Search Results (3,891)

Anxiety and depression are common comorbidities in patients with chronic obstructive pulmonary disease (COPD), which can contribute to increased morbidity, reduced quality of life, and worse clinical outcomes. Nevertheless, these psychological conditions remain largely overlooked. This narrative review includes studies published between 1983 and 2025 to synthesise the current evidence on the risk factors, clinical impacts, and therapeutic strategies for these comorbidities. While the exact mechanisms leading to their increased prevalence are not fully understood, growing evidence implicates a combination of biological (e.g., systemic inflammation), social (e.g., isolation and stigma), and behavioural (e.g., smoking and inactivity) factors. Despite current guidelines recommending the identification and management of these comorbidities in COPD, they are not currently included in COPD assessments. Undetected and unmanaged anxiety and depression have serious consequences, including poor self-management, non-adherence to medications, increased risk of exacerbation and hospitalisations, and even mortality; thus, there is a need to incorporate screening as part of COPD assessments. There is robust evidence showing that pulmonary rehabilitation, a core non-pharmacological intervention, can improve mood symptoms, enhance functional capacity, and foster psychosocial resilience. Psychological therapies such as cognitive behavioural therapy (CBT), mindfulness-based approaches, and supportive counselling have also demonstrated value in reducing emotional distress and improving coping mechanisms. Pharmacological therapies, particularly selective serotonin reuptake inhibitors (SSRIs) and serotonin–norepinephrine reuptake inhibitors (SNRIs), are commonly prescribed in moderate to severe cases or when non-pharmacological approaches prove inadequate. However, the evidence for their efficacy in COPD populations is mixed, with concerns about adverse respiratory outcomes and high discontinuation rates due to side effects. There are also barriers to optimal care, including underdiagnosis, a lack of screening protocols, limited provider training, stigma, and fragmented multidisciplinary coordination. A multidisciplinary, biopsychosocial approach is essential to ensure early identification, integrated care, and improved outcomes for patients with COPD. Full article

With the rapid development of the social economy, human activities have increasingly disrupted water environments, and the continuous input of pollutants poses significant challenges for water environment management. Taking the Xiaoxingkai Lake basin as the study area, this paper develops a social–economic–water environment model based on the system dynamics methodology, incorporating subsystems for population, agriculture, and water pollution. The model focuses on four key indicators of pollution severity, namely, total nitrogen (TN), total phosphorus (TP), chemical oxygen demand (COD), and ammonia nitrogen (NH₃-N), and simulates the changes in pollutant loads entering the river under five different scenarios from 2020 to 2030. The results show that agricultural non-point sources are the primary contributors to TN (79.5%) and TP (73.7%), while COD primarily originates from domestic sources (64.2%). NH₃-N is mainly influenced by urban domestic activities (44.7%) and agricultural cultivation (41.2%). Under the status quo development scenario, pollutant loads continue to rise, with more pronounced increases under the economic development scenario, thus posing significant sustainability risks. The pollution control enhancement scenario is most effective in controlling pollutants, but it does not promote socio-economic development and has high implementation costs, failing to achieve coordinated socio-economic and environmental development in the region. The dual-reinforcement scenario and moderate-reinforcement scenario achieve a balance between pollution control and economic development, with the moderate-reinforcement scenario being more suitable for long-term regional development. The findings can provide a scientific basis for water resource management and planning in the Xiaoxingkai Lake basin. Full article

