Search Results (39)

Background: Maxillary hypoplasia and skeletal Class III malocclusion are deeply intertwined with upper airway constriction and paranasal sinus dysfunction. Conventional orthopedic interventions often struggle to achieve true 3D skeletal translation without inducing undesirable rotational side effects. The Right Angle Maxillary Protraction Appliance (RAMPA) therapy offers a biomimetic and mechanotherapeutic approach, focusing on anterosuperior protraction to restore both structural harmony and respiratory function. Methods: Structured as a comprehensive narrative review, this feature paper thoroughly reviews the multi-disciplinary evidence supporting RAMPA therapy by synthesizing our group’s recent computational (FEM, CFD) and clinical findings alongside the broader literature. We examine Finite Element Method (FEM) simulations detailing sutural mechanotransduction and osteogenic “BMP-2 Trigger Zones”, Computational Fluid Dynamics (CFD) utilizing shear-thinning rheological models for two-phase air–mucus interactions, and large-cohort CBCT and Coben analyses quantifying longitudinal growth. Results: FEM studies confirm that RAMPA, especially when combined with intraoral devices (e.g., gHu-1, VomPress, Hybrid), achieves predictable anterosuperior displacement and concentrates tensile stress to levels hypothesized to stimulate molecular bone remodeling. CFD simulations reveal that this precise skeletal remodeling optimizes wall shear stress (WSS) and theoretically facilitates paranasal mucus clearance via enhanced suction and shear-thinning effects. Clinically, RAMPA induces a 1.2-fold acceleration in natural sinonasal growth velocity. Furthermore, volumetric gains are distinctively pronounced in patients with pre-existing empyema (61.2% increase) compared to those with clear sinuses (18% increase), indicating rapid pathophysiological obstruction relief. Conclusions: By integrating controlled biomechanical forces with fluid-dynamic airway optimization, RAMPA therapy acts as a mechanotherapeutic modulator. It bridges the gap between mechanical intervention, molecular signaling, and physiological homeostasis, offering a comprehensive paradigm for pediatric craniofacial and respiratory restoration. Full article

Evidence suggests that protracted conflicts persist because several forms of socio-political organization run simultaneously on the same population, resources, and territory. Reading Service’s typology of bands, tribes, chiefdoms, and states not as evolutionary stages but as coexisting and superposed social organizations, we model conflict as a reaction network where each social form is a self-maintaining set of stocks—a chemical organization—and conflicts arise where competing productive logics between organizations generate stocks with negative connotation, such as grievances and displacement. Taking the Lake Chad Basin as inspiration, we build a ladder of progressively richer models arriving a mixed chiefdom–state configuration compatible with current views on the conflict. As the model complexifies, kinetic approaches become uninformative; we therefore develop complementary stoichiometric methods that are parameter-free and thus are far easier to measure and compute. These diagnostics reveal a structural bias toward conflict: transitions into conflict regimes are systematically richer than transitions out. We show how a dual chiefdom–state form acts as a conflict attractor within a closed conflict–peace loop that transits among documented different forms of organization. Conflict management then becomes the identification of the mechanisms that redirect rather than change the state of a self-sustaining organization—here, elite-surplus redistribution—and of the timescales at which such redirection is observable, turning intervention design into a structural rather than a parameter-tuning problem. Full article

Background: Management of skeletal Class III malocclusion of maxillary origin in late adolescence remains challenging, as conventional tooth-borne orthopedic approaches show reduced effectiveness at advanced stages of skeletal maturation. Minimally invasive, bone-anchored alternatives supported by digital workflows may improve clinical feasibility and patient acceptance. Objective: To describe a digitally guided clinical protocol combining a hybrid maxillary expander and supragingival mandibular miniplates, and to explore skeletal and dentoalveolar outcomes in late adolescents. Methods: This retrospective pilot clinical study included ten late adolescents (mean age 16.0 ± 1.3 years; range 13.8–17.7) in advanced skeletal maturation stages (CS4–CS6) with skeletal Class III malocclusion of maxillary origin. Treatment consisted of a hybrid maxillary expander anchored to palatal miniscrews and custom supragingival mandibular miniplates, placed using a fully digital workflow. Maxillary protraction was performed using a modified Alt-RAMEC protocol followed by continuous intermaxillary elastic traction for 12 months. Pre- and post-treatment cephalometric analyses were conducted. Results: A significant increase in SNA was observed (mean +6.1°, p < 0.001), indicating forward maxillary displacement. The Wits appraisal improved by 3.3 mm (p = 0.007), and the SeMax increased by 2.9 mm (p = 0.0013). No significant changes were found in the SNB or mandibular plane angle. Dentoalveolar effects were limited. Conclusions: Within the limitations of this pilot clinical study, the proposed digitally guided protocol demonstrated clinically relevant maxillary advancement with minimal dentoalveolar side effects and preserved vertical control. This relatively minimally invasive approach compared to conventional subgingival miniplates and orthognathic surgery may represent a feasible treatment option for selected late adolescent patients. Further controlled studies are required to confirm these findings. Full article

