Search Results (315)

This paper extends the post-factual polity framework into AI infrastructure and public administration systems theory. It asks how proprietary analytical platforms alter the state’s capacity to produce, audit, and contest the categories through which risk, threat, eligibility, fraud, and deviance become actionable. Using a structured documentary case analysis of Palantir Technologies across United States agencies and allied jurisdictions, the study applies three diagnostic markers—categorical opacity, contestation displacement, and substitutive dependency—to examine the migration of sovereign classification into vendor-controlled infrastructure. The research gap was identified through an integrative review of public administration, AI governance, algorithmic accountability, systems theory, surveillance studies, and Palantir scholarship. The analysis distinguishes AI epistemic capture from ordinary IT vendor lock-in: the former concerns not merely technical dependence or high exit costs but the loss of public capacity to define and contest consequential administrative categories. The paper argues that administrative law, procurement reform, and algorithmic impact assessment remain necessary but insufficient when agencies lack substitutive capacity. It specifies untangling as a systems-level task involving capacity reconstruction, categorical repatriation, contractual restructuring, and procurement reorientation. Hybrid intelligence is advanced as a post-untangling architecture that embeds machine processing within contestable, accountable, and legally governed human judgment. The contribution is diagnostic, methodological, and design-oriented for AI systems governance. Full article

Background: Influenza poses a serious threat to the health of older adults, and vaccination is a key strategy for prevention. As an economically developed city, Suzhou has a rapidly aging population, yet the influenza vaccination rate among older adults remains substantially lower than that in developed countries. There is an urgent need to understand the current vaccination status and its associated factors to inform future strategies for improving vaccination coverage. Objectives: To compare influenza- and vaccine-related knowledge, attitudes, practices, and information access channels between vaccinated and unvaccinated older adults (≥60 years) in Suzhou, and to identify factors associated with vaccination behavior in economically developed areas. Methods: A comparative cross-sectional survey was conducted from April to August 2024 across six districts or county-level cities randomly selected from Suzhou’s ten county-level administrative divisions. Participants were divided into vaccinated and unvaccinated groups based on their influenza vaccination status during the 2023–2024 influenza season. A two-stage sampling method was employed: the six districts were selected as primary sampling units; within each district, eligible older adults (aged ≥60 years) were randomly selected from two independent sampling frames—the vaccination information system for the vaccinated group and the basic public health service system for the unvaccinated group. Face-to-face structured interviews were conducted using a questionnaire consisting of four sections; data were entered using EpiData 13.1 and analyzed using SPSS 27.0. The χ² test, t-test, and multivariable logistic regression were used for statistical analysis. Results: Among 4622 valid older adults (vaccinated: n = 2007; unvaccinated: n = 2615), the vaccinated group scored significantly higher on influenza-related knowledge (4.06 ± 2.21 vs. 3.16 ± 2.33, p < 0.001), vaccine-related knowledge (2.10 ± 1.18 vs. 0.67 ± 1.07, p < 0.001), and perceived influenza risk scores (2.72 ± 1.42 vs. 2.26 ± 1.64, p < 0.001). Vaccine safety and efficacy endorsement were also markedly higher among the vaccinated group (70.3% vs. 22.0%; 49.7% vs. 9.3%). Regarding information sources, the vaccinated group relied more on healthcare institutions (54.56% vs. 46.92%), whereas the unvaccinated group relied more on television (60.34% vs. 51.17%). Multivariable logistic regression revealed that awareness of the influenza vaccine (aOR = 9.151, 95%CI: 6.32–13.25), having a planned vaccination site (aOR = 2.66, 95%CI: 2.01–3.54), and perceiving the vaccine as safe (aOR = 1.81, 95%CI: 1.31–2.49) were positively associated with vaccination, while rural household registration (aOR = 0.76, 95%CI: 0.63–0.93), full-time employment (aOR = 0.41, 95%CI: 0.28–0.60), and hypertension (aOR = 0.79, 95%CI: 0.65–0.94) were inversely associated. Conclusions: Compared with the unvaccinated group, the vaccinated group demonstrated significantly better influenza- and vaccine-related knowledge, risk perception, and recognition of vaccine safety and efficacy, and relied more on healthcare institutions for information. Multivariable regression analysis identified awareness of the influenza vaccine as the strongest associated factor. These findings suggest that vaccination coverage could be improved by strengthening vaccine knowledge promotion through healthcare professionals and increasing awareness of vaccination policies that integrate medical insurance reimbursement. Full article

