Search Results (4,366)

This article examines the persistence of structural racism and the process of ethno-stratification affecting immigrants from the Global South in Spain. Drawing on national survey data and recent research, it analyses the socio-economic incorporation of immigrants in the aftermath of the Great Recession and subsequent economic recovery, emphasising both their rootedness in Spanish society and their continued segregation. The findings indicate that immigrants remain disproportionately concentrated in low-wage and temporary employment, positioned beneath the native-born precariat and distant from average living standards. This persistent segmentation cannot be explained solely by immigrants’ qualifications or cultural adaptation, but rather by an interplay of structural, institutional, social, and ethnic factors. At the core lies the Spanish “Mediterranean” development model, characterised by a low-productivity economy dependent on cheap labour, a limited welfare state, and strong family-based social protection, which together generate continuous demand for flexible immigrant workers. Additional drivers include migration and labour policies, gendered labour segmentation, and ethnic discrimination, all reinforcing immigrants’ vulnerability. The article concludes that immigrant labour has become essential to Spain’s economic and demographic model, yet its enduring segregation underscores the need for renewed public policies that promote social cohesion and intercultural integration. Full article

Background/Objectives: Colorectal cancer (CRC) is a major public health challenge in Brazil, characterized by marked regional disparities. Although national legislation mandates that treatment begin within 60 days after diagnosis, compliance remains inconsistent, particularly within the Unified Health System (SUS). This study aimed to analyze the time to treatment initiation for colon (C18) and rectal (C20) cancer in Brazil from 2013 to 2024, assessing regional inequalities, temporal trends, and factors associated with treatment delays. Methods: We conducted an ecological study using secondary data from the Ministry of Health’s PAINEL-Oncologia platform, which integrates information from SIA/SUS, SIH/SUS, and SISCAN. Records of patients diagnosed with colon and rectal cancer (ICD-10 C18–C20) were evaluated. Temporal trends were analyzed using Joinpoint regression, and factors associated with delayed treatment initiation (>60 days) were identified through multiple logistic regression models. Results: Persistent discrepancies were observed between diagnostic and treatment trends from 2013 to 2024, with the Annual Percent Change (APC) for diagnosis exceeding that for treatment, particularly among adults aged 55–69 years. The Southeast and South regions accounted for over 70% of all diagnosed cases, starkly contrasting with the less than 25% in the North and Northeast. More than 50% of patients across all clinical stages initiated treatment after the legally mandated 60-day period. Women with rectal cancer had a 28% higher risk (RR = 1.28) of being diagnosed at stage IV. Chemotherapy was the predominant initial therapeutic modality, while the need for combined chemo-radiotherapy was associated with markedly elevated risk ratios for delay (e.g., RR = 26.53 for stage IV rectal cancer). Treatment initiation delays (>60 days) were significantly associated with residence in the North/Northeast regions, female sex (for rectal cancer), advanced-stage disease, and complex therapeutic regimens. Conclusions: The study demonstrates persistent regional inequalities and highlights a substantial mismatch between diagnostic capacity and therapeutic availability in Brazil. These gaps contribute to treatment delays and reinforce the need to strengthen and expand oncological care networks to ensure equitable access and improve outcomes, particularly in underserved regions. Full article

Canada’s ageing population continues to grow rapidly and significantly more diverse, which will require unique health and home service needs. The COVID-19 pandemic exacerbated existing challenges in Canada’s healthcare system and demonstrated the need for long-term care (LTC). Semi-structured interviews were conducted with 17 decision makers, managers, and leaders in long-term ethnically focused facility care. Braun & Clarke’s six-stage process of thematic analysis was applied using an iterative, deductive approach to examine the experiences of stakeholders involved in the operational, managerial, financial, and clinical aspects of an ethnicity-focused LTC. Findings highlighted salient characteristics of impactful ethnicity-focused care and factors were uniquely shaped by the delivery of culturally specific care. Key subthemes included social isolation and emotional impact, operational and logistic difficulties during COVID-19, mitigation measures implemented in response, and the social, behavioural, and health benefits observed among seniors living in these LTC homes. Participants identified political and economic constraints (e.g., provincial funding) to establishing ethnicity-focused care homes but proposed several solutions and highlighted potential benefits that could support successful implementation. Analysis of experiences of operational challenges in safely and adequately running ethnicity-focused LTC reinforces the value of ethnicity-focused LTC during times of crisis such as the COVID-19 pandemic, as they provide a culturally safe and familiar space with preventive measures applied in a timely manner for seniors to engage with their peers in an environment that meets their health needs, ensuring safety standards. Full article

