Search Results (545)

Science teaching in early years contexts has been identified as deficient due to poor educator confidence, lack of content knowledge, or minimal opportunities being made available for science experiences. To identify strategies to counteract these factors, this study explored how these deficiencies are enacted in learning contexts by examining the beliefs and practices of educators across three early learning sites. The focus of this study was threefold: to gather the perception of educators in relation to early childhood science; explore the learning environments; and observe the interactions facilitated by the educators to develop scientific knowledge and skills for young children. During the four stages of the research project, a disconnect was identified between the perception held by educators about science, science’s role in the early years, and the educators’ practice. We found that educators did not appear to reflect on the disconnect between their understanding of theory and implementation in practice—their praxis. Full article

As global airspace operations grow increasingly complex, the risk of near-mid-air collisions (NMACs) poses a persistent and critical challenge to aviation safety. Traditional collision-avoidance systems, while effective in many scenarios, are limited by rule-based logic and reliance on transponder data, particularly in environments featuring diverse aircraft types, unmanned aerial systems (UAS), and evolving urban air mobility platforms. This paper introduces a novel, integrative machine learning framework designed to analyze NMAC incidents using the rich, contextual information contained within the NASA Aviation Safety Reporting System (ASRS) database. The methodology is structured around three pillars: (1) natural language processing (NLP) techniques are applied to extract latent topics and semantic features from pilot and crew incident narratives; (2) cluster analysis is conducted on both textual and structured incident features to empirically define distinct typologies of NMAC events; and (3) supervised machine learning models are developed to predict pilot decision outcomes (evasive action vs. no action) based on integrated data sources. The analysis reveals seven operationally coherent topics that reflect communication demands, pattern geometry, visibility challenges, airspace transitions, and advisory-driven interactions. A four-cluster solution further distinguishes incident contexts ranging from tower-directed approaches to general aviation pattern and cruise operations. The Random Forest model produces the strongest predictive performance, with topic-based indicators, miss distance, altitude, and operating rule emerging as influential features. The results show that narrative semantics provide measurable signals of coordination load and acquisition difficulty, and that integrating text with structured variables enhances the prediction of maneuvering decisions in NMAC situations. These findings highlight opportunities to strengthen radio practice, manage pattern spacing, improve mixed equipage awareness, and refine alerting in short-range airport area encounters. Full article

Emerging evidence suggests some bacterial infections may be early signs of hidden cancers rather than random events. Yet this link remains under-recognized in practice, representing an often-missed diagnostic opportunity. Large registry studies show that certain infections are linked to a sharply increased short-term risk of cancer detection, with most of the excess diagnoses clustering in the first 6 months after the index episode. Key associations include the following: (i) anaerobic or gut-derived bacteremia with Bacteroides, Clostridium, Fusobacterium, or pks⁺ Escherichia coli before colorectal neoplasm; (ii) Streptococcus gallolyticus/bovis bacteremia and colorectal neoplasm; (iii) cryptogenic Klebsiella pneumoniae liver abscess and pancreaticobiliary or colorectal cancer; (iv) non-resolving pneumonia and segmental collapse before lung cancer. Overall, short-term cancer detection risks range from about 3% after unselected Gram-negative bacteremia to ~8% or higher after cryptogenic liver abscess—similar to accepted thresholds that justify targeted cancer work-up. Even hidden tumors disrupt immunity, compromise barriers, and create conditions that favor microbial invasion. This review synthesizes evidence for the “sentinel infection phenotype”; outlines pathogen-specific associations, including their possible pathogenetic mechanisms; and proposes a practical diagnostic framework. Recognizing these infection signatures may enable earlier cancer detection and better outcomes. Full article

The increasing speed of network connections is placing increasing demands on the performance of network security and monitoring systems, where Key–Value Stores (KVSs) are becoming critical in network security applications. There is a compelling demand to enhance both the throughput and storage utilization of KVSs. The FPGA-based parallel architecture presents a remarkable opportunity to achieve outstanding performance and power efficiency. In this paper, we propose an FPGA-based implementation of KVSs using a multi-level multi-hash approach, which can effectively avoid false misses and false inserts, in addition to addressing skewed workloads. Decoupled storage exceeds 95% memory utilization, and the pipeline scheme achieves high performance, reaching 400 million requests per second (MRPS). The latency of insert, query, and delete operations is only 60 ns. Full article

