Search Results (12,787)

Construction and demolition waste (CDW) represents a critical environmental challenge in the building sector, with global generation exceeding 3.57 billion tonnes annually. The circular economy (CE) framework offers a transformative pathway through selective deconstruction and material recovery, yet implementation faces significant barriers including information asymmetry, supply chain fragmentation, and regulatory uncertainty. This study conducts a systematic literature review using the Context–Mechanism–Outcome (CMO) framework to analyze how computational methods, specifically Digital Twins (DT), Building Information Modeling (BIM), Internet of Things (IoT), blockchain, artificial intelligence, and robotics, act as enablers for resilience in CDW management. Following PRISMA 2020 guidelines and realist synthesis principles, we analyzed 42 high-quality empirical studies from Web of Science and Scopus (2015–2025). Our analysis identifies seven primary mechanisms: traceability (M1), simulation (M2), classification (M3), tracking (M4), collaboration (M5), analytics (M6) and robotics (M7). These mechanisms interact with four critical contexts (information asymmetry, supply chain fragmentation, economic uncertainty, operational risks) to generate outcomes at two levels: resilience capabilities (visibility, monitoring, collaboration, flexibility, anticipation) and performance indicators (recovery rates, cost reduction, CO₂ emissions mitigation, occupational safety). Key findings from the CMO analysis reveal that blockchain-enabled traceability increases material recovery rates by 15–25%, DT simulation reduces deconstruction costs by 20–30%, and computer vision automation improves sorting accuracy to 85–95%. The study contributes middle-range theories explaining how digital technologies enable circular transitions under specific contextual conditions, offering actionable strategic implications for researchers, project managers, technology developers, and policymakers committed to advancing computational economics in sustainable construction. Full article

Pancreatic ductal adenocarcinoma (PDAC) is a highly aggressive malignancy with a five-year survival rate of approximately 13%. Patients with PDAC also have an elevated incidence of venous thromboembolism (VTE), despite prophylactic anticoagulation. Thus, there is an urgent need for therapeutic strategies that target tumor progression and hypercoagulability. Protein S (PS), a physiological anticoagulant encoded by the PROS1 gene, has recently been shown to inhibit PDAC growth in preclinical models. To further examine the physiological relevance of intratumoral PS in PDAC, we performed a meta-analysis of four independent PDAC patient cohorts obtained from cBioPortal. Patients were stratified based on low versus high intratumoral PROS1 expression based on below- and above-average mean expression, overall survival, and gene expression of select pro-growth genes, implementing a fixed-effects model. High intratumoral PROS1 expression was associated with a 41.8% reduction in the risk of death compared with low PROS1 expression (pooled hazard ratio = 0.581) within 30 months of diagnosis from survival data in three cohorts. Elevated PROS1 expression correlated with marked downregulation of key genes implicated in PDAC invasion and metastasis, including MMP2 and SNAI2, in all four cohorts. Collectively, these findings suggest that PROS1 is a potential prognostic biomarker and molecular regulator in PDAC and thus support further investigation into the dual role of PS in tumor progression. Full article

The article examines the persistent stability of the weighted average cost of capital (WACC) disclosed by German DAX40 companies despite substantial declines in risk-free interest rates between 2004 and 2021. While theory suggests that WACC should reflect lower risk-free interest rates and decline as well with falling government bond yields, empirical evidence reveals minimal adjustment in reported WACC figures. Disclosed WACC of DAX40 companies remains between 7% and 8% as the yield of the ten-year German government bond fell from 4.1% to −0.2%. This study employs quantitative analyses to investigate whether systematic increases in risk exposure can explain this phenomenon. Using capital market data spanning from 2000 to 2023, we analyze five risk dimensions: systematic risk (beta factors), overall market volatility, risk aversion (lambda factors), earnings risk, and financial structure risk. Bootstrap analyses reveal a 41.5% reduction in beta factor variance, while volatility analyses demonstrate declining market risk exposure. The market price of risk analysis does not reveal definite findings. Earnings risk measures indicate improved financial stability, and debt ratios show modest declines. These findings suggest that observable risk parameters cannot explain persistent WACC levels, indicating a disconnect between theoretical WACC calculations and practitioner applications in investment project decision-making following value-based management principles. Full article