Wildfires are an increasing threat to Mediterranean ecosystems and populated areas. This study proposes an innovative static wildfire risk assessment methodology for the Apulia Region (southern Italy). The framework produces a Fire Risk Global Index (FRGi) by spatially combining two sub-indices related to risk, which are hazard and vulnerability, in line with European Community and United Nations guidelines. Hazard is quantified through five sub-indices—vegetational, historical, climatic, morphological, and anthropogenic—combined into a Long-Term Danger Index (LTDi). Vulnerability integrates ecological, economic, and wildland-urban interface components into a Fire Vulnerability Index (FVi). All processing was performed in an open-source GIS environment (QGIS) at a spatial resolution of 20 m, ensuring full reproducibility for public administrations. Preliminary validation confirms the internal consistency of the model, demonstrating a statistically significant relationship between risk classes and historical fire occurrence. Beyond its scientific contribution, the methodology serves as an operational tool for civil protection planning at the regional scale. Full article

Municipal social services remain among the least examined public functions in the local-government efficiency literature, owing to the scarcity of structured administrative data and the difficulty of measuring their outputs. Addressing that gap, this study provides the first Data Envelopment Analysis (DEA)-based efficiency assessment of municipal primary social-care departments in the Valencian Community (Spain), drawing on a purpose-built dataset that combines 2023 administrative survey, budgetary, and socio-demographic information. Its methodological contribution is an integrated evaluation architecture articulating well-established components—input-oriented DEA under variable and constant returns to scale, the Banker–Morey treatment of non-discretionary contextual variables across an exhaustive lattice of specifications, and a super-efficiency ranking—into a single design that disentangles managerial, scale, and environmental sources of inefficiency. Applied to 18 municipalities, the analysis detects substantial technical inefficiency but shows that much of it reflects scale constraints and structurally demanding socio-demographic environments rather than managerial underperformance; several municipalities with high social vulnerability and below-average income attain full efficiency once context is incorporated, while a small set of units emerges as consistent benchmarks. The architecture yields objective evidence for inter-municipal benchmarking, offers a replicable template for data-poor public services, and cautions against context-blind efficiency metrics in allocating social-policy resources. Full article

Drug recall is a critical regulatory mechanism implemented to protect public health by removing defective, unsafe, or non-compliant pharmaceutical products from the market. Despite stringent regulatory approval processes, issues related to manufacturing defects, contamination, labeling errors, stability failures, and post-marketing safety concerns may lead to drug recalls. Regulatory authorities across the world, including the Central Drugs Standard Control Organization (CDSCO), the United States Food and Drug Administration (US FDA), the European Medicines Agency (EMA), and other national agencies, have developed structured recall guidelines and rapid alert systems to ensure timely withdrawal of defective products. Drug recalls are typically classified based on the level of health risk and may be executed at different levels of the distribution chain, including wholesale, retail, and consumer levels. Effective recall management involves risk assessment, recall communication, product traceability, documentation, and recall effectiveness checks. Pharmacovigilance systems also play an important role in identifying adverse drug reactions and quality defects that may lead to product recalls. This review article provides a comprehensive overview of drug recall systems, including causes of recalls, regulatory frameworks in India and other countries, recall classification, recall procedures, rapid alert systems, and global recall trends. The article also discusses challenges in recall implementation and provides recommendations to strengthen drug recall systems and regulatory coordination worldwide. The review additionally summarizes major official sources of recall information, including recall alerts, safety communications, and regulatory databases maintained by the Food and Drug Administration (FDA), EMA, CDSCO, Medicines and Healthcare products Regulatory Agency (MHRA), and World Health Organization (WHO), and provides a comparative global perspective on contemporary pharmaceutical recall practices. Full article

