Search Results (161)

Modern healthcare remains structurally and conceptually fragmented, with profound clinical and policy implications. At its root lies an ontological fracture: the prevailing biomedical model reduces patients to discrete biological systems (organs, biomarkers, and symptoms) detached from the psychological, social, and ecological contexts in which health and illness are experienced. This is compounded by epistemological fragmentation, where medical knowledge is compartmentalized into increasingly narrow specialties, limiting holistic understanding. These philosophical divisions manifest in downstream operational, informational, financial, and policy dysfunctions duplicative testing, misaligned incentives, disconnected care pathways, and population health failures. To address these multilevel fractures, we propose a unified architecture grounded in three interlocking components. First, the Precision and Personalized Population Health (P3H) framework offers a principle-based realignment toward care that is integrated, personalized, proactive, and population wide. P3H addresses the conceptual shortcomings of fragmented care by focusing on the full human trajectory across time, systems, and determinants. Second, General Purpose Technologies including artificial intelligence, biosensors, mobile diagnostics, and multimodal data systems enable the operationalization of whole-person care at scale, especially in low-resource settings. Third, the AI-WHOLE policy framework (Alignment, Integration, Workflow, Holism, Outcomes, Learning, and Equity) provides governance principles to guide ethical, equitable, and context-specific implementation. We argue that this triadic blueprint is particularly critical for Global South nations, where the lack of legacy infrastructure offers an opportunity for leapfrogging toward integrated, intelligent systems of care. Early models illustrate how policy-aligned, technology-enabled care rooted in whole-person principles can yield improvements in continuity, cost-efficiency, and chronic disease outcomes. This manuscript offers a systems-level strategy to overcome fragmentation and reimagine healthcare delivery, not only by refining clinical tools, but by redefining what it means to care for the human being in full. Full article

Digital transformation of municipal public services remains uneven in transition economies, while national e-government indices often obscure substantial disparities across cities. This study develops a composite E-Government Maturity and Performance Index (EGMPI) to evaluate eleven Armenian municipalities across four governance dimensions: digital service availability, administrative efficiency, transparency and accountability, and citizen interaction and participation. Using publicly available data for Q1 2024, the analysis reveals pronounced metropolitan concentration, with large cities significantly outperforming smaller municipalities. Although performance correlates with population size and fiscal capacity, institutional and managerial factors strongly mediate outcomes, as comparable municipalities display substantial differences in service maturity. Results further show that local governments tend to prioritize transparency measures over functional efficiency, indicating symbolic digitalization rather than substantive service transformation. Unlike national e-government indices, this study provides a city-level diagnostic framework enabling intra-country performance comparison and actionable municipal policy design. Based on the findings, a multi-level policy roadmap is proposed, including shared national platforms, regional digital hubs, targeted capacity building, and leapfrogging strategies for low-maturity cities. The proposed governance-oriented framework offers a replicable tool for transition economies and demonstrates that effective digital transformation depends primarily on institutional coordination and citizen-centric management rather than financial resources alone. Full article

Background: Patient safety is evaluated using both internal assessments of safety culture and external hospital rating systems; however, the extent to which these measures capture related dimensions of patient safety remains uncertain. Methods: This study examined the association between hospital patient safety culture ratings and hospital safety grades. Using 2024 hospital-level data, patient safety culture was measured using the overall safety rating from the AHRQ Hospital Survey on patient safety culture and hospital safety grades derived from Leapfrog Safety Grades. Results: No significant association was observed between patient safety culture ratings and the likelihood of receiving higher Leapfrog Grades. Hospital bed size, however, was significantly associated with Leapfrog Grades, with larger hospitals demonstrating lower odds of receiving higher grades. Conclusions: These findings indicate that further research is needed to assess congruence between internal perceptions of patient safety culture and external hospital safety ratings. The results underscore potential measurement differences between federal survey-based assessments and private nonprofit grading methodologies and suggest caution in assuming equivalence across patient safety metrics. Further research is warranted to clarify how these tools align and to determine their respective roles in evaluating hospital patient safety. Full article