(1) Background: Colombia hosts one of the world’s largest mixed-displacement crises, combining longstanding internal displacement with the influx of Venezuelan migrants. This case study examines how the Emergency Medical Team (EMT) Hospital Barco San Raffaele (HBSR) adapted its service-delivery model to respond simultaneously to internal displacement in the Colombian Pacific region and the Venezuelan refugee influx. Using the WHO EMT Surge Capacity Framework, the study analyses how health services were adapted across two concurrent displacement contexts. (2) Methods: A mixed-methods comparative case study was conducted using mission reports, epidemiological surveillance data, policy reports and institutional documents collected between November 2020 and May 2021. Data were analyzed through a thematic analysis structured around the four domains of the WHO EMT Surge Capacity Framework (Staff, Structure, Supplies and Systems), to examine how service adaptation was operationalized across different geographic, sociocultural and legal environments; (3) Results: EMT HBSR adapted staffing composition, supply chains, infrastructure, and operational systems across both settings. Its hybrid model, combining a hospital boat platform with mobile outreach teams, enabled continuity of primary care, mental, maternal and child health, and community-based services in geographically isolated and culturally diverse communities; (4) Conclusions: The findings illustrate how flexible EMT operational models can support the adaptation of health services, and reduce health access inequalities in displacement contexts characterized by high mobility, confinement and limited health system capacity. Mobile platforms, such as hospital boats, appear to be a viable strategy for ensuring continuity of care along migratory routes and in geographically isolated areas affected by protracted instability. Full article

Objective: This retrospective comparative cohort study investigated the craniofacial growth effects of the RAMPA (Right Angle Maxillary Protraction Appliance) system. The system aims to protract the maxilla in an anterosuperior direction to address maxillary hypoplasia and skeletal Class III malocclusion, potentially mitigating the posteroinferior displacement often associated with conventional orthopedic approaches. Materials and Methods: Craniofacial measurements were analyzed before (T1) and after (T2) RAMPA treatment in 30 growing patients (17 males, mean age 7.32 years; 13 females, mean age 8.34 years). Coben analysis was utilized to quantitatively evaluate coordinate relationships and proportional changes based on the Frankfurt Horizontal plane. Statistical significance was determined using paired t-tests or Wilcoxon signed-rank tests (two-sided, α = 0.05) without adjustment for multiple comparisons due to the exploratory nature of the study. Results: RAMPA treatment was associated with significant increases in facial depth (Ba-N) and anterior facial height (N-Me) in both sexes. Specifically, facial depth increased by an average of 2.65 mm in males (p = 0.001) and 2.18 mm in females (p = 0.007). Female patients showed a significant increase in the maxillary depth ratio (Ptm-A/Ba-N), while males exhibited a significant decrease in the Gonial Angle (avg. 1.47° decrease), suggesting anterior mandibular rotation. Conclusions: RAMPA treatment effectively promoted anterosuperior craniofacial growth and induced favorable mandibular rotation in this cohort. These findings suggest the system has potential clinical value for improving craniofacial balance in skeletal Class III malocclusion. While improved cervical posture is a theoretical benefit of such remodeling, systemic outcomes were not directly measured in this study. Full article

In 2022, Austria experienced a significant surge in Syrian arrivals. Unlike refugees arriving to Europe in 2015/2016, who predominantly embarked on direct journeys from Syria, most of the recently admitted cohort experienced protracted displacement in Turkey. During these prolonged periods in transit, individuals’ fundamental rights and essential economic, social, and psychological needs frequently remained unmet, due to the weak Temporary Protection Status they were granted in Turkey and rising tensions with the local population. To assess protracted displacement histories of recently arrived Syrians in Austria, we employ a qualitative approach with four qualitative focus group discussions, 17 semi-structured interviews (in total N = 29) and an additional online questionnaire on sociodemographic characteristics to support the qualitative data collection. Furthermore, expert interviews (N = 21) help to contextualize the situation of recently arrived Syrians in Austria and assess differences to the first cohort of arrivals (2015–2016). Our results reflect the marginalizing dynamics encountered by Syrians who underwent impermanent settlement experiences and their multidimensional experience of socio-economic marginalization in Turkey. This includes limited employment opportunities and economic deprivation, limited access to education as well as experiences of racial discrimination, harassment, violence, and state-sanctioned deportations. These have added to their eventual secondary migration to the EU. Our study allows for a more comprehensive understanding of the (im)permanent settlement challenges faced by refugee populations with Temporary Protection such as applied to Syrians in Turkey. Full article

