Search Results (792)

In Italy, the management of built assets confiscated from organized crime groups is particularly relevant. Returning these assets to the community is becoming increasingly important for Italian municipalities, thanks to the many social benefits that can be generated (e.g., new spaces to provide community services, a visible and tangible symbol of legality, etc.). The process of redeveloping confiscated buildings, due to procedural complexity and a lack of resources, is currently characterized, on one hand, by a limited number of projects actually implemented compared to the potential of the total number of buildings available and, on the other hand, by the lengthy duration of the redevelopment process (12 years on average), which significantly increases the time it takes for the asset to return social value to the community. The objective of this research was to study, develop, and describe a mechanism that (i) enables an increase in the number of redevelopment actions of confiscated assets, (ii) accelerates the attribution of social value to these assets over time and (iii) extends the social impact of the requalification interventions that provide an opportunity for the professional training of students and the professional qualification of vulnerable people. There are two main tasks of the research shown in this article: (i) to highlight the main critical issues and needs in the management of confiscated assets by Italian municipalities, through a survey conducted among key informants; (ii) to build and test an innovative ‘win–win model’ for the requalification process of confiscated buildings, aimed at overcoming obstacles and anticipating the delivery of social benefits to a large group of stakeholders, including vulnerable people, tested in a pilot project. This “win–win model” combines building requalification and training through the activation of a “construction site school”. All original contributions are derived from the research “Co-WIN”, funded by the “Polisocial Awards 2021”, which developed methods, strategies, and tools capable of reducing social imbalances, with an equity and sustainability perspective. The results illustrated the drivers and challenges for the renovation and reuse of confiscated built assets; the necessary changes in documents and procedures to activate and replicate the “Co-WIN model”; and a training program for the construction-site school based on the social categories involved. Finally, the discussion highlights the network and the mutual benefits for stakeholders, focusing on the social relevance and social impact achievable through applying the Co-WIN model to the requalification process of confiscated buildings. Full article

Background: The U.S. Medicare Annual Wellness Visit (AWV) offers a structured opportunity for cognitive screening and personalized prevention planning among older adults. Yet, implementation of AWVs, particularly for individuals with cognitive impairment, remains inconsistent across primary care or other diverse care settings. Methods: We conducted a scoping review using the Consolidated Framework for Implementation Research (CFIR) to explore multilevel factors influencing the implementation of the Medicare AWV’s cognitive screening component, with a focus on how these processes support the detection and management of cognitive impairment among older adults. We searched four databases and screened peer-reviewed studies published between 2011 and March 2025. Searches were conducted in Ovid MEDLINE, PubMed, EBSCOhost, and CINAHL databases. The initial search was completed on 3 January 2024 and updated monthly through 30 March 2025. All retrieved citations were imported into EndNote 21, where duplicates were removed. We screened titles and abstracts for relevance using the predefined inclusion criteria. Full-text articles were then reviewed and scored as either relevant (1) or not relevant (0). Discrepancies were resolved through consensus discussions. To assess the methodological quality of the included studies, we used the Joanna Briggs Institute critical appraisal tools appropriate to each study design. These tools evaluate rigor, trustworthiness, relevance, and risk of bias. We extracted the following data from each included study: Author(s), year, title, and journal; Study type and design; Data collection methods and setting; Sample size and population characteristics; Outcome measures; Intervention details (AWV delivery context); and Reported facilitators, barriers, and outcomes related to AWV implementation. The first two authors independently coded and synthesized all relevant data using a table created in Microsoft Excel. The CFIR guided our data analysis, thematizing our findings into facilitators and barriers across its five domains, viz: (1) Intervention Characteristics, (2) Outer Setting, (3) Inner Setting, (4) Characteristics of Individuals, and (5) Implementation Process. Results: Among 19 included studies, most used quantitative designs and secondary data. Our CFIR-based synthesis revealed that AWV implementation is shaped by interdependent factors across five domains. Key facilitators included AWV adaptability, Electronic Health Record (EHR) integration, team-based workflows, policy alignment (e.g., Accountable Care Organization participation), and provider confidence. Barriers included vague Centers for Medicare and Medicaid Services (CMS) guidance, limited reimbursement, staffing shortages, workflow misalignment, and provider discomfort with cognitive screening. Implementation strategies were often poorly defined or inconsistently applied. Conclusions: Effective AWV delivery for older adults with cognitive impairment requires more than sound policy and intervention design; it demands organizational readiness, structured implementation, and engaged providers. Tailored training, leadership support, and integrated infrastructure are essential. These insights are relevant not only for U.S. Medicare but also for global efforts to integrate dementia-sensitive care into primary health systems. Our study has a few limitations that should be acknowledged. First, our scoping review synthesized findings predominantly from quantitative studies, with only two mixed-method studies and no studies using strictly qualitative methodologies. Second, few studies disaggregated findings by race, ethnicity, or geography, reducing our ability to assess equity-related outcomes. Moreover, few studies provided sufficient detail on the specific cognitive screening instruments used or on the scope and delivery of educational materials for patients and caregivers, limiting generalizability and implementation insights. Third, grey literature and non-peer-reviewed sources were not included. Fourth, although CFIR provided a comprehensive analytic structure, some studies did not explicitly fit in with our implementation frameworks, which required subjective mapping of findings to CFIR domains and may have introduced classification bias. Additionally, although our review did not quantitatively stratify findings by year, we observed that studies from more recent years were more likely to emphasize implementation facilitators (e.g., use of templates, workflow integration), whereas earlier studies often highlighted systemic barriers such as time constraints and provider unfamiliarity with AWV components. Finally, while our review focused specifically on AWV implementation in the United States, we recognize the value of comparative analysis with international contexts. This work was supported by a grant from the National Institute on Aging, National Institutes of Health (Grant No. 1R01AG083102-01; PIs: Tzeng, Kuo, & Raji). Full article

