Search Results (184)

Background: The natural motion of the human knee involves a combination of rotation and translation, resulting in a variable Instantaneous Center of Rotation (ICR) throughout the gait cycle. Traditional prosthetic knee designs often fail to reproduce this complex kinematic behavior. Objectives: This study aims to propose a customized, biomimetic knee mechanism through the synthesis of a four-bar linkage capable of approximating the physiological ICR trajectory with high precision. Methods: A Genetic Algorithm (GA) was implemented to optimize the geometric parameters of the four-bar mechanism, specifically its link lengths and inter-link angles. The optimization process is based on Freudenstein’s equation, which analytically relates the input and output angles of the linkage to the lengths of its links. The desired ICR trajectory was derived from experimental data, and the objective function minimized the Euclidean error between the generated and target trajectories. Results: The proposed method yielded customized mechanisms that closely approximate the target ICR curves, achieving an overall mean Euclidean tracking error of 1.95% (±1.68%) across diverse patient profiles, with a best-case optimization error as low as 0.355%. Furthermore, the GA demonstrated high computational efficiency, converging on optimal geometric configurations in an average execution time of just 3.98 min. Conclusions: These numerical results validate the robustness of the GA in navigating the design space while strictly adhering to kinematic constraints, Grashof’s condition, and anatomical motion limits. The integration of Freudenstein’s equation with GA-based optimization techniques enables the customized synthesis of four-bar linkages with a high capacity to reproduce the physiological kinematics of the knee. This computational approach could be highly beneficial for the design of polycentric knee prostheses, as it reduces design and manufacturing time by providing the initial parameters for the development of the four-bar mechanism, ultimately ensuring a better biomechanical fit between prosthetic and natural human movement. Full article

Background/Objectives: Arterial hypertension (AH) and hepatitis C virus (HCV) infection are interlinked, with AH increasing the risk of severe liver disease and HCV contributing to cardiovascular issues. Treating HCV in hypertensive patients is critical, though data on direct-acting antivirals (DAAs) in this group remain limited. Methods: This retrospective study evaluated the effects of DAAs in AH patients with HCV using data from the 2015–2023 EpiTer-2 project, a multicenter study in Poland. Results: Among the 18,968 HCV-infected DAA-treated patients, 5976 had AH. These patients were older, predominantly women, and had higher rates of obesity, comorbidities, cirrhosis, hepatocellular carcinoma, and genotype 1b infection. Sustained virologic response rates were high and comparable between the AH and non-AH groups in the intent-to-treat (94.8% vs. 94.2%) and per-protocol analyses (97.6% vs. 97.6%). AH was not independently associated with treatment failure (OR 0.87, 95% CI: 0.69–1.10). Predictors of failure included genotype 3, decompensated liver function, cirrhosis, thrombocytopenia, and treatment with asunaprevir + daclatasvir. While therapy discontinuation was more common in the AH patients, most completed treatment, with fatigue being the most frequent adverse event. Although not directly evaluated, the overall safety outcomes suggest that potential drug–drug interactions with antihypertensive therapies are unlikely to have a major clinical impact in routine practice. Conclusions: This study highlights the safety and efficacy of DAAs in AH patients and emphasizes the importance of early HCV detection and treatment in this population. Full article

In multi-hazard environments, women’s social reproductive labor often constitutes a foundation of community survival, yet remains undertheorized in disaster scholarship. This study contributes to an active scholarly conversation by examining Daya Annisa, a women-led grassroots organization in Bantul Regency, Yogyakarta, Indonesia, a region under continuous geological stress from the Sunda Megathrust, the Opak Fault, and Mount Merapi. Drawing on in-depth interviews and focus group discussions analyzed through Social Reproduction Theory (SRT), with a Strengths, Weaknesses, Opportunities, and Threats (SWOT) framework reinterpreted as an analytical lens on the structural conditions of reproductive labor, the analysis traces four interlinked practices: preparedness embedded in arisan and pengajian gatherings, community-based vulnerability mapping, trust-based crisis response, and informal post-disaster livelihoods. The paper argues that resilience in such settings is best understood not as a passive capacity to absorb shocks, but as the active, gendered, and largely uncompensated labor through which communities are materially sustained when formal systems are stretched. Three policy shifts follow: long-term flexible funding calibrated to continuous reproductive preparedness; institutional integration of community-generated vulnerability data with appropriate privacy and inclusion safeguards; and inclusion of grassroots women’s organizations as autonomous decision-making actors in disaster governance. Full article