Tuberculosis (TB) remains a public health threat in low- and middle-income countries (LMICs) of the World Health Organization (WHO) Eastern Mediterranean Region (EMR), driven by a combination of social determinants including undernutrition, fragile health systems, conflict-related disruptions, human mobility and displacement, sub-optimal programmatic implementation, and insufficient domestic investment. These programmatic and governance constraints operate within a broader geopolitical context marked by conflict, sanctions, protracted crises, and large-scale displacement, which further limit countries’ ability to deliver uninterrupted TB services. In 2023, the region’s TB incidence was estimated at 116 per 100,000 population, with Pakistan alone accounting for about 73% of the regional burden. Despite a multitude of efforts, progress in reducing the TB burden in the EMR remains slow, with high case detection and treatment coverage gaps, low uptake of TB preventive treatment (TPT), underutilization of WHO-recommended rapid diagnostics, and only 25% of drug-resistant TB (DR-TB) cases initiated on treatment. Vulnerable populations, including internally displaced persons, migrants, refugees, prisoners, and returnees, continue to face major access barriers, and cross-border TB collaboration remains limited. This commentary reasons that the slow pace of TB burden reduction in the region is not only a biomedical or resource issue but also a reflection of structural and governance shortcomings. It proposes a ten-point strategic vision focused on building a sustainable ecosystem, enhancing primary healthcare systems, adopting people-centered and rights-based approaches, leveraging artificial intelligence, and gradually reducing dependency on external donors where feasible. However, in highly fragile settings such as Yemen or Somalia, domestic financing remains limited, and sustained external support will continue to be indispensable. The commentary calls for stronger national leadership, inclusive stakeholder engagement, and increased domestic financing to deliver integrated and resilient TB services. Ending TB in the EMR is within reach, but it requires boldly committed, coordinated, and country-led action. Full article

Persons with disabilities (PWDs) face disproportionate risks during humanitarian crises, yet their inclusion in aid delivery remains limited. To address this, the Inter-Agency Standing Committee (IASC) introduced the Guidelines on the Inclusion of Persons with Disabilities in Humanitarian Action in 2019. The IASC guidelines provide a global framework for mainstreaming disability inclusion. This exploratory study examines how these guidelines are applied in Borno State, Northeastern Nigeria, a region marked by protracted conflict, displacement and insecurity. Using a qualitative phenomenological approach, data were gathered through in-depth interviews from 20 humanitarian practitioners and supplemented with secondary sources. Thematic analysis revealed that while organisations adopted strategies such as data disaggregation, door-to-door outreach and local committee representation, implementation was inconsistent and constrained by cultural beliefs about disability, political interference, population displacement and weak monitoring standards. The findings also highlighted that although the IASC Guidelines are good in principle, the guidelines require context-specific adaptation, stronger organisational commitment and active inclusive engagement with PWDs and their representative organisations. The study recommends incorporating disability inclusion through mandatory organisational policies, dedicated funding, community-based advocacy and improved data systems to ensure that humanitarian responses are both inclusive and sustainable. Full article