Land subsidence and structural instability at the Slănic Prahova salt mine have evolved significantly over 190 years of underground extraction, particularly following the mine’s expansion in 1970. This study reconstructs the complete geomechanical history from 1835 to 2025 and forecasts deformation trajectories up to 2050 using a calibrated creep-based numerical model. A high-fidelity geological model was developed in Leapfrog Works, with the numerical mesh generated in Rhinoceros and converted to FLAC^3D format via the Griddle plug-in. Salt creep was characterized using a Norton power-law constitutive model, with initial parameters derived from the steady-state phases of laboratory creep tests, and subsequently with calibrated parameters identified at the mine scale as n = 2.03 and A = 3 × 10⁻²⁵ s⁻¹ MPa⁻ⁿ. The simulation results demonstrate a high degree of correlation with field observations. These parameters were subsequently refined at the mine scale by integrating surface leveling data (1994–2025) and underground displacement records (2004–2019). The simulation results demonstrate a high degree of correlation with field observations, highlighting critical deformation zones. Maximum surface subsidence increased from approximately −560 mm in 1970 to −1020 mm by 1992, reflecting the intensified impact of later mining phases. The current maximum cumulative displacement is estimated at −1640 mm (2025) and is projected to reach −2060 mm by 2050. Underground, the largest displacement rates are concentrated in the eastern sector, driven by the synergistic effects of overburden loading and regional horizontal stress. Full article

At the critical juncture where Chinese cities are transitioning toward intensive urban renewal and sustainable development, the revitalization and adaptive reuse of industrial heritage face a collective action dilemma stemming from the misaligned interests among three key stakeholders: the Local Government (LG), the Industrial Heritage Developer (IHD), and the Neighboring Complementary Merchants (NCMs). To address this challenge, this study constructs a tripartite evolutionary game model and innovatively proposes an analytical framework of a Multi-Dimensional Policy Lever System, which integrates spatial synergy (k, w, v), economic incentives (p₁, p₂, q), and behavioral regulation (m, n). Numerical simulations reveal that the successful regeneration of industrial heritage does not rely on any single policy but fundamentally depends on the systematic coordination and dynamic adaptation of these three-dimensional levers. The nonlinear coupling of spatial elements forms the foundation for value leapfrogging. The economic driving force requires a critical shift from government subsidies (p) towards a market-based value capture and recycling mechanism (q). Behavioral interventions provide the necessary cognitive and normative safeguards for cooperation. The research elucidates a three-phase evolutionary pattern of the system, transitioning from a stalemate to synergy, and emphasizes the need for an adaptive and sequential combination of policies. The theoretical contribution of this study lies in providing an integrative quantitative analytical framework. Its practical significance is to offer a scientific basis for decision-makers to construct a dynamic policy toolbox and promote the sustainable collaborative governance of industrial heritage. Full article

Urbanization in mountainous valley regions is constrained by rigid topography, generating complex correlations between spatial growth and ecological security. The coupling between urban expansion and landscape ecological risk (ERI) was evaluated for six representative valley cities in western China from 1985 to 2023. Annual land-cover data (CLCD) and fine-scale terrain models were integrated with expansion metrics, slope gradient analysis, and spatial statistics to identify growth trajectories and risk reorganization. Urban growth shifted from edge expansion to leapfrog development as valley floors became saturated. Two vertical trajectories emerged: a low-slope lock-in pattern (e.g., Lanzhou) where development remains largely on slopes < 6° and an uplift towards mid-slopes pattern (e.g., Chongqing), where expansion increasingly occurs on 6–25° terrain. ERI correspondingly showed three spatial typologies: valley contrast, heterogeneous mosaic, and high-risk background dominance. Although ERI generally declined, reflecting structural hardening with rising built-up land shares, the spatial clustering of risk remained stable. GeoDetector results indicate that terrain sets a baseline for ERI differentiation, but its explanatory power varies across cities and is often surpassed by land-cover composition. These findings support differentiated governance, requiring strict controls on slope disturbance in uplift cities and prioritizing corridor connectivity in lock-in cities. Full article

