Search Results (1,417)

Scan-assisted interocclusal registration may vary with record extent and occlusal support. Using separately fabricated high-hardness vinyl polysiloxane (VPS) records, a fixed bilateral buccal intraoral scanner (IOS) acquisition protocol, optical reference articulations, and position-level three-dimensional analysis, this in vitro study compared prepared-tooth (Hard-Prep) and complete-arch (Hard-Arch) records across three support configurations and assessed a no-record IOS workflow. Ninety VPS-based and 45 no-record IOS acquisitions were analyzed. VPS records were fabricated under a 3.0 kg load; measurements used a 1.0 kg load. Overall three-dimensional deviation (dXYZ) was averaged over five mandibular positions. Log-transformed dXYZ was analyzed by ordinary least squares with Holm-adjusted contrasts. The Hard-Arch/Hard-Prep contrast was not statistically significant under bilateral extended support. Hard-Arch showed higher dXYZ under unilateral extended support (ratio, 1.75; 95% confidence interval (CI), 1.54–1.99; p < 0.001) and unilateral limited support (ratio, 1.58; 95% CI, 1.39–1.80; p < 0.001). In the no-record workflow, unilateral extended support exceeded bilateral extended support (ratio, 1.50; 95% CI, 1.31–1.72; p < 0.001), whereas unilateral limited support was lower than unilateral extended support (ratio, 0.68; 95% CI, 0.59–0.77; p < 0.001). Prepared-tooth records yielded lower deviation in both unilateral configurations, while the no-record workflow varied with support configuration. Full article

Background: Prognostic assessment after neoadjuvant chemotherapy and curative gastrectomy remains challenging in patients with gastric adenocarcinoma because postoperative outcomes are influenced by both pretreatment disease burden and pathological response. We aimed to develop and internally validate a clinicopathological prognostic model and a simple postoperative risk classification for predicting disease-free survival (DFS). Methods: This single-center retrospective cohort study included patients with gastric adenocarcinoma who underwent neoadjuvant chemotherapy followed by curative gastrectomy. Pretreatment clinicopathological variables, Becker tumor regression grade (TRG), and serum tumor markers were evaluated. Logistic regression was used to identify predictors of favorable pathological response, whereas Cox proportional hazards regression was performed to identify independent prognostic factors for disease-free survival (DFS). Sequential prognostic models were developed and internally validated using 1000 bootstrap resamples. A simplified postoperative clinicopathological risk classification based on pretreatment clinical N stage and Becker tumor regression grade was additionally developed to facilitate clinical interpretation and postoperative risk stratification. Results: A total of 109 patients were included. Favorable pathological response (Becker TRG1–2) was achieved in 68 patients (62.4%), whereas 41 patients (37.6%) had minimal or no pathological response (TRG3). In multivariable logistic regression analysis, pretreatment clinical T stage (cT4 vs. cT1–3) and clinical N stage (cN2–3 vs. cN0–1) were independently associated with a lower likelihood of achieving a favorable pathological response. For disease-free survival, pretreatment clinical N stage, Becker tumor regression grade, and log10-transformed CA19-9 remained independent prognostic factors in the multivariable Cox model. Sequential model development demonstrated progressive improvement in model discrimination, with the optimism-corrected Harrell’s C-index increasing from 0.697 for the clinical N stage model to 0.770 for the final model incorporating clinical N stage, Becker tumor regression grade, and CA19-9. Bootstrap internal validation demonstrated minimal optimism, and calibration analysis showed good agreement between predicted and observed disease-free survival. A simple postoperative clinicopathological risk classification successfully stratified patients into distinct prognostic groups. Conclusions: A clinicopathological prognostic model integrating pretreatment clinical N stage, Becker tumor regression grade, and serum CA19-9 demonstrated improved prognostic discrimination for disease-free survival compared with clinical N stage alone. The derived postoperative risk classification may provide a simple framework for postoperative risk stratification and could assist in individualizing postoperative surveillance. External validation is warranted before routine clinical implementation. Full article

