Search Results (544)

The Syrian conflict has created one of the largest displacement crises of the twenty-first century, disproportionately affecting adolescent girls. Syrian girls have been primarily portrayed as victims of war or “the lost generation”, neglecting the plurality of their experiences. Building on Bandura’s social cognitive theory, Giddens’ structuration theory, Kabeer’s empowerment framework, and Mahmood’s modalities of agency, this study examines how Syrian refugee adolescent girls in Lebanon enact agency within contexts of forced displacement and how structural factors shape these processes. We conducted a secondary analysis of 293 first-person narratives from Syrian girls and mothers collected in 2016 using Cognitive Edge’s SenseMaker^®. Thematic analysis revealed seven structural barriers—restricted access to education, economic insecurity, inadequate infrastructure/living conditions, limited healthcare, gender and social norms, xenophobia, and lack of legal status—as well as key enablers including community services, parental support, and peer networks. Girls expressed agency through seven interconnected processes: awareness/acknowledgement of barriers, emotional navigation, resource identification, decision-making, future planning, reflection, and action execution. These processes were adaptive and recursive, highlighting that agency during displacement is dynamic, relational, and conditioned by structural forces. These findings inform approaches that both reduce structural barriers and enable refugee girls’ agency. Full article

This perspective provides a multidisciplinary assessment of the use of lithium-ion batteries from electric vehicles (EVs) for second-life applications, motivated by the need to improve resource efficiency, reduce environmental impacts, and support a circular battery economy. Second-life deployment requires the integrated consideration of technical performance, legal compliance, and economic viability. The analysis combines a technical evaluation of battery aging mechanisms, operational load effects, and qualification strategies with a legal assessment of the EU Batteries Regulation (EU) 2023/1542 and an economic analysis of market potential and business models (BM). From a technical perspective, the limitations of State of Health (SOH) as a standalone indicator are demonstrated, highlighting the need for multiple health indicators and degradation-aware qualification. A scalable two-step qualification approach, combining qualitative inspection with a standardized quantitative measurement protocol, is discussed. From a legal perspective, regulatory requirements and barriers related to repurposing, waste classification, and conformity assessment are analyzed. From an economic perspective, business model patterns and market dynamics are evaluated, identifying Automated Guided Vehicles (AGVs) and industrial Energy Storage Systems (ESSs) for renewable firming as particularly promising applications. The paper concludes with recommendations for action and key research needs to enable safe, economically viable, and legally compliant second-life deployment. Full article

Very Low Earth Orbit (VLEO) satellites, operating at altitudes below 450 km, provide tremendous potential in the domain of remote sensing. Their proximity to Earth offers high resolution, low latency, and rapid revisit rates, allowing continuous monitoring of dynamic systems and real-time delivery of vertically integrated earth observation products. Nonetheless, the application of VLEO is not yet fully realized due to numerous complexities associated with VLEO satellite development, considering atmospheric drag, short satellite lifetimes, and social, political, and legal regulatory fragmentation. This paper reviews the recent technological developments supporting sustainable VLEO operations with regards to aerodynamic satellite design, atomic oxygen barriers, and atmospheric-breathing electric propulsion (ABEP). Furthermore, the paper provides an overview of the identification of regulatory and economic barriers that extort additional costs for VLEO ranging from frequency band allocation and space traffic management to life-cycle cost and uncertain commercial demand opportunities. Nevertheless, the commercial potential of VLEO operations is widely acknowledged, and estimated to lead to an economic turnover in the order of 1.5 B USD in the next decade. Learning from the literature and prominent past experiences such as the DISCOVERER and CORONA programs, the study identifies key gaps and proposes a roadmap to sustainable VLEO development. The proposed framework emphasizes modular and serviceable satellite platforms, hybrid propulsion systems, and globally harmonized governance in space. Ultimately, public–private partnerships and synergies across sectors will determine whether VLEO systems become part of the broader space infrastructure unlocking new capabilities for near-Earth services, environmental monitoring, and commercial innovation at the edge of space. Full article