Background/Objectives: The drug development response to the unique pharmacology of fentanyl, which drives the current opioid epidemic, has primarily focused on increasing naloxone doses and employing longer-acting antidotes. While having lower withdrawal liability, the commonly perceived disadvantage of naloxone is its reduced effectiveness against re-narcotization or “fentanyl rebound,” due to a significant mismatch between its half-life (t_1/2) and that of fentanyl. Methods: We conducted a pharmacokinetic profile (PK) crossover study in fentanyl-sedated dogs to assess naloxone (NX) and its lipophilic prodrug (NX90) with regard to fentanyl PK and re-narcotization risk. Results: Our findings showed that naloxone redistributed fentanyl into the plasma, with correlating (R² = 0.9121) fentanyl and naloxone plasma levels when seven plasma samples per dog for each treatment (including placebo) were analyzed. This redistribution led to reductions in fentanyl’s volume of distribution at steady state (V_ss: 11.8 ± 1.7, 8.4 ± 2.4, and 8.7 ± 2.6 L/kg), mean residence time (MRT: 19.9 ± 1.8, 18.6 ± 7.2, and 16.2 ± 8.8 min), and half-life (t_1/2: 14.3 ± 1.9, 13.0 ± 4.9, and 11.2 ± 6.1 min) after the administration of a placebo, NX, and NX90, respectively. Additionally, we observed that the delay in the transient re-sedation (re-narcotization) of the dogs correlated (R² = 0.794) with naloxone’s exposure (AUC_inf). These data suggest that (i) the displacement of fentanyl into a metabolically active compartment and (ii) the delay in re-narcotization risk are both independent of naloxone’s half-life and are likely to be more effectively achieved with higher doses of naloxone. Conclusions: Combined with the lower risk of precipitating protracted withdrawal, these findings support the clinical use of higher-dose naloxone over longer-acting antidotes for reversing fentanyl-related overdoses. Full article

Objective: The material properties of craniofacial sutures significantly influence the outcomes of orthodontic treatment, particularly with newer appliances. This study specifically investigates how the Young’s modulus of craniofacial sutures impacts the anterosuperior protraction achieved using a recently developed extraoral appliance. Our goal is to identify the patterns by which suture properties affect skull deformation induced by this device. Materials and Methods: We conducted four finite element (FE) simulations to evaluate the Right Angle Maxillary Protraction Appliance (RAMPA) when integrated with an intraoral device (gHu-1). We tested Young’s moduli of 30 MPa, 50 MPa, and 80 MPa for the sutures, drawing on values reported in previous research. To isolate RAMPA’s effects on craniofacial deformation, we also performed an additional simulation with rigid sutures and a separate model that included only the intraoral device. Results: Simulations with flexible sutures showed consistent displacement and stress patterns. In contrast, the rigid suture model exhibited substantial deviations, ranging from 32% to 76%, especially in the maxillary palatine suture and orbital cavity. Both displacements and von Mises stresses were proportional to the Young’s modulus, with linear variations of approximately 15%. Conclusions: Our findings demonstrate that RAMPA effectively achieves anterosuperior protraction across a broad spectrum of suture material properties. This positions RAMPA as a promising treatment option for patients with long-face syndrome. Furthermore, the observed linear relationship (with a fixed slope) between craniofacial deformation and the Young’s modulus of sutures provides a crucial foundation for predicting treatment outcomes in various patients. Full article

While existing studies document physical and economic impacts of new-build gentrification, the temporally protracted trauma of indirect displacement in communities adjacent to redeveloped areas remains understudied. Employing constructivist grounded theory, this study asks the following question: how do residents experience place attachment erosion during prolonged policy suspension in Shanghai’s new-build gentrification? Through iterative analysis of 25 interviews, we reveal a temporal vicious cycle of waiting triggered by uneven redevelopment and policy inertia. This cycle systematically dismantles belonging through several mechanisms: (1) chronic place-identity deterioration; (2) progressive social network fragmentation; (3) the collapse of imagined futures; and (4) the ambiguous loss of place attachment—where physical presence coexists with psychological disengagement. Crucially, we redefine indirect displacement as a temporal erosion of place identity and attachment, revealing a paradoxical state of physical presence coexisting with psychological disengagement. This paper provides a new perspective for better understanding the different dimensions of indirect displacement in new-build gentrification, which will help inform equitable development efforts that are more inclusive and just. Full article

Water treadmill (WT) exercise is used for horses’ rehabilitation and training. Given that each training needs to be individualized for each horse, the goal is to assess whether infrared thermography (IRT) can serve as a non-invasive tool for daily monitoring of individual training and rehabilitation progress in horses undergoing WT exercise. Fifteen Polish Warmblood school horses were subjected to five WT sessions: dry treadmill, fetlock-depth water, fetlock-depth water with artificial river (AR), carpal-depth water, and carpal-depth water with AR. IRT images, collected pre- and post-exercise, were analyzed for the mean temperature (Tmean) and maximal temperature (Tmax) across 14 regions of interest (ROIs) representing the body surface overlying specific superficial muscles. While on a dry treadmill, Tmean and Tmax increased post-exercise in all ROIs; wetting of the hair coat limited surface temperature analysis in ROIs annotated on limbs. Tmax over the m. brachiocephalicus, m. trapezius pars cervicalis, m. triceps brachii, and m. semitendinosus increased during walking in carpal-depth water, which therefore may be suggested as an indirect indicator of increased activity related to forelimb protraction and flexion–extension of the limb joints. Tmax over the m. latissimus dorsi and m. longissimus increased during carpal-depth WT exercise with active AR mode, which may be suggested as an indicator of increased workload including vertical displacement of the trunk. Full article