In the paper, using the three-statement financial modelling methodology as applied to a representative development project, we aim to analyse, ex ante, the industry-level impact of transition to mandatory escrow schemes in residential and mixed-use construction in Tashkent city (due to be implemented in Uzbekistan from 2026). Modelling single-milestone escrow plans against the current steep-discount advance-based system of off-plans as a baseline, the model accounts for salient institutional features of the Tashkent city development market, including land auctioning, full-cycle Value-added tax (VAT) accounting, and Tax loss carryforward provisions. It also incorporates a framework for demand-driven residual valuations for the development land element. Our findings indicate practically unchanged cashflow profitability of developers on the market in question. Around 30% p.a. in nominal Free-cashflow-to-equity based IRRs expressed in the national currency, provided that the transition to the greater use of leverage in funding unfolds as expected. The disappearance of steep off-plan discounts while the transition to escrows unfolds will be countervailed by the reliance on costly loans from escrow banks. Absent the greater use of leverage, the IRR (FCFE) profitability of the developers is expected to decline by some 5%. For the apartment buyers, this is effectively equivalent to increasing property transaction prices on the primary market in line with their headline asking amounts. Thus-generated economic surplus will be partially captured by the developers and partially passed through to escrow banks, increasing their gross profits by up to $50M, p.a. due to their new role in financing Tashkent city residential developments that are still largely equity-driven. Apart from this effect, we find only a moderate financial leverage influence on developers’ profitability due to the high-interest-rate environment prevailing in Uzbekistan. We also find a demand-driven pressure on land auction prices suggested by increasingly back-loaded alterations in project cashflow profiles. This study also purports to make a material contribution to the evolving body of literature on financial modelling of apartment and mixed-use property developments by offering a flexible three-statement modelling framework with innovative endogenised equity management features. Full article

The Multi-User Textile Analysis Laboratory (LTex), a case study from a Brazilian university, was established to address the technical demands of the local textile industry, a regional hub with a predominantly female workforce. Globally, laboratories seeking recognition for their technical competence rely on accreditation to a widely adopted international standard. This work explores how the technical requirements of this standard can be integrated with Environmental, Social, and Governance (ESG) principles, using a Brazilian recommended practice aligned with global frameworks such as the UN Sustainable Development Goals as a reference. The goal is to propose a unified framework for sustainable and inclusive management in university laboratories. The research employed an exploratory literature review, a documentary analysis comparing the two normative documents, the development of a structured checklist, and the formulation of a conceptual model for sustainable and inclusive laboratory management. The findings identified both overlaps and gaps, particularly regarding risk management, transparency, and gender equity, and supported the creation of an evaluation tool structured around six thematic axes. The proposed checklist enables simultaneous assessment of technical compliance and ESG maturity, guiding laboratories toward aligning accreditation processes with sustainability goals. The LTex case study demonstrates the model’s applicability and its potential to foster regulatory compliance, organizational improvement, and female empowerment in technical leadership. Full article

