Search Results (291)

Introduction: Low medication adherence and low hypertension control are a public health challenge, particularly in low- and middle-income countries (LMICs). Healthcare system- and patient-related barriers hinder the successful management of hypertension. This study aimed to identify the perceptions of barriers and facilitators to hypertension management among health system stakeholders in Santander, Colombia. Materials and Methods: We conducted a qualitative, phenomenological, and interpretative study, comprising five focus groups, to explore the barriers and facilitators to managing people with hypertension. Each focus group was formed by stakeholders from territorial entities, healthcare insurers, or healthcare providers. Meetings were held between December 2022 and February 2023. The sessions were recorded and transcribed using NVivo Transcription and analyzed using NVivo version 1.6.1. Results: Seven categories of barriers and facilitators were identified: strategies, resources, access, risk assessment, cross-sector collaboration, articulation, and stewardship. Of these categories, articulation and stewardship emerged as the main barriers, as revealed through axial coding and cluster analysis, which highlighted deficiencies in stewardship practices, a lack of clear objectives, and misalignment with public policy frameworks. Conclusions: Multisectoral actions extending beyond healthcare providers and aimed at improving coordination and intersectoral collaboration are essential for enhancing hypertension control in LMICs, such as Colombia. Addressing social determinants and strengthening primary healthcare through community-based strategies are critical, making stewardship and improved access key priorities. Full article

This article examines the epistemological and homiletical implications of postmodernity for Christian preaching. It addresses the communicative crisis introduced by postmodern skepticism toward metanarratives. It proposes a constructive theological response through the re-articulation of the gospel as a coherent, storied, and transformative metanarrative. Drawing on interdisciplinary scholarship in theology, homiletics, epistemology, and cultural theory, this study argues that a thoughtful engagement with postmodern critique can serve as a catalytic force for ecclesial renewal. The article advocates for a homiletic method that re-engages Scripture’s narrative form while emphasizing relational epistemology, incarnational witness, and contextual sensitivity. By utilizing narrative theology, post-critical epistemologies, and performative models of preaching, this study proposes a recalibrated approach to gospel proclamation, adapted for fragmented and skeptical audiences, while safeguarding theological orthodoxy. Full article

This research presents a reinforcement learning framework for stable quadruped locomotion using Proximal Policy Optimization (PPO). We address critical challenges in articulated robot control—including mechanical complexity and trajectory instability by implementing a 12-degree-of-freedom model in PyBullet simulation. Our approach features three key innovations: (1) a hybrid reward function ($R_t=0.72 · e^{-\Delta {\mathrm{CoG}}_t} + 0.25 · v_t - 0.11 · ‖{\tau }_t‖$) explicitly prioritizing center-of-gravity (CoG) stabilization; (2) rigorous benchmarking demonstrating Adam’s superiority over SGD for policy convergence (68% lower reward variance); and (3) a four-metric evaluation protocol quantifying locomotion quality through reward progression, CoG deviation, policy loss, and KL-divergence penalties. Experimental results confirm an 87.5% reduction in vertical CoG oscillation (from 2.0″ to 0.25″) across 1 million training steps. Policy optimization achieved −6.2 × 10⁻⁴ loss with KL penalties converging to 0.13, indicating stable gait generation. The framework’s efficacy is further validated by consistent CoG stabilization during deployment, demonstrating potential for real-world applications requiring robust terrain adaptation. Full article

