Search Results (305)

As one of the fastest growing economies in the world, it is critical for India to build climate-resilient infrastructure. Its rapidly increasing population growth and the consequent migration to urban areas, coupled with climate risks, have made infrastructure development a key priority area in India. Thus, ensuring that existing infrastructure and future constructions integrate strategies to address climate-related risks is vital. Despite the growing recognition of the importance of legal and policy landscapes on climate-resilient infrastructure, there is a very limited number of studies on this topic, especially in India. Thus, this study sought to bridge this gap by evaluating the influence of the Indian legal and policy framework on climate-resilient infrastructure. To this end, an analytical, comparative, and evaluative approach was adopted, employing benchmarks from international legal provisions and best practices from Japan’s legal and policy systems. In addition to doctrinal legal analysis using primary and secondary sources, case studies on the Mumbai Coastal Road Project and the Chandigarh–Manali Highway were performed to assess how the extant laws operate in the field. The findings indicate that while India’s legal system is gradually incorporating climate-risk considerations into its infrastructure sector, the effects of these considerations remain constrained due to institutional co-ordination challenges and limited enforceable obligations. Therefore, streamlining climate-resilient infrastructure governance requires more robust climate change legislation and improved implementation mechanisms. The findings of this study provide useful insights for legislators and policymakers in strengthening climate resilience integration within India’s infrastructure governance framework. Full article

Considering the high prevalence of adolescent depression and anxiety, the profound functional consequences of untreated early psychosis and suicide being the number one cause of death in Australia among 15–19-year-olds, ensuring that teachers are literate about these disorders should be a high priority. Teachers’ disorder-specific literacy is a pragmatic response to healthcare system constraints. This scoping review aimed to map the evidence of teacher mental health literacy training programs, specifically for depression, anxiety, early psychosis and suicide risk. PRISMA-ScR guidelines were followed. Included studies were published in English between 2000 and 2024, focused on teachers working with students in Year 7–12 and measured teachers’ knowledge of depression, anxiety, psychosis or suicide risk. Studies were appraised for quality. Eighteen studies met the inclusion criteria. Nine evaluated knowledge of student depression, five evaluated knowledge of anxiety and five evaluated knowledge of psychosis, while nine studies focused on suicide risk. Providing disorder-specific training and evaluation, rather than general mental health literacy training, is recommended for future research. When healthcare systems lack the capacity to provide care for ill adolescents, schools often function as frontline sites for recognition and triage. Disorder-specific literacy is recommended for teachers so they can manage their real-world, health-system compensation role. Full article

This systematic review maps and compares experimental strategies for estimating residual expansion in concrete elements affected by internal expansive reactions (IER), with emphasis on cores extracted from in-service structures. It adopts an operational taxonomy distinguishing achieved expansion (deformation already occurred, inferred through DRI/SDT or back-analysis), potential expansion (upper limit under free conditions), and residual expansion (remaining portion estimated under controlled temperature, T, and relative humidity, RH), in addition to the free vs. restrained condition and the diagnostic vs. prognostic purpose. Seventy-eight papers were included (PRISMA), of which 14 tested cores. The limited number of core-based studies is itself a key outcome of the review, revealing that most residual expansion assessments rely on adaptations of laboratory ASR/DEF protocols rather than on standardized methods specifically developed for concrete cores extracted from in-service structures. ASR predominated, with emphasis on accelerated free tests ASTM/CSA/CPT (often at 38 °C and high RH) for reactivity characterization, and on Laboratoire Central des Ponts et Chaussées (LCPC) No. 44 and No. 67 protocols or Concrete Prism Test (CPT) adaptations to estimate residual expansion in cores. Significant heterogeneity was observed in temperature, humidity, test media, specimen dimensions, and alkali leaching treatment, as well as discrepancies between free and restrained conditions, limiting comparability and lab-to-field transferability. A minimum reporting checklist is proposed (type of IER; element history; restraint condition; T/RH/medium; anti-leaching strategy; schedule; instrumentation; uncertainty; decision criteria; raw data) and priority gaps are highlighted: standardization of core protocols, leaching control, greater use of simulated restraint, and integration of DRI/SDT–expansion curves to anchor risk estimates and guide rehabilitation decisions in real structures. Full article