This study presents a sensor-fused field investigation and simulation-based analysis of four horizontal and vertical traffic-calming devices—two raised speed tables, a speed hump, and a raised crosswalk—installed along a 5250-ft two-lane residential collector in Nashville, TN, USA. A dual-sensor architecture combining a Miovision Scout video-based vehicle counter and WAAS/EGNOS-augmented GPS probe-vehicle logging (5 m 3-D RMS horizontal accuracy, 1 Hz sampling) was used to reconstruct 30 quality-controlled free-flow vehicle trajectories and 12-h per-lane volume counts. A spatial kinematic transform (a = v·dv/dx) was applied to extract device-specific approach-deceleration and post-device recovery-acceleration rates, and a three-parameter log-logistic cumulative-distribution function was fitted to the field-observed desired-speed percentiles (root-mean-square error below 0.043 for both speed-table devices). The camera- and GPS-derived observations were used to calibrate and statistically validate a PTV VISSIM microsimulation replica of the corridor, achieving a mean-speed calibration error of 0.71% or better at every device, a GEH statistic below 1.5 at all four analysis turning movements, and independent travel-time validation errors of 5.7–12.1%, within the accepted 15% threshold. The validated model was then used to reconstruct device- and spacing-specific May–Keller macroscopic speed–density–flow relationships, calibrated against simulated capacities of 650–775 vehicles per hour per lane at 350-, 700-, and 1050-ft device spacing. Results show capacity reductions of 20–33% relative to free-flow conditions and yield kinematically derived maximum recommended spacings of 265–630 ft to maintain crossing speeds at or below 15 mph, depending on device geometry. The findings demonstrate a reproducible, low-cost sensor-fusion workflow for quantifying the safety–capacity trade-off of traffic-calming corridors and for informing the design of sensor-in-the-loop adaptive-calming infrastructure. Full article

Accurate estimation of subsurface acoustic impedance is fundamental to quantitative reservoir characterization in seismic exploration. Nevertheless, a single network architecture cannot adequately represent both the local details and the global trends of seismic records within a unified framework, while the severe scarcity of annotated well-log data substantially constrains the generalization capability and predictive accuracy of deep-learning-based inversion approaches. To overcome these limitations, a semi-supervised acoustic impedance inversion framework based on a hybrid deep learning architecture is proposed. The framework employs a cascaded architecture consisting of a multi-scale depthwise separable convolution with channel attention (MSDSE) module and a convolution-augmented Transformer encoder. Seismic data are first processed by the MSDSE module to extract local multi-scale temporal features, and are subsequently passed to the convolution-augmented Transformer encoder, which captures global long-range sequence dependencies while retaining complementary local temporal information. The two modules progress hierarchically and jointly achieve a feature representation that spans from local details to global trends, and the initial low-frequency model is fused with the network output via channel-wise concatenation. Meanwhile, an initial-model constraint together with a physical-consistency constraint are simultaneously imposed within the loss function, thereby improving training stability while fully leveraging the physical information embedded in unlabeled traces. Experiments on both synthetic and field data confirm the effectiveness of the proposed method. The results show that, even with a small number of labels, the method produces stable impedance estimates and outperforms conventional deep learning methods in both generalization and prediction accuracy. Full article

This study evaluated the influence of the manufacturing method and cementation protocol on the fracture load of zirconia molar crowns. A total of 32 full-contour crowns with a wall thickness of 1 mm were fabricated from 3 mol% yttria-stabilized tetragonal zirconia polycrystal (3Y-TZP). Sixteen crowns were produced by 3D printing (LithaCon 3Y 210, Lithoz) and 16 by milling (e.max ZirCAD LT, Ivoclar Vivadent). Within each manufacturing group, eight crowns were adhesively luted with a dual-cure resin cement (Bifix QM, VOCO) and eight were conventionally cemented with a glass ionomer cement (Ketac Cem, Solventum). All crown–die complexes underwent thermomechanical aging (6000 thermal cycles between 5 °C/55 °C; 1.2 × 10⁶ cycles at 50 N) as a correlate of five years of clinical service, followed by axial loading to failure. The statistical analysis was a two-way ANOVA on log10-transformed fracture loads with manufacturing and cement as fixed effects (α = 0.05). All crowns survived thermomechanical loading without failure. Milled zirconia crowns showed significantly higher fracture loads when adhesively luted (7162 ± 1294 N) compared with conventional cementation (4021 ± 1126 N; p < 0.001). In contrast, no significant differences were observed between adhesive (4986 ± 1301 N) and conventional cementation (5581 ± 1618 N) for 3D-printed zirconia crowns. Additively manufactured crowns exhibited greater variability in fracture loads (broader interquartile ranges) than their milled counterparts. Two-way ANOVA detected a significant Manufacturing × Cement interaction (p < 0.001), indicating that the effect of cementation differed by manufacturing route. Adhesive cementation increased fracture load for milled zirconia, whereas no statistically significant cementation effect was detected for 3D-printed zirconia under the present conditions. Given the sample size and the observed variability, the study was powered to detect very large effects but not medium or small ones; therefore, this non-significant difference should not be interpreted as proof of no effect. Full article