Articulated Tugs and Barges (ATBs) are increasingly recognised for their effectiveness in transporting chemicals, petroleum, bulk goods, and containers, primarily due to their exceptional flexibility and fuel efficiency. Recent projections indicate that the ATB market is on track for significant growth, which is expected to lead to an increase in the annual growth rate from 2025 to 2032. This study aims to analyse the current advancements in ATB technology and provide insights into the ATB fleet and the systems that connect tugboats and barges. Furthermore, it highlights the advantages of this transportation system, especially regarding its role in enhancing energy efficiency within the maritime transport sector. Currently, there is limited information available in the public domain about ATBs compared to other commercial vessels. The analysis reveals that much of the required information for modern ATB design is not accessible outside specialised design companies. The study also focuses on conceptual design aspects, which include the main dimensions, articulated connections, propulsion systems, and machinery, concluding with an evaluation of economic viability. Special emphasis is placed on defining the main dimensions, which is a critical part of the complex design process. In this context, the ratios of length to beam (L/B), beam to draft (B/D), beam to depth (B/T), draft to depth (T/D), and power to the number of tugs cubed (Pw/N³) are established as design control parameters in the conceptual design phase. This aspect underscores the novelty of the present study. Additionally, the economic viability is analysed in terms of both CAPEX (capital expenditures) and OPEX (operational expenditures). While CAPEX does not significantly differ between the methods used in different types of commercial ships, OPEX should account for the unique characteristics of ATB vessels. Full article

Sacred choral music continues to hold a significant place in contemporary concert settings, with historical and newly composed works featuring in today’s choral programmes. Contemporary choral composers have continued to engage with the longstanding tradition of setting sacred texts to music, bringing fresh interpretations through their innovative compositional techniques and fusion of styles. Irish composer Rhona Clarke’s (b. 1958) expansive choral oeuvre includes a wealth of both sacred and secular compositions but reveals a notable propensity for the setting of sacred texts in Latin. Her synthesis of archaic and contemporary techniques within her work demonstrates both the solemn and visceral aspects of these texts, as well as a clear nod to tradition. This article focuses on Clarke’s choral work O Vis Aeternitatis (2020), a setting of a text by the medieval musician and saint Hildegard of Bingen (c. 1150). Through critical score analysis, we investigate the piece’s melodic, harmonic, and textural frameworks; the influence of Hildegard’s original chant; and the use of extended vocal techniques and contrasting vocal timbres as we articulate core characteristics of Clarke’s compositional style and underline her foregrounding of the more visceral aspects of Hildegard’s words. Clarke’s fusion of creative practices from past and present spotlights moments of dramatic escalation and spiritual importance, and exhibits the composer’s distinctive compositional voice as she reimagines Hildegard’s text for the twenty-first century. Full article

This study presents a critical evaluation of image-based 3D reconstruction techniques for small archaeological artifacts, focusing on a quantitative comparison between Neural Radiance Fields (NeRF), its recent Gaussian Splatting (GS) variant, and traditional Structure-from-Motion (SfM) photogrammetry. The research targets artifacts smaller than 5 cm, characterized by complex geometries and reflective surfaces that pose challenges for conventional recording methods. To address the limitations of traditional methods without resorting to the high costs associated with laser scanning, this study explores NeRF and GS as cost-effective and efficient alternatives. A comprehensive experimental framework was established, incorporating ground-truth data obtained using a metrological articulated arm and a rigorous quantitative evaluation based on root mean square (RMS) error, Chamfer distance, and point cloud density. The results indicate that while NeRF outperforms GS in terms of geometric fidelity, both techniques still exhibit lower accuracy compared to SfM, particularly in preserving fine geometric details. Nonetheless, NeRF demonstrates strong potential for rapid, high-quality 3D documentation suitable for visualization and dissemination purposes in cultural heritage. These findings highlight both the current capabilities and limitations of neural rendering techniques for archaeological documentation and suggest promising future research directions combining AI-based models with traditional photogrammetric pipelines. Full article

The presented research is focused on the development of the bus rapid transit (BRT) system, combining the high capacity of rail transport with the flexibility of bus routes. Classic BRT systems have certain limitations, particularly concerning a single rolling stock capacity. The main motivation of the work is to find efficient and cost-effective solutions to increase passenger traffic in the BRT system while optimizing fuel consumption. The main contribution of this study is the comprehensive analysis and optimization of various configurations of trailer bus trains, which represent a flexible and cost-effective alternative to traditional single or articulated buses. Based on two schemes, four possible options for using trailer bus trains are offered, which differ in the number of sections and working engines. Among the suggested schemes of trailer bus trains, the two-section and three-section schemes with all engines running and the three-section scheme with one engine turned off are appropriate for use due to improved fuel efficiency indicators with better or acceptable traction and speed properties. Calculations carried out on a mathematical model show that, for example, a two-section bus train can provide a reduction of specific fuel consumption per passenger by 6.3% compared to a single bus at full load, while a three-section train can provide even greater savings of up to 8.4%. Selective shutdown of one of the engines in a multi-section train can lead to an additional improvement in fuel efficiency by 5–10%, without leading to a critical reduction in the required traction characteristics. Full article