Volcanic crater interiors in Nicaragua’s Pacific region are a valuable, understudied, and threatened native plant resource. Laguna de Apoyo Nature Reserve encompasses a crater and lake formed following a Quaternary volcanic explosion in Pacific Nicaragua. The flora of the tropical dry forest in the crater’s interior surrounding the lake has not been extensively assessed. We identified 403 native and 72 introduced plant species and their uses through a combination of survey plots, unstructured interviews, expert consultations, and targeted searches for plant species coordinated with key informants in the Reserve. Fabaceae, Euphorbiaceae, and Asteraceae were the most represented native species, whereas the most significant numbers of introduced species were found in Poaceae, Euphorbiaceae, and Fabaceae. Forty-one species have conservation priority status. Documented uses were found for 70% of the native species and 88% of the introduced species. The most significant numbers of plant species with reported use types were ornamentals and fuelwood. This study constitutes the most comprehensive plant species inventory in a protected area of Nicaragua’s tropical dry forest biome. These findings indicate native plant diversity is high, introduced species pose considerable risks, and most species are integrated into local uses. Consequently, management decisions should explicitly promote native diversity, protect threatened species, better control introduced species, and encourage sustainable use. Full article

Background: Postoperative delirium (POD) is one of the most common surgical complications in elderly patients. This study investigated the incidence of and perioperative risk factors for POD following urological surgery. Methods: A total of 162 male patients aged ≥50 years undergoing elective major urological surgery under general anesthesia from May 2024 to March 2025 were included in this prospective observational study. Delirium was assessed using CAM-ICU twice a day for five postoperative days. Groups with and without delirium were compared, and perioperative predictors of delirium were analyzed. Multivariate regression analysis was used to identify independent risk factors for POD. Results: Overall, 16% of patients developed delirium during the follow-up period. Patients with POD were significantly older (mean age, 73.3 ± 5.2 years vs. 66.3 ± 7.2, p < 0.001), had more comorbidities, and lived in rural areas. Atrial fibrillation and COPD were particularly significant. The incidence of POD was higher in patients with mild/moderate alcohol consumption than in those who never drink. Analysis of intraoperative factors revealed a significant difference between groups in the presence of intraoperative hypotension and blood transfusion. Patients with delirium had more severe postoperative pain. Optimal cutoff values of age (≥67.5), number of comorbidities (≥2), preoperative MMSE score (≤25.5), and postoperative NRS score (≥4.85) were determined using ROC curves. The multivariate analysis identified age ≥ 67.5 years, COPD, mild/moderate alcohol consumption, preoperative MMSE score ≤ 25.5, intraoperative hypotension, and postoperative NRS score ≥ 4.85 as independent risk factors in this cohort. Conclusions: Considering that some of the above risk factors can be modified, it is necessary to emphasize that the prevention of POD is possible and should be one of the treatment priorities in older patients. Full article

Air quality assessment and waste management are key priorities within the Sustainable Development Goals. This study proposes an integrated approach to optimizing waste management and assessing air quality on Chalki Island, located in the Southeastern Aegean region. For analysis, measurements of a mobile air quality system located in the port area were employed to investigate the variability in pollutant concentrations and discomfort conditions. In addition, the ERA5 reanalysis dataset was used to study the impact of climate parameters on air quality. This case study covers the period from February to June 2025. In the context of waste management, a multi-criteria-driven analytical framework was developed to determine the optimal number and configuration of source separation bin arrays tailored to different waste streams at the municipal level. The findings show that anthropogenic activities (i.e., traffic and tourist density) and meteorological parameters significantly affect air pollution. The simultaneous degradation in air quality and discomfort conditions during the high tourist (warm) season increases health risk. In parallel, the deployment of five- and eight-bin source separation arrays was identified as optimal for the off-season and peak tourism season, respectively. This research contributes to a deeper understanding of air pollution variability while additionally guiding sustainable waste management for vulnerable island ecosystems. Full article