Disaster resilience has become a key focus of risk reduction efforts, but measuring it remains complex due to differences in hazards, development paths, and data systems. This study modifies the Baseline Resilience Indicators for Communities (BRIC) approach, based on the Disaster Resilience of Place (DROP) framework, to evaluate community resilience in Serbia and highlight regional differences. An initial list of 186 indicators was created from international BRIC studies and resilience research, then tailored to Serbian conditions through contextual review and data checks. Indicators were normalized using min–max scaling (0–1), and indicators with negative orientation were inverted to ensure that higher values indicate greater resilience. Scores for each dimension were calculated as equally weighted averages across six areas: social, economic, social capital, institutional, infrastructural, and environmental. The overall BRIC index was derived as the average of these dimension scores. Z-scores facilitated the classification of resilience levels and the comparison between regions. The results show clear regional disparities: in the complete model, Belgrade has the highest resilience (BRIC = 0.557), while Southern and Eastern Serbia have the lowest (BRIC = 0.414). Patterns across dimensions show that Belgrade excels in social and economic capacity but lags in environmental indicators; Vojvodina has the strongest institutional and infrastructural capacity; and Šumadija and Western Serbia perform best in environmental indicators. Correlation analysis revealed multicollinearity, leading to the removal of 14 redundant indicators and the refinement to a set of 57. After this reduction, regional rankings change, with Vojvodina (BRIC = 0.530) and Šumadija and Western Serbia (BRIC = 0.522) emerging as higher-resilience regions, while Southern and Eastern Serbia remain the least resilient (BRIC = 0.456). The adapted BRIC-DROP model offers a clear, locally relevant tool for mapping resilience and guiding targeted policies in Serbia, enabling region-specific efforts to address structural resilience gaps. Full article

Background: Intramyocardial bridge (MB) is a coronary anomaly characterized by a segment of the artery tunneling within the myocardium. While often asymptomatic, it may lead to ischemic events. Despite traditional disqualification from competitive sports, 2023 guidelines now permit participation for athletes with MBs that do not meet specific high-risk morphological criteria. This study aims to evaluate a novel combined provocative test, integrating Cardiopulmonary Exercise Testing (CPET) and stress echocardiography for the assessment of myocardial deformation (twist), to assess the functional impact of MB in asymptomatic athletes. Methods: This cross-sectional case–control study included 18 participants (nine cases with “significant” MB diagnosed via Computed Tomography (CT) coronary angiography and nine healthy, trained controls), aged 18–78 years. All subjects underwent evaluation at our facility for competitive certification. Assessment protocols included resting echocardiography, Global Longitudinal Strain (GLS), and Cardiopulmonary Exercise Testing (CPET) to quantify exercise capacity and dynamic myocardial function. Results: No significant differences in echocardiographic parameters were observed between groups at rest. However, during exercise, athletes with MB demonstrated a significant reduction in GLS and ventricular twist compared to the control group. These findings indicate a notable loss of apical reserve in the MB cohort during physical stress. Conclusions: The integration of CPET and myocardial deformation analysis provides an effective diagnostic tool for identifying functional impairment in asymptomatic athletes with MB. This combined approach offers a superior follow-up strategy for managing athletes who may be at risk for ischemic events despite lack of clinical symptoms. Full article

Vessel vibrations have serious safety risks and must be effectively mitigated. This study investigates the reduction in ship pitch–roll vibrations modeled as a two degrees of freedom of nonlinear spring–pendulum system subjected to multi-parametric excitation, using proportional–derivative controller. The main objective is to develop a rapid and efficient analytical approach to nonlinear vibration analysis. A non-perturbative approach is employed to transform weakly nonlinear oscillators of ordinary differential equations into equivalent linear ones without using Taylor expansions. He’s frequency formula plays a central role in this transformation. The resulting parametric solutions are validated using Mathematica Software (v13) and show a strong agreement with the original nonlinear model. The effects of various parameters on stability are examined. Theoretical analysis is conducted using the multiple time scales method to identify worst resonance conditions and derive frequency response equations. Stability near simultaneous sub-harmonic resonance is assessed using Routh–Hurwitz criterion. Numerical simulations based on the fourth-order Runge–Kutta method confirm the effectiveness of proportional–derivative control. Excellent agreement between analytical and numerical results demonstrates the accuracy, efficiency, and practical applicability of the proposed method. Full article