The purpose of this article is to examine a previously unrecognized role for the vasopressin–oxytocin (VP-OT) system in mammalian “stress-response hormesis.” The current review adds hormesis to the long list of beneficial effects of OT. Hormesis, a biphasic adaptive response to low-level stressors, is introduced here to contextualize the dynamic roles of oxytocin and vasopressin. As with hormesis, the properties of the VP-OT system are context-, time-, and dose-sensitive. Here we suggest that one key to understanding hormesis is the fact that VP and OT and their receptors function as an integrated system. The VP-OT system is capable of changing and adapting to challenges over time, including challenges necessary for survival, reproduction and sociality. Prior research suggests that many beneficial effects of OT are most apparent only following stressful experiences, possibly reflecting interactions with VP, its receptors and other components of the hypothalamic–pituitary–adrenal axis. The release of OT is documented following various kinds of hormetic experiences such as birth, vigorous exercise, ischemic events and the ingestion of emetics, including psychedelics. The phasic or cyclic modulation of VP and related “stress” hormones, accompanied or followed by the release of OT, creates conditions that conform to the core principles of hormesis. This concept is reviewed here in the context of other hormones including corticotropin releasing hormone (CRH) and urocortin, as well as cytokines. In general, VP and classic “stress hormones” support an active response, helping to quickly mobilize body systems. OT interacts with all of these, and may subsequently re-establish homeostasis and precondition the organism to deal with future stressors. However, the individual history of an organism, including epigenetic modifications of classical stress hormones such as VP, can moderate the effects of OT. Oxytocin’s effects also help to explain the important role of sociality in mammalian resilience and longevity. A hormetic perspective, focusing on a dynamic VP-OT system, offers new insights into emotional and physical disorders, especially those associated with the management of chronic stress, and helps us to understand the healing power of social behavior and perceived safety. Full article

Background: Exposure-based cognitive behavioral therapy (Ex-CBT) is widely seen as the gold-standard treatment for anxiety and obsessive-compulsive disorder (OCD). Yet, minoritized youth are underrepresented in efficacy studies, raising questions about the applicability of Ex-CBT to minoritized youth. Effectiveness data suggest systematic adaptation of Ex-CBT to address youth culture and context is likely needed, and many clinicians make adaptations and augmentations in practice. However, research on the specific strategies clinicians use to address their youth clients’ culture and context within anxiety and OCD treatment is lacking. In the current study, we assess practice-based adaptations, augmentations, and process-based approaches utilized when delivering treatment to youth for OCD and anxiety in public mental health clinics. Methods: We conducted qualitative interviews with 16 clinicians from both specialty anxiety and general mental health clinics serving youth with anxiety or OCD in the public mental health system. Participating clinicians had a mean age of 32.19 (SD = 5.87) and 69% of therapists identified as female; 69% identified as White, 25% identified as Asian, and 6% as Black or African American. In qualitative interviews, clinicians shared how they addressed clients’ culture and context (e.g., social identities, stressors and strengths related to social identities and lived environment). Thematic analysis identified the strategies clinicians employed to address culture and context. Results: Clinicians reported incorporating culture and context through process-based approaches (e.g., building trust gradually, considering clients’ social identity stressors, engaging in self-awareness to facilitate cultural responsiveness) and through culturally adapting and augmenting treatment to promote person-centered care. Core strategies included proactive and ongoing assessment of clients’ cultural and contextual factors, adapting exposures and augmenting Ex-CBT with strategies such as case management and discussion of cultural context, and taking a systems-informed approach to care. Conclusions: Examining practice-based adaptations, augmentations, and process-based approaches to treatment for minoritized youth with OCD or anxiety can inform efforts to understand what comprises person-centered culturally responsive Ex-CBT. Empirical testing of identified strategies is a needed area of future research. Full article

Over the past 30 years, the City of Portland, Oregon, USA, has emerged as a national leader in green stormwater infrastructure (GSI). The initial impetus for implementing sustainable stormwater infrastructure in Portland stemmed from concerns about flooding and water quality in the city’s two major rivers, the Columbia and the Willamette. Heavy rainfall often led to combined sewer overflows, significantly polluting these waterways. A partial solution was the construction of “The Big Pipe” project, a large-scale stormwater containment system designed to filter and regulate overflow. However, Portland has taken a more comprehensive and long-term approach by integrating sustainable stormwater management into urban planning. Over the past three decades, the city has successfully implemented GSI to mitigate these challenges. Low-impact development strategies, such as bioswales, green streets, and permeable surfaces, have been widely adopted in streetscapes, pathways, and parking areas, enhancing both environmental resilience and urban livability. This perspective highlights the history of the implementation of Portland’s GSI programs, current design and performance standards, and challenges and lessons learned throughout Portland’s recent history. Innovative approaches to managing runoff have not only improved stormwater control but also enhanced green spaces and contributed to the city’s overall climate resilience while addressing economic well-being and social equity. Portland’s success is a result of strong policy support, effective integration of green and gray infrastructure, and active community involvement. As climate change intensifies, cities need holistic, adaptive, and community-centered approaches to urban stormwater management. Portland’s experience offers valuable insights for cities seeking to expand their GSI amid growing concerns about climate resilience, equity, and aging infrastructure. Full article

