Search Results (675)

This conceptual position is based on the diagnosis that artificial intelligence (AI) accentuates existing economic and geopolitical divides in communities in the Global South, which provide data without receiving rewards. Based on bioethical precedents of fair distribution of genetic resources, it is proposed to transfer the principle of benefit-sharing to the emerging algorithmic governance in the context of AI. From this discussion, the study reveals an algorithmic concentration in the Global North. This dynamic generates political, cultural, and labor asymmetries. Regarding the methodological design, the research was qualitative, with an interpretive paradigm and an inductive method, applying documentary review and content analysis techniques. In addition, two theoretical and two analytical categories were used. As a result, six emerging categories were identified that serve as pillars of the studied principle and are capable of reversing the gaps: equity, accessibility, transparency, sustainability, participation, and cooperation. At the end of the research, it was confirmed that AI, without a solid ethical framework, concentrates benefits in dominant economies. Therefore, if this trend does not change, the Global South will become dependent, and its data will lack equitable returns. Therefore, benefit-sharing is proposed as a normative basis for fair, transparent, and participatory international governance. Full article

Extreme heat poses growing health risks in tropical regions, yet public perception of this threat remains understudied in the Caribbean. This study examines how residents in Puerto Rico perceived heat-related health risks and how these perceptions relate to vulnerability and protective behaviors during the extreme heat events of the summer of 2020. We conducted a cross-sectional telephone survey of 500 adults across metropolitan and non-metropolitan areas of Puerto Rico, using stratified probability sampling. The questionnaire assessed heat risk perception, sociodemographic characteristics, health status, prior heat exposure, and heat-related behaviors. While most participants expressed concern about climate change and high temperatures, fewer than half perceived heat as a high level of personal health risk. Higher levels of risk perception were significantly associated with being male, aged 50–64, unemployed, and in fair health, having multiple chronic conditions, and prior experience with heat-related symptoms. Those with symptoms were nearly five times more likely to report high levels of risk perception (OR = 4.94, 95% CI: 2.93–8.34). In contrast, older adults (65+), despite their higher level of vulnerability, reported lower levels of risk perception and fewer symptoms. Nighttime heat exposure was widespread and strongly associated with heat-related symptoms. Common coping strategies included the use of fans and air conditioning, though economic constraints and infrastructure instability limited access. The findings highlight the disparity between actual and perceived vulnerability, particularly among older adults. Public health strategies should focus on risk communication tailored to vulnerable groups and address barriers to heat adaptation. Strengthening heat resilience in Puerto Rico requires improved infrastructure, equitable access to cooling, and targeted outreach. Full article

The integration of renewable energy into power grids is imperative for reducing carbon emissions and mitigating reliance on depleting fossil fuels. In this paper, we develop symmetric and asymmetric evolutionary game-theoretic models to analyze how user–grid cooperation in peak shaving can be enhanced by incorporating whole-process democracy (deliberative governance) into decision-making. Our framework captures excess returns, cooperation-driven profits, energy pricing, participation costs, and benefit-sharing coefficients to identify equilibrium conditions under varied subsidy, cost, and market scenarios. Furthermore, this study integrates the theory, path, and mechanism of deliberative procedures under the perspective of whole-process democracy, exploring how inclusive and participatory decision-making processes can enhance cooperation in renewable energy systems. We simulate seven scenarios that systematically adjust subsidy rates, cost–benefit structures, dynamic pricing, and renewable-versus-conventional competitiveness, revealing that robust cooperation emerges only under well-aligned incentives, equitable profit sharing, and targeted financial policies. These scenarios systematically vary these key parameters to assess the robustness of cooperative equilibria under diverse economic and policy conditions. Our findings indicate that policy efficacy hinges on deliberative stakeholder engagement, fair profit allocation, and adaptive subsidy mechanisms. These results furnish actionable guidelines for regulators and grid operators to foster sustainable, low-carbon energy systems and inform future research on demand response and multi-source integration. Full article