A longstanding ambiguity surrounds the operationalization of consciousness in artificial systems, complicated by the philosophical and cultural weight of subjective experience. This work examines whether cognitive architectures may be designed to support a functionally explicit form of artificial consciousness, focusing not on the replication of phenomenology, but rather on measurable, technically realizable introspective mechanisms. Drawing on a critical review of foundational and contemporary literature, this study articulates a conceptual and methodological shift: from investigating the experiential perspective of agents (“what it is like to be a bat”) to analyzing the informational, self-regulatory, and adaptive structures that enable purposive behavior. The approach combines theoretical analysis with a comparative review of major cognitive architectures, evaluating their capacity to implement access consciousness and internal monitoring. Findings indicate that several state-of-the-art systems already display core features associated with functional consciousness—such as self-explanation, context-sensitive adaptation, and performance evaluation—without invoking subjective states. These results support the thesis that cognitive engineering may progress more effectively by focusing on operational definitions of consciousness that are amenable to implementation and empirical validation. In conclusion, this perspective enables the development of artificial agents capable of autonomous reasoning and self-assessment, grounded in technical clarity rather than speculative constructs. Full article

This article examines the struggles for water justice led by women in the Aconcagua River Basin (Valparaíso, Chile) through a hydrofeminist perspective. Chile’s water crisis, rooted in a colonial extractivist model and exacerbated by neoliberal policies of water privatization, reflects a deeper crisis of socio-environmental injustice. Rather than understanding water merely as a resource, this research adopts a relational epistemology that conceives water as a living entity shaped by and shaping social, cultural, and ecological relations. Drawing on life-history interviews and the construction of a hydrofeminist cartography with women river defenders, this article explores how gendered and racialized bodies experience the crisis, resist extractive practices, and articulate alternative modes of co-existence with water. The hydrofeminist framework offers critical insights into the intersections of capitalism, colonialism, patriarchy, and environmental degradation, emphasizing how women’s embodied experiences are central to envisioning new water governance paradigms. This study reveals how women’s affective, spiritual, and territorial ties to water foster strategies of resilience, recovery, and re-existence that challenge the dominant extractivist logics. By centering these hydrofeminist life histories, this article contributes to broader debates on environmental justice, decolonial feminisms, and the urgent need to rethink human–water relationships within the current climate crisis. Full article

The COVID-19 pandemic has illuminated and intensified pre-existing structural vulnerabilities among older adults living with HIV/AIDS in sub-Saharan Africa, particularly Nigeria. Within already overstretched healthcare infrastructures, these individuals faced heightened economic precarity, disrupted HIV care, and pronounced psychosocial distress. Exploring their lived experiences critically advances an understanding of resilience and informs contextually responsive interventions that can mitigate future health crises. This study employed a narrative qualitative approach to explore the lived experiences of older adults (aged 50 and above) attending the Infectious Diseases Institute (IDI) clinic in Ibadan, Nigeria, during the pandemic lockdown. Purposive sampling guided by maximum variation principles enabled the selection of 26 participants who provided detailed accounts through in-depth interviews. Reflective thematic analysis identified complex narratives illustrating intensified financial hardships, disrupted access to antiretroviral therapy (ART), and heightened psychological distress, including anxiety, depression, and profound isolation. Conversely, participants also articulated experiences of resilience, manifesting in improved medication adherence, strengthened family bonds, and introspective growth fostered by enforced isolation. These nuanced findings highlights the necessity of developing an adaptive, integrated healthcare interventions that addresses economic vulnerabilities, psychosocial wellbeing, and ART continuity, thereby better preparing resource-constrained health systems to support older adults with HIV/AIDS in future public health crises. Full article