Objectives: This study aims to evaluate whether contemporary artificial intelligence (AI), including convolutional neural networks (CNNs) for medical imaging and large language models (LLMs) for language processing, could replace physicians in the near future and to identify the principal clinical, technical, and regulatory barriers. Methods: A narrative review is conducted on the scientific literature addressing AI performance and reproducibility in medical imaging, LLM competence in medical knowledge assessment and patient communication, limitations in out-of-distribution generalization, absence of physical examination and sensory inputs, and current regulatory and legal frameworks, particularly within the European Union. Results: AI systems demonstrate high accuracy and reproducibility in narrowly defined tasks, such as image interpretation, lesion measurement, triage, documentation support, and written communication. These capabilities reduce interobserver variability and support workflow efficiency. However, major obstacles to physician replacement persist, including limited generalization beyond training distributions, inability to perform physical examination or procedural tasks, susceptibility of LLMs to hallucinations and overconfidence, unresolved issues of legal liability at higher levels of autonomy, and the continued requirement for clinician oversight. Conclusions: In the foreseeable future, AI will augment rather than replace physicians. The most realistic trajectory involves automation of well-defined tasks under human supervision, while clinical integration, physical examination, procedural performance, ethical judgment, and accountability remain physician-dependent. Future adoption should prioritize robust clinical validation, uncertainty management, escalation pathways to clinicians, and clear regulatory and legal frameworks. Full article

Since the COVID-19 pandemic, wastewater monitoring has become an additional tool in the surveillance of infectious diseases. Many EU countries put wastewater surveillance systems (WSS) in place to track SARS-CoV-2 and its variants and other pathogens, such as the influenza virus or Respiratory syncytial virus (RSV). In Germany, several research and pilot projects funded by the EU, the Federal Ministry of Education and Research, the Federal Ministry of Health, and projects at Federal State level have been launched in the last four years. In Germany, wastewater monitoring was not implemented as a public health tool before the COVID-19 pandemic, but in September 2022, it has been legally determined in the German infection protection act (Infektionsschutzgesetz, IfSG). As Germany is a federal state, competencies in epidemic management partly belong to the 16 federal states (“Länder”). In the federal states, the local health authorities at the county (“Kreise”) level also have specific risk management and communication competencies. Furthermore, WSS has been incorporated into the revised Urban Wastewater Treatment Directive (EU) 2024/3019. For this reason, the federal states and local health authorities play a pivotal role in successfully implementing wastewater monitoring as a supplementary component of disease surveillance in Germany. Between November 2021 and August 2022, the federal state of Thuringia, Germany, supported a pilot study to implement a surveillance system for SARS-CoV-2-RNA in wastewater of 23 wastewater treatment plants in 17 counties in Thuringia. Here, we describe the study design and the system behind the logistics and the planning, and we provide an overview of the options for involving the public health service. Furthermore, the possibilities for IT concepts and approaches to innovative AI solutions are shown. We also aim to explore the feasibility and potential barriers to further implementing wastewater surveillance as a supplementary public health tool in Thuringia. Full article

Biogas production from agricultural residues is a promising solution for renewable energy production, improved waste management, and beneficial impact on climate change mitigation. The aim of this study is to assess the actual use and theoretical potential of agricultural biogas produced from animal manure in Poland at the local level. The potential and actual use of agricultural biogas are presented regionally (16 voivodeships) and locally (314 districts). The theoretical potential of agricultural biogas was estimated based on data from the Agricultural Census conducted by the Central Statistical Office in Poland in 2020. Actual biogas production is based on data from the Register of Agricultural Biogas Producers maintained by the National Support Center for Agriculture. The study shows that Poland is only tapping into the existing potential for agricultural biogas production to a limited extent. Furthermore, both actual agricultural biogas production and the identified theoretical potential vary spatially (greater potential in the northern part of the country, significantly lower in the southern part). This situation is attributed to existing barriers that hinder the utilization of existing potential. Therefore, it is crucial to seek new solutions to reduce existing barriers of an organizational, legal, technical, economic, environmental, spatial, and social nature. Full article