The integrity of halal supply chains is increasingly threatened by fragmented paper-based records, certificate fraud, and the absence of real-time traceability. This paper presents HalalChain, a blockchain-based halal product traceability system that enforces role-based access control (RBAC) through three Solidity smart contracts deployed on an Ethereum-compatible blockchain. HalalChain is designed for production deployment on an EVM-compatible Layer-2 or sidechain such as Polygon or BNB Chain, on which the contracts run without code changes. A dual-storage architecture synchronises every supply chain event to both a PostgreSQL relational database and the blockchain, balancing on-chain immutability with off-chain query performance. The system supports five stakeholder roles, namely administrator, supplier, manufacturer, logistics, and retailer, each restricted to specific supply chain event types enforced at the smart contract level. Consumers can verify product halal status and full supply chain history by scanning a QR code linked to a public verification endpoint that cross-checks database records against on-chain event counts, producing a chain-integrity indicator. As the current chain-integrity check is count-base, it can detect missing or extra database rows, but it cannot detect content-level modification if the row count remains unchanged. A total of 107 automated test cases were executed covering functional correctness, edge cases, end-to-end integration, and gas performance benchmarks. Core smart contract operations consume between 25,365 and 213,684 gas units, indicating feasible deployability on Ethereum-compatible networks. An exploratory analysis was carried out with a preliminary survey of 40 respondents (mean = 4.10 on a 5-point Likert scale), suggesting that consumer demand for blockchain-verified halal certification is encouraging. The results demonstrate that HalalChain provides a tamper-evident, role-enforced traceability foundation for the halal food industry. The system secures the digital chain of custody cryptographically and the physical–digital binding between the QR code, and the product remains a separate trust assumption requiring complementary anti-tamper mechanisms. Full article

Digital transformation has become a strategic pillar of modernization in public administration; however, evidence from emerging economies shows that technology implementation alone does not guarantee institutional transformation. This study examines the structural relationships among digital competencies, change management, technology adoption, and digital transformation in public administration institutions in Lima, Peru, incorporating Digital Inclusion Practices (DIP) as a moderating variable. A quantitative, non-experimental, cross-sectional design was applied to a sample of 358 public servants working in ministries, national agencies, regional administrative units, and municipal governments located in Lima. Data were analyzed using Partial Least Squares Structural Equation Modeling (PLS-SEM). The results indicate that digital competencies and change management are positively associated with technology adoption, and that change management and technology adoption show significant positive relationships with digital transformation. Technology adoption partially mediates the relationships between digital competencies and digital transformation, and between change management and digital transformation. Additionally, digital competencies show a direct and statistically significant, although weak, relationship with digital transformation. The moderating relationship involving DIP was not statistically significant. These findings suggest that digital governance in emerging public administrations may depend less on individual skills alone and more on structured institutional processes that support effective technology adoption, strategic change management, and institutional modernization. Full article

Background: Hospital-acquired infections (HAIs) represent the most significant complications in patients hospitalized for severe burn injuries, after the immediate post-burn resuscitation phase, and are associated with substantial morbidity and mortality. Methods: This is a narrative review. Evidence was extracted mainly with an in-depth search of MEDLINE, focusing on guidelines, randomized controlled trials, and relevant observational studies published in the last 25 years. The reference lists of the most relevant publications were screened to retrieve additional relevant information. Results: Wound infections, bloodstream infections, pneumonia, and urinary tract infections account for the majority of infectious complications. Their diagnosis can be challenging, particularly in the context of wound infections and sepsis. Burn severity and the resulting disruption of tissue and organ homeostasis can alter the pharmacokinetic and pharmacodynamic (PK/PD) properties of antibiotics, rendering standard dosing and administration strategies inadequate. Higher doses, prolonged or continuous infusions, and therapeutic drug monitoring may be required to optimize antibiotic exposure. The emergence of multidrug-resistant (MDR) pathogens (particularly MDR Gram-negative bacilli) has been widely reported across diverse epidemiological settings and occurs frequently in patients with prolonged hospitalization, further complicating treatment. As a result, the use of broad-spectrum antibiotics is substantial, both for empirical therapy and for targeted treatment. Although antimicrobial stewardship programs can promote more appropriate antibiotic use, evidence on how to effectively implement these strategies in Burn Intensive Care Units remains limited. Conclusions: HAIs in burn patients represent a highly complex clinical scenario. Clinical severity is often significant, diagnosis can be challenging, and MDR pathogens are very prevalent, with high consumption of broad-spectrum antibiotics. Moreover, PK/PD properties of antibiotics can be altered. Antimicrobial stewardship can promote appropriate antimicrobial use, but implementation in this setting has not been adequately studied. Close multidisciplinary collaboration between burn specialists and infectious diseases physicians is essential to ensure effective patient management. Full article