Integrated water resources management uses decision-making and planning techniques in developing long-term strategies to ensure the sustainability of water resources and the resulting water security of future generations. Policy formulation through such integrated planning interlinks with indicators serving as an information channel to decision-makers. The present effort aims to develop a specific methodology using technical, environmental, and social indicators, formulating composite indices to identify vulnerability to changing water conditions. Thus, a set of indices developed through a multiyear research effort in Latin America, namely Drought Vulnerability Index (DVI), Water Stress Vulnerability Index (WSTVI), Water Scarcity Vulnerability Index (WSCVI), and Water Changing Conditions Vulnerability Index (WCCVI). Time series analysis covered the years 1991–2020, whereas the reference period was 1961–2020. Climate and water resources information is mainly obtained from ERA5-Land reanalysis; social, economic, infrastructure, and institutional data derived from harmonized sources (COROADO Project-EU, FAO, The World Bank, WHO/UNICEF JMP). Statistical tests and Principal Component Analysis (PCA) identified the indicators included in the equations for each index. Expert knowledge played an important role in the development as data were collected according to known local specificities and global trends, as well as scientific criteria and methodological rigor regarding the proposed new indices. Finally, application of such a framework for spatially explicit analysis indicated higher levels of vulnerability to changing water conditions in the northern part of Mexico, the Andes, Bolivia, Paraguay, and Central America, and lower levels in Chile, Brazil, Uruguay, and Argentina. This application demonstrates that the produced composite indices may be implemented with matching success all over Latin America and, therefore, in diversified natural, technical, environmental, social and economic conditions. Full article

(1) Background: Climate change and inequality are topics of major interest in Mediterranean Archaeology. However, comparatively less attention has been dedicated to how these themes are interlinked in the literature. No scoping review has ever addressed this issue. This study aims to identify major research trends on inequality and climate change in the Mediterranean c. 4000 BC–AD 500. It also pinpoints current research gaps on the topic and nascent areas of enquiry. (2) Method: We performed a scoping review on JSTOR, Scopus, Google Scholar and PubMed in December 2025–January 2026. A modified version of the PRISMA-ScR protocol was followed. We sampled journal articles, book chapters, edited volumes and monographs published between 2015 and 2025 which matched the search and inclusion criteria. Additional searches were done on Google Scholar in February 2026 to expand upon emerging research trends relevant to our topic but largely absent from the scoping review. We manually extracted, charted, analysed and synthesised the data. (3) Results: A total of 154 studies were eligible for the scoping review. We identified six research trends prominent in the sampled literature: 1. the rise and fall of world systems, macroscale causal links, and collapse research; 2. inequality, subalternity, and marginality; 3. agriculture, crops, and diet; 4. natural resource management, and water supply; 5. epistemology and methodology; and 6. natural archives and climate proxy datasets. We also recognised the following research gaps or topics that were comparatively less addressed: collapse research applied to the microscale level and marginalised communities; isotope analysis applied to both climate change and inequality in the same study; biomedical approaches applied to both climate change and inequality in the same study; social marginality as a complex construct in human–climate interactions; and the environmental and climate dimensions of the early Roman expansion, especially regarding marginality and the microscale. Finally, we identified artificial intelligence (AI), Big Data, environmental and climate activism, and the perception of climate hazards by subaltern communities as nascent topics of interest that might rise to prominence in the future. (4) Conclusions: We identified major research trends and gaps on climate change and inequality in the ancient Mediterranean in literature published 2015–2025. We also recognised nascent or unexplored topics. The review is intended as a benchmark for developing novel research on the cutting-edge of Mediterranean Archaeology. Full article