Addressing climate change and advancing clean energy transitions demand holistic approaches that capture complex, interconnected system behaviors. This review focuses on the application of causal loop diagrams (CLDs) as a core systems-thinking methodology to understand and manage dynamic feedback within environmental, social, and technological domains. CLDs visually map the reinforcing and balancing loops that drive climate risks, clean energy adoption, and sustainable development, offering intuitive insights into system structure and behavior. Through a synthesis of empirical studies and case examples, this paper demonstrates how CLDs help identify leverage points in renewable energy policy, carbon management, and ecosystem resilience. Despite their strengths in simplifying complexity and enhancing stakeholder communication, challenges remain—including data gaps, model validation, and the integration of diverse knowledge systems. The review also examines recent innovations that improve CLD effectiveness, such as hybrid modeling approaches and digital tools that enhance transparency and decision support. By emphasizing CLDs’ unique capacity to reveal feedback mechanisms critical for climate action and energy planning, this study provides actionable recommendations for researchers, policymakers, and practitioners seeking to leverage systems thinking for transformative, sustainable solutions. Full article

The goals of the European Union towards the energy transition imply profound changes in the energy field, so as to promote sustainable energy development while fostering economic growth. To achieve these changes, the incorporation of sustainable technologies supporting decentralisation, energy efficiency, renewable energy production, and demand flexibility is of vital importance. Blockchain has the potential to change energy services towards this direction. To optimally exploit blockchain, innovative business models need to be designed, identifying the opportunities emerging from unmet needs, while also considering potential risks so as to take action to overcome them. In this context, the scope of this paper is to examine the opportunities and the risks that emerge from the adoption of blockchain in four innovative business models, while also identifying mitigation strategies to support and accelerate the energy transition, thus proposing optimal approaches of exploitation of blockchain in energy services. The business models concern Energy Performance Contracting with P4P guarantees, improved self-consumption in energy cooperatives, energy efficiency and flexibility services for natural gas boilers, and smart energy management for EV chargers and HVAC appliances. Firstly, the value proposition of the business models is analysed and results in a comprehensive SWOT analysis. Based on the findings of the analysis and consultations with relevant market actors, in combination with the examination of the relevant literature, risks are identified and evaluated through a qualitative assessment approach. Subsequently, specific mitigation strategies are proposed to address the detected risks. This research demonstrates that blockchain integration into these business models can significantly improve energy efficiency, reduce operational costs, enhance security, and support a more decentralised energy system, providing actionable insights for stakeholders to implement blockchain solutions effectively. Furthermore, according to the results, technological and legal risks are the most significant, followed by political, economic, and social risks, while environmental risks of blockchain integration are not as important. Strategies to address risks relevant to blockchain exploitation include ensuring policy alignment, emphasising economic feasibility, facilitating social inclusion, prioritising security and interoperability, consulting with legal experts, and using consensus algorithms with low energy consumption. The findings offer clear guidance for energy service providers, policymakers, and technology developers, assisting in the design, deployment, and risk mitigation of blockchain-enabled business models to accelerate sustainable energy development. Full article

Objectives: Diabetes Mellitus involves demanding challenges that interfere with family functioning and routines. In turn, family and social context impacts individual glycemic control. This study aims to identify this recursive interplay, the mutual influences of family systems and diabetes management. Design: Data was collected through a cross-sectional design comparing patients, aged 22–55, with and without metabolic control. Methods: Participants filled out a set of self-report measures of sociodemographic, clinical and family systems assessment. Patients (91) were also invited to describe their perception about disease management interference regarding family functioning. We first examined the extent to which family variables grouped dataset to determine if there were similarities and dissimilarities that fit with our initial diabetic groups’ classification. Results: Cluster analysis results identify a two-cluster solution validating initial classification of two groups of patients: 49 with metabolic control (MC) and 42 without metabolic control (NoMC). Independent sample tests suggested statistically significant differences between groups in family subscales- family difficulties and family communication (p < 0.05). Binary logistic regression shed light on predictors of explained variance to no metabolic control, in four models: Sociodemographic, Clinical data, SCORE-15/Congruence Scale and Eating Behavior. Furthermore, groups differ on family support, level and sources of family conflict caused by diabetes management issues. Considering only patients who co-habit with a partner for more than one year (N = 44), NoMC patients score lower on marital functioning in all categories (p < 0.05). Discussion: Family-Chronic illness interaction plays a significant role in a patient’s adherence to treatment. This study highlights the Standards of Medical Care for Diabetes, considering caregivers and family members on diabetes care. Full article