Background/Objectives: Cervical drainage has traditionally been used after thyroidectomy to reduce postoperative fluid accumulation and mitigate bleeding-related complications. However, advances in surgical technique, perioperative hemostasis, and postoperative care pathways have led to an increase in the use of short-stay and outpatient thyroidectomy, prompting renewed evaluation of the role of routine drainage. The objective of this systematic review and meta-analysis was to examine the association between postoperative cervical drainage and postoperative outcomes following thyroidectomy. Methods: A systematic literature search was conducted across PubMed/MEDLINE, Google Scholar, Semantic Scholar, and the Cochrane Central Register of Controlled Trials to identify studies comparing thyroidectomy with versus without cervical drainage. Studies published between January 2005 and January 2026 were eligible for inclusion. Randomized controlled trials and non-randomized comparative studies involving adult patients were included. The outcomes of interest were cervical hematoma, surgical site infection (SSI), seroma formation, postoperative bleeding, reoperation, and length of hospital stay. Random-effects meta-analyses were performed using odds ratios for binary outcomes and mean differences for continuous outcomes. Sensitivity and influence analyses were conducted to assess robustness. The results were additionally examined in prespecified sensitivity analyses restricted to randomized trials, and study-design-stratified estimates are presented. Results: Thirty studies comprising 2810 patients were included. Drain use was not statistically significantly associated with postoperative cervical hematoma (OR 1.28, 95% CI 0.93–1.75; p = 0.124). In contrast, drain use was associated with a significantly increased risk of surgical site infection (OR 2.04, 95% CI 1.46–2.85; p = 0.0002) and a significantly longer postoperative length of hospital stay (mean difference 1.96 days, 95% CI 0.42–3.50; p = 0.016). No statistically significant associations were observed between drainage and seroma formation (OR 0.95, 95% CI 0.70–1.30; p = 0.750), postoperative bleeding (OR 1.26, 95% CI 0.85–1.86; p = 0.228), or reoperation (OR 0.89, 95% CI 0.59–1.32; p = 0.525). Sensitivity and influence analyses demonstrated consistent results across analytical approaches and study designs. Conclusions: In thyroidectomy, routine cervical drainage is not associated with a reduction in bleeding-related complications and is associated with adverse recovery-related outcomes, including increased risk of surgical site infection and prolonged hospitalization. Overall, the findings indicate that routine cervical drainage after thyroidectomy offers no clear advantage in preventing postoperative complications and may be associated with adverse postoperative outcomes. Routine cervical drainage after thyroidectomy was not associated with a protective effect on complications and showed associations with less favorable recovery-related outcomes. Full article

Treatment wetlands (TWs) are increasingly deployed as nature-based solutions for water and wastewater management due to their cost-effectiveness, operational simplicity, and provision of wider ecosystem benefits. The UK has been at the forefront of TW application since the 1980s. This study evaluated their development and performance within Southern Water, a water utility in the UK. In total, 35 sewage treatment sites have incorporated TWs since 1991, primarily for tertiary treatment and stormwater overflow control. Performance data were available for 16 sites, comprising 14 horizontal subsurface flow (HSSF) and two surface flow (SF) wetlands. HSSF wetlands achieved substantial reductions in TSSs (up to 97%), ${\mathrm{N}\mathrm{H}}_4^{+}$ (up to 99%), and BOD5 (up to 92%). The COD removal showed more variance (0–62%) in the studied sites. In contrast, SF wetlands provided moderate reductions in TSSs (17–79%) and COD (36–67%) but were less effective for ${\mathrm{N}\mathrm{H}}_4^{+}$ and BOD5 (14–65%). The TWs operated by Southern Water currently serve more than 100,000 people and illustrate the expanding role of such systems in meeting wastewater treatment needs. However, challenges and further research are needed, including risks of media clogging, the evaluation of emerging micropollutants treatment, and inconsistent maintenance. To address these, the study highlights opportunities for innovation through hybrid and aerated designs, advanced monitoring, and a more detailed understanding of plant–microbe interactions. The findings emphasise both the potential and future research needs of TWs and support their continued integration into wastewater management strategies under evolving environmental and regulatory pressures. Full article