Failure Mode and Effects Analysis (FMEA) is a systematic risk assessment tool that effectively evaluates the safety and reliability of products prior to their deployment. However, traditional FMEA fails to consider and leverage inherent system-specific information during risk assessment, while also neglecting the weights of risk factors (RFs) when processing data related to the Risk Priority Number (RPN). This leads to significant subjectivity in the final risk ranking of failure modes. To overcome these drawbacks, this study proposes an improved FMEA risk assessment method based on load sharing, aiming to develop an improved FMEA method that addresses the critical limitations of traditional approaches by integrating load sharing principles and systematic weight determination, thereby enhancing risk assessment objectivity and accuracy in complex multi-component systems. First, probabilistic linguistic terms are adopted to quantify experts’ risk assessment information, and the geometric mean method is then used to aggregate assessments from multiple experts. Second, the Fuzzy Best–Worst Method (FBWM) is employed to determine the relative weights of the three RPN factors (Occurrence, Severity, and Detection). Additionally, partial system structural data are obtained through load sharing, and these data—combined with the calculated factor weights—are integrated into the Technique for Order Preference by Similarity to Ideal Solution (TOPSIS) to generate the final risk ranking of failure modes. Finally, a case study of a magnetic crane is conducted to verify the feasibility and effectiveness of the proposed method, supplemented by comparative experiments to demonstrate its superiority. Full article

Background/Objectives: Chronic hepatitis C virus (HCV) remains a major public health concern in Taiwan, particularly in southern regions with high endemicity. While HCV elimination is a national priority, resources are often limited. Relying solely on broad, township-level prevalence rates is inefficient, as the true disease burden can vary dramatically at the village level. Therefore, identifying local hotspots through fine-scale mapping is critical for efficient resource allocation and targeted intervention. This study aimed to validate village-level prevalence estimates and evaluate the efficiency of a community-based, targeted screening approach utilizing this detailed prevalence data in Chiayi County. Methods: We integrated data from the Chiayi Health Bureau and Chiayi Chang Gung Memorial Hospital (2000–2015) to generate village-level risk maps for five townships: Lioujiao (LJ), Yijhu (YH), Dongshih (DS), Taibao (TB), and Lucao (LC). Between 2018 and 2021, we conducted door-to-door community screening using anti-HCV testing with reflex HCV antigen (Ag) testing. Anti-HCV/HCV Ag prevalence, number needed to test (NNT), and linkage-to-care rates were calculated to validate prevalence estimates and assess screening efficiency. Results: Among 3910 participants, anti-HCV prevalence ranged from 5.4% (TB) to 8.7% (DS). Estimated and observed village-level prevalence showed moderate-to-strong correlation (r = 0.696–0.830, p < 0.001). Screening efficiency was highest in DS (NNT = 21) and lowest in TB (NNT = 42). Of 132 antigen-positive individuals, 131 (99.2%) initiated direct-acting antiviral therapy. Conclusions: The village-level risk maps accurately predicted local HCV burden, enabling targeted screening with high diagnostic yield and near-complete treatment uptake. This approach maximizes resource efficiency and may serve as a scalable model for advancing Taiwan and the WHO’s 2030 HCV elimination goals. Full article

Exosome-derived microRNAs (miRNAs) have been proposed as minimally invasive biomarkers for laryngeal squamous- cell carcinoma (LSCC). Because oral and maxillofacial surgeons are integral to head-and-neck oncologic and reconstructive pathways, such liquid-biopsy signals could support perioperative decision-making (selection for organ-preserving surgery), margin surveillance, and reconstructive planning. We conducted a preregistered, protocol-driven search of PubMed/MEDLINE, Web of Science, and Scopus from inception to 1 June 2025. Given the very small number of clinically comparable diagnostic studies, discordant index tests/thresholds, and high heterogeneity, we did not perform quantitative pooling or publication-bias testing. Instead, we undertook a narrative synthesis and constructed an evidence map; risk of bias tools (QUADAS-2; ROBINS-I) were applied descriptively to inform qualitative confidence. Nine studies were formally analysed based on eligibility to the study topic. Two serum-based case–control investigations (111 LSCC, 80 controls) reported areas under the ROC curve of 0.876 (miR-21 + HOTAIR) and 0.797 (miR-941), with corresponding sensitivities of 94% and 82%. Seven mechanistic papers showed that vesicular cargos—including miR-1246, circPVT1, and LINC02191—drive STAT3-dependent M2 polarisation, NOTCH1-mediated stemness, Rap1b-VEGFR2 angiogenesis, and glycolytic re-programming, producing 1.6–2.6-fold increases in invasion, tube formation, or xenograft growth. Only three studies fulfilled MISEV-2018 characterisation criteria, and none incorporated external validation. This narrative review and evidence map identifies promising but preliminary diagnostic signals and biologically plausible mechanisms for exosomal miRNAs in LSCC; however, the evidence is sparse, single-region, methodologically inconsistent, and at high risk of bias. Findings do not support clinical implementation at this stage. Priorities include harmonised EV workflows, prespecified thresholds, and prospective, multi-centre validation. Full article

