Search Results (5,710)

Background: Sustainable head and neck cancer (HNC) surgery is challenged by environmental impact, workforce shortages, inequitable access to advanced techniques, and policy constraints. Addressing these areas is critical for equitable, high-quality care. Methods: This structured narrative review synthesizes evidence on environmental sustainability, workforce development, technological innovation, health policy, and socioeconomic determinants in HNC surgery, without aiming to provide a systematic or exhaustive evidence synthesis. Sources included peer-reviewed literature, global workforce surveys, and international policy reports, with a focus on disparities between high-income countries (HICs) and low- and middle-income countries (LMICs). Results: Operating rooms produce up to 70% of hospital solid waste and consume 3–6 times more energy than other units; reusable instruments and improved waste segregation can reduce carbon footprints by over 50%. Workforce shortages are severe in LMICs, where subspecialty training is scarce; global partnerships, bidirectional education, and simulation-based learning can expand local capacity. Telemedicine, artificial intelligence, and three-dimensional printing enhance surgical planning, training, and access but may widen disparities without equitable deployment. Policy tools—including diagnosis-related groups, bundled payments, and universal coverage—affect access and innovation uptake. Pandemic preparedness underscores the value of resilient systems with flexible staffing and telehealth integration. Conclusions: HNC surgery requires coordinated action across environmental, workforce, technological, socioeconomic, and policy domains; however, future systematic reviews are needed to comprehensively map the evidence base and assess its methodological quality. Embedding sustainability in clinical practice, ensuring equitable innovation access, and aligning reimbursement with high-value care can strengthen system resilience, improve outcomes, and support long-term surgical service viability. Full article

Continouous unmanned aerial vehicle (UAV) missions are fundamentally limited by Lithium-Polymer (LiPo) battery endurance under intermittent and power-constrained renewable energy conditions. This paper proposes an integrated energy management and charging framework for a photovoltaic (PV)-powered mobile station equipped with a hybrid energy storage system (HESS) and an automated battery replacement (ABR) mechanism. A lexicographic priority-based allocator sequentially serves ABR actuation, multi-slot LiPo charging, and Brushless DC (BLDC) propulsion, while the HESS compensates for PV intermittency. At the charging level, a constraint-aware constant current–constant voltage (CC–CV) strategy is enhanced by an adaptive neuro-fuzzy inference system (ANFIS) trained on optimization-derived labels using battery temperature and its rate of change, thus enabling anticipatory thermal current derating with smooth, discontinuity-free control action. Anti-windup proportional–integral (PI) regulation and bumpless mode transfer ensure stable CC-to-CV transitions. An event-triggered emergency mode accelerates battery readiness via a max-first selection policy. Comparative simulations against a PSO/DE-optimized PID benchmark over a full diurnal PV cycle demonstrate that the ANFIS controller reduces the CC-mode current tracking root-mean-square error (RMSE) by up to 96.9%, delivers higher charge throughput, and lowers battery degradation proxies, including SOC-weighted thermal dose and equivalent full cycles (EFC). The proposed framework reliably sustains continuous charge–swap–recharge logistics under fluctuating renewable generation. Full article

Accurately mapping surface freshwater bodies (e.g., ponds, reservoirs, and small lakes) is vital for managing insular ecosystems and communities. However, satellite-based extraction in coastal settings is challenged by seawater intrusion, complex topography, and cloud cover. Focusing on bedrock islands outside China’s Pearl River Estuary, this study developed a robust method to address these issues. We used both Gaofen-1 (GF-1) optical and Gaofen-3 (GF-3) Synthetic Aperture Radar (SAR) imagery, supported by field-collected water quality samples from surface freshwater body shorelines for model training and validation. The performance of two index-based methods (the Normalized Difference Water Index, NDWI, and the Normalized Difference Vegetation Index, NDVI), two machine learning algorithms (Random Forest, RF, and Support Vector Machine, SVM), and a U-Net convolutional neural network (U-Net) deep learning model was compared. The U-Net model achieved the highest accuracy, with Area Under the Curve (AUC) values of 0.881 (GF-1) and 0.840 (GF-3). It effectively discriminated freshwater from seawater and mitigated cloud interference, demonstrating superior precision and robustness over traditional methods. This work establishes a high-precision framework for monitoring island freshwater resources, supporting sustainable water management. The proposed framework provides a practical tool for tracking freshwater availability under climate variability and anthropogenic pressures, contributing to the monitoring of Sustainable Development Goal (SDG) indicator 6.3.2 on ambient water quality. Full article