Obesity is increasingly recognized as a chronic, relapsing, and multifactorial disease requiring individualized care. This narrative review synthesizes recent developments in the definition, diagnosis, and treatment of obesity, highlighting key shifts in diagnostic frameworks (e.g., ICD-11), advances in pharmacotherapy, and the psychosocial dimensions shaping care engagement. Limitations of BMI, the impact of stigma, and structural inequities are discussed as barriers to effective management. By integrating clinical, psychological, and societal perspectives, this review advocates for a multidimensional, stigma-informed, and equity-oriented approach to obesity care. Full article

Over the past 30 years, the City of Portland, Oregon, USA, has emerged as a national leader in green stormwater infrastructure (GSI). The initial impetus for implementing sustainable stormwater infrastructure in Portland stemmed from concerns about flooding and water quality in the city’s two major rivers, the Columbia and the Willamette. Heavy rainfall often led to combined sewer overflows, significantly polluting these waterways. A partial solution was the construction of “The Big Pipe” project, a large-scale stormwater containment system designed to filter and regulate overflow. However, Portland has taken a more comprehensive and long-term approach by integrating sustainable stormwater management into urban planning. Over the past three decades, the city has successfully implemented GSI to mitigate these challenges. Low-impact development strategies, such as bioswales, green streets, and permeable surfaces, have been widely adopted in streetscapes, pathways, and parking areas, enhancing both environmental resilience and urban livability. This perspective highlights the history of the implementation of Portland’s GSI programs, current design and performance standards, and challenges and lessons learned throughout Portland’s recent history. Innovative approaches to managing runoff have not only improved stormwater control but also enhanced green spaces and contributed to the city’s overall climate resilience while addressing economic well-being and social equity. Portland’s success is a result of strong policy support, effective integration of green and gray infrastructure, and active community involvement. As climate change intensifies, cities need holistic, adaptive, and community-centered approaches to urban stormwater management. Portland’s experience offers valuable insights for cities seeking to expand their GSI amid growing concerns about climate resilience, equity, and aging infrastructure. Full article

Heart failure (HF) is a major global health challenge, characterized by high morbidity, mortality, and frequent hospital readmissions. Despite the advent of guideline-directed medical therapies (GDMTs), the burden of HF continues to grow, necessitating a shift toward comprehensive, multidisciplinary care models. Heart Failure Disease Management Programs (HF-DMPs) have emerged as structured frameworks that integrate evidence-based medical therapy, patient education, telemonitoring, and support for social determinants of health to optimize outcomes and reduce healthcare costs. This review outlines the key components of HF-DMPs, including patient identification and risk stratification, pharmacologic optimization, team-based care, transitional follow-up, remote monitoring, performance metrics, and social support systems. Incorporating tools such as artificial intelligence, pharmacist-led titration, and community health worker support, HF-DMPs represent a scalable approach to improving care delivery. The success of these programs depends on tailored interventions, interdisciplinary collaboration, and health equity-driven strategies. Full article

This paper explores the intervening role in SEP performance of corporate environmental, cultural, and ethnic activities (ECEAs) and diversity, equity, inclusion, and social initiatives (DEISIs) on blockchain adoption (BCA) strategy, particularly useful in the Western Balkans (WB), which demands transparency due to extended fraud and ethnic complexities. In this domain, a question has been raised: In BCA strategies, is there any correlation between SEP performance and ECEAs and DEISIs in a mediating role? A serial mediation model was tested on a dataset of 630 WB and EU companies, and the research conceptual model was validated by CFA (Confirmation Factor Analysis), and the SEM (Structural Equation Model) fit was assessed. We found a statistically sound (significant, positive) correlation between BCA and ESG success performance, especially in the innovation and integrity ESG performance success indicators, when DEISIs mediate. The findings confirmed the influence of technology, and environmental, cultural, ethnic, and social factors on BCA strategy. The findings revealed some important issues of BCA that are of worth to WB companies’ managers to address BCA for better performance. This study adds to the literature on corporate blockchain transformation, especially for organizations seeking investment opportunities in new international markets to diversify their assets and skill pool. Furthermore, it contributes to a deeper understanding of how DEI initiatives impact the correlation between business transformation and socioeconomic performance, which is referred to as the “social impact”. Full article