Background/Objectives: Digital systems are being increasingly used to mediate pediatric care, yet many competency models remain predominantly technical and may unintentionally dilute patient- and family-centered care. This study aimed to identify empirically grounded digital competencies that enable pediatric nurse leaders to sustain patient- and family-centered care and to propose a practice-ready competency map. Methods: An interpretative phenomenological study was conducted across three hospitals in Saudi Arabia, purposively selected for varying levels of digital maturity. Ten pediatric nurse leaders completed two in-depth, semi-structured interviews (60–90 min) and a four-week reflective journal. Data were analyzed ideographically and then across cases using interpretative phenomenological analysis. Interviews were conducted in Arabic or English; translation included professional translation, partial back-translation (30%), and bilingual review. Results: Four interlinked competency domains emerged: (1) Relational digital presence, co-viewing the electronic health record, narrating documentation, and coordinating gaze and screen use to preserve relational connection; (2) Vulnerable expertise, micro-coaching at the point of care and transparent discussion of near-misses to build psychological safety; (3) Culturally legible communication, multimodal, language-congruent communication and explicit boundaries for sensitive information; and (4) Judgment-with-data, documenting override rationales and balancing algorithmic indicators with contextual family need. Together, these domains formed a screen-side competency map translating lived experience into trainable micro-practices. Conclusions: Digital competence in pediatric nursing leadership is relational, culturally situated, and clinically interpretive rather than a linear technical checklist. Embedding these competencies into leadership development and digital workflow design may help protect and strengthen patient- and family-centered care in technology-mediated pediatric care. Full article

Poor mental health (problems and well-being) among children, particularly those with disabilities, represents a significant individual and public health burden, with multifactorial origins including family environment and participation limitations. Family climate also impacts participation, suggesting the three structures may be interlinked. Furthermore, children with disabilities face additional obstacles increasing their vulnerability to poor mental health, such as limitations to participation. Therefore, the present study aimed to (1) investigate whether participation mediated the relationship between family climate and mental health and (2) whether possible relationships differed by disabilities. The Swedish Statistics (SCB) register on the conditions of life for children (barnULF) was utilised. This interview-based registry study employs a repeated cross-sectional design, where children are recruited yearly and invited to participate in the study. The present study used data from 2013–2019, resulting in 3676 children aged 10–18, of whom 510 reported some type of disability. Structural Equation Models (SEMs) mediation analyses were conducted to assess the possible mediating role of participation between family climate and mental health (well-being and problems separately), including models with and without covariates (age and gender). Multigroup analyses were conducted to assess whether children with and without disability differed. Results showed that participation significantly mediated the relationship between family climate and mental well-being but not mental health problems, amongst all children. Models including covariates indicated mediating models for both well-being and problems, but only amongst children without disabilities. However, model fits were poor. Implications of the study direct preventative strategies to focus on family climate as a route to improve mental well-being and highlight the importance of earlier strategies amongst children with disabilities and in particular girls. Full article

Background: Antibiotic resistance (ABR) is a critical global health threat, disproportionately affecting low- and middle-income countries (LMICs) where systemic constraints, economic pressures and sociocultural factors drive inappropriate antibiotic use. While quantitative studies describe prevalence patterns, they fail to capture the underlying motivations and contextual barriers influencing prescribing and dispensing behaviors. This systematic review synthesizes qualitative evidence on the perceptions of healthcare professionals, patients, and caregivers regarding antibiotic use and explores the barriers and facilitators for implementing antibiotic stewardship programs in LMIC healthcare settings. Methods: We conducted a systematic review following PRISMA 2020 guidelines, based on a registered protocol in PROSPERO ID: CRD42024583749. Searches were performed in Medline, Embase, Cochrane Library, Web of Science, and Google Scholar for English-language studies published between 2014 and 2024. Qualitative and mixed-method studies examining stakeholder perspectives on antibiotic use and antibiotic stewardship implementation in LMICs were included. Studies were excluded if they focused exclusively on pediatric or neonatal populations, veterinary medicine, or quantitative outcomes without qualitative components. The data were analyzed using thematic analysis to identify and categorize codes and identify themes following methodological quality assessment of included studies using the Critical Appraisal Skills Programme Qualitative Studies Checklist by two independent reviewers. Results: Out of 2214 studies screened, a total of 119 studies from 33 LMICs were included, encompassing over 4000 participants across hospital, primary care, and community settings. Five interlinked themes emerged: (1) antibiotic use as a pragmatic response to diagnostic uncertainty and resource constraints; (2) financial and commercial drivers shaping prescribing and dispensing practices; (3) the disconnect between knowledge, sociocultural norms, and clinical behavior; (4) multi-level structural and professional barriers to antibiotic stewardship implementation; and (5) the critical role of health system vulnerabilities in perpetuating misuse. Conclusions: Inappropriate antibiotic use in LMICs reflects rational adaptations to systemic limitations rather than isolated knowledge gaps. Effective ABS strategies must address structural deficiencies, economic incentives, and sociocultural norms, while integrating context-specific interventions that strengthen health systems and engage all levels of care. The findings should, however, be evaluated in light of the geographic unevenness of the evidence base, the exclusion of non-English and gray literature, and lack of certainty assessments for synthesized themes. Full article