Background/Objectives: Trauma-related distress poses significant mental health challenges, with psychotherapy serving as a primary intervention. The Walters Method is a promising new alternative that may help where traditional methods fall short (i.e., in complex or violent cases), but before it can be implemented widely, the existing evidence on the effectiveness of other psychotherapies for trauma-related distress must be mapped to see how and where it relates to other techniques. The aim of this scoping review was to provide an overview of existing evidence on the effectiveness of psychotherapy for trauma-related distress. Methods: A scoping review was conducted to better understand the effectiveness of psychotherapies for trauma-related distress (including PTSD, acute stress disorder, or other serious mental health issues). Results: Thirty-three articles were analysed. Included articles included adults with PTSD, incarcerated women, childbirth trauma survivors, female survivors of sexual abuse, hospitalised COVID-19 patients, adults with serious mental illness, veterans and active soldiers, firefighters, and refugees. Eye Movement Desensitisation and Reprocessing and Cognitive Behavioural Therapy were the most studied and effective treatments. Prolonged Exposure and Narrative Exposure Therapy were less common but noteworthy. Other therapies, including psychodynamic approaches, are seldom studied but have proven effective when explored, highlighting knowledge gaps and potential missed opportunities. Success with these alternative approaches—especially in complex trauma cases like intimate partner violence or child loss where EMDR and CBT may be less effective—suggests they have potential, but further research is needed for validation. Conclusions: This review offers novel contributions to the field by emphasising innovative therapeutic perspectives that extend beyond traditional, more studied, evidence-based approaches such as CBT and EMDR, thereby expanding treatment options for diverse clinical presentations. Alternative therapies show promise, particularly for complex trauma cases like intimate partner violence or child loss where established approaches may be less effective; however, further research is needed to validate their efficacy across diverse populations. Selection of psychotherapy should be based on clients’ goals and comfort, and the cultural and contextual compatibility between the person and intervention. Future research should prioritise underexplored therapies to address current knowledge gaps and improve treatment accessibility for varied clinical needs. Full article

In the fight against growing energy poverty in Europe, remote and rural areas are most affected but play a crucial role in promoting a fair and sustainable transition. Furthermore, energy communities have been recognized as cost-efficient options and opportunities to enhance the active participation of citizens in electricity markets. Despite the wide recognition of their potential in alleviating energy poverty, evidence is still limited. This paper investigates the ‘missing links’ in producing clean energy through community-based practices in remote areas. This study presents a literature review aimed at identifying case studies at the European level to build a knowledge base on the state of the art in the context of the Green Deal. Of the 4422 publications found, we identified and analyzed 266 publications with one or more European cases. Of these, only 67 publications used keywords relevant to our research objective, which we further explored and categorized according to the primary purpose of the study, i.e., assessment, barriers and gaps, implementation, management and planning, modeling, and public opinion. Our results show that publications serve mainly to test a methodology for potential use and not to recount an experience, lacking practical application and policy integration. Nevertheless, we noticed a tendency to activate citizen engagement forms or gather perceptions to increase social acceptability. Full article

Zoological establishments have five main roles: education, conservation, recreation, research, and provision of positive welfare to exhibited and housed animals. This review highlights the effect direct human–animal interactions had on the non-human animals’ physical and psychological wellbeing in relation to short- and long-term education and conservation engagement and action. The literature was reviewed from worldwide English sources, which focused on welfare, direct animal interactions, and alternative provisions. With over 700 million visits made to zoological establishments annually, only USD350 million in funds were reported to be reinvested into conservation efforts worldwide, with the true outcome and impact of this effort unknown. Currently, the main focal area is recreation, with 75% of those surveyed (N = 1241) worldwide found to offer direct human–animal interactions. This review takes a holistic approach to human–animal interactions and highlights key opportunities that are missed in the delivery method of these. Worldwide, direct human–animal interactions during the last 30 years have had no to limited regulations. Organisations such as Pan-Africa Association of Zoos and Aquaria and British and Irish Association of Zoos and Aquaria aim to regulate and monitor welfare, breeding, and husbandry within collections; however, joining is entirely voluntary. This has led to only 13 zoological establishments in Africa accredited under PAAZA, compared to over 100 establishments accredited under BIAZA in the United Kingdom. This review highlights that clear training plans need to be implemented before and during human–animal interactions with particular focus on feeding time demonstrations, CGI models, film rooms, and no-contact interactive areas. Further research needs to quantify the significance of the taxonomy used in direct interactions. Full article