Healthcare fraud poses significant risks to insurance systems, undermining both financial sustainability and equitable access to care. Accurate detection of fraudulent claims is therefore critical to ensuring the integrity of healthcare insurance operations. However, the increasing sophistication of fraud techniques and limited data availability have undermined the performance of traditional detection approaches. To address these challenges, this paper proposes WCGAN-GA-RF, an integrated fraud detection framework that synergistically combines Wasserstein Conditional Generative Adversarial Network with gradient penalty (WCGAN-GP) for synthetic data generation, genetic algorithm-based feature selection (GA-RF) for dimensionality reduction, and Random Forest (RF) for classification. The proposed framework was empirically validated on a real-world dataset of 16,000 healthcare insurance claims from a Chinese healthcare technology firm, characterized by a 16:1 class imbalance ratio ($5.9\%$ fraudulent samples) and 118 original features. Using a stratified $80/20$ train–test split with results averaged over five independent runs, the WCGAN-GA-RF framework achieved a precision of $96.47\pm 0.5\%$, a recall of $97.05\pm 0.4\%$, and an F1-score of $96.26\pm 0.4\%$. Notably, the GA-RF component achieved a $65\%$ feature reduction (from 80 to 28 features) while maintaining competitive detection accuracy. Comparative experiments demonstrate that the proposed approach outperforms conventional oversampling methods, including Random Oversampling (ROS), Synthetic Minority Oversampling Technique (SMOTE), and Adaptive Synthetic Sampling (ADASYN), particularly in handling high-dimensional, severely imbalanced healthcare fraud data. Full article

Zonal ship central cooling systems, which are primarily implemented in naval platforms and advanced specialized vessels to ensure high survivability, exhibit complex fluid–thermal interactions and multi-level valve networks, challenging conventional resilience analysis, especially under large-scale fault scenarios and dynamic topology reconfiguration. This paper presents a physics-informed dynamic resilience assessment and reconfiguration optimization method tailored for such systems. To address the high-dimensional reconfiguration search space, a physics-informed pruning mechanism combining topological reachability filtering and nodal continuity-based feasible-flow verification is introduced, eliminating 42.6% of invalid topologies and reducing optimization time by approximately 38%. Additionally, a cumulative thermal severity (CTS) metric is developed to capture transient thermal shock risks, quantitatively assessing deviation from the 50 °C system safety boundary at the most critical node. Simulation results for a main seawater pump failure scenario demonstrate that the proposed reconfiguration strategy, which coordinates cross-zone tie valves and leverages healthy zones’ pressure margins, shortens recovery time by 47%, suppresses peak temperature from 51.5 °C to 50.2 °C, reduces maximum over-temperature from 1.5 °C to 0.2 °C, and decreases CTS from 8.5 °C·s to 0.1 °C·s (a 98.8% reduction). These findings demonstrate that physics-informed pruning substantially reduces the computational burden of high-dimensional reconfiguration, while the proposed CTS metric enables quantitative assessment of transient thermal-shock risk. Together, they offer robust methodological guidance for resilience-oriented decision support and fault-tolerant design in complex shipboard fluid–thermal systems. Full article