This paper explores the potential for aligning theoretical approaches and good practices for intersectional approaches to recruitment and career development in academia, focusing on a European university alliance comprising eight institutions. The study applies a participatory approach that includes comparative analysis and stakeholder engagement to assess how institutional practices can become more inclusive. The findings highlight structural barriers, including entrenched notions of meritocracy and inadequate legal and procedural frameworks. Current strategies often juxtapose inequalities rather than addressing their intersections, resulting in approaches remaining siloed. Based on a reflexive case study, the paper identifies critical factors such as the need for formalised procedures, training and financial investment to effectively operationalise intersectional frameworks. It emphasises the need for tailored approaches that take into account the diversity of institutional and legal contexts and enable more inclusive academic policies and services. Together, these efforts aim to address structural inequalities and create sustainable practises that support the professional development and mobility of marginalised groups in academia, responding to the persistent gaps between policy commitments to intersectionality and their practical implementation within higher education institutions. Full article

To evaluate the effects of swimming training on growth, swimming performance, and osmoregulatory-related indices in juvenile coho salmon, freshwater-reared fish were subjected to current of 1 body length per second (BL·s⁻¹) from December 2024 to April 2025. Fork length, body weight, condition factor, insulin-like growth factor-1 (IGF-1), and gill and intestinal Na⁺/K⁺-ATPase (NKA) protein abundance were measured monthly, and critical swimming speed (U_crit) was evaluated after one month of training. Trained fish showed greater fork length in March and higher body weight in March and April than controls. The condition factor was higher in trained fish in February and March, but declined during spring smolt development. Swimming capacity was enhanced by training, as indicated by significantly higher U_crit. Mean IGF-1 levels did not differ between groups, but IGF-1 correlated positively with body size only in trained fish. No significant training effect was detected for either gill or intestinal NKA protein abundance, although gill NKA increased significantly in April, likely reflecting seasonal smoltification. In addition, IGF-1 was significantly correlated with gill NKA in trained fish in March. Collectively, these results indicate that sustained swimming training improves growth and swimming performance and may enhance associations among measured physiological variables during smoltification in juvenile coho salmon. Full article

Engaging students in sustainability challenges is often easier in theory than in practice. This study examines first-year French undergraduates’ patterns of engagement with the TEDS module (Transition Ecologique pour un Développement Soutenable), a nationwide programme developed in France to promote ecological transition and sustainable development. Data were collected through an online questionnaire comprising 24 closed- and open-ended questions exploring students’ self-reported familiarity with, understanding of, concern about, and self-reported intentions to engage in sustainability-related actions, as well as perceived learning needs and background characteristics. Only 18 questions (143 items) were included in the present analysis, covering all dimensions except those related to the evaluation of the training programme. Results indicate that environmental concern is the factor most strongly associated with self-reported engagement intention, despite persistent gaps in conceptual understanding, particularly regarding the Anthropocene and alternative socio-economic models. Knowledge score and concern are structured hierarchically according to issue visibility, with climate change ranking highest. Engagement depends not only on concern but also on perceived opportunities for action, yet students struggle to identify concrete pathways. The absence of significant differences across gender and disciplines points to a strong generational convergence that reshapes the determinants of environmental engagement. Overall, the key challenge for sustainability education is linking systemic knowledge to concrete contexts of learning and everyday life. Full article

Operational landslide susceptibility mapping (LSM) remains challenging in regions with pronounced geo-environmental heterogeneity, where single global models often overlook spatially variable landslide-environment relationships. Northern Guangdong, China, is a typical humid mountainous region where steep terrain, diverse lithology, and highly variable rainfall produce non-stationary landslide controls. To address this challenge, we develop a cluster-informed LSM framework that integrates unsupervised consensus K-means sub-zoning with localized Random Forest (RF) models and SHapley Additive exPlanations (SHAP). We use a harmonized inventory of 1510 landslides (2011–2022), together with twelve 30 m conditioning factors, for model training and validation. Compared with logistic regression, Support Vector Machines (SVM), and Light Gradient Boosting Machine (LightGBM), RF consistently achieves higher accuracy across clusters, and the cluster-wise RF ensemble attains pooled ACC = 0.8212, F1 = 0.8176, and AUC = 0.8956. SHAP highlights both regionally consistent predictors (e.g., NDVI, distance to road) and distinct cluster-specific controls linked to geomorphic and hydrologic settings. The proposed framework enhances predictive accuracy, produces finer susceptibility gradients, and yields better-calibrated probability estimates than a single global model. These results demonstrate that explicitly accounting for geo-environmental heterogeneity can generate interpretable, spatially adaptive susceptibility outputs. By identifying high-risk zones for priority monitoring, land-use regulation, infrastructure protection, and mitigation planning, the proposed framework provides a practical decision-support tool for sustainable mountain development and disaster risk reduction in heterogeneous mountainous regions. Full article