The increasing accumulation of medical waste, especially discarded pharmaceutical blister packs, poses both environmental risks and missed opportunities for resource recovery. In this work, we demonstrate, for the first time, the direct upcycling of tablet blister waste into a potential frictional layer in triboelectric nanogenerators (TENGs). The polymer structure of blister packs, combined with Silicone rubber as a counter frictional layer, enabled the fabrication of durable TENG devices (TS-TENGs). Systematic electrical testing revealed that the TS-TENG achieved an open-circuit voltage of approximately 300 V, a short-circuit current of about 40 μA, and a peak power density of 3.54 W/m² at an optimal load resistance of 4 MΩ. The devices maintained excellent stability over 10,000 mechanical cycles, confirming their durability. Practical demonstrations included powering 240 LEDs, four LED lamps, and portable electronic devices, such as calculators and hygrometers, through capacitor charging. This study shows that not only can tablet blister waste be used as a triboelectric material but it also presents a sustainable method to reduce pharmaceutical waste while advancing self-powered systems. The approach offers a scalable and low-cost means to integrate medical waste management with renewable energy technologies. Full article

Background and Objectives: Cardiovascular–kidney–metabolic (CKM) syndrome reflects the interconnection between metabolic risk factors, chronic kidney disease (CKD), and cardiovascular disease (CVD). Despite increasing awareness, population-based data on CKM syndrome are limited, particularly in Europe. This study assessed the prevalence of CKM syndrome and the use of renal and cardiac biomarkers in Lithuania. Materials and Methods: Health records of 923,329 adults aged ≥40 years from the national Electronic Health Services and Cooperation Infrastructure Information System were analyzed. CKM-associated conditions (prediabetes/type 2 diabetes, obesity, CKD) and cardiovascular outcomes (atherosclerotic CVD, peripheral vascular disease, stroke, heart failure, atrial fibrillation) were identified. CKM stages were defined as stage 0 (no CKM conditions), stages 1–3 (at least one CKM condition), and stage 4 (at least one CVD diagnosis). The use of estimated glomerular filtration rate (eGFR), albumin-to-creatinine ratio (ACR) and N-terminal pro–B-type natriuretic peptide (NT-proBNP) testing was evaluated. Results: Overall, 34.8% of adults met criteria for stage 4 CKM syndrome, and 23.4% were classified as stage 1–3. Obesity (21.2%) and type 2 diabetes (17.2%) were the most common CKM-associated conditions. Heart failure (25.4%) and atrial fibrillation (14.0%) were the most common cardiovascular outcomes, with ≥2 CVD diagnoses present in 15.4% of patients. Among stage 1–3 patients, eGFR, ACR, and NT-proBNP were measured in 53.5%, 9.0%, and 4.9%, respectively. Conclusions: A third of Lithuanian adults aged ≥40 years had stage 4 CKM syndrome. The underuse of biomarker testing highlights missed opportunities for early detection. Broader implementation of biomarker testing and integrated care is warranted to slow progression of CKM syndrome and reduce cardiovascular risk. Full article