Stroke remains a major cause of morbidity and mortality worldwide. Although reperfusion therapies and secondary prevention have advanced, the global stroke burden continues to rise, driven by increasing rates of hypertension and diabetes mellitus. Type 2 diabetes (T2DM) increases the risk of acute ischemic stroke (AIS) through mechanisms involving chronic hyperglycemia, endothelial dysfunction, inflammation, and accelerated atherogenesis. In recent years, glucagon-like peptide-1 receptor agonists (GLP-1RAs) have emerged as promising agents for cardiovascular and cerebrovascular risk reduction in patients with T2DM. Beyond their glucose-lowering properties, GLP-1RAs improve blood pressure regulation and lipid metabolism, as mentioned in the 2025 AHA Journal guidelines for the prevention, detection, evaluation, and management of high blood pressure in adults. Emerging preclinical and clinical evidence indicates that GLP-1RAs also provide direct neurovascular protection by stabilizing the blood–brain barrier, modulating neuroinflammation, and promoting neuronal survival. These mechanisms may reduce ischemic injury, improve recovery after stroke, and protect against cognitive decline. Major cardiovascular outcome trials have demonstrated significant reductions in major adverse cardiovascular events and, to a lesser degree, non-fatal stroke among patients receiving GLP-1RAs. This narrative review evaluates current evidence on the neurovascular, cardiometabolic, and anti-inflammatory actions of GLP-1RAs and their potential role in mitigating stroke risk and promoting cerebrovascular health. Additionally, it highlights gaps in the literature, explores clinical and guideline implications, and outlines future directions for integrating GLP-1RA therapy into comprehensive stroke prevention and recovery strategies. Full article

Background/Objectives: Liver fat represents an early metabolic lesion in the development of diabetes and its cardiometabolic complications. Diets high in free sugars, particularly from sugar-sweetened beverages (SSBs), are associated with abdominal obesity and increased cardiometabolic risk, prompting global guidelines to limit SSBs as a major public health strategy. Low-fat cow’s milk is promoted as the preferred caloric replacement strategy for SSBs due to its high nutritional value and cardiometabolic advantages. Fortified soymilk is a plant-based alternative with approved health claims for cholesterol and coronary heart disease risk reduction that offers an equivalent nutritional value to cow’s milk. However, given concerns about its classification as an ultra-processed food (UPF), it is unclear whether soymilk offers comparable metabolic health benefits to milk as part of clinical and public health strategies to reduce SSB intake. The Soy Treatment Evaluation for Metabolic (STEM) health trial seeks to evaluate the impact of replacing SSBs with either 2% soymilk or 2% cow’s milk on liver fat and other cardiometabolic risk factors in habitual adult consumers of SSBs with obesity. Methods: The STEM trial is a 24-week, pragmatic, 3-arm, parallel, randomized trial. We recruited adults with obesity (high BMI plus high waist circumference based on ethnic specific cut-offs) consuming ≥1 SSB/day. Participants were randomized to one of three groups based on their usual SSB intake at baseline (servings/day): continued SSB (355 mL can) intake; replacement with fortified, sweetened 2% soymilk (250 mL); or replacement with 2% cow’s milk (250 mL). The primary outcome is the change in intrahepatocellular lipid (IHCL) measured by ¹H-MRS at 24 weeks. Hierarchical testing will be done to reduce the familywise error rate. The superiority of cow’s milk to SSBs will be assessed first to establish assay sensitivity. If superiority is established, then the non-inferiority of soymilk to cow’s milk will be assessed using a pre-specified non-inferiority margin of 1.5% IHCL units (assessed by difference of means using a 90% confidence interval [CI]). Analyses will be conducted according to the intention-to-treat (ITT) principle using inverse probability weighting (IPW) for superiority testing and per-protocol analyses for non-inferiority testing, using ANCOVA adjusted for age, sex, metabolic dysfunction-associated steatotic liver disease (MASLD) status, medication use, intervention dose, and baseline levels. We hypothesize that soymilk will be non-inferior to cow’s milk (Clinicaltrials.gov NCT05191160). Results: Recruitment began in November 2021. A total of 3050 individuals were screened. We randomized 186 participants (62 per group) between 19 April 2022 and 16 April 2024. Participants are 57% male; with a mean [SD] age of 39.9 [11.8] years; BMI of 34.6 [6.1] kg/m², waist circumference of 112.6 [13.8] cm; IHCL of 10.0 [8.2] % with 64.1% meeting the criteria for MASLD; and SSBs intake of 2.3 [1.3] servings/day. Conclusions: Baseline characteristics were balanced across the study arms, with participants representing adults with a high-risk metabolic phenotype, and 64.1% meeting the criteria for MASLD. Findings will contribute to evidence on the cardiometabolic benefits of soymilk, informing clinical practice guidelines and public health policy. Full article