Aircraft maintenance delays (AMD) remain a significant challenge in commercial aviation, adversely affecting operational efficiency, flight punctuality, and passenger satisfaction. Despite advancements in maintenance strategies, recurring disruptions continue to generate financial losses and reputational risks. This study proposes an integrated five-step framework that combines failure mode and effects analysis (FMEA) with the Define–Measure–Analysis–Improve–Control (DMAIC) methodology to systematically address and reduce AMD. The framework involves the definition of problems, the identification of contributing factors and failure modes, the assessment of risk and root cause analysis, the mitigation of risk, and continuous monitoring. The main contribution of this study lies in the integration of FMEA and DMAIC into a unified data-driven system that proactively reduces maintenance delays, offering a novel approach to continuous process improvement in aviation operations. Its practical applicability is demonstrated through a case study of the AFRIQIYAH Airways Airbus A320 fleet, which represents the majority of the airline’s operations. High-risk landing gear failure modes were identified, evaluated and addressed through targeted improvement projects, including predictive maintenance, supplier diversification, inventory optimization, and improved quality assurance for critical spare parts. Implementing these initiatives is expected to reduce the overall Risk Priority Number (RPN) by approximately 59%, highlighting the effectiveness and potential to minimize AMD. Full article

Uncertainty is a key factor in the reliability assessment of complex engineering systems, especially when they operate under variable conditions that affect component degradation. This study presents a framework for the systematic and uncertainty-based prioritization of critical components and failure modes. The method combines Reliability Block Diagrams, Fault Tree Analysis, and Importance Measures with Failure Mode and Effects Analysis. This two-level approach links component failures with their effect on system reliability. Uncertainty is introduced through the statistical parameters of component reliability distributions and the resulting impact on system behavior is examined. Components with the highest importance are then examined through Failure Mode and Effects Analysis to identify main failure modes and calculate their Risk Priority Numbers. The framework is applied to a fleet of Solid Waste Collection and Compaction Trucks used by a waste management company in a Colombian city. This system operates under high-load variability, mechanical shocks, and environmental stress. The combined Importance Measures and Risk Priority Number analysis provides a probabilistic basis for identifying critical components and their dominant failure modes, linking reliability uncertainty with maintenance prioritization. The results show that combining Importance Measures and Risk Priority Number improves the identification of critical components and dominant failure modes, supporting maintenance prioritization based on reliability impact. The framework offers a practical approach for reliability assessment and maintenance planning under uncertainty, linking component-level uncertainty with system performance to guide decision-making in complex systems. Full article

Herb-induced liver injury (HILI) is an increasingly recognized cause of liver damage, associated with the widespread global use of herbal products. Despite its rising incidence, HILI remains underrecognized and underreported due to the absence of specific biomarkers, limited regulatory oversight, and the complexity of multi-ingredient formulations. Diagnostic efforts rely heavily on the Roussel Uclaf Causality Assessment Method (RUCAM), with clinical presentations often nonspecific and dominated by hepatocellular patterns of injury. Epidemiological data demonstrate regional variation, with notably higher case numbers in Asia and the Americas. Mechanistically, HILI may result from either intrinsic (predictable, dose-dependent) or idiosyncratic (unpredictable, immune-mediated) reactions. Genetic predispositions, including certain HLA alleles, have been identified as risk factors. Hepatotoxicity is often linked to specific phytochemicals such as pyrrolizidine alkaloids, catechins, anthraquinones, and diterpenoids, which may contribute to oxidative stress, mitochondrial damage, or immune activation. Additionally, product inconsistencies and contamination complicate risk assessment and safety evaluation. Current management focuses on immediate discontinuation of the suspected product and supportive care, though severe cases may require liver transplantation. Future directions include the development of specific diagnostic tools, implementation of globally harmonized regulatory standards, improved pharmacovigilance systems, and enhanced public and professional education. Addressing these priorities is crucial for reducing HILI-related morbidity while supporting the safe use of herbal therapies. Full article