Objectives: Individuals with type 2 diabetes (T2D) remain at high cardiovascular disease (CVD) risk. The pan-immune-inflammation value (PIV) integrates circulating neutrophils, monocytes, platelets, and lymphocytes but does not capture albumin-related nutritional and inflammatory reserve. We investigated associations between the PIV-to-albumin ratio (PIVA) and incident CVD, cardiovascular mortality, and disease progression in individuals with T2D. Methods: This prospective study included 15,355 UK Biobank participants with T2D and no baseline CVD. PIVA was calculated from peripheral blood cell counts and serum albumin and was natural log-transformed. Fine–Gray competing-risk and cause-specific Cox models were used to evaluate incident CVD and cardiovascular mortality. Multi-state models characterized transitions from T2D to CVD and death. We also examined nonlinear associations, renal biomarker mediation, joint associations with the CVD polygenic risk score and triglyceride–glucose index, sensitivity analyses, and external validation of cardiovascular mortality in the National Health and Nutrition Examination Survey. Results: During median follow-ups of 12.94 years for incident CVD and 14.49 years for cardiovascular mortality, 4829 incident CVD events and 514 cardiovascular deaths occurred. Each 1-unit increase in lnPIVA was associated with higher risks of incident CVD (subdistribution hazard ratio [sHR], 1.140; 95% confidence interval [CI], 1.088–1.194) and cardiovascular mortality (sHR, 1.449; 95% CI, 1.247–1.684). Associations were nonlinear. Higher lnPIVA was also associated with transitions from T2D to CVD, from T2D directly to cardiovascular death, and from incident CVD to cardiovascular death. Cystatin C explained a larger proportion of these associations than creatinine. Elevated lnPIVA identified excess cardiovascular risk across strata of genetic susceptibility and insulin resistance, and the findings were generally supported by sensitivity and external validation analyses. Conclusions: lnPIVA was associated with incident CVD, cardiovascular mortality, and adverse cardiovascular transitions in individuals with T2D. As an immune-inflammatory and albumin-based index, PIVA may help identify high-risk individuals beyond conventional cardiometabolic and genetic risk profiles. Full article

Soil organic carbon (SOC) stocks are strongly influenced by land use, vegetation condition and climate, particularly in heterogeneous mountain catchments. This study quantified SOC stocks and simulated long-term SOC dynamics in the Çapakçur micro-catchment, eastern Türkiye, by integrating field assessment, geostatistical prediction, uncertainty analysis, inverse RothC calibration and scenario modelling. A total of 428 soil samples were collected from the 0–30 cm layer across forest, degraded forest, and pasture areas. SOC stocks were calculated from SOC concentration, bulk density and soil depth, and spatially predicted using ordinary kriging of log-transformed SOC stocks. RothC was calibrated for each land-use class to estimate the annual carbon inputs required to maintain observed SOC stocks, followed by 50-year restoration and climate-sensitivity simulations. SOC stocks ranged from 7.69 to 247.68 Mg C ha⁻¹, averaging 55.52 Mg C ha⁻¹. Forest had the highest mean SOC stock (78.5 Mg C ha⁻¹), followed by pasture (55.9) and degraded forest (50.2 Mg C ha⁻¹). Required annual carbon inputs were 5.17, 4.58 and 3.29 Mg C ha⁻¹ yr⁻¹, respectively. Increasing degraded forest carbon inputs to forest-equivalent levels increased SOC by 14.76 Mg C ha⁻¹ over 50 years, equivalent to 37.77 Gg C or 138.49 Gg CO₂eq at the catchment scale. A stronger restoration scenario increased this potential to 63.77 Gg C. Warming caused SOC losses, with +2 °C reducing catchment SOC by 56.78 Gg C. These findings demonstrate the potential of degraded forest restoration for SOC sequestration while highlighting the vulnerability of long-term SOC gains to climate warming. Full article