Parenteral nutrition (PN) is essential for patients who are unable to tolerate oral or enteral feeding, providing them with necessary nutrients intravenously, including dextrose, amino acids, electrolytes, vitamins, trace elements, and lipid emulsions. Clinical pharmacists (CPs) play a critical role in PN management by ensuring proper formulation, monitoring therapy, preventing complications, and optimizing patient outcomes. In Saudi Arabia, limited literature exists on CPs’ involvement in total parenteral nutrition (TPN) administration, health information management (HIM) systems, and pharmacist staffing ratios. This paper examines the evolving role of CPs in PN management, addressing key challenges such as the optimal patient-to-CP ratio, the impact of HIM systems on PN prescribing, and the advantages and limitations of centralized versus decentralized PN prescription models. It highlights the need for standardized staffing levels, structured pharmacist training, and improved HIM integration to enhance workflow efficiency and prescribing accuracy. Additionally, the study examines how the adoption of advanced HIM systems can streamline documentation, reduce prescribing errors, and enhance interdisciplinary collaboration. This paper provides a framework for optimizing PN delivery, enhancing healthcare quality, and strengthening CPs’ contributions to nutrition support by addressing these factors. Implementing these recommendations will improve patient outcomes and establish a more efficient PN management system in Saudi Arabia, reinforcing the vital role of CPs in multidisciplinary care. Full article

Atrial fibrillation (AF) and heart failure with preserved ejection fraction (HFpEF) coexist in 40–60% of cases and mutually reinforce each other through adverse electrical, cellular, and functional remodelling. There is considerable overlap in signs and symptoms, and diagnosis may be challenging due to nonspecific clinical presentations and chronic course. AF is clearly linked with worsening morbidity and mortality in HFpEF with higher rates of HF hospitalizations, HF progression, stroke, systemic embolism, and all-cause death. Optimal management of HFpEF-AF patients requires aggressive treatment of comorbidities and risk factor modification. Sodium-glucose cotransporter 2 (SGLT2) inhibitors have demonstrated consistent benefit with respect to HF hospitalizations, symptoms and exercise haemodynamics, and potential to reduce AF burden. Gastric inhibitory polypeptide (GIP)/glucagon-like peptide-1 (GLP-1) agonists, mineralocorticoid receptor antagonists (MRAs), angiotensin receptor-neprilysin inhibitors (ARNIs), and statins may provide benefit in selected phenotypes, though evidence remains heterogeneous. A rhythm control strategy in the early clinical course of HFpEF might be a reasonable strategy to improve symptoms and delay both AF and HFpEF disease progression. Catheter ablation appears to improve exercise haemodynamics and quality of life, and observational data suggest it may reduce mortality and HF hospitalization, though current evidence is inconsistent and not yet definitive. Emerging device-based and molecular therapies could represent promising avenues for future research. Overall, early detection of AF, comprehensive risk-factor modification, and tailored rhythm-control strategies are central to improving outcomes in the HFpEF-AF overlap syndrome. Full article

The gut immune microenvironment and the liver engage in intricate information exchange via the gut–liver axis. The disruption of these interactions plays a pivotal role in the formation and exacerbation of pathological damage to the liver. The gut immune microenvironment is not an independent layer of the gut barrier; rather, it permeates and regulates all other barrier functions, serving as the core coordinator. Disruption of the immune microenvironment in the gut–liver axis drives progression across the full disease spectrum—from steatosis to hepatitis, fibrosis, and even liver cancer—through the continuous influx of immune-stimulatory signals that overwhelm the liver’s intrinsic immune regulatory mechanisms. Dysfunction of innate immunity components, amplification of inflammatory factors and key cellular signaling pathways, activation of adaptive immune T cells, and systemic effects mediated by liver-derived inflammatory factors collectively form a disordered immune microenvironment. This damages the intestinal barrier and exacerbates liver disease via the gut–liver axis, leading to further intestinal injury, thus establishing a self-reinforcing vicious cycle. Current therapeutic strategies based on modulating the gut–liver axis microenvironment remain limited, yet studies have demonstrated that suppressing gut immune cells, cytokines, and signaling pathways can help delay liver disease progression. Hopefully, future combined, precise, and cutting-edge gut immunotherapies will provide more effective strategies for liver disease treatment. Full article