The transformation of transport towards solutions based on renewable energy sources (RES) and energy storage systems represents a response to global climate and regulatory challenges. The integration of electric vehicles with charging infrastructure and the power grid reduces emissions and enhances system flexibility; however, it simultaneously introduces new areas of risk and should therefore be subject to significance assessment. This study applies an integrated methodology for assessing the significance of changes, combining FMEA-based analysis with risk registers and sustainability indicators (six criteria). The transport system and associated storage infrastructure were compared before and after the implementation of RES, considering criteria such as the effects of system failure, complexity, innovation, monitoring, reversibility, and additionality. The results indicate that traditional risks associated with fossil fuels (e.g., exhaust emissions, pipeline failures) are eliminated, but new risks emerge. The highest increases in Risk Priority Numbers (RPN) were observed for cyber threats, charging infrastructure overloads, and the cyclic degradation of energy storage systems. Environmental and organizational risks also intensified, including those related to battery recycling as well as the lack of regulatory frameworks and procedures. The integration of transport with RES and energy storage should be regarded as a significant change. In addition to environmental and energy benefits, it introduces new, complex risk areas that require in-depth risk analysis, the implementation of monitoring systems, and adequate regulatory and preventive measures. At the same time, the proposed methodology enables the identification of changes critical to power system stability, the improvement of energy efficiency, and the advancement of the transition towards climate neutrality. Full article

Occupational health and safety (OHS) is essential for protecting the life, health, and physical integrity of workers. In a complex and dynamic professional context, the prevention of occupational risks has become a priority for employers and decision-makers, going beyond legal compliance to create a safe and efficient work environment. This article explores the history and the main theoretical aspects of OHS and explores the implementation of the ISO 45001 standard and introduces managing workplace health and safety (WHS) risks based on the 5M Method and a weighted composite algorithm for OHS risk assessment integrating factors such as severity, probability, frequency of exposure, number of exposed employees, organizational response capacity, and incident history. Applied in a mixed industrial case study, this approach demonstrated superior risk prioritization compared to the classic severity–probability model. The findings have practical applications: organizations can use the Weighted Composite Score to prioritize interventions, allocate resources efficiently, and prevent high-risk incidents. The approach is adaptable across industries, supporting data-driven safety decisions. The integration of this method supports ISO 45001’s principles of a systematic, proactive, and continuous improvement approach to OHS management. Full article

Background/Objectives: As the aging population is growing globally, oral health has become integral to ensuring healthy aging and quality of life. This study assessed the oral health status of older adults in a Malaysian long-term care facility and explored caregiver-reported challenges in providing oral care. Methods: A convergent mixed-methods design was applied, involving 115 residents aged ≥60 years and 16 caregivers in a public facility. The residents’ oral health was assessed using interviewer-assisted questionnaires (demography, dependency level, Oral Frailty Five-item Checklist), clinical examinations (dental caries status, number of remaining teeth, oral and denture hygiene), and the Decayed, Missing, and Filled Teeth (DMFT) index. Focus group discussions with caregivers were conducted, transcribed, and thematically analyzed. Quantitative data were descriptively analyzed using SPSS version 29.0. Results: Over one-third of the residents (39%) were moderately to highly dependent on caregivers. All had experienced dental caries, with most having fewer than 20 teeth (92.9%) and requiring dentures (81.7%). Overall, both oral and denture hygiene were poor. Assessment of oral frailty indicated that the majority of residents (94.8%) were at risk of impaired oral function. A thematic analysis identified four key themes influencing oral health: (1) health and oral health conditions of residents; (2) variety in oral care practices; (3) older adults’ attitudes and behaviors; and (4) system factors. These themes were mapped in a conceptual framework demonstrating multilevel influences on oral care. Conclusions: Despite the single-center design, these findings provide actionable insights for improving geriatric oral health policies in Malaysia. Practical recommendations include integrating oral health into aged-care standards, expanding mobile dental services, and establishing oral care champions within facilities. Addressing these challenges is critical to improving quality of life and aligning long-term care practices with the WHO’s healthy aging priorities. Full article