Medical drone delivery (MDD), defined as the use of uncrewed aerial vehicles to transport medical products, is an emerging technological innovation responding to persistent health supply chain challenges in rural and low-resource settings. Within sub-Saharan Africa, MDD systems have demonstrated large-scale success in improving key health outcomes, health supply chain efficiency, and reductions in medical product stockouts and wastage. However, the existing evidence base on the effectiveness of this technology is dominated by quantitative, performance-based evaluations, with limited emphasis on the community-driven mechanisms that shape such outcomes. Drawing on original qualitative research, this article presents a qualitative secondary analysis (QSA) of interview data collected as part of a larger case study on MDD in Madagascar. The QSA, guided by socio-technical systems theory, analyzes a subset of 18 interviews with 23 community-level stakeholders to understand how MDD affects healthcare services in remote regions of the country. Participants reported that MDD led to downstream healthcare improvements in vaccination coverage and malaria-related health outcomes. These improvements were enabled through four interconnected socio-technical mechanisms: (1) improved medical product availability through the mitigation of geographic and transportation barriers, (2) stabilization of vaccine and cold chain transportation, (3) building trust and healthcare-seeking behaviours through predictable service delivery, and (4) reduced physical, mental, and financial burdens experienced by healthcare workers. A final, cross-cutting theme emphasized was the criticality of MDD program continuity, with participants noting that operation disruptions or withdrawals risked reversing benefits and breaking communities’ trust in the health system. By centering lived realities, perceptions, and social processes, this article bridges the gap between predominantly quantitative evidence on MDD systems and the experiences of the communities they are intended to serve. Full article

The electrification of mobility increases the need for efficient local distribution and charging infrastructures. In this context, direct current (DC) architectures may reduce conversion stages, transmission losses, and material demand compared with alternating current (AC) systems. This study aims to quantify the environmental implications of AC- and DC-based grid and charging infrastructures for large-scale rollout in Germany. For this purpose, a dynamic life-cycle assessment (DLCA) is conducted for parking garages, parcel centers, and delivery bases over the period 2023–2045, covering the production and use phases with respect to global warming potential (GWP) and material demand. The results show that DC configurations achieve lower total GWP across all application contexts investigated. For parking garages, DC reduces total GWP by 9.3% compared with AC, while for parcel logistics facilities the reduction amounts to 5.7%. Copper is identified as the dominant material driver, and DC reduces copper demand by 17.1–58.7% depending on the application. A screening-based supply-risk assessment further indicates the elevated relevance of copper due to rising demand and Germany’s import dependence. Overall, the findings provide quantitative evidence that DC-based infrastructures can reduce both environmental impacts and copper demand in large-scale charging infrastructure deployment. Full article

For nearly two decades, 12 months of dual antiplatelet therapy (DAPT) after acute coronary syndrome (ACS) has been the standard recommendation. Recent evidence suggests that abbreviated DAPT durations may reduce bleeding without compromising ischemic protection in selected patients. This review synthesizes randomized controlled trials, meta-analyses, and guideline updates published between 2023 and 2025, evaluating abbreviated DAPT strategies after ACS with percutaneous coronary intervention. Immediate aspirin withdrawal after PCI increased early stent thrombosis in NEO-MINDSET and STOPDAPT-3. One-month DAPT followed by ticagrelor monotherapy reduced bleeding without increasing ischemic events in ULTIMATE-DAPT and T-PASS. Three-month strategies demonstrated the most consistent safety profile, with TWILIGHT showing 50% bleeding reduction without increased death, myocardial infarction, or stroke (noting that TWILIGHT included 35% chronic coronary syndrome patients). Clopidogrel monotherapy after abbreviated DAPT increased myocardial infarction in STOPDAPT-2 ACS, highlighting the importance of potent P2Y12 inhibition. Meta-analyses confirmed bleeding reductions with early P2Y12 inhibitor monotherapy across broader populations, though benefits were more pronounced in East Asian cohorts. Abbreviated DAPT strategies offer personalized alternatives to standard 12-month therapy. Three-month DAPT followed by ticagrelor monotherapy represents a reasonable and evidence-supported strategy in selected patients with ACS. Risk stratification tools and individual patient factors should guide therapy duration decisions. Full article