Botulinum neurotoxin-A (BoNT-A) injections are effective in reducing focal limb spasticity; however, their impact on strength and active function needs to be established. This review was a secondary analysis aimed at evaluating changes to active function in the context of muscle strength changes following BoNT-A intramuscular injection for adult upper and lower limb spasticity. The original review searched eight databases (CINAHL, Cochrane Central Register of Controlled Trials (CENTRAL), Embase, Google Scholar, MEDLINE, PEDro, PubMed, Web of Science) and was conducted with methodology that followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines as described in section 6.2 of Gill et al. For this secondary analysis, no databases were searched; only further data were extracted. The current and preceding review were registered in the Prospective Register of Systematic Reviews (PROSPERO: CRD42022315241). Twenty studies were screened for inclusion, and three studies were excluded because active function was not assessed in all participants. Seventeen studies (677 participants) met the inclusion criteria for analysis. Quality was examined using the PEDro scale and modified Downs and Black checklist and rated as fair to good. Pre- and post-BoNT-A injection strength (agonist, antagonist, and global), active function (activity), participation, and quality-of-life outcomes at short-, mid-, and long-term time points were extracted and analysed. Significant heterogeneity and limited responsiveness in strength and active function outcome measures limited the ability to determine whether changes in strength mediate an effect on active function. Further, variability in BoNT-A type and dose, adjunctive therapies provided, and variability in reporting limited analyses. Overall, no clear relationship existed between the change in muscle strength and active function following BoNT-A injections to the upper and lower limbs for focal spasticity in adult-onset neurological conditions. Full article

Background: Brain-derived neurotrophic factor (BDNF) plays a pivotal role in neuroplasticity and cognitive development. While exercise has been shown to modulate BDNF levels in adults, evidence in children remains limited and heterogeneous. Methods: A systematic review was conducted following PRISMA guidelines to examine randomized controlled trials investigating exercise effects on BDNF in children aged 5–12 years. The databases searched included FECYT, PubMed, SPORTDiscus, ProQuest Central, SCOPUS, and Cochrane Library through June 2025. Study quality was assessed using the PEDro scale. Results: Five randomized controlled trials (N = 385 participants) met inclusion criteria. Two studies (40%) demonstrated significant BDNF increases following exercise interventions. Successful interventions were characterized by neuromotor activities or martial arts programs, training frequencies ≥ 3 sessions/week, durations ≥ 12 weeks, and healthy participant populations. Methodological quality was mostly fair, with four studies rated as fair and one as good. Conclusions: Structured physical exercise may enhance BDNF levels in healthy children, with neuromotor activities and martial arts showing particular promise. However, children with overweight/obesity may require modified intervention approaches. The evidence supports the implementation of cognitively engaging physical activities in educational settings to optimize brain health during critical developmental periods, though larger standardized trials are needed to strengthen these preliminary findings. Full article

This study examines how several gender-encoding strategies in Spanish and social factors influence gender perception, reinforcing or mitigating a sexist male bias. Using an experimental design, we tested four linguistic conditions in a job recruitment context: masculine forms (theoretically generic), gender-splits, epicenes, and non-binary neomorpheme “-e”. After reading a profile in one of these conditions, 837 participants (52% women) selected an image of a woman or man. Results show that masculine forms lead to the lowest selection of female candidates, manifesting a male bias. In contrast, gender-fair language (GFL) strategies, particularly the neomorpheme (les candidates), elicited the highest selection of female images. Importantly, not only did linguistic factors and participants’ gender identity influence results—with male participants selecting significantly more men in the masculine condition, but affinity with feminist movements and LGBTQIA+ communities or positive attitudes towards GFL also modulated responses—increasing female selections in GFL, but reinforcing male selections in the masculine. Additionally, no extra cognitive cost was found for GFL strategies compared to masculine expressions. These findings highlight the importance, not only of linguistic forms, but of social and attitudinal factors in shaping gender perception, with implications for reducing gender biases in language use and broader efforts toward social equity. Full article