Purpose: Root cause analysis carried out to establish the likely causes for pancreatic cancer not being diagnosed on previous imaging. Methods: Records of pancreatic cancer patients between 2016 and 2021 at two NHS providers were examined. Post-Imaging Pancreatic Cancer (PIPC) was defined as pancreatic cancer diagnosed 3–18 months after an index scan that did not report cancer. Index and diagnostic imaging were reviewed by two radiologists independently. An algorithm was developed to categorise PIPC. Results: 46 of 600 patients (7.7%) were classified as having PIPC, with 43 CT and 3 MRI scans undertaken 3–18 months before cancer diagnosis. The median age was 75.9 (IQR 69.6–80.2) years, with 58.7% female. PIPCs were categorised as focal lesion reported on index scan in the same pancreatic segment as diagnostic scan (2.2%); imaging changes associated with pancreatic cancer reported on index scan (17.4%); missed focal lesion or imaging changes associated with pancreatic cancer on index scan (26.1%); no focal lesion or imaging changes associated with pancreatic cancer on index scan (54.3%). Following exclusion of two patients (one declined investigations and one was too unwell), 16 of 46 (35%) PIPC patients could have been diagnosed earlier. Twelve had a missed focal lesion, and four had duct dilatation or a focal lesion reported but were inadequately investigated. Conclusions: Approximately three out of 100 pancreatic cancer patients could have been diagnosed earlier due to a missed lesion or inadequately investigated lesion or duct dilatation on index imaging. There are opportunities for earlier diagnosis of pancreatic cancer on imaging. Full article

Background/Objectives: Currently, 873,000 patients within the VA Health Administration potentially have prediabetes, based on HbA1c. The primary objective of this analysis was to describe and compare Veterans with and without a documented prediabetes diagnosis, across age, sex, race, rurality, and select comorbidities. Secondary objectives included the following: (1) Identify prediabetes diagnosis documentation trends between the VISN 6 facility complexity and (2) evaluate the relationship between specific prescribed medication classes for Veterans and a documented prediabetes diagnosis. Methods: Veterans presenting to a VISN 6 VA facility within the past 24 months for at least one visit were identified. Veterans were excluded if they had a documented diabetes diagnosis, an HbA1c > 6.5%, or missing demographic data. Veterans with an HbA1c >/= 5.7% to 6.4% were noted if they had a documented prediabetes diagnosis. Data was analyzed between groups (diagnosis code vs. no diagnosis code) using descriptive analyses not designed for causal inference. Results: Of the 105,737 Veterans meeting the analysis criteria, over 68% did not have a documented diagnosis. Median age was similar between groups. Black and female Veterans were more likely to have a documented prediabetes diagnosis. Documentation among VISN 6 facilities varied (nearly 28% to over 36%). Those with dyslipidemia, hypertension, or heart failure were less likely to have a documented diagnosis, as well as those with depressive, anxiety, and stress and adjustment disorder diagnoses. Those prescribed metformin or a GLP1 agonist had a higher rate of diagnosis documentation, while over 71% of Veterans prescribed an antipsychotic had no documented diagnosis. There was no linear trend with documentation across facility complexity or rurality. Conclusions: Most VISN 6 Veterans with prediabetes do not have a documented diagnosis. There is an opportunity to increase provider awareness of prediabetes diagnosis documentation, particularly among at-risk Veterans, to improve type 2 diabetes prevention in Veterans. Full article

Spent mushroom substrate (SMS), the residual material left after mushroom cultivation, represents an abundant yet underutilized bioresource. With global mushroom production generating millions of tons of SMS annually, its disposal constitutes a missed opportunity within the circular bioeconomy. This Opinion article highlights why SMS should be repositioned as a valuable raw material for sustainable biorefineries and outlines the technological, economic, and regulatory steps needed to unlock its potential. Full article