Traditional flexible polyurethane (PU) foams frequently exhibit limited mechanical support and suboptimal moisture–heat regulation, which can compromise the microenvironmental comfort required for high-quality sleep. In this study, natural luffa fibers (LF) were incorporated as a microstructural modifier to simultaneously enhance the mechanical and moisture–heat regulation performance of PU foams. PU/LF composite foams with varying LF loadings were prepared via in situ polymerization, and their foaming kinetics, cellular morphology evolution, and physicochemical characteristics were systematically investigated. The results indicate that LF functions both as a reinforcing skeleton and as a heterogeneous nucleation site, thereby promoting more uniform bubble formation and controlled open-cell development. At an optimal loading of 4 wt%, the composite foam developed a highly interconnected porous architecture, leading to a 7.9% increase in tensile strength and improvements of 19.4% and 22.6% in moisture absorption and moisture dissipation rates, respectively, effectively alleviating the heat–moisture accumulation typically observed in unmodified PU foams. Ergonomic pillow prototypes fabricated from the optimized composite further exhibited enhanced pressure-relief performance, as evidenced by reduced peak cervical pressure and improved uniformity of contact-area distribution in human–pillow pressure mapping, together with an increased SAG factor, indicating improved load-bearing adaptability under physiological sleep postures. Collectively, these findings elucidate the microstructural regulatory role of biomass-derived luffa fibers within porous polymer matrices and provide a robust material basis for developing high-performance, sustainable, and ergonomically optimized sleep products. Full article

Age-related osteoporosis is driven in part by senescence-associated rewiring of bone marrow mesenchymal stem cells (MSCs) from osteogenic toward adipogenic fates. Accumulating evidence indicates that epigenetic drift and reduced autophagy are not isolated lesions but are mechanistically coupled through a bidirectional DNA methylation and autophagy axis. Here, we summarize how promoter hypermethylation of genes involved in autophagy and osteogenesis suppresses autophagic flux and osteoblast lineage transcriptional programs. Conversely, autophagy insufficiency reshapes the methylome by limiting methyl donor availability, most notably S-adenosylmethionine (SAM), and by reducing the turnover of key epigenetic regulators, including DNA methyltransferases (DNMTs), ten-eleven translocation (TET) dioxygenases, and histone deacetylases (HDACs). This self-reinforcing circuitry exacerbates mitochondrial dysfunction, oxidative stress, and inflammation driven by the senescence-associated secretory phenotype (SASP), thereby stabilizing adipogenic bias and progressively impairing marrow niche homeostasis and bone remodeling. We further discuss therapeutic strategies to restore balance within this axis, including selective modulation of epigenetic enzymes; activation of AMP-activated protein kinase (AMPK) and mechanistic target of rapamycin (mTOR) signaling with downstream engagement of Unc-51-like autophagy-activating kinase 1 (ULK1) and transcription factor EB (TFEB); targeting sirtuin pathways; mitochondria- and autophagy-supportive natural compounds; and bone-targeted delivery approaches or rational combination regimens. Full article

Geothermal energy is a crucial component of climate adaptation and sustainability transitions, as it provides a dependable, low-carbon source of baseload power that can accelerate sustainable energy transitions and enhance climate resilience. Yet, in East Africa—one of the world’s most promising geothermal regions, with the East African Rift—a unique climate-energy opportunity zone—the harnessing of geothermal power remains slow and uneven. This study examines the contextual conditions that facilitate the successful and sustainable development of geothermal power in the region. Drawing on semi-structured interviews with 17 experienced professionals who have worked extensively on geothermal projects across East Africa, the analysis identifies how technical, institutional, managerial, and relational circumstances interact to shape outcomes. The findings indicate an interdependent configuration of success conditions, with structural, institutional, managerial, and meta-conditions jointly influencing project trajectories rather than operating in isolation. The most frequently emphasised enablers were resource confirmation and technical design, leadership and team competence, long-term stakeholder commitment, professional project management and control, and collaboration across institutions and communities. A co-occurrence analysis reinforces these insights by showing strong patterns of overlap between core domains—particularly between structural and managerial factors and between managerial and meta-conditions, highlighting the mediating role of managerial capability in translating contextual conditions into operational performance. Together, these interrelated circumstances form a system in which structural and institutional foundations create the enabling context, managerial capabilities operationalise this context under uncertainty, and meta-conditions sustain cooperation, learning, and adaptation over time. The study contributes to sustainability research by providing a context-sensitive interpretation of how project success conditions manifest in geothermal development under climate transition pressures, and it offers practical guidance for policymakers and partners working to advance SDG 7 (Affordable and Clean Energy), SDG 9 (Industry, Innovation and Infrastructure), and SDG 13 (Climate Action) in Africa. Full article