Combining a large collection of patient data and advanced technology, healthcare organizations can excel in medical research and increase the quality of patient care. At the same time, health records present serious privacy and security challenges because they are confidential and can be breached through networks. Even traditional methods with federated learning are used to share data, patient information might still be at risk of interference while updating the model. This paper proposes the Privacy-Preserving Federated Learning with Homomorphic Encryption (PPFLHE) framework, which strongly supports secure cooperation in healthcare and at the same time providing symmetric privacy protection among participating institutions. Everyone in the collaboration used the same EfficientNet-B0 architecture and training conditions and keeping the model symmetrical throughout the network to achieve a balanced learning process and fairness. All the institutions used CKKS encryption symmetrically for their models to keep data concealed and stop any attempts at inference. Our federated learning process uses FedAvg on the server to symmetrically aggregate encrypted model updates and decrease any delays in our server communication. We attained a classification accuracy of 83.19% and 81.27% when using the APTOS 2019 Blindness Detection dataset and MosMedData CT scan dataset, respectively. Such findings confirm that the PPFLHE framework is generalizable among the broad range of medical imaging methods. In this way, patient data are kept secure while encouraging medical research and treatment to move forward, helping healthcare systems cooperate more effectively. Full article

Background/Objectives: This study aimed to examine the occurrence and risk factors for proximal junctional kyphosis (PJK) in relation to preoperative sagittal alignment, particularly the shape of thoracolumbar kyphosis (TLK) and the proportion of lumbar lordosis. Methods: We recruited 38 consecutive patients with adolescent idiopathic scoliosis (AIS) who underwent isolated posterior fusion. Participants were categorized according to the presence or absence of PJK at 1 year postoperatively (PJK+ or non-PJK) and by preoperative TLK status (positive or negative; pre-TLK+ or pre-TLK, respectively). We compared spinal parameters preoperatively, immediately postoperatively, and at 1 year postoperatively between groups. Results: Among the 38 participants, PJK occurred in 21 patients (55.3%). The PJK group had significantly larger preoperative TLK and LDI values and decreased postoperative TLK and LDI. Simple linear regression revealed a moderate positive correlation between ΔPJA and preoperative TLK as well as a fair positive correlation between ΔPJA and changes in TLK and LDI. The prevalence of PJK was high (83.3%) in the pre-TLK+ group (24 patients), and preoperative LDI was significantly larger compared with the pre-TLK group. However, TLK and LDI were significantly decreased after surgery in the pre-TLK+ group. Conclusions: Patients with Lenke-5C curvature who exhibit positive preoperative TLK are at a very high risk of developing PJK after isolated posterior surgery. Preoperative sagittal alignment should be considered when planning the extent of sagittal correction. Full article

This study explores how Human Resource Management (HRM) can help organizations to face the challenges of digital transformation, focusing on reducing digital inequalities and improving employee performance. As digital tools become more important in workplaces, many employees still experience digital exclusion, which affects not only their productivity but also their sense of fairness and inclusion, as well. To investigate these issues, quantitative research was conducted using a structured questionnaire distributed online to employees across EU-based companies. The data were analyzed through PLS-SEM, including IPMA and mediation analysis, to understand the relations between HRM practices, digital skills, and perceptions of organizational justice. The findings show that HRM strategies have a significant impact on bridging the digital divide, especially by promoting digital adaptability and supporting inclusive work environments. Inclusion was also found to mediate the relation between HRM and employee performance. This research offers practical suggestions, like using Key Performance Indicators (KPIs) to monitor digital participation and encouraging continuous learning. The study adds value by connecting digital empowerment with HRM policies in a way that supports both organizational efficiency and equality. Future research could focus on specific sectors or use longitudinal data to better capture how digital inclusion develops over time. Full article