The strategic allocation of advertising billboards has become a critical aspect of urban planning and resource management. While previous studies have explored site selection based on road network and population data, they have often overlooked the diminishing marginal returns of overlapping coverage and neglected to efficiently process large-scale urban datasets. To address these challenges, this study proposes two complementary optimization methods: an enhanced greedy algorithm based on geometric modeling and spatial acceleration techniques, and a reinforcement learning approach using Proximal Policy Optimization (PPO). The enhanced greedy algorithm incorporates population-weighted road coverage modeling, employs a geometric series to capture diminishing returns from overlapping coverage, and integrates spatial indexing and parallel computing to significantly improve scalability and solution quality in large urban networks. Meanwhile, the PPO-based method models billboard site selection as a sequential decision-making process in a dynamic environment, where agents adaptively learn optimal deployment strategies through reward signals, balancing coverage gains and redundancy penalties and effectively handling complex multi-step optimization tasks. Experiments conducted on Wuhan’s road network demonstrate that both methods effectively optimize population-weighted billboard coverage under budget constraints while enhancing spatial distribution balance. Quantitatively, the enhanced greedy algorithm improves coverage effectiveness by 18.6% compared to the baseline, while the PPO-based method further improves it by 4.3% with enhanced spatial equity. The proposed framework provides a robust and scalable decision-support tool for urban advertising infrastructure planning and resource allocation. Full article

Background: Since the election of Hamas in 2006, Gaza has endured eight major military conflicts, culminating in the ongoing 2023–2025 war, now surpassing 520 days. This protracted violence, compounded by a 17-year blockade, has resulted in the near-total collapse of Gaza’s health system. Over 49,000 deaths, widespread displacement, and the destruction of more than 60% of health infrastructure have overwhelmed both local capacity and international humanitarian response. Objectives: This narrative review aims to examine and synthesize the current literature (October 2023–April 2025) on the health crisis in Gaza, with a specific focus on identifying key themes and knowledge gaps relevant to rebuilding a sustainable health system. The review also seeks to outline strategic pathways for recovery in the context of ongoing conflict and systemic deprivation. Methods: Given the urgency and limitations of empirical data from conflict zones, a narrative review approach was adopted. Fifty-two sources—including peer-reviewed articles, editorials, reports, and correspondence—were selected through targeted searches using Medline and Google Scholar. The analysis was framed within a public health and political economy perspective, also taking health system building blocks into consideration. Results: The reviewed literature emphasizes emergency needs: trauma care, infectious disease control, and supply chain restoration. Innovations such as mobile clinics and telemedicine offer interim solutions. Gaps include limited attention to mental health (including that of health workers), local governance, and sustainable planning frameworks. Conclusions: Sustainable reconstruction requires a durable ceasefire; international stewardship aligned with local ownership; and a phased, equity-driven strategy emphasizing primary care, mental health, trauma management, and community engagement. Full article

This study employs k-means clustering to analyze local organizations responsible for land improvement in Greece, identifying four distinct groups with consistent geographic patterns but divergent financial and operational characteristics. By integrating unsupervised machine learning with spatial analysis, the research offers a novel perspective on irrigation water pricing and cost recovery. The findings reveal that organizations located on islands, despite high water costs due to limited rainfall and geographic isolation, tend to achieve relatively strong financial performance, indicating the presence of adaptive mechanisms that could inform broader policy strategies. In contrast, organizations managing extensive irrigable land or large volumes of water frequently show poor cost recovery, challenging assumptions about economies of scale and revealing inefficiencies in pricing or governance structures. The spatial coherence of the clusters underscores the importance of geography in shaping institutional outcomes, reaffirming that environmental and locational factors can offer greater explanatory power than algorithmic models alone. This highlights the need for water management policies that move beyond uniform national strategies and instead reflect regional climatic, infrastructural, and economic variability. The study suggests several policy directions, including targeted infrastructure investment, locally calibrated water pricing models, and performance benchmarking based on successful organizational practices. Although grounded in the Greek context, the methodology and insights are transferable to other European and Mediterranean regions facing similar water governance challenges. Recognizing the limitations of the current analysis—including gaps in data consistency and the exclusion of socio-environmental indicators—the study advocates for future research incorporating broader variables and international comparative approaches. Ultimately, it supports a hybrid policy framework that combines data-driven analysis with spatial intelligence to promote sustainability, equity, and financial viability in agricultural water management. Full article

Background and Objectives: Gender disparities in pain management persist, with women frequently receiving inadequate analgesia despite reporting similar or higher pain levels compared with men. This issue is particularly evident across various medical and gynecological procedures. Materials and Methods: This integrative literature review synthesizes recent empirical studies examining gender biases in pain perception and management, focusing specifically on procedural pain in women. It includes an analysis of clinical research, patient-reported outcomes, and healthcare provider behaviors. Results: The findings indicate that unconscious biases, a lack of gender-specific clinical protocols, and prevailing cultural stereotypes contribute to the undertreatment of pain in women during procedures such as intrauterine device insertion and diagnostic hysteroscopy. Additionally, communication gaps between patients and healthcare providers exacerbate these disparities. Conclusions: Addressing gender disparities in pain management necessitates systemic reforms, including the implementation of gender-sensitive clinical guidelines, enhanced provider education, and targeted policy changes. Personalized, gender-informed approaches are essential to improving equity and quality of care in pain treatment. Full article