Heart failure (HF) is a major global health challenge, characterized by high morbidity, mortality, and frequent hospital readmissions. Despite the advent of guideline-directed medical therapies (GDMTs), the burden of HF continues to grow, necessitating a shift toward comprehensive, multidisciplinary care models. Heart Failure Disease Management Programs (HF-DMPs) have emerged as structured frameworks that integrate evidence-based medical therapy, patient education, telemonitoring, and support for social determinants of health to optimize outcomes and reduce healthcare costs. This review outlines the key components of HF-DMPs, including patient identification and risk stratification, pharmacologic optimization, team-based care, transitional follow-up, remote monitoring, performance metrics, and social support systems. Incorporating tools such as artificial intelligence, pharmacist-led titration, and community health worker support, HF-DMPs represent a scalable approach to improving care delivery. The success of these programs depends on tailored interventions, interdisciplinary collaboration, and health equity-driven strategies. Full article

Road networks are essential for access, resource distribution, and population evacuation during natural events. These challenges are pronounced in rural areas, where network redundancy is limited and communities may have social disparities. While traditional risk management systems often focus on the physical consequences of hazard events alone, specialized literature increasingly suggests the development of a more comprehensive approach for risk assessment, where not only physical aspects associated with infrastructure, such as damage level or disruptions, but also the social and economic attributes of the affected population are considered. Consequently, this paper proposes a Vulnerability Access Index (VAI) to support road network decision-making that integrates the social vulnerability of rural communities exposed to natural events, their accessibility to nearby critical infrastructure, and physical risk. The research methodology considers (i) the Social Vulnerability Index (SVI) calculation based on socioeconomic variables, (ii) Importance Index estimation (I_imp) to evaluate access to critical infrastructure, (iii) VAI calculation combining SVI and I_imp, and (iv) application to a case study in the influence area of the Villarrica volcano in southern Chile. The results show that when incorporating social variables and accessibility, infrastructure criticality varies significantly compared to the infrastructure criticality assessment based solely on physical risk, modifying the decision-making regarding road infrastructure robustness and resilience improvements. Full article

The integration of Internet of Things (IoT) systems with social networking concepts has opened new business and social opportunities, particularly by allowing smart objects to autonomously establish social relationships with each other and exchange information. However, these relations must be properly quantified and integrated with trust in order to proliferate the provisioning of IoT composite services. Therefore, this proposed work focuses on quantitatively computing social strength and trust among smart objects in IoT for the purpose of aiding efficient service composition with reasonable accuracy. In particular, we propose a trust-augmented social strength (TASS) management protocol that can cope with the heterogeneity of IoT and demonstrate high scalability and resiliency against various malicious attacks. Afterward, we show how the TASS measurements can be applied to service planning in IoT service composition. Based on the experimental results, we conclude that the proposed protocol is, in fact, capable of exhibiting the above-mentioned characteristics in real-world settings. Full article

This study presents an integrated geospatial framework for assessing the risk to high-speed railway (HSR) infrastructure, combining a persistent scatterer interferometric synthetic aperture radar (PS-InSAR) analysis with multi-criteria decision-making in a geographic information system (GIS) environment. Focusing on the Honam HSR corridor in South Korea, the model incorporates both maximum ground deformation and subsidence velocity to construct a dynamic hazard index. Social vulnerability is quantified using five demographic and infrastructural indicators, and a two-stage analytic hierarchy process (AHP) is applied with dependency correction to mitigate inter-variable redundancy. The resulting high-resolution risk maps highlight spatial mismatches between geotechnical hazards and social exposure, revealing vulnerable segments in Gongju and Iksan that require prioritized maintenance and mitigation. The framework also addresses data limitations by interpolating groundwater levels and estimating train speed using spatial techniques. Designed to be scalable and transferable, this methodology offers a practical decision-support tool for infrastructure managers and policymakers aiming to enhance the resilience of linear transport systems. Full article