Access to health care is a fundamental human right established in various legal frameworks worldwide. However, increasing evidence indicates that individuals with physical disabilities in rural Ethiopia continue to face barriers and disparities in accessing health care, leading to unmet needs and worsening health. Guided by Critical Disability Theory and Intersectionality Theory, this instrumental case study explored the barriers to accessing primary health care (PHC) for adults with physical disabilities in rural Ethiopia and examined how disability intersects with poverty, gender, and rurality to shape exclusion. Following purposeful sampling, we conducted 14 interviews and one focus group discussion (n = 7) with adults with physical disabilities, supplemented by PHC facility infrastructure observation. Using reflexive thematic analysis, we identified intersecting barriers across four domains: physical and environmental barriers, socioeconomic marginalization, socio-cultural stigma and attitudinal barriers, and systemic weaknesses in health service delivery. This revealed that disability-related barriers are rooted in structural ableism and intersecting inequities, underscoring the urgent need for inclusive policies and disability-inclusive practices. Such practices include enforcing accessibility standards, expanding community-based health insurance to cover disability-specific needs, supporting transportation, and providing disability-specific training for health professionals. Implementing these practices is essential to advancing disability rights and ensuring equitable health access in Ethiopia. Full article

The Netherlands is widely recognised as the global leader in water management, with its flood risk management (FRM) infrastructure lauded as being of the best in the world. This status notwithstanding, Dutch FRM primarily maintains established infrastructural practices and experimental applications of NBSs remain less frequent than established structural projects. This paper details and examines the challenges associated with the prevailing ‘business-as-usual’ approach to FRM in The Netherlands, in which traditional ‘grey’ infrastructural techniques are prioritised over innovative ‘green’ nature-based solutions (NBSs). In line with emerging international trends, such as the EU Water Resilience Strategy, NBSs are increasingly advocated as a strategic, complementary layer to enhance the resilience of existing safety frameworks rather than a self-evident replacement for them. Contrary to grey infrastructure, NBSs provide a number of environmental and social co-benefits extending beyond their flood and drought protection utility. The literature on NBSs details the design, effectiveness, and positive socio-economic impact of the operationalisation of such projects for FRM. This notwithstanding, the uptake and practical implementation of NBSs have been slow in The Netherlands. From a legal and policy perspective, this has been attributed to a lack of political will and the corresponding failure to include NBSs in long term FRM planning. Given the long planning horizons associated with FRM (50–100 years), the failure to incorporate NBSs can lead to policy lock-in that blocks future adaptations. Against this backdrop, this paper employs a semi-systematic literature review to clarify the obstacles to implementing NBSs in Dutch FRM and sets a research agenda that charts a course to mainstreaming NBSs in Dutch FRM. Seven core focus areas for future research are identified. The paper concludes by drawing on these identified focus areas to construct a research agenda aimed at systematically addressing each barrier to the practical operationalisation of NBSs in Dutch FRM, emphasising a hybrid green–grey approach which may serve to inspire similar research in other jurisdictions. Full article

This scoping literature review examines the outcomes and institutional adaptations of pathway programs designed to increase diversity in medical and allied health professions. These programs address systemic barriers faced by students from underrepresented (UR) backgrounds through a targeted focus on improving their academic performance and preparedness for healthcare careers. Utilizing a scoping approach, peer-reviewed publications from 2014 to March 2024 were analyzed, focusing on pathway programs within the United States. Following PRISMA-ScR guidelines, no formal quality appraisal was conducted. The review highlights the geographical distribution of these programs, particularly in the Greater Philadelphia area, and evaluates their success rates and key components, such as mentorship, academic support, and clinical exposure. Key thematic findings include the importance of sustained mentorship, financial and emotional support, early exposure to health careers, and comprehensive academic preparation. The study also discusses the recent implications of the Supreme Court rulings on race-conscious admissions and the resulting institutional strategies to maintain diversity within legal constraints. By providing a comprehensive overview of the literature, this review aims to inform the development and implementation of pathway programs that can improve diversity in the healthcare workforce. Full article

Renewable hydrogen has become a versatile technology that can play a key role in the deployment of energy communities, although technological, economic, environmental, legal, and social challenges remain to be addressed. This study conducts a systematic review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) methodology that analyzes the current state of technologies, the different applications, challenges and limitations, and future lines of research related to the enabling role of hydrogen in energy communities. Results from the bibliometric analysis show sustained growth in the number of publications over the last five years (2020–2025), with a predominance of applications in which hydrogen is combined with other energy carriers (58%). The versatility of hydrogen has prompted the evaluation of different applications, with particular emphasis on energy storage to capitalize on energy surpluses (51%), mobility (19%), and heating (20%). The main existing barriers come from the absence of stable long-term regulation, interoperability between components and technologies, and a lack of real data. Overcoming these challenges should be based on new technologies such as artificial intelligence and the construction and operation of pilot projects. In addition, a Strengths, Weaknesses, Opportunities and Threats (SWOT) analysis has been conducted building upon the SHARED-H2 SUDOE project, yielding particularly insightful results through the active involvement of stakeholders in the preparatory process. Based on all the points given above, the research concludes that it is necessary to improve long-term policies and increase training at all levels aimed at active end-user participation and a profound restructuring of the energy system. Full article