Background/Objectives: Drug supply disruptions represent an increasingly serious problem for health systems worldwide, with systemic antibiotics among the most frequently affected therapeutic categories. Although regulatory authorities have repeatedly signaled this risk, comparative studies analyzing patterns of antibiotic shortages across multiple countries simultaneously remain scarce. Methods: We performed a cross-sectional comparative analysis based on data from public national shortage registries in seven jurisdictions: Belgium, France, Germany, Romania, Spain, the United States (FDA), and the Kingdom of Saudi Arabia. All records corresponding to systemic antibiotics in ATC group J01 were extracted, harmonized, and analyzed, with the active substance (INN) as the unit of analysis. The association between critical drug status according to the EMA list and the multinational recurrence of shortages was assessed using chi-square tests, the Mann–Whitney U test, and multivariate logistic regression. To verify the robustness of the results, a sensitivity analysis was also performed using alternative thresholds for jurisdictions. Results: A total of 350 shortage records were mapped, corresponding to 64 unique active pharmaceutical ingredients. On average, each active substance was reported as out of stock in 3.48 jurisdictions (SD = 1.46). Macrolides (J01F) and quinolones (J01M) exhibited the widest geographic spread of shortages. Antibiotics included on the EMA’s list of critical medicines were reported as missing in multiple countries simultaneously significantly more frequently than those not included on this list (82.86% vs. 37.14%; χ² = 71.99, p < 0.001; Cramer’s V = 0.454). In the multivariate logistic regression model, EMA critical medicine status remained an independent predictor of multinational recurrence of shortages (OR = 8.29; 95% CI: 4.93–13.94; p < 0.001), while the injectable route of administration did not reach the threshold for statistical significance (OR = 0.78; p = 0.341). Sensitivity analysis confirmed that this association remains statistically significant regardless of the threshold chosen. Conclusions: Shortages of systemic antibiotics tend to occur simultaneously in multiple countries, and drugs designated as critical by the EMA are disproportionately affected. The results suggest that the identified weaknesses are not specific to a single health system but reflect structural fragilities in international antibiotic supply chains. This underscores the need for internationally coordinated strategies, both for monitoring the availability of essential antibiotics and for preventing and managing shortages. Full article

Sustainable metropolitan development depends on the effective transformation of spatial linkages into functional integration, including efficient commuting, equitable public service accessibility, spatial connectivity, and cross-boundary governance. However, existing studies often rely on administrative boundaries, static indicators, or coarse spatial units, limiting their ability to identify fine-scale spatial heterogeneity and explain how metropolitan linkages shape functional integration. Taking the Beijing Metropolitan Area as a case study, this study develops an integrated framework combining metropolitan boundary delineation, spatial linkage network analysis, and spatial–functional urban integration assessment. SDGSAT-1 nighttime light data (NTL) and transport accessibility analysis are used to identify Beijing’s main urban center and delineate the metropolitan extent. Population flow, resource linkage, and comprehensive spatial linkage networks are constructed to characterize network structure and nodal hierarchy. Spatial–functional urban integration is then evaluated at the township/subdistrict scale from three dimensions: commuting integration, public service accessibility, and spatial connectivity. The results show that Beijing’s main urban center extends beyond the traditional central urban area, and the metropolitan area exhibits concentric attenuation, directional differentiation, and heterogeneous expansion. Although cross-boundary linkages have emerged, the network remains dominated by Beijing’s core functions, with localized support from Tianjin and absorptive roles of adjacent Hebei areas. Spatial–functional integration advances primarily along major linkage corridors and key nodes, forming a hierarchical pattern consistent with the comprehensive spatial linkage network. These findings provide fine-scale spatial evidence for optimizing functional corridors, strengthening secondary nodes, improving public service allocation, and promoting cross-boundary spatial governance in sustainable metropolitan development. Full article