This article examines the intersecting forces of gender, class, and education in early twentieth-century Britain through a feminist reading of Pip Williams’ historical novel The Bookbinder of Jericho. Centering on the fictional character Peggy Jones—a working-class young woman employed in the Oxford University Press bindery—the study explores how women’s intellectual ambitions were constrained by economic hardship, institutional gatekeeping, and patriarchal social norms. By integrating close literary analysis with historical research on women bookbinders, educational reform, and the impact of World War I, the paper reveals how the novel functions as both a narrative of personal development and a broader critique of systemic exclusion. Drawing on the genre of the female Bildungsroman, the article argues that Peggy’s journey—from bindery worker to aspiring scholar—mirrors the real struggles of working-class women who sought education and recognition in a male-dominated society. It also highlights the significance of female solidarity, especially among those who served as volunteers, caregivers, and community organizers during wartime. Through the symbolic geography of Oxford and its working-class district of Jericho, the novel foregrounds the spatial and social divides that shaped women’s lives and labor. Ultimately, this study shows how The Bookbinder of Jericho offers not only a fictional portrait of one woman’s aspirations but also a feminist intervention that recovers and reinterprets the overlooked histories of British women workers. The novel becomes a literary space for reclaiming agency, articulating resistance, and criticizing the gendered boundaries of knowledge, work, and belonging. Full article

Background: It is generally well-known that narration of care is critically important to high-quality nursing care. Narration of care is loosely defined as a nurse’s ability to describe to patients and families the clinical purpose behind nursing practice, what is hoped to be achieved, and the “why” (or clinical rationale) behind nursing activities. Despite the importance of narration of care, there is little practical guidance given to nurses about how to narrate care—what makes for effective or ineffective narration of care. Objective: Our aim was to develop a framework for teaching nurses and patient care assistants (PCAs) on how to effectively narrate care. In this article, we provide a practical framework for teaching nurses and PCAs how to narrate care. We describe the process of developing the framework as part of quality improvement efforts and implementing a course for eight hospitals based on the framework. Methods: Consistent with a Plan-Do-Study Act (PDSA) quality improvement approach, we developed the framework by first conducting a data and literature review, then convening a taskforce, discussing with patients on our existing committees, and finally formulating a framework. We then drafted supplementary cases and course material and implemented a course to teach nurses and PCAs how to narrate care. Results: The narration of care framework (NOC) that we developed and implemented consisted of the following five principles, which can be called RECAP as an acronym: 1. The “R” in RECAP stands for removing uncertainty. 2. The “E” in RECAP stands for explaining the environment. 3. The “C” in RECAP stands for being calm and sincere. 4. The “A” in RECAP stands for assume nothing. 5. The “P” in RECAP stands for personal connection. As for the course developed based on the RECAP principles, there was a total of 276 course offerings conducted by 30 facilitators, and 7341 nurses and PCAs completed the course. The evaluations reflected that 99% of learners believed their learning was improved by the course. Discussion: There are several multifaceted benefits to NOC: nurses’ and PCAs’ capability to narrate care well shows empathy and compassion to patients; it strengthens patient understanding and education that can lead to improved patient outcomes; and it helps allay patients’ uncertainties and anxieties. In essence, narrating care in an effective manner cultivates a strong nurse–patient therapeutic relationship. Yet, in the absence of any practical guidance, nurses and PCAs are left to develop narration skills on their own, learning by trial and error, and, in doing so, perhaps failing to meet patients’ needs and failing to fully derive the many benefits that the NOC is designed to achieve. Our hope is that, if hospital systems adopt our work, nurses and PCAs can comfortably and confidently enter the profession knowing the purpose or narrating care, its many benefits, and how to practically conduct sufficient narration, and what would constitute insufficient narration. Hospitals, in turn, can specify and clearly articulate their expectations for nurses and PCAs narrating with patients—what would make for a strong, compassionate process and what would be inadequate. For more experienced nurses, they can use the RECAP framework to reflect on their own practices and perhaps strengthen or refreshen existing skills. Conclusions: NOC is acknowledged, somewhat implicitly, as being critical to nursing and PCA practice, yet practical instruction and specified principles are lacking. We aimed to fill this gap by developing, implementing, and teaching a practical framework, armed with many tools nurses can use. Full article