This paper examines the changing role of emissions trading systems (ETSs) within the macro-financial framework of energy markets, emphasizing price dynamics and systemic spillovers. Utilizing monthly data from seven ETS jurisdictions spanning January 2021 to December 2024 (N = 287 observations after log transformation and first differencing), which includes four auction-based markets (United States, Canada, United Kingdom, South Korea), two secondary markets (China, New Zealand), and a government-set fixed-price scheme (Germany), this research estimates a panel vector autoregression (PVAR) employing a Common Correlated Effects (CCE) model and augments it with machine learning analysis utilizing XGBoost and explainable AI methodologies. The PVAR-CEE reveals numerous unexpected findings related to carbon markets: ETS returns exhibit persistence with an autoregressive coefficient of −0.137 after a four-month lag, while increasing inflation results in rising ETS after the same period. Furthermore, ETSs generate spillover effects in the real economy, as elevated ETSs today forecast a 0.125-point reduction in unemployment one month later and a 0.0173 increase in inflation after two months. Impulse response analysis indicates that exogenous shocks, including Brent oil prices, policy uncertainty, and financial volatility, are swiftly assimilated by ETS pricing, with effects dissipating completely within three to eight months. XGBoost models ascertain that policy uncertainty and Brent oil prices are the most significant predictors of one-month-ahead ETSs, whereas ESG factors are relevant only beyond certain thresholds and in conditions of low policy uncertainty. These findings establish ETS markets as dynamic transmitters of macroeconomic signals, influencing energy management, labor changes, and sustainable finance under carbon pricing frameworks. Full article

Artificial intelligence has taken a seat at the executive table and is threatening the fact that human beings are the only ones who should be in a position of power. This article gives conjectures on the future of leadership in which managers will collaborate with learning algorithms in the Neural Adaptive Artificial Intelligence Leadership Model, which is informed by the transformational literature on leadership and socio-technical systems, as well as the literature on algorithmic governance. We assessed the model with thirty in-depth interviews, system-level traces of behavior, and a verified survey, and we explored six hypotheses that relate to algorithmic delegation and ethical oversight, as well as human judgment versus machine insight in terms of agility and performance. We discovered that decisions are made quicker, change is more effective, and interaction is more vivid where agile practices and good digital understanding exist, and statistical tests propose that human flexibility and definite governance augment those benefits as well. It is single-industry research that contains self-reported measures, which causes research to be limited to other industries that contain more objective measures. Practitioners are provided with a practical playbook on how to make algorithmic jobs meaningful, introduce moral fail-safes, and build learning feedback to ensure people and machines are kept in line. Socially, the practice is capable of minimizing bias and establishing inclusion by visualizing accountability in the code and practice. Filling the gap between the theory of leadership and the reality of algorithms, the study provides a model of intelligent systems leading in organizations that can be reproduced. Full article

Improving occupational health and safety (OHS) in the construction industry can contribute to the advancement of the Sustainable Development Goals (SDGs), particularly Goals 3 (Good Health and Well-being) and 8 (Decent Work and Economic Growth). Yet, workers’ risk-taking behaviors (RTBs) remain a persistent challenge. Drawing on Social Cognitive Theory and Social Information Processing Theory, this study develops and tests a social influence model to examine how foremen’s safety attitudes (SAs) shape workers’ RTBs. Drawing on survey data from 301 construction workers in China, structural equation modeling reveals that foremen’s SAs significantly and negatively predict workers’ RTBs. However, the three dimensions of SAs—cognitive, affective, and behavioral—exert their influence through different pathways. Risk perception (RP) plays a key mediating role, particularly for the cognitive and behavioral dimensions. Furthermore, interpersonal trust (IPT) functions as a significant moderator in some of these relationships. By identifying the micro-social pathways that link foremen’s attitudes to workers’ safety behaviors, this study offers a testable theoretical framework for implementing the Sustainable Development Goals (particularly Goals 3 and 8) at the frontline workplace level. The findings provide empirical support for organizations to move beyond rule-based management and instead build more resilient OHS governance systems by systematically cultivating the multidimensional attitudes of frontline leaders. Full article