This study examines how parental legal status operates as a fundamental social determinant of health and educational equity, focusing on long-term outcomes among U.S.-born and foreign-born children of immigrants. We hypothesized that intergenerational stress and institutional exclusion associated with undocumented status would lead to lower educational attainment and poorer health. Using data from the National Longitudinal Study of Adolescent to Adult Health (Add Health), a nationally representative cohort, participants were classified by inferred parental legal status: native-born, documented immigrant, and undocumented immigrant. Outcomes included high school graduation, college enrollment, depression scores, and chronic health conditions. Children of undocumented parents exhibited the most adverse outcomes—lower graduation (63.8%) and college enrollment rates (39.9%), higher depression, and greater chronic illness. In models controlling for socioeconomic factors, parental undocumented status independently predicted reduced odds of college enrollment (OR = 0.61, p < 0.001) and increased odds of reporting fair/poor health (OR = 2.10, p < 0.001). Findings highlight legal precarity as a potent driver of intergenerational disadvantage and underscore the need for policies addressing the barriers faced by children in undocumented families to promote health and educational equity. Full article

Introduction: Rare diseases disperse expertise across institutions and borders, making structured second-opinion systems a pragmatic way to concentrate subspecialty knowledge and reduce diagnostic delays. This scoping review mapped the design, governance, adoption, and impacts of such services across implementation scales. Objectives: To describe how second-opinion services for rare diseases are organized and governed, to characterize technological and workflow models, to summarize benefits and barriers, and to identify priority evidence gaps for implementation. Methods: Using a population–concept–context approach, we included peer-reviewed studies describing implemented second-opinion systems for rare diseases and excluded isolated case reports, purely conceptual proposals, and work outside this focus. Searches in August 2025 covered PubMed/MEDLINE, Scopus, Web of Science Core Collection, Cochrane Library, IEEE Xplore, ACM Digital Library, and LILACS without date limits and were restricted to English, Portuguese, or Spanish. Two reviewers screened independently, and the data were charted with a standardized, piloted form. No formal critical appraisal was undertaken, and the synthesis was descriptive. Results: Initiatives were clustered by scale (European networks, national programs, regional systems, international collaborations) and favored hybrid models over asynchronous and synchronous ones. Across settings, services shared reproducible workflows and provided faster access to expertise, quicker decision-making, and more frequent clarification of care plans. These improvements were enabled by transparent governance and dedicated support but were constrained by platform complexity, the effort required to assemble panels, uneven incentives, interoperability gaps, and medico-legal uncertainty. Conclusions: Systematized second-opinion services for rare diseases are feasible and clinically relevant. Progress hinges on usability, aligned incentives, and pragmatic interoperability, advancing from registries toward bidirectional electronic health record connections, alongside prospective evaluations of outcomes, equity, experience, effectiveness, and costs. Full article

Background: Integrating palliative care (PC) into primary health care (PHC) is essential for achieving Universal Health Coverage and reducing avoidable suffering. Despite global progress in PC development, the extent to which PC is effectively embedded within PHC systems remains unclear, particularly in low- and middle-income countries. Colombia illustrates this gap, with an advanced legal framework but persistent territorial inequities. This study explored how national experts conceptualize PC integration into PHC to inform the development of context-sensitive indicators. Methods: A directed thematic analysis was conducted using qualitative comments from a modified Delphi process (pre-Delphi, Round 1, Round 2). Coding was guided by the WHO model for PC development and the WHO–UNICEF Operational Framework for PHC, combining deductive and inductive approaches to identify recurrent themes. Results: A total of 230 qualitative comments from experts in PC, PHC, and public health were analyzed. Experts described integration as the alignment of policy, education, service delivery, and community participation within PHC structures. They emphasized that laws and training programs alone are insufficient; integration depends on implementation capacity, equitable access, and locally responsive systems. Rural areas were identified as facing the greatest barriers, including limited trained staff, restricted medicine availability, and weak referral pathways. Conclusions: Experts understood PC integration into PHC as a dynamic and ethical process linking system design with human experience. Strengthening equity, workforce preparation, and community engagement is essential to translate policy into practice and to develop meaningful indicators for health system improvement. Full article