This paper develops a novel entropy-based framework to quantify tail risk and detect speculative bubbles in financial markets. By integrating extreme value theory with information theory, I introduce the Tail-Weighted Entropy (TWE) measure, which captures how information scales with extremeness in asset price distributions. I derive explicit bounds for TWE under heavy-tailed models and establish its connection to tail index parameters, revealing a phase transition in entropy decay rates during bubble formation. Empirically, I demonstrate that TWE-based signals detect crises in equities, commodities, and cryptocurrencies days earlier than traditional variance-ratio tests, with Bitcoin’s 2021 collapse identified weeks prior to the peak. The results show that entropy decay—not volatility explosions—serves as the primary precursor to systemic risk, offering policymakers a robust tool for preemptive crisis management. Full article

Sustainability in the non-alcoholic beverage industry requires effective metrics to assess environmental, social, and economic performance. However, the lack of standardised indicators for small and medium-sized enterprises (SMEs) hinders the implementation of sustainable strategies. This study aims to select a set of sustainability indicators for small and medium-sized non-alcoholic beverage industries in Brazil. Seventy-four indicators were identified based on the Global Reporting Initiative (GRI) guidelines, which were subsequently evaluated and refined by industry experts for prioritisation. Statistical analysis led to the selection of 31 final indicators, distributed across environmental (10), social (12), and economic (9) dimensions. In the environmental dimension, priority indicators include water management, energy efficiency, carbon emissions, and waste recycling. The social dimension highlights working conditions, occupational safety, gender equity, and impacts on local communities. In the economic dimension, key indicators relate to supply chain efficiency, technological innovation, financial transparency, and anti-corruption practices. The results provide a robust framework to guide managers in adopting sustainable practices and support policymakers in improving the environmental, social, and economic performance of small and medium-sized non-alcoholic beverage industries. Full article

Although intracranial hypertension (ICH) has traditionally been framed as simply a numerical escalation of intracranial pressure (ICP) and usually dealt with in its clinical form and not in terms of its complex underlying pathophysiology, an emerging body of evidence indicates that ICH is not simply an elevated ICP process but a complex process of molecular dysregulation, glymphatic dysfunction, and neurovascular insufficiency. Our aim in this paper is to provide a complete synthesis of all the new thinking that is occurring in this space, primarily on the intersection of glymphatic dysfunction and cerebral vein physiology. The aspiration is to review how glymphatic dysfunction, largely secondary to aquaporin-4 (AQP4) dysfunction, can lead to delayed cerebrospinal fluid (CSF) clearance and thus the accumulation of extravascular fluid resulting in elevated ICP. A range of other factors such as oxidative stress, endothelin-1, and neuroinflammation seem to significantly impair cerebral autoregulation, making ICH challenging to manage. Combining recent studies, we intend to provide a revised conceptualization of ICH that recognizes the nuance and complexity of ICH that is understated by previous models. We wish to also address novel diagnostics aimed at better capturing the dynamic nature of ICH. Recent advances in non-invasive imaging (i.e., 4D flow MRI and dynamic contrast-enhanced MRI; DCE-MRI) allow for better visualization of dynamic changes to the glymphatic and cerebral blood flow (CBF) system. Finally, wearable ICP monitors and AI-assisted diagnostics will create opportunities for these continuous and real-time assessments, especially in limited resource settings. Our goal is to provide examples of opportunities that exist that might augment early recognition and improve personalized care while ensuring we realize practical challenges and limitations. We also consider what may be therapeutically possible now and in the future. Therapeutic opportunities discussed include CRISPR-based gene editing aimed at restoring AQP4 function, nano-robotics aimed at drug targeting, and bioelectronic devices purposed for ICP modulation. Certainly, these proposals are innovative in nature but will require ethically responsible confirmation of long-term safety and availability, particularly to low- and middle-income countries (LMICs), where the burdens of secondary ICH remain preeminent. Throughout the review, we will be restrained to a balanced pursuit of innovative ideas and ethical considerations to attain global health equity. It is not our intent to provide unequivocal answers, but instead to encourage informed discussions at the intersections of research, clinical practice, and the public health field. We hope this review may stimulate further discussion about ICH and highlight research opportunities to conduct translational research in modern neuroscience with real, approachable, and patient-centered care. Full article