This study explores the development of reflective thinking among Physical Education Teachers (PETs) through a professional development program grounded in Paralympic values and inclusive education. Employing a qualitative action research design, the study involved seven PETs teaching in Greek primary schools. The intervention lasted ten weeks and comprised 20 Physical Education lessons, during which data were collected via semi-structured interviews, reflective journals, and non-participatory observation. The findings indicate a progressive shift in the teachers’ reflective thinking—from Technical Reflection to Practical and Critical Reflection—as defined in van Manen’s theoretical model. Most participants initially demonstrated a practical orientation but gradually developed a critical stance, incorporating values such as fairness, inclusion, and respect for diversity into their pedagogical thinking. Furthermore, the results revealed increased student sensitivity toward inclusive practices and a more democratic classroom climate. These findings suggest that targeted professional development programs can foster deeper reflective engagement and promote inclusive practices within Physical Education. This study highlights the potential of Paralympic values as meaningful educational content and reinforces the role of Physical Education as a catalyst for social inclusion and teacher professional growth. Full article

Background: This study aimed to evaluate the association between physical activity and suicidal ideation in adult women and to examine the moderating effect of self-rated health status. Methods: This study utilized raw data from the Korea National Health and Nutrition Examination Survey (KNHANES) from the 6th to the 8th cycle (2013–2021). Complex sample logistic regression analysis was performed to assess the association between physical activity and suicidal ideation, and stratified analysis was conducted to examine differences in effects according to self-rated health status. Results: The prevalence of suicidal ideation among participants was 5.5%. Stratified analysis revealed that the effect of physical activity on suicidal ideation varied by self-rated health status. Among women with good self-rated health, physical activity was associated with significantly reduced odds of suicidal ideation (OR = 2.116, 95% CI: 1.229–3.643). However, among those with fair or poor self-rated health, physical activity showed no significant protective effect (OR = 1.173, 95% CI: 0.902–1.525). Conclusions: This study demonstrates a significant association between physical activity and suicidal ideation, with self-rated health status playing a key moderating role. Suicide prevention strategies should incorporate interventions that promote physical activity while considering self-rated health status. Full article

In classical transferable-utility models, components typically participate in an all-or-nothing manner and are evaluated under a single criterion. This study generalizes such models by allowing each component to engage through multiple acting measures and by incorporating multiple evaluating attributes simultaneously. We introduce two influence-based assessments, the stable min value and the minimal self-stable value, to evaluate fair assessments of minimal impact across multi-attribute multi-choice environments. These values are rigorously defined via axiomatic characterizations grounded in minimal influence behavior, where coalitions select activity levels that jointly minimize systemic effects. A key theoretical contribution is the identification of a unique, 0-normalized, and efficient multi-attribute potential function corresponding to the minimal self-stable value. The proposed framework enables structured and interpretable evaluation of influence in complex cooperative systems with heterogeneous participation and conflicting objectives. Full article

Background/Objectives: Mental health conditions represent a growing global health concern, disproportionately impacting populations in low- and middle-income countries like Pakistan. Limited epidemiological data, coupled with recent socioeconomic and environmental disruptions, has intensified the need for current insights into psychological burden and coping capacities in the Pakistani population. Methods: A descriptive, cross-sectional survey was conducted from January to May 2023 among 400 community-dwelling adults attending outpatient departments in Islamabad and Rawalpindi. A structured 75-item questionnaire incorporating validated tools (PHQ-9, GAD-7, WHO-5, CSES, and SRQ-20) was used to assess depression, anxiety, well-being, coping self-efficacy, and mental distress. Descriptive statistics, χ² and Fisher’s exact tests, and Spearman’s rank correlation (r_s) analyses were performed using IBM SPSS 22.0. Results: Most respondents were male (73.0%), aged 25–34 (60.0%), and urban-dwelling (80.0%). Clinically relevant depression and anxiety were observed in 57.0% and 19.5% of participants, respectively; 38.0% reported mental distress. Conversely, 76.5% demonstrated fair-to-good coping efficacy and 51.0% had high well-being scores. Younger age (≤34 years), higher income, urban residence, and male gender were associated with significantly better mental health outcomes. Strong positive correlation was found between PHQ-9 and GAD-7 scores (r_s = 0.672), and moderate negative correlations were found between GAD-7 and WHO-5 (r_s = −0.496), and PHQ-9 and WHO-5 (r_s = −0.310). Conclusions: Our findings highlight the significant psychological burden among urban Pakistani adults, alongside promising levels of resilience and coping self-efficacy. These results emphasize the urgent need for early, culturally adapted mental health screening and intervention programs in outpatient settings. Integrating such strategies into primary care, particularly for vulnerable subgroups like women, older adults, and those with lower income could facilitate timely diagnosis, improve outcomes, and reduce stigma surrounding mental health. Full article