Background: Since the election of Hamas in 2006, Gaza has endured eight major military conflicts, culminating in the ongoing 2023–2025 war, now surpassing 520 days. This protracted violence, compounded by a 17-year blockade, has resulted in the near-total collapse of Gaza’s health system. Over 49,000 deaths, widespread displacement, and the destruction of more than 60% of health infrastructure have overwhelmed both local capacity and international humanitarian response. Objectives: This narrative review aims to examine and synthesize the current literature (October 2023–April 2025) on the health crisis in Gaza, with a specific focus on identifying key themes and knowledge gaps relevant to rebuilding a sustainable health system. The review also seeks to outline strategic pathways for recovery in the context of ongoing conflict and systemic deprivation. Methods: Given the urgency and limitations of empirical data from conflict zones, a narrative review approach was adopted. Fifty-two sources—including peer-reviewed articles, editorials, reports, and correspondence—were selected through targeted searches using Medline and Google Scholar. The analysis was framed within a public health and political economy perspective, also taking health system building blocks into consideration. Results: The reviewed literature emphasizes emergency needs: trauma care, infectious disease control, and supply chain restoration. Innovations such as mobile clinics and telemedicine offer interim solutions. Gaps include limited attention to mental health (including that of health workers), local governance, and sustainable planning frameworks. Conclusions: Sustainable reconstruction requires a durable ceasefire; international stewardship aligned with local ownership; and a phased, equity-driven strategy emphasizing primary care, mental health, trauma management, and community engagement. Full article

Climate data consistently indicate a rising temperature trend and a simultaneous decline in precipitation across Syria. Empirical records confirm projections of intensifying drought conditions throughout the Middle East, including Syria, with an increasing frequency, severity, and duration of drought events. However, a major challenge in assessing climate trends is the significant spatial and temporal gaps in Syria’s meteorological records. These gaps stem from the uneven distribution of weather stations—primarily located in populated areas, often lacking automation—and the widespread destruction of stations due to the ongoing civil war, which has coincided with worsening climate impacts. To address these challenges, in this study, an integrated methodology was developed leveraging remote sensing (RS) and geographic information system (GIS) techniques to identify the regions most affected by rising temperatures. While previous research has primarily analyzed the overall trend of meteorological drought in Syria, this study uniquely focuses on temperature rise at a national scale, systematically identifying the most severely impacted areas. Our analysis reveals 23 highly affected regions covering over 31,000 square kilometers, with significant current and projected consequences. These hotspots currently expose over 2.5 million people to thermal drought and encompass approximately 25% of Syria’s agricultural land, intensifying food security vulnerabilities. Notably, some of these affected pockets are in historically settled areas—previously considered resilient to direct climate change impacts—such as the coastal region. Given that Syria has endured a protracted crisis for thirteen years, the compounded effects of climate change further exacerbate daily hardships for millions, driving both internal displacement and migration, particularly toward Europe. This study underscores the urgent need for climate-responsive policies to mitigate the socio-economic and environmental repercussions of rising temperatures in Syria. Full article

The integration or resettlement efforts aimed at self-reliance of refugees are requisite for their adaptation to social and economic shocks and consequently to their human development and contribution to economic growth. This study analyses the drivers of financial inclusion and social integration and estimates the respective gender gap among households in Kakuma Refugee Camp, Kenya. Based on a 2019 socio-economic survey dataset, the study constructs indices to reveal the extent of financial inclusion and social integration. Using the ordered logistic regression, factors such as earning wages, asset accumulation, food security, social capital, education, and access to information demonstrate significant explanatory power for financial inclusion and social integration. The Blinder-Oaxaca decomposition technique for measuring the gender gap reveals that women are significantly better off with respect to financial inclusion compared to men. These results suggest that gendered financial inclusive and social integration programs can build refugee self-reliance. Accordingly, government and development partners should promote gender-inclusive strategies for refugees in Kenya. This study contributes to the literature on refugee financial inclusion and social integration by offering gender-specific insights into their barriers and enablers in protracted displacement contexts. Full article