Using 1135 customer–supplier–year observations involving Chinese A-share listed firms and their major suppliers from 2011 to 2023, together with prefecture-level government work reports and patent-assignment records, we examine whether environmental policy pressure faced by downstream customers shapes upstream suppliers’ external green technology acquisition. External green technology acquisition is measured as the log-transformed annual number of green patents assigned to each supplier. We find that suppliers acquire more external green patents when their customers face stronger local environmental policy pressure, with a one-standard-deviation increase in policy intensity associated with approximately 5.7% higher external green patent acquisition. The result is robust to placebo tests, alternative measures, and PPML estimation, while instrumental-variable estimates point in the same direction. Further analyses document stronger customer green-transition urgency and supplier-perceived supply-chain uncertainty under greater downstream policy intensity, and they show that the relationship is stronger among suppliers with weaker bargaining power or lower R&D intensity. Environment-related policy intensity is more strongly associated with end-of-pipe technology acquisition, whereas energy-transition and market-incentive policy intensity are more strongly associated with source-control technology acquisition. Overall, the findings indicate that environmental policy intensity in downstream customers’ cities is associated with upstream suppliers’ external green technology acquisition within observed customer–supplier relationships. Full article

The global threat of multidrug-resistant infections requires new approaches for its management. A blend of polymethyl methacrylate (PMMA) and poly(ε-caprolactone) (PCL) electrospun nanofibrous membrane was utilised as a scaffold to sustain the release of three broad-spectrum antiseptics to combat multidrug-resistant (MDR) microorganisms. The scaffold was characterised by Fourier transform infrared spectroscopy, contact angle, and scanning electron microscopy. The latter revealed a random and smooth structure. The contact angle value of 81.8 ± 1.8 confirmed the hydrophilic nature of the scaffold, which is important for wound healing. The high surface-to-volume ratio of the scaffolds was utilised for loading benzoic acid (BA), methylparaben (MPB), and propylparaben (PPB) which were released during 72 h concentrations ranging between 0.20 and 0.8 mg mL⁻¹. The initial release of antiseptics was high and was then sustained for over 72 h. After 8 h, the burst release was 61.64 ± 4.11% for BA, 41.11 ± 2.98% for MPB and 34.32 ± 3.13% for PPB. The release profile of BA was superior to that of the MPB and PPB. The loaded scaffolds inhibited MDR-resistant methicillin-resistant Staphylococcus aureus, Escherichia coli and Candida albicans and were not cytotoxic to a fibroblast cell line. They inhibited their colonisation by the tested microorganisms to non-detectable counts or at least reduced microbial counts by at least 6–7 logs (p ≤ 0.001) for 72 h. Crystal violet techniques and electron microscopy confirmed colonisation inhibition. Because of their non-cytotoxicity and broad-spectrum antimicrobial activity, the antiseptic-loaded PMMA/PCL nanofibrous scaffolds could be utilised as wound dressings, particularly in non-healing wounds. Full article

Background/Objectives: Low parathyroid hormone (PTH) levels in maintenance hemodialysis may reflect malnutrition, inflammation, reduced functional reserve, or low bone turnover rather than optimal CKD-MBD control. We evaluated associations of longitudinal PTH burden with nutritional-inflammatory and functional-dependence profiles, hospitalization, and mortality. Methods: This retrospective cohort included 188 adults receiving maintenance hemodialysis. Serial PTH measurements were summarized using time-weighted mean PTH. Associations with nutritional-inflammatory biomarkers, functional-dependence measures, and hospitalization were assessed using regression models. Mortality was primarily evaluated using a joint longitudinal–survival model linking repeated log2-transformed PTH measurements with time to death and adjusting for age, sex, dialysis vintage, and dialysis access. A 6-month landmark analysis was performed as a complementary sensitivity analysis. Results: Median time-weighted mean PTH was 292 pg/mL. Lower longitudinal PTH burden was associated with lower albumin, cholesterol, and transferrin and higher C-reactive protein and ferritin. Higher PTH was associated with lower odds of worse mobility and dependence in dressing, bathing, toileting, and continence after adjustment. Hospitalization was not significantly associated with PTH. During follow-up, 62 patients died. In the joint model, each twofold higher estimated current PTH level was associated with a lower observed mortality hazard (adjusted hazard ratio [HR] 0.58, 95% confidence interval [CI] 0.46–0.73; p < 0.001). The 6-month landmark analysis included 159 patients and 44 subsequent deaths. Each twofold higher PTH level was associated with lower subsequent mortality hazard (HR 0.69, 95% CI 0.51–0.95; p = 0.021), while PTH < 150 pg/mL was associated with higher mortality than PTH 300–600 pg/mL (HR 2.84, 95% CI 1.22–6.63). Conclusions: Low time-weighted PTH was associated with adverse nutritional-inflammatory and functional profiles, and lower estimated current PTH with higher mortality. Findings were consistent in the 6-month landmark analysis, do not establish causality, and support interpreting PTH in the broader clinical context. Full article