Smartphone-embedded inertia sensors are widely available nowadays. We have developed a smartphone application that could assess temporal gait characteristics using the built-in inertia measurement unit with the aim of enabling mass screening for gait abnormality. This study aimed to examine the test–retest reliability and concurrent validity of the smartphone-based gait assessment in assessing temporal gait parameters in level-ground walking. Twenty-six healthy young adults (mean age: 20.8 ± 0.7) were recruited. Participants walked at their comfortable pace on a 10 m pathway repetitively in two walking sessions. Gait data were simultaneously collected by the smartphone application and a VICON system during the walk. Gait events of heel strike and toes off were detected from the sensors signal by a peak detection algorithm. Further gait parameters were calculated and compared between the two systems. Pearson Product–Moment Correlation was used to evaluate the concurrent validity of both systems. Test–retest reliability was examined by the intraclass correlation coefficients (ICCs) between measurements from two sessions scheduled one to four weeks apart. The validity of smartphone-based gait assessment was moderate to excellent for parameters involving only heel strike detection (r = 0.628–0.977), poor to moderate for parameters involving detection of both heel strike and toes off (r = 0.098–0.704), and poor for the proportion of gait phases within a gait cycle. Reliability was good to fair for heel strike-related parameters (ICC = 0.845–0.388), good to moderate for heel strike and toes-off-related parameters (ICC = 0.827–0.582), and moderate to fair for proportional parameters. Validity was adversely affected when toe off was involved in the calculation, when there was an insufficient number of effective steps taken, or when calculating sub-phases with short duration. The use of smartphone-based gait assessment is recommended in calculating step time and stride time, and we suggest collecting no less than 100 steps per leg during clinical application for better validity and reliability. Full article

The rapid integration of the Internet of Medical Things (IoMT) into healthcare systems raises urgent demands for secure communication mechanisms capable of protecting sensitive patient data. Quantum key agreement (QKA), a collaborative approach to key generation based on quantum principles, provides an attractive alternative to traditional quantum key distribution (QKD), as it eliminates dependence on a trusted authority and ensures equal participation from all users. QKA demonstrates particular suitability for IoMT’s decentralized medical networks by eliminating trusted authority dependence while ensuring equitable participation among all participants. This addresses fundamental challenges where centralized trust models introduce vulnerabilities and asymmetric access patterns that compromise egalitarian principles essential for medical data sharing. However, practical QKA applications in IoMT remain limited, particularly for schemes that avoid complex entanglement operations and authenticated classical channels. Among the few QKA protocols employing Grover’s search algorithm (GSA), existing proposals potentially suffer from limitations in fairness and security. In this paper, the author proposes an improved GSA-based QKA protocol that ensures fairness, security, and correctness without requiring an authenticated classical communication channel. The proposed scheme guarantees that each participant’s input equally contributes to the final key, preventing manipulation by any user subgroup. The scheme combines Grover’s algorithm with the decoy photon technique to ensure secure quantum transmission. Security analysis confirms resistance to external attacks, including intercept-resend, entanglement probes, and device-level exploits, as well as insider threats such as parameter manipulation. Fairness is achieved through a symmetric protocol design rooted in quantum mechanical principles. Efficiency evaluation shows a theoretical efficiency of approximately 25%, while eliminating the need for quantum memory. These results position the proposed protocol as a practical and scalable solution for future secure quantum communication systems, particularly within distributed IoMT environments. Full article