The global swine industry suffers persistent economic losses and health challenges due to major viral pathogens such as African swine fever virus (ASFV), porcine reproductive and respiratory syndrome virus (PRRSV), classical swine fever virus (CSFV), and porcine circovirus (PCV). Traditional diagnostic methods, including virus isolation, serology, and quantitative PCR (qPCR), are limited by time, equipment requirements, and field applicability. Recent advances in CRISPR-based diagnostics, particularly those leveraging the collateral cleavage activity of Cas12a and Cas13a, have enabled rapid, sensitive, and field-deployable nucleic acid detection. This review outlines the principles of CRISPR-Cas12a/13a systems, their integration with isothermal amplification techniques, and their application in detecting major swine viruses. Cas12a-based platforms (e.g., DETECTR) and Cas13a-based systems (e.g., SHERLOCK) achieve detection limits as low as single-copy/μL within 25–60 min at 37 °C, offering high specificity and compatibility with visual readouts. Applications include ASFV, PRRSV, CSFV, PCV, foot-and-mouth disease virus (FMDV), porcine rotavirus (PoRV), and porcine parvovirus 7 (PPV7). Despite significant advances, challenges remain, notably the reliance on nucleic acid extraction and the need for fully integrated “sample-in, result-out” systems. Ongoing innovations in extraction-free methods, lyophilized reagents, and multiplex detection will strengthen the role of CRISPR diagnostics in swine disease surveillance and control. From an application standpoint, the technology offers a low-capital, field-adaptable alternative to qPCR, with its value proposition rooted in early outbreak containment and loss prevention. Its adoption pathway is expected to vary across production systems—serving as a sentinel tool in intensive settings, a leapfrogging solution in rapidly intensifying regions, and through shared-service models in resource-limited contexts. However, translation to routine use still requires overcoming standardization hurdles, regulatory validation, and workflow integration. Full article

This study develops a Smart Mobility Index (SMI) tailored to the 17 Local Government Units (LGUs) of Metro Manila to evaluate their readiness to adopt integrated, efficient, and technology-enabled mobility systems. While global smart mobility indices are often ill-suited to the realities of developing countries, this research proposes a context-specific framework built around four thematically grounded dimensions: public transportation service, active mobility, unified cashless fare systems, and smart traffic management. The SMI was constructed through a mixed-method approach combining expert interviews with metropolitan transport specialists and co-occurrence network analysis. The results reveal substantial disparities across LGUs, with central jurisdictions such as Makati, Manila, and Pasay demonstrating significantly higher smart mobility readiness than peripheral LGUs. Clustering identifies three distinct mobility profiles, underscoring persistent structural inequalities in infrastructure, institutional capacity, and digital integration. Forecasts incorporating the completion of six major railway projects by 2035 indicate moderate improvements in overall SMI scores and limited changes in relative rankings, suggesting that infrastructural expansion alone will not reduce regional disparities. Expert insights further highlight both the potential and the constraints of leapfrogging, with interviewees expressing optimism regarding advanced ICT-enabled mobility solutions while acknowledging challenges related to governance fragmentation, limited funding, and uneven technical capabilities. Full article

We present a linearly implicit and structure-preserving scheme to solve the space-fractional Ginzburg–Landau–Schrödinger equation. The fully discrete scheme is obtained by combining the modified leap-frog method in the temporal direction and the finite difference methods in the spatial direction. It is shown that the scheme can be unconditionally energy-stable. In particular, the equation becomes the space-fractional Schrödinger equation. Then, the scheme can keep both the discrete mass and energy conserved. Moreover, convergence of the scheme is obtained. Numerical experiments are performed to confirm the theoretical results. Full article