Background/Objectives: Familial hypercholesterolemia (FH) is an inherited lipid disorder that markedly elevates lifetime risk of premature cardiovascular disease (CVD), yet remains under-recognized globally. We aimed to estimate the prevalence of phenotype-defined FH among adults in Almaty, Kazakhstan, describe lipid profiles and treatment patterns, and examine the association between FH status and prevalent CVD. Methods: We conducted a cross-sectional analysis of routinely collected clinical and laboratory data from adults (≥18 years) recorded between March 2023 and March 2024. FH status was classified using Dutch Lipid Clinic Network criteria (probable: 6–8 points; possible: 3–5). Outcomes included lipid measures, statin use, and CVD. Group comparisons used standard tests; multivariable logistic regression estimated adjusted odds ratios (AORs) for prevalent CVD, controlling for age, sex, smoking, body mass index (BMI), systolic blood pressure (SBP), and LDL-C. Results: Among 2468 participants (mean age 45.2 ± 14.3 years; 64.7% women), FH prevalence was 0.4% probable (n = 10) and 6.7% possible (n = 166). FH groups had substantially higher LDL-C and higher systolic blood pressure. Overall statin use was 6.7%; within FH, 13.3% (possible) and 10.0% (probable) used statins. Prevalent CVD affected 18.6% overall, rising to 48.2% (possible FH) and 60.0% (probable FH) (p < 0.001). After adjustment, FH remained independently associated with CVD (AOR 8.15, 95%CI 5.30–12.53 for possible; AOR 40.60, 95%CI 9.15–180.2 for probable vs. non-FH). Age and BMI were positively associated with CVD; LDL-C showed an inverse association consistent with treatment confounding. Conclusions: In this Kazakhstani adult cohort, phenotype-defined FH was present in 0.4% probable and 6.7% possible with a high burden of prevalent CVD and low statin use. These findings highlight substantial missed opportunities for early detection and aggressive lipid-lowering therapy, and support implementing FH identification, treatment intensification, and family-based cascade strategies in Kazakhstan. Full article

This study examined residents’ perceptions, preferences, and experiences of urban green spaces in four regional units of the Region of Attica—West Athens, Central Athens, South Athens, and Piraeus—demonstrating how demographic diversity, urban morphology, and external stressors—such as extreme heat and the COVID-19 pandemic—shape green space use. The results show that, while green spaces are essential for health, well-being, and social cohesion, their distribution is uneven, which limits their availability (27.3%) and access (21.8%) to residents. Main concerns expressed by residents when visiting green spaces and open green spaces are poor maintenance (50.7%), lack of security (36.7%), and socially irresponsible behaviour (e.g., littering, vandalism) (32.8%). Extreme heat emerged as a major constraint on outdoor activities, particularly affecting women and the elderly. Household-associated outdoor areas (balconies, courtyards, and verandas) were highly valued (59.8%), highlighting the role of private green spaces in dense urban environments. Major metropolitan parks were the most visited and valued by residents for providing contact with nature (23.0%) and benefiting from stress relief (54.0%) while practicing their favourite activity, though their use was limited during heatwaves (30.3% of the residents do not visit). Most activities during and after the COVID-19 pandemic were reported unchanged, though reported increases in walking (34.3%) and park visits (28.3%) demonstrate the importance of green spaces in fostering urban resilience. However, the reported lack of engagement in gardening (48.0%), indoor plant care (41.2%) and bird/wildlife watching (58.3%) suggest missed opportunities for ecological and cultural enrichment. Overall, the study underscores the urgent need for integrated planning strategies to improve accessibility, maintenance, and equity in green space provision. By aligning with the sustainable development goals, the four regional units of the Region of Attica can transform its green infrastructure into an inclusive, resilient system that supports public health, social inclusion, and climate adaptation. Full article

Human papillomavirus (HPV) vaccination is a cornerstone of cancer prevention across genders. In the United Kingdom (UK), the programme now includes boys, yet uptake remains below target, with persistent disparities by gender and region. This commentary examines the drivers of these gaps, including the historical framing of the HPV vaccine as a vaccine for girls, limited public awareness of boys’ eligibility, and challenges in school-based delivery. Gendered misconceptions, cultural norms, and inadequate communication continue to limit uptake in boys, while healthcare professionals, including general practitioners, dentists, and pharmacists, remain underused in supporting vaccine access and tackling parental hesitancy. Schools are central to equitable delivery, but teachers often lack training and possess low-to-moderate knowledge of HPV-related topics, including HPV vaccination availability for boys and HPV-related cancers affecting men. Drawing on health behaviour theory, we propose evidence-informed, multi-level recommendations to improve uptake, from gender-inclusive messaging and more efficient consent processes to digital engagement tools that support parents. We also highlight our ongoing research into parental attitudes toward HPV vaccination for boys aged 9–12 in England, which will inform future targeted interventions and policy development. Full article