Road traffic crashes remain a global public health burden and a persistent resource allocation problem that undermines progress toward the sustainable development of safe, equitable mobility systems. Saudi Arabia’s Vision 2030 targets fewer than 10 fatalities per 100,000 population, a goal aligned with United Nations Sustainable Development Goal 3.6 (halving road traffic deaths) and SDG 11.2 (safe and sustainable transport), yet a gap persists between crash prediction research and how agencies deploy enforcement resources. This paper builds a closed-loop predict–optimize–evaluate framework connecting Long Short-Term Memory (LSTM) neural networks to a goal-distance gap metric and constrained optimization, feeding forecast outputs directly into enforcement scheduling decisions. Using monthly casualty data from official Saudi sources covering the entire kingdom (all 13 administrative regions) from 2010 through 2024 (N = 42,856 fatal and serious injuries across 180 monthly observations), we validate LSTM forecasting against five benchmarks plus a GRU and a Transformer baseline, apply gap analysis as a standardized goal-distance metric, optimize enforcement allocation with triangulated elasticity estimates, and evaluate past policy reforms through multi-method counterfactual analysis. A headline finding is that roughly 28% of fatal and serious injuries cluster within only about 6% of weekly hours, creating an unusually concentrated target for enforcement reallocation. The LSTM achieves RMSE = 2.47 with MASE = 0.83, beating ARIMA by 35% while maintaining robustness during COVID disruptions (RMSE = 2.38 in the post-acute period 2022–2024 versus 2.61 in the acute period 2020–2021). Temporal analysis confirms 28% of fatalities (95% CI: 26.0–30.0%) cluster within 6% of weekly hours. Enforcement elasticity triangulated from three independent sources converges at α ≈ 0.31 (90% CI: 0.25–0.40). The optimization model allocates 56% of enforcement resources to Thursday–Friday midnight-to-4 AM windows, projecting a 17.1% casualty reduction (90% CI: 13.5–20.6% under Monte Carlo uncertainty in α). Monte Carlo sensitivity analysis with 10,000 iterations confirms a median benefit-cost ratio of 1.88 (90% CI: 1.18–2.97), with P (BCR > 1.0) = 98.9%, using locally calibrated VSL = SAR 4.2 million (equivalent to approximately USD 1.12 million at the SAMA-pegged rate of 3.75 SAR/USD, in constant 2024 prices). Counterfactual evaluation finds that the post-2018-reform period was associated with a 22.1% casualty reduction (95% CI: 16.4–27.8%), with magnitude robust across four methods (LSTM counterfactual, Bayesian Structural Time-Series, Synthetic Control, and an inverse-variance-weighted synthesis of the three); we stress, however, that attribution to the driving reform itself cannot be cleanly separated from concurrent Saher camera expansion, public awareness campaigns, and trauma-care improvements. By translating prediction into evidence-based, resource-efficient enforcement, the framework supports sustainable road safety policy in middle-income and rapidly motorizing settings. Full article

Legal advocacy for parents involved in the public child welfare system in the United States is typically initiated only after a child has been removed and a dependency petition has been filed. For infants, removal at or shortly after birth constitutes a profound disruption of the parent–child attachment relationship and is increasingly recognized as an adverse childhood experience. This paper focuses on a summative program evaluation of the Family Intervention Response to Stop Trauma (FIRST) Legal Clinic in Washington State, a prevention-oriented model providing free, confidential legal advocacy and peer support to pregnant and postpartum parents prior to Child Protective Services (CPS) investigation or court involvement. Administrative data from 2019 to 2025 for 1232 eligible families were utilized to examine eligibility and referral patterns, reasons for ineligibility, and case outcomes. Findings demonstrated that eligible families with known outcomes avoided dependency court involvement entirely or experienced case closure without child removal, while a smaller proportion proceeded to dependency court filings. These findings highlight the need to reduce unnecessary child welfare system entry and mitigate traumatic disruption of the parent–child attachment relationship at birth by providing legal advocacy before investigation and court involvement. Full article