Integrated urban–rural development is an inevitable requirement of regional development. Developing green industries based on rural ecological resources are important approaches to promoting urban–rural integration. The National Key Ecological Function Zones (NKEFZ) policy focuses on safeguarding national ecological security. However, whether the resulting ecological improvements can, through the realization of ecological value, provide momentum for urban–rural integration remains unclear in existing research. This study uses a sample of 284 prefecture-level cities in China from 2006 to 2023, treating the establishment of NKEFZ as a quasi-natural experiment. First, the study constructs a “Driving-constraining” bidirectional theoretical framework, and then uses the entropy weight method to measure the level of urban–rural integration, which is selected by 18 sub-indicators from the populational, spatial, and economic dimensions. Finally, a multi-period difference-in-differences (DID) model is constructed to test the impact of NKEFZ on urban–rural integration, and the transmission mechanisms and heterogeneity are explored. The results indicate the following: (1) Following the implementation of the NKEFZ policy, it shows an overall inhibitory trend on urban–rural integration, consequently slowing the progress of urban–rural integration. The inhibitory effects are particularly pronounced in spatial and economic integration dimensions, and these results are robust. (2) Constrained industrial upgrading and increased fiscal pressure on local governments are the main mechanisms behind the slowed urban–rural integration. (3) Due to differences in policy coverage and the heterogeneous characteristics of city locations, the negative effects of the policy are more pronounced in cities with a high proportion of key ecological function counties, as well as in prefecture-level cities in central and western regions. Based on these findings, it is suggested to promote high-quality urban–rural integration in eco-priority areas through pathways such as developing ecological industries, improving the ecological compensation system, and clarifying central–local collaborative governance. Full article

This paper is dedicated to analysing sustainability and digitalisation in the transport systems of the European Union (EU) and Ukraine, with a particular focus on three representative subsectors: freight rail, urban public transport and last-mile postal logistics. It explores how technological innovation, operational efficiency and environmental responsibility interact within these sectors under distinct institutional and economic conditions: mature, market-based systems in the EU and resilience-driven systems in wartime Ukraine. This study applies a comparative, descriptive–analytical methodology using secondary data drawn from corporate sustainability reports, official statistics and sectoral databases for 2022. Quantitative KPls were complemented with a qualitative assessment of digitalisation maturity to ensure cross-country comparability. Through a comparative analysis of KPIs, such as freight volumes, emissions intensity, revenue efficiency and digital maturity, this study identifies structural and policy gaps that hinder progress toward sustainable mobility. This study develops a multi-dimensional framework combining operational, financial, environmental and digital indicators. In this paper, digital integration refers to the degree to which transport operators embed digital tools such as tracking, data management and automation into their core processes, while environmental efficiency denotes the ability to deliver transport services with minimal resource consumption and carbon emissions per operational unit. Institutional resilience is understood here as the capacity of transport organisations and governing institutions to maintain functionality, adapt and recover under crisis or systemic stress, which is particularly relevant for Ukraine’s wartime context. The findings demonstrate that while EU operators lead in transparency, digital integration and environmental performance, Ukrainian actors exhibit rapid adaptive innovation and significant potential for technological leapfrogging during reconstruction. This paper concludes that the EU must overcome regulatory inertia and infrastructure fatigue, while Ukraine should institutionalise resilience and transparency. Full article

To improve the comprehensive performance of indium oxide (In₂O₃) thermoelectric materials, this study systematically investigates the regulatory effects of tantalum (Ta) doping on their electrical transport characteristics, thermoelectric conversion efficiency, and mechanical properties. The results show that Ta doping achieves synchronous optimization of multiple properties through precise regulation of crystal structure, electronic structure, and microdefects. In terms of electrical transport, the electron doping effect of Ta⁵⁺ substituting In³⁺ and the introduction of impurity levels lead to a continuous increase in carrier concentration; lattice relaxation and impurity band formation at high doping concentrations promote mobility to first decrease and then increase, resulting in a significant growth in electrical conductivity. Although the absolute value of the Seebeck coefficient slightly decreases, the growth rate of electrical conductivity far exceeds the attenuation rate of its square, increasing the power factor from 1.83 to 5.26 μWcm⁻¹K⁻² (973 K). The enhancement of density of states near the Fermi level not only optimizes carrier transport efficiency but also provides electronic structure support for synergistic performance improvement. For thermoelectric conversion efficiency, the substantial increase in power factor collaborates with thermal conductivity suppression induced by lattice distortion and impurity scattering, leading to a leapfrog increase in ZT value from 0.055 to 0.329 (973 K). In terms of mechanical properties, lattice distortion strengthening, formation of strong Ta-O covalent bonds, and dispersion strengthening effect significantly improve the Vickers hardness of the material. Ta doping breaks the bottleneck of mutual property constraints in traditional modification through an integrated mechanism of “electronic structure regulation-carrier transport optimization-multiple performance synergistic enhancement”, providing a key strategy for designing high-performance indium oxide-based thermoelectric materials and facilitating their practical application in the field of green energy conversion. Full article