Construction project delays remain a persistent issue, often exacerbated by variation orders that adversely affect both financial and environmental performance, even in the UK. Although Modern Methods of Construction (MMC) have been increasingly employed to mitigate delays and improve efficiency, limited research has examined how variations affect small- and medium-sized enterprises (SMEs) adopting MMC in the UK construction sector. Given the pivotal role of SMEs and their financial vulnerability, this study examines the key challenges posed by variation orders for SMEs adopting MMC, with the broader aim of enhancing future project performance. Employing a two-stage iterative methodology, the research first identifies challenges through a comprehensive literature review, followed by a questionnaire survey and expert interviews. The resulting data were analysed thematically and statistically using SPSS and subsequently validated through a detailed case study involving interviews and document analysis. The findings highlight three principal clusters of challenges: operational, contractual, and module alteration-related, of which operational issues, particularly cost discrepancies, client approval delays, and rework, exert the most significant influence. The study provides a structured understanding of these interlinked challenges and underscores the need for targeted mitigation strategies to improve productivity and performance among UK construction SMEs engaged in MMC projects. Full article

This article examines the policy drift of the 1st Right, Portugal’s main housing program, originally designed to guarantee the right to adequate housing for families in situations of severe deprivation. This study aims to analyze how the program’s integration into the EU’s Recovery and Resilience Plan (RRP) reconfigured its redistributive objectives. Taking the Lisbon Metropolitan Area (LMA) as a critical case, this study employs a mixed-methods approach, combining systematic documentary and legislative analysis (2018–2025), discourse analysis of official communications, and empirical analysis of 18 municipal Local Housing Strategies, supplemented by financial execution data from RRP monitoring reports. The results reveal three interlinked forms of policy drift: (i) territorial deviation, driven by unequal municipal capacities and resource absorption; (ii) instrumental deviation, resulting from the prioritization of rehabilitation of pre-existent public housing stock over the provision of new housing; and (iii) social deviation, marked by the expansion of eligibility criteria that extend benefits to middle-income groups. Together, these dynamics demonstrate how a social-rights-based housing policy can be reshaped when integrated into a financial recovery framework, such as the RRP. This article contributes to international debates on housing governance by demonstrating how multilevel financing mechanisms can reinforce territorial inequalities, reorient policy instruments, and dilute redistributive objectives—even within ostensibly progressive recovery frameworks. It concludes by advocating for stronger social performance monitoring, differentiated instruments for distinct target groups, and improved temporal alignment between social policy objectives and EU funding cycles. Full article

This research focuses on the challenge of measuring the socio-economic impact of road traffic accidents (RTAs) by examining how losses are redistributed across major institutional sectors, including the government, businesses, and households. Unlike traditional cost-based approaches, the analysis relies on a modified input–output framework that captures not only the direct losses but also the indirect damage flows transmitted from one sector to another. This methodology makes it possible to reveal the multiplicative propagation of losses, determine the proportion of net costs, and quantify the transfer dependencies between institutional agents. Using compiled and adapted data for the Azerbaijani economy, the study estimates the net economic damage from RTAs at 2268.17 million manats after adjusting for internal transfers. The results show that households bear more than 47% of total losses, the enterprise sector accounts for approximately 39%, and the government absorbs nearly 13%. The model also isolates an “additional damage” component, reflecting lost income, profits, and tax revenues, and demonstrates that every 1000 RTA generates a chain reaction of interlinked costs that substantially amplifies the overall effect. The findings highlight the necessity of integrating input–output analytical approaches into the practical assessment of RTA-related economic consequences, particularly in countries with limited statistical capacity and structurally diverse institutional linkages. Full article