The present study explores the relationship between the systemic approach, educational innovation, and the use of digital technologies in higher education, with an emphasis on military academies. The aim of the research is to shed light on how systemic thinking can support strategic planning, the quality of education, and the effective integration of innovative practices, such as artificial intelligence, information and communication technologies, and virtual reality. The methodology was based on quantitative research using a questionnaire, which was distributed to 452 members of the Hellenic Non-Commissioned Officers Academy educational community (teaching staff, cadets, and recent graduates). Data analysis showed that the adoption of a systemic approach is positively associated with the readiness of trainers, including both instructors and future professionals (cadets), to support and implement educational innovations. Furthermore, it was found that the clarity of educational objectives and the alignment of critical elements of the educational system (resources, technology, instructors, trainees, and processes) significantly reinforce the intention to adopt innovative practices. The findings also show that educators’ positive perceptions of artificial intelligence and virtual/augmented reality are associated with a higher appreciation of learning benefits, such as improved performance, trainee satisfaction, and collaboration. In contrast, demographic and professional factors have a limited effect on attitudes toward innovation. Overall, findings indicated that innovation in military academies is not limited to the technological dimension, but requires a holistic, systemic approach that integrates organizational, pedagogical, and strategic parameters. The study contributes both theoretically and practically, providing empirical evidence for the role of systemic thinking in the design and implementation of innovative educational policies in military and broader academic education. Full article

Curling presents a challenging continuous-control problem in which shot outcomes depend on long-horizon interactions between complex physical dynamics, strategic intent, and opponent responses. Despite recent progress in applying reinforcement learning (RL) to games and sports, curling lacks a unified environment that jointly supports stable, rule-consistent simulation, structured state abstraction, and scalable agent training. To address this gap, we introduce a comprehensive learning framework for curling AI, consisting of a full-sized simulation environment, a task-aligned Markov decision process (MDP) formulation, and a two-phase training strategy designed for stable long-horizon optimization. First, we propose a novel MDP formulation that incorporates stone configuration, game context, and dynamic scoring factors, enabling an RL agent to reason simultaneously about physical feasibility and strategic desirability. Second, we present a two-phase curriculum learning procedure that significantly improves sample efficiency: Phase 1 trains the agent to master delivery mechanics by rewarding accurate placement around the tee line, while Phase 2 transitions to strategic learning with score-based rewards that encourage offensive and defensive planning. This staged training stabilizes policy learning and reduces the difficulty of direct exploration in the full curling action space. We integrate this MDP and training procedure into a unified Curling RL Framework, built upon a custom simulator designed for stability, reproducibility, and efficient RL training and a self-play mechanism tailored for strategic decision-making. Agent policies are optimized using Soft Actor–Critic (SAC), an entropy-regularized off-policy algorithm designed for continuous control. As a case study, we compare the learned agent’s shot patterns with elite match records from the men’s division of the Le Gruyère AOP European Curling Championships 2023, using 6512 extracted shot images. Experimental results demonstrate that the proposed framework learns diverse, human-like curling shots and outperforms ablated variants across both learning curves and head-to-head evaluations. Beyond curling, our framework provides a principled template for developing RL agents in physics-driven, strategy-intensive sports environments. Full article

Abdominal aortic aneurysm (AAA) is a serious disease with no effective pharmacological therapy. Although inflammation is recognized as a key regulator of AAA, targeting inflammatory pathways once the disease is established does not improve outcomes. Understanding the earliest molecular indicators could clarify precise biological targets and prognostic markers for AAA. Using ApoE-deficient mice, we performed RNA-Seq on suprarenal abdominal aortas (SRAs) from Ang II- and saline-treated mice 24 h after infusion. We further developed a unique model of hyperlipidemic mice in which the expression of the inhibitor of nuclear factor kappa B kinase subunit beta (IKKβ) can be conditionally suppressed in vascular smooth muscle cells (VSMCs). RNA-Seq data revealed early IKKβ-dependent cellular anabolic processes in SRAs, including activation of the mammalian target of rapamycin complex 1 (mTORC1) pathway. Furthermore, deletion of the Ikbkb gene in VSMCs significantly reduced the rate of aneurysm rupture in mice exposed to Ang II. In situ analysis further confirmed that the absence of IKKβ in VSMCs is associated with a reduced inflammatory response and the preservation of their contractile phenotypes. Our results reinforce the crucial role of VSMCs in rapid adaptation, leading to deleterious inflammation-dependent remodeling of the vascular wall, and define a previously unrecognized anabolic role of IKKβ in AAA pathogenesis. Full article