We present the ContEvol (continuous evolution) formalism, a family of implicit numerical methods which only need to solve linear equations and are almost symplectic. Combining values and derivatives of functions, ContEvol outputs allow users to recover full history and render full distributions. Using the classic harmonic oscillator as a prototype case, we show that ContEvol methods lead to lower-order errors than two commonly used Runge–Kutta methods. Applying first-order ContEvol to simple celestial mechanics problems, we demonstrate that deviation from equation(s) of motion of ContEvol tracks is still 𝒪(h⁵) (h is the step length) by our definition. Numerical experiments with an eccentric elliptical orbit indicate that first-order ContEvol is a viable alternative to classic Runge–Kutta or the symplectic leapfrog integrator. Solving the stationary Schrödinger equation in quantum mechanics, we manifest ability of ContEvol to handle boundary value or eigenvalue problems. Important directions for future work, including mathematical foundations, higher dimensions, and technical improvements, are discussed at the end of this article. Full article

Background: Randomized controlled trials (RCTs) are the foundation of evidence-based medicine. However, the rapid pace of technological innovation in cardiovascular surgery and interventional cardiology challenges the traditional RCT framework. Observational studies may hold renewed value in fields where device evolution outpaces the time required to validate clinical outcomes. Methods: This analysis evaluates 270 randomized and non-randomized studies in transcatheter aortic valve implantation (TAVI), one of the most rapidly evolving areas in cardiovascular medicine. The investigation follows two lines: first, mapping the timeline of major RCTs against the introduction of new prosthetic models; second, comparing the prevalence, duration, and role of randomized (R) versus non-randomized (NR) studies. Results: The timeline reveals a persistent misalignment between innovation and validation. New prosthetic models frequently enter the market while RCTs for prior generations are still ongoing. For example, the Sapien 3 valve was approved, while trials on Sapien XT were still enrolling. Similarly, newer Evolut and Acurate models were introduced during ongoing studies of earlier versions, often prompting new studies before existing ones concluded. This leapfrogging effect fragments the evidence base and delays definitive comparisons. In parallel, randomized trials have increased in number and tend to be shorter in duration, reflecting a maturing field. However, non-randomized studies remain crucial for early testing and post-market surveillance. Conclusions: In a field with rapid technological evolution a sort of Zeno’s paradox occurs: long-term validation cannot keep pace with fast innovation, resetting the evidence base with each new model. To overcome this paradox, a paradigm shift in evidence generation is desirable. Future strategies must augment adaptive trial designs, leverage real-world data and use higher-level, advanced analyses to incorporate subjective variables and phenotypic diversity, to reduce confounding factors and speed up data access. Higher-level, integrative evidence analytics could help Achilles walk alongside the tortoise. Full article

For a considerable period, China’s eastern and western regions have grappled with imbalances in industrial development, with industrial leapfrogging emerging as a pivotal solution. This study examines the impact of artificial intelligence technology spillovers and sustainable innovation on industrial leapfrogging between eastern and western regions. Empirical analysis is conducted using panel data from 22 provinces and municipalities across eastern and western China spanning 2014–2024, employing both a spatial difference-in-differences model and a dual machine learning model. Findings reveal that both AI technology spillovers and sustainable innovation significantly enhance the efficiency of industrial leapfrogging across regions. Their synergistic effects are pronounced, generating positive spatial spillovers. Institutional environments exert a significant influence on leapfrog industrial development. By regulating AI technology environments and sustainable innovation environments, institutional frameworks enhance leapfrogging efficiency, though this mediation exhibits a dual-threshold effect: most western provinces have yet to cross the first threshold. Industrial and economic heterogeneity weaken the efficiency of AI technology spillovers and sustainable innovation in facilitating industrial leapfrogging between eastern and western regions. This research provides robust empirical support for addressing industrial development imbalances and enhancing industrial resilience between eastern and western regions. Full article