This study applies a prespecified dynamic MFDFA workflow across pandemic, geopolitical-conflict, and tariff-policy regimes for ten non-stable, long-history cryptoassets selected ex post from the 23 July 2026 market-cap ranking. The common sample comprises 3155 daily log returns per asset from 2 December 2017 to 22 July 2026; the final endpoint regime includes the U.S.–Iran conflict. The estimator uses $q=-10,-8,\dots ,10$, linear detrending, 22 scales from 16 to $⌊N/10⌋$, adjacent-secant Legendre transformation, a cubic spectrum peak, and 500-day windows stepped by 21 days plus a terminal endpoint. Full-sample $\mathrm{I}\mathrm{E}=|{\alpha }_0-0.5|$ ranges from 0.01397 (LINK) to 0.08706 (BNB), and observed width ranges from 0.32625 to 0.74678. The controlled incremental U.S.–Iran endpoint coefficient is −0.02734 (two-way clustered SE 0.02369; $p=0.2489$), with asset-cluster $t(9)$ interval [−0.08226, 0.02759]. Quantile estimates range from +0.00206 at the 0.10 quantile to −0.04769 at the 0.90 quantile; all five 999-replication asset-cluster bootstrap percentile intervals include zero. Exact rolling sensitivities are negative for the 500/14, 500/30, and 730/30 designs but positive for the 250/21 design, and every small-cluster interval includes zero. Direct spectrum-width contrasts also remain nonsignificant after Holm adjustment. None of ten observed widths survives BH correction in 200 shuffled-return surrogates per asset (2000 fits in total). The results document heterogeneous and specification-sensitive dynamic multifractal patterns, not isolated or causal crisis effects. Full article

Inland container depot (ICD) truck schedules must absorb new orders, service delays, appointment changes, congestion, and port cut-offs without destabilizing an already executed plan. This study asks whether event-triggered local repair can be separated into an explicit business-rule audit and a learned ranking of feasible task–vehicle actions. The proposed decision-support framework connects a static baseline, candidate task chains, six modeled hard-feasibility predicates, a Transformer encoder trained with proximal policy optimization (Transformer-PPO), and discrete-event execution logs. A five-seed, 120-episode confirmation gave Transformer-PPO a held-out online completion proxy (α_online) of 0.3226 and reward of 110.58, compared with 0.2581 and 61.87 for the matched multilayer perceptron (MLP); deterministic rules and search remained competitive. An independent audit of 4,968,000 action cells across 552 decision states found no disagreement with an independently coded oracle for the implemented hard predicates, while a reward-weight screen exposed the expected efficiency-stability trade-off. Together with a rolling-horizon comparator and a three-scale by three-disturbance stress test, the evidence supports an auditable system-integration contribution, not a new generic reinforcement learning (RL) algorithm or universal performance superiority. Claims are limited to synthetic simulation-based decision support. Full article