Objectives: Improving the interoperability of electronic health records is critical for efficient, cost-effective delivery of quality services, enhanced care coordination, and improved treatment outcomes within the United States healthcare system. Healthcare leaders and administrators often experience EHR interoperability issues, restricting communication between health systems and impacting electronic health data utilization. Methods: This systematic literature review explored innovative strategies to improve electronic health record interoperability between health information systems to enhance data exchange efficiency, accuracy, and security in U.S. healthcare settings. A search transpired using the Public Medline, Institute of Electrical and Electronics Engineers Xplore Digital Library, and Cumulative Index to Nursing and Allied Health Literature following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results: Data from 24 relevant articles were analyzed using screening criteria revolving around the research question. Five themes emerged during data analysis. The themes included the utilization of blockchain-based EHR systems (67%), the drive of the Cures Act to achieve interoperability (17%), the advent of artificial intelligence and how it can be used (33%), how the Internet of Things drives the industry to strategically enhance the system (33%), and how the value of interoperability drives outcomes (79%). Conclusions: Findings indicate strategies from a technical perspective and from policy initiatives can improve communication between health information systems. Findings suggest that by strategically leveraging available resources and implementing innovative strategies, healthcare leaders can achieve comprehensive EHR interoperability long term. Full article

Thailand’s Community Liquor Law Reform aimed to encourage small-scale alcohol production in 2022. Early evidence suggests a mismatch between legislative changes and the capacity of existing institutions to implement them. This study aims to examine governance challenges, stakeholder experiences, and implementation gaps during the early phase of the reform across four provinces. A qualitative policy analysis was performed through semi-structured interviews with fifty-eight participants, comprising twenty-three community liquor producers and thirty-five officials from excise units, public health offices, and local administrative bodies. Data was collected through interviews, meeting records, field observations, and policy documents. Thematic analysis followed a hybrid inductive and deductive approach, and triangulation strengthened the credibility of the findings. The research revealed a significant gap between national policy goals and local implementation. Stakeholders noted the unclear procedural guidelines, resulting in continued reliance on pre-reform practices. They also reported substantial administrative challenges and inconsistent enforcement across regions. Limited technical capacity among producers contributed to unstable alcohol strength, variable product quality, and inadequate waste management. Furthermore, the reform raised concerns about increased alcohol availability, potential youth access, and community misinterpretation of policy objectives. These findings suggest that legislative reform alone is insufficient for effective implementation. Clear guidelines, coordinated enforcement, technical training, and monitoring systems are essential to align policy with practice. Full article

A widely reproduced error in hydrogeologic maps originated from a provisional delineation drawn in the mid-1990s to depict the southern extent of the Mesilla Bolson aquifer along the western margin of the El Paso–Juárez metropolitan area. The delineation was created solely to satisfy a U.S. Environmental Protection Agency contractual milestone during early binational groundwater inventory efforts and was never intended to represent a final hydrogeologic basin limit. Nevertheless, the outline persisted, became institutionalized in reports, models, management documents, and public imagery, and was ultimately labeled the “Mesilla/Conejos–Médanos Basin Transboundary Aquifer,” where it continues to be treated as a valid transboundary aquifer delineation. This paper documents the origin of the provisional delineation and proposes a revised delineation for the Mesilla/Conejos–Médanos Basin Transboundary Aquifer, based on internationally recognized definitions of transboundary aquifers and groundwater basins, including United Nations frameworks, and established scientific criteria. These criteria include basin-scale geologic and structural controls, hydrostratigraphic continuity, groundwater divides, and permeability contrasts at basin interfaces. Results indicate that the newly defined aquifer delineation falls within Mexico’s much larger administrative Acuífero Conejos–Médanos (0823), a unit that represents groundwater management jurisdiction in Mexico rather than solely a hydrogeologic basin. The proposed transboundary aquifer is defined on hydrogeological principles and does not coincide with either the administrative unit of Mexico or the historic provisional outline that has become widely used by multiple binational entities and by different experts in groundwater science. Full article