Understanding the economic performance of heritage-rich towns requires a systematic evaluation of how heritage-related components collectively contribute to revenue generation. Existing studies often examine heritage assets, socio-cultural factors, physical infrastructure, and local economic conditions independently, resulting in fragmented insights that limit comprehensive planning for local economic development. This study develops and validates an integrated Cultural Heritage Economy Model that quantifies the influence of heritage resources, social, physical, and economic aspects on revenue generation in heritage contexts. The model is conceptualized through a structured synthesis of theoretical literature and domain-specific indicators, followed by construct operationalization, expert validation, and pilot-level assessment. Using Structural Equation Modelling (SEM-PLS), the study demonstrates strong reliability, convergent validity, discriminant validity, and significant structural relationships. The predictive relevance of the final model is further evaluated through PLSpredict, confirming its suitability for future estimation. The findings confirm that revenue generation is a product of the combined and mutually reinforcing effects of heritage, socio-cultural, physical, and economic dimensions, rather than just by the influence of heritage resources. By offering this novel, empirically grounded, multidimensional framework to estimate heritage-driven economic outcomes, this research establishes a foundational model that can guide evidence-based resource allocation, policy formulation, and long-term sustainable urban development planning. Full article

Background/Objectives: Emerging evidence suggests that multiple micronutrient supplements (MMS) provide additional benefits for maternal and neonatal health compared with iron and folic acid (IFA) supplements. To achieve effective coverage, acceptability, and adherence—and to inform a nationwide rollout of MMS—it is essential to understand the context-specific factors that shape implementation. This study evaluated the pilot implementation of MMS in Rwanda to identify key enablers, areas for improvement, and challenges related to antenatal care (ANC) attendance and MMS use. Methods: Data were collected through a survey of 3257 women who attended ANC services, seven focus group discussions with 35 ANC attendees, and key informant interviews with 20 ANC nurses and 21 community health workers. Results: Pregnant women reported high ANC attendance (74%) and MMS consumption (79%), largely driven by strong motivation and awareness of MMS benefits. Strategies to remember daily intake and to manage side effects supported adherence, as did reminders, motivation, and information from family members and healthcare providers. Limited patient-centered counselling, financial constraints, barriers to accessing ANC services, and product stock-outs were key areas for strengthening service delivery in Rwanda. Conclusions: Sustaining high ANC attendance and MMS adherence as the program transitions from the pilot phase to national scale-up is essential. Improving counseling quality and strengthening supply chains may reinforce ANC services and support sustained MMS adherence, with benefits for maternal and child health. Full article

Drought stress is a major abiotic factor limiting global crop productivity by disrupting cellular homeostasis, impairing photosynthesis, and restricting metabolic activity. Plant-associated microorganisms, including rhizobacteria, endophytes, and arbuscular mycorrhizal fungi, play key roles in enhancing drought resilience through molecular, biochemical, and physiological mechanisms. These beneficial microbes modulate phytohormone biosynthesis, enhance osmolyte accumulation, increase organic acid exudation, and activate ROS-scavenging antioxidant pathways. Microbe-mediated regulation of aquaporins, heat shock proteins, and root system architecture further improves water-use efficiency, hydraulic conductance, and stress acclimation. Advances in microbial genomics and systems biology have revealed the molecular drivers of plant–microbe synergism, enabling the development of tailored microbial consortia and next-generation bioinoculants. Complementarily, genetic and genome-guided modulation of drought-responsive regulatory hubs including transcription factors (DREB, NAC, MYB, bZIP), signal transducers (MAPKs, CDPKs), and protective proteins enhances adaptive plasticity under water deficit conditions. This review integrates current molecular insights into drought-induced perturbations in plants and highlights the convergence of microbial interventions and genome-guided strategies in reinforcing drought tolerance. Emphasizing mechanistic frameworks, scalable microbial technologies, and molecular breeding approaches, this work underscores their potential to improve crop resilience in increasingly water-limited environments. Full article