Background/Objectives: High-sensitivity cardiac troponin I (hs-cTnI) has shown inconsistent diagnostic performance for acute cellular rejection (ACR) after heart transplantation. We evaluated whether time-normalized hs-cTnI kinetics provide incremental diagnostic value beyond the concurrent concentration for detecting ACR grade ≥ 2R and whether this association varies with time after transplantation. Methods: This retrospective single-center study included 1237 biopsy episodes from 139 heart transplant recipients. Two generalized linear mixed-effects logistic regression models with patient-specific random intercepts were compared. M1 included concurrent log₂-transformed hs-cTnI, whereas M2 additionally included the time-normalized change in log₂-transformed hs-cTnI per 7 days. Discrimination was assessed using leave-one-patient-out cross-validation with patient-level cluster bootstrap confidence intervals. Exploratory analyses examined early (≤90 days), late (>90 days), and continuous post-transplant time. Results: In the overall cohort, M1 showed modest discrimination (AUC 0.641, 95% CI 0.592–0.689), whereas M2 provided no improvement (AUC 0.635; ΔAUC −0.007). Within 90 days, neither model was informative (M1 AUC 0.503; M2 AUC 0.494). Beyond 90 days, M1 showed moderate discrimination (AUC 0.758, 95% CI 0.664–0.838), but M2 again provided no improvement (AUC 0.746; ΔAUC −0.012). Continuous-time modeling showed that the association between concurrent hs-cTnI and ACR strengthened with increasing time after transplantation, whereas the kinetic term remained non-informative. Conclusions: Time-normalized hs-cTnI kinetics did not provide incremental diagnostic value beyond concurrent hs-cTnI. Concurrent hs-cTnI may warrant further evaluation as an adjunctive late-period marker, but the 90-day threshold remains exploratory and requires external validation. Neither hs-cTnI concentration nor its kinetics should replace endomyocardial biopsy. Full article

Background/Objectives: Selenoprotein P (SePP) has been linked to cardiovascular risk, but its relationship with aortic stiffness in patients on maintenance hemodialysis (MHD) is unclear. This study examined that association. Methods: In this cross-sectional study of 138 patients on MHD, serum SePP levels were measured with enzyme-linked immunosorbent assay, and carotid-femoral pulse wave velocity (cfPWV) was measured using the SphygmoCor system. Aortic stiffness was defined as a cfPWV of >10 m/s. Associations of SePP with cfPWV and aortic stiffness were assessed by correlation, linear regression, and penalized logistic regression. Results: Fifty-six patients (40.6%) had aortic stiffness and had lower serum SePP levels than those without aortic stiffness (p = 0.001). Patients with aortic stiffness were older (p = 0.037) and had higher systolic blood pressure (p = 0.005), higher glucose (p = 0.021) and C-reactive protein (p = 0.021) levels, and a higher prevalence of diabetes mellitus (p = 0.034) and hypertension (p = 0.006). Log-transformed SePP was independently and inversely associated with log-transformed cfPWV in both the forward stepwise and forced-entry models (p < 0.001 for both). By Spearman’s analysis, SePP was negatively correlated with cfPWV (p < 0.001). After adjustment for significant covariates, higher SePP levels remained independently associated with lower odds of aortic stiffness in multivariable and penalized logistic regression models. Conclusions: Lower serum SePP levels were independently associated with higher cfPWV and greater odds of aortic stiffness in patients receiving MHD. Full article

While low-impact development and retention strategies are widely studied in urban and agricultural contexts, a distinct knowledge gap remains regarding the quantitative evaluation of dispersed, natural microretention structures in small, ungauged, mountainous forested catchments under complex topographic conditions. To address this limitation, this study provides a novel quantitative assessment of how natural bioretention interventions—specifically arcuate deadwood log barriers, cascading reservoir systems, and strategic afforestation—influence runoff reduction and substrate infiltration dynamics. Focusing on the 4.57 km² basin of the Stankowice Stream in southwestern Poland, the research integrates field geodetic and hydrological measurements with Iszkowski’s empirical flow formulas and high-resolution digital elevation modeling (SCALGO platform). Delineation of 10 key subcatchments revealed that surface runoff potential is heavily concentrated within specific flow pathways rather than determined solely by subbasin area. In unit No. 9, deploying an arcuate arrangement of 19 deadwood logs achieved an 11% reduction in surface runoff (retaining 8662.50 m³), whereas coupling these log structures with a downstream cascading two-dam system significantly enhanced retention performance by establishing 79,065.68 m³ of depression storage and driving 264,066.16 m³ of subsurface infiltration. Furthermore, multi-scenario land use modeling demonstrated that transforming land cover to forest reduced surface runoff by over 70% in topographically steep subcatchments (e.g., unit No. 7). These findings demonstrate that effective flood mitigation in headwater catchments requires a systemic, targeted hybrid strategy combining decentralized bioretention with localized storage nodes, offering a transferable framework for sustainable regional water governance. Full article