Accurate land use/land cover (LULC) mapping from remotely sensed data remains challenging in arid regions, particularly for spatial and seasonal generalization. This work proposes a novel exclude-one-city-out (EOCO) framework based on machine learning (ML) to achieve LULC generalization across summer and winter in arid environments. Four cities in Saudi Arabia witnessing rapid urban growth were selected: Riyadh, Madinah, Jeddah, and Dammam. The ML models were trained on three cities and tested on the unseen city. Sentinel-2 surface reflectance data for the visible (Blue, Green, and Red) and near-infrared bands (NIR, SWIR1, and SWIR2) were used. Spectral indices, texture features, and topographical data were used to form five feature sets, which were utilized as inputs for four ML algorithms: random forest, support vector machine, classification and regression trees, and K-nearest neighbors. Statistical tests (Friedman, Kendall’s W, and Wilcoxon signed rank) were conducted to assess differences across ML models, feature sets, and seasons. The random forest model consistently outperformed other models across the five feature sets, while the spectral texture and combined feature sets outperformed other feature combinations. Significant differences in feature importance were observed across cities and seasons for spectral texture during summer and winter (p-values: 1.25 × 10⁻⁴ and 9.2 × 10⁻⁵, respectively), with strong agreement (Kendall’s W = 0.9212 and 0.9424). The findings can support urban environmental monitoring in arid regions, contributing to sustainable urban development. Full article

Digital transformation has become an essential component of sustainable rural development, yet substantial inequalities persist in how communities access, adopt, and benefit from digital technologies. Understanding these disparities requires not only information about technological resources but also knowledge of the relational structures through which information, support, and opportunities circulate. This article presents a reproducible synthetic socio-digital network dataset designed to support the analysis of digital gaps in community-based tourism (CBT) environments. Rather than containing original respondent-level observations, the repository was computationally reconstructed from aggregate statistics derived from field studies conducted in three rural communities in the province of Guayas, Ecuador: Bucay (5 de Septiembre), Manglares Churute, and Ruta de los Chirijos. All node-level records, survey variables, and support relationships included in the repository were synthetically generated to preserve aggregate community characteristics while protecting participant confidentiality and preventing individual re-identification. The repository contains synthetic actor metadata, reconstructed socio-digital variables, directed support networks, graph representations in interoperable formats, and precomputed Social Network Analysis (SNA) indicators. The dataset includes 90 synthetic actors, more than one thousand generated support interactions distributed across multiple socio-digital dimensions, machine-readable metadata, and reusable scripts for preprocessing, validation, graph construction, and metric computation. The represented dimensions include financial assistance, training support, information exchange, technological support, social media promotion, institutional collaboration, trust, and emotional closeness. To facilitate reuse, all resources are distributed in standardized formats compatible with NetworkX, Gephi, Neo4j, and graph-learning frameworks. The repository follows FAIR principles and includes documentation intended to support transparency, reproducibility, and methodological benchmarking. Potential applications include social network analysis, graph mining, graph neural networks, digital inequality research, computational social science, community resilience studies, and educational activities. By providing an openly documented synthetic dataset and reproducible computational workflow, the repository contributes to the study of socio-digital systems, privacy-preserving data sharing, and community-level digital transformation processes. Full article

Supplier selection in healthcare is a complex multi-criteria decision-making (MCDM) challenge requiring a balance of sustainability, resilience, and operational efficiency. Traditional methods struggle with scalability and subjectivity when applied to large administrative datasets. This study introduces a transparent hybrid Machine Learning–MCDM (ML–MCDM) framework, validated using a U.S. Medicare dataset of 661 suppliers. The framework integrates eXtreme Gradient Boosting (XGBoost) and SHapley Additive exPlanations (SHAP) for criterion prioritization, the Full Consistency Method (FUCOM) for mathematically consistent weighting, and Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS) for final ranking. As the dataset lacks direct sustainability metrics, seven indicators were synthetically generated; thus, the results serve as proof-of-concept demonstration of the framework