Ecolabelling has emerged as a key instrument to communicate environmental performance to consumers, particularly in the agri-food sector where resource use and ecological pressures are highly interlinked. Conventional Life Cycle Assessment (LCA)-based ecolabels often suffer from methodological discretion, lack of territorial specificity, and limited consumer trust. This study investigates how the Water–Energy–Food–Ecosystem (WEFE) Nexus could be integrated into LCA-based ecolabelling, with a specific focus on pasta production as a representative case in the food industry. Indicators were collected from recent literature on LCA and Nexus applications, selected for simplicity and clear attribution to one WEFE dimension, and then evaluated by experts from COST Action CA20138 (NexusNet) through a two round Delphi protocol. The process yielded 23 indicators distributed across the four dimensions, which were subsequently compared with six Environmental Product Declarations to assess data availability and compatibility. The results suggest that many indicators can be computed with standard LCA inventories, while the Nexus perspective adds value by capturing multidimensional impacts and regional resource pressures. Further refinement and empirical testing are expected to enhance the framework’s applicability, but the findings already indicate that incorporating WEFE-based indicators into pasta ecolabelling could represent a promising pathway to improve analytical depth and consumer relevance, aligning circular economy principles with corporate assessment practices. Full article

Interventions on Heritage Buildings (HBs) involve significant challenges due to their tangible (embodied in the material, architectural, physical and technical integrity of the cultural asset), and intangible values (linked to socio-historical–cultural and collective identity, memory, customs and symbols meanings), which must be preserved while also adapting to current sustainability and circular economy goals. However, current conservation and management practices often lack systematic tools to trace, assess, and organise material and component information, hindering the implementation of circular strategies. In line with the European Union’s objectives for climate neutrality and resource efficiency and sufficiency, Material and Product Passports (MPPs) have emerged as digital tools that enhance data traceability, interoperability and transparency throughout a building’s lifecycle. This paper examines the potential of MPPs to support circular management of HBs by analysing the structure of MPPs and outlining the information flows generated by rehabilitation, maintenance and adaptive reuse strategies. A mixed methods approach, combining literature review and data structure analysis, is adopted to identify how the different categories of data produced during maintenance, rehabilitation and adaptive reuse processes can be integrated into MPP modules. The research highlights the conceptual opportunities of MPPs to document and interlink historical, cultural, and technical data, thereby improving decision-making and transparency across intervention stages. The analysis suggests that adapting MPPs to the specificities of historic contexts, such as authenticity preservation, reversibility, and contextual sensitivity, can foster innovative, sustainable, and circular practices in the conservation and management of HBs. Full article

Improving alignment between timber sawmilling and prefabrication, defined as the coordination of information, materials, and decision-making across the supply chain, is critical for sustainable construction. This study examined integration through semi-structured interviews with 15 industry practitioners. Using framework analysis supported by NVivo, eight interlinked themes were identified: supply chain fragmentation and market cycles; data-driven forecasting; inventory and moisture management; digital integration; smart planning and production; quality assurance and workforce capability; circular economy and residue utilisation; and systemic enablers and constraints. The findings show that technical capabilities such as optimisation, grading, and QR-based traceability are often undermined by organisational and policy barriers, including distributor-mediated purchasing, limited interoperability, outdated standards, and uneven skills pathways. Integration was considered more feasible for mass timber prefabrication, where batch planning, tighter quality assurance, and vertical integration align with mill operations, compared with frame-and-truss networks that rely on just-in-time project workflows. The study provides empirical evidence of practitioner perspectives and identifies priorities for action that translate into sustainability gains through improved material efficiency, waste reduction, higher-value residue pathways, and supportive policy settings. Full article

The exponential growth in the usage of textual data across industries and data sharing across institutions underscores the critical need for frameworks that effectively balance data utility and privacy. This paper proposes an innovative agentic AI-based framework specifically tailored for textual data, integrating user-driven qualitative inputs, differential privacy, and generative AI methodologies. The framework comprises four interlinked topics: (1) A novel quantitative approach that translates qualitative user inputs, such as textual completeness, relevance, or coherence, into precise, context-aware utility thresholds through semantic embedding and adaptive metric mapping. (2) A differential privacy-driven mechanism optimizing text embedding perturbations, dynamically balancing semantic fidelity against rigorous privacy constraints. (3) An advanced generative AI approach to synthesize and augment textual datasets, preserving semantic coherence while minimizing sensitive information leakage. (4) An adaptable dataset-dependent optimization system that autonomously profiles textual datasets, selects dataset-specific privacy strategies (e.g., anonymization, paraphrasing), and adapts in real-time to evolving privacy and utility requirements. Each topic is operationalized via specialized agentic modules with explicit mathematical formulations and inter-agent coordination, establishing a robust and adaptive solution for modern textual data challenges. Full article