissue-resident macrophages. These findings provide new insights into immune-microenvironment remodeling in HF and suggest potential directions for mechanistic and therapeutic investigations. Full article

Over several decades, digital cultural heritage has been increasingly reused across research, education, creative practice and through public community engagement. However, these activities remain undescribed or inconsistently documented and difficult to compare. Organisations typically rely on ‘proxy metrics’ such as downloads, page views or reverse searches to assess use/reuse. However, these metrics reveal little about how materials were transformed, interpreted, or how they generated value and impact. GLAMs often rely on unstructured anecdotes to capture/trace reuse, as it is difficult to retrospectively document reuse when GLAMs publish cultural heritage data openly without the expectation of users to tell the organisation what they did with the digital cultural heritage they accessed and used. Documenting reuse approaches often focuses on single dimensions or factors such as sector, content type, audience or impact. This has resulted in fragmented knowledge about digital cultural heritage reuse, which has created limitations in carrying out evaluations across examples, learning from good practice and planning digital cultural heritage initiatives. This article introduces and empirically grounds a flexible, multi-dimensional schema for documenting and planning digital cultural heritage reuse. Using an abductive methodology that combines literature analysis and synthesis, practitioner interviews, user-journey examinations and iterative prototyping, we developed a six-category framework capturing (1) organisation and context, (2) heritage assets and technologies, (3) purpose and process, (4) users and engagement modes, (5) nature of use and availability, and (6) impact and sustainability. Applied across real-world examples, this framework can reveal forms of value, dependency and risk, often absent from conventional reporting in the reuse of digital cultural heritage. We argue that reuse documentation functions as a form of socio-technical infrastructure, enabling a shared vocabulary and understanding for cross-case comparison, cumulative learning and strategic design of digital heritage initiatives. By shifting categorisation from retrospective description to include prospective planning, the framework supports a more meaningful impact assessment and sustainable reuse of digital cultural heritage as a societal resource. Full article

(1) Background: As urbanization accelerates worldwide, mental health issues have become a major public health challenge, threatening the social sustainability of cities. Despite growing attention to restorative urban landscapes, the visual characteristics of slopes—an integral yet underexplored component—remain insufficiently studied regarding their psychological benefits. (2) Methods: This study employed an online questionnaire survey across three slope variable groups: gradient, quantity, and shape. Open-ended feedback was also collected to explore latent behavioral intentions. (3) Results: Perceived restorative benefit scores decreased with increasing slope gradient; however, this decline tended to level off when the slope exceeded 30%. Gradient changes primarily influenced emotional, cognitive, and behavioral dimensions, with limited effects on self-reported physiological sensations. Combinations of 2–3 slopes yielded the highest perceived restorative benefits, with significant gender differences observed. Irregular and curved shapes received the highest scores, whereas participants under 18 displayed a unique preference for sharp-edged forms. Open-ended responses frequently mentioned “lying down” and “lying flat.” (4) Conclusions: These findings reveal differentiated effects of slope visual characteristics on psychological restoration and landscape preference, offering evidence-based guidance for health-oriented and sustainable urban landscape design. These findings contribute to the Sustainable Development Goals (SDGs), particularly SDG 3 (Good Health and Well-being) and SDG 11 (Sustainable Cities and Communities), by demonstrating how slope morphology can be strategically used to create restorative urban environments that support both human well-being and ecological rationality. Full article

Socio-emotional skills are essential for teachers’ wellbeing, classroom functioning, and promotion of students’ social–emotional development. Digital game-based learning (DGBL) represents a promising approach to promote these competencies through engaging and experiential learning processes. Empathy Quest is a DGBL experience—aimed at fostering emotional intelligence—designed by a multidisciplinary group involving game design, educational psychology, media communication, and teaching expertise. An exploratory evaluation involved 83 teachers in training (74 female; mean age = 46.11 years). Our research questions inquired about teachers’ perceptions of Empathy Quest in terms of game enjoyment, user experience, motivation toward DGBL, and interest in emotional intelligence. After completing a gameplay session, participants filled in the individual interest questionnaire, situational motivation scale, intrinsic motivation inventory, user experience questionnaire, and ad hoc items. Descriptive analyses indicated high levels of motivation, enjoyment, and interest in emotional intelligence. Participants also reported positive user experiences in terms of attractiveness, novelty, and stimulation, alongside good ratings for dependability, perspicuity, and efficiency. Although the post-test-only design does not allow for causal conclusions, the findings suggest that Empathy Quest is a promising tool for engaging future teachers with emotional intelligence and may support the integration of socio-emotional learning into teacher education and professional development contexts. Full article

Background/Objectives: Osteoarthritis of the hip and/or knee is a major contributor to pain, disability, and reduced quality of life. The aim of this study was to provide preliminary validity and reliability evidence for a Greek adaptation of the Quality Indicators for Physiotherapy Management of Hip and Knee Osteoarthritis (QUIPA) questionnaire. Methods: This cross-sectional methodological study involved cross-cultural adaptation and psychometric evaluation of the Greek QUIPA in 90 adults aged 45–65 years with hip and/or knee osteoarthritis attending private physiotherapy clinics. Participants completed the questionnaire twice, seven days apart. Structural validity was explored using exploratory factor analysis, and exploratory subgroup analyses by age and sex were also conducted. Internal consistency, categorical item-level test–retest reliability, total-score test–retest reliability, and floor/ceiling effects were assessed. Results: Exploratory factor analysis of the initial 18-item pool suggested a three-factor 12-item solution explaining 51.5% of the total variance, with eigenvalues of 3.11, 1.58, and 1.49. Internal consistency was borderline for the total score (Cronbach’s alpha = 0.675) and the first factor (alpha = 0.662), and poor for the second (alpha = 0.424) and third (alpha = 0.598) factors. Item-level observed agreement ranged from 79.7% to 97.8%, with Cohen’s kappa values ranging from 0.580 to 0.887. Total-score test–retest reliability was good (ICC = 0.829, 95% CI = 0.748–0.896), although the total proportion-positive score increased by 5.6 percentage points at retest. Ceiling effects were observed for Q1, Q7, and Q8. Conclusions: The present study provides preliminary validity and reliability evidence for a derived 12-item Greek QUIPA short-form model. However, given the marginal sampling adequacy, low-to-moderate communalities, six-item reduction from the original 18-item questionnaire, categorical item properties, and borderline-to-poor internal consistency of some factors, the findings should be interpreted cautiously. At present, the Greek QUIPA is best interpreted using the total proportion-positive score, whereas factor-level scores should be treated as exploratory. Independent confirmatory factor analysis and further validation in larger and more diverse samples are required. Full article