Background/Objectives: Family members are the principal providers of home-based care for migrant older adults. Linguistic, cultural, and structural barriers within health systems exacerbate the caregiver burden across emotional, physical and financial domains. Although home healthcare services may alleviate this burden, variability in access, cultural safety, and care coordination can also intensify it. This scoping review maps the evidence on the burden experienced by family caregivers who deliver home-based healthcare to migrant older adults and examines how these arrangements affect caregivers’ health and well-being. It synthesizes the literature on facilitators and barriers—including access, cultural-linguistic fit, coordination with formal services, and legal/immigration constraints—and distills implications for policy and practice to strengthen equitable, culturally responsive home care. Method: The Joanna Briggs Institute (JBI) scoping review framework was used to conduct the review. A comprehensive search was performed across six databases (CINAHL, Scopus, Web of Science, PsycINFO, MEDLINE and Sociological Abstracts) for articles published between 2000 and 2025. Studies were selected based on predefined inclusion criteria focusing on the family caregiver burden in providing home healthcare for migrant older adults. Data extraction and thematic analysis were conducted to identify key themes. Results: The review identified 20 studies across various geographical regions, highlighting four key themes: (1) Multidimensional Caregiver Burden, (2) The Influence of Gender, Family Hierarchy, and Migratory Trajectories on Caregiving, (3) Limited Access to Formal and Culturally Appropriate Support, and (4) Health Outcomes, Coping, and the Need for Community-Based Solutions. Conclusions: System-level reforms are required to advance equity in home healthcare for aging migrants. Priorities include establishing accountable cultural-safety training for providers; expanding multilingual access across intake, assessment, and follow-up; and formally recognizing and resourcing family caregivers (e.g., navigation support, respite, training, and financial relief). Investment in community-driven programs, frameworks and targeted outreach—co-designed with migrant communities—can mitigate isolation and improve uptake. While home healthcare is pivotal, structural inequities and cultural barriers continue to constrain equitable access. Addressing these gaps demands coordinated policy action, enhanced provider preparation, and culturally responsive care models. Future research should evaluate innovative frameworks that integrate community partnerships and culturally responsive practices to reduce the caregiver burden and improve outcomes for migrant families. Full article

Background/Objectives: Pediatric asthma remains a pressing public health issue, especially among low-income, minority children living in subsidized housing. Methods: This study employed a community-based participatory research approach to explore barriers and potential solutions for improving asthma management in this vulnerable population. Semi-structured interviews were conducted with 22 caregivers of children with asthma and 8 community health workers in Washington, DC—a city marked by high childhood asthma rates and concentrated subsidized housing. Results: Thematic analysis identified six core findings: (1) families frequently encountered multiple home environmental asthma triggers, including pests, mold, secondhand smoke, leaks, poor ventilation, and aging infrastructure; (2) healthy housing services were under implemented, often due to unresponsive landlords, inadequate inspections, and poor maintenance; (3) existing services such as pest control, mold remediation, and smoke-free policies were ineffectively implemented; (4) challenges to service delivery included difficulties faced by landlords and structural barriers tied to geography, race, and socioeconomic status; (5) substandard housing conditions contributed to residents’ feelings of powerlessness, frustration, and distrust, with some taking legal action to address persistent hazards; and (6) participants recommended stronger housing code enforcement, sustained funding for home-based environmental interventions, housing-health liaisons, strengthened landlord accountability, support for landlords to facilitate repairs, centering families’ voices, and advocacy. Conclusions: This study underscores the persistent challenges caregivers face in managing asthma triggers in subsidized housing. The findings highlight the critical need for improved housing conditions, greater landlord and housing authority accountability, and policy reforms to ensure consistent, equitable, and sustainable healthy housing services that reduce pediatric asthma disparities. Full article