Revealing the complex system of transboundary conflicts would help to understand the behavior of states and anticipate potential actions that would collectively reflect the state doctrine. However, a specific approach to the state political doctrine (SPD) for governing transboundary water has not been formalized. The core academic contribution of this research is to formalize the structure of the SPD for transboundary water, which might assist in fostering water cooperation and peacebuilding in one of the most conflict-prone regions—the Middle East and South Africa—by examining the upstream countries’ behavior. Case studies include Turkey in the Euphrates–Tigris Basins, Israel in the Jordan River Basin, and Ethiopia in the Nile River Basin. The theoretical framework presents a new paradigm that systematically links a state’s essential drivers, political philosophy, and potential actions, employing the Hegelian dialectic of thesis–antithesis–synthesis and the three Doctrines of Being, Essence, and Concept to articulate the state’s behavior and its indispensable core principles for survival. It is integrated with Arnold Toynbee’s challenge-and-response theory to analyze upstream motives. This study reviewed 328 documents and pieces of literature alongside 105 expert discussions. The key findings include the three upstream countries embracing different SPDs to address specific challenges at the state level, where Turkey employs the Water-Bank Doctrine, Israel utilizes the Identity-Seeking Doctrine, and Ethiopia adopts the Nation Rise Power Doctrine. Besides the critical external challenges that limit water availability, such as the impact of climate change, the time factor is a crucial key to shifting the bargaining power and impacting the adopted SPD, thereby affecting water diplomacy and regional water cooperation. Full article

Surface-guided tram systems are increasingly being recognised not only as mobility instruments but also as agents of urban regeneration that reshape spatial and social dynamics. This study evaluates the configurational impact of the Trambesòs tram in Barcelona on accessibility, integration, and urban cohesion within the Levante del Besòs area. A Space Syntax analysis was conducted in UCL DepthmapX for axial map analysis and visual graph analysis within a 500 m radius around each station. Three typologies of intervention (site-specific, articulation axes, and saturation pieces) guided the assessment. This analysis shows that Avinguda Diagonal and Avinguda Meridiana are primary structural corridors, while stations Glòries, Ca l’Aranyó, and Pere IV recorded the highest accessibility and visual openness. The results indicate that targeted interventions have positive impacts on the Space Syntax metrics regardless of their spatial centrality, highlighting the critical role of this diverse intervention typology in shaping the study area’s spatial configuration and influencing a hierarchy of social appropriation and use. It is concluded that the Trambesòs tram and associated urban interventions have jointly enhanced centrality and permeability in key sectors, and specific peripheral enclaves have local functioning. These findings, focused on spatial and morphological patterns, may support future interventions in urban design and mobility planning. Although the analysis centres on spatial configuration, future research may integrate socioeconomic variables to broaden the understanding of regeneration processes. Full article

This essay serves as an expansive, conceptual anchor and scholarly argument that demonstrates the modality of “reflexive extractivist” religious studies and also orients the Special Issue on Religion in Extractive Zones. We demonstrate that critical religious and theological scholarship have existing tools and methods for deepening the study of extraction in the environmental humanities and related discourses. We make two interconnected arguments: that religion has been and continues to be produced out of extractive zones in the conflicts, negotiations, and strategic alliances of contact zones and that the complex production of sacred and secular in these zones can be fruitfully analyzed as imaginaries and counter-imaginaries of extraction. We present these arguments through a dialogical and critically integrative methodology, in which arguments from theorists across several disciplines are put into conversation and from which our insights emerge. This methodology leads to a final section of the essay that sets a framework for, and invites further dialogical and integrative scholarship on, the practical ethics of non- or counter-extractive academic research, scholarship, and publishing. Offering theoretical, methodological, and practical suggestions, we call for a turn toward reflexive extractivist religious studies, articulate the specific conceptual and methodological approaches linking religion and extraction, and thus set the framework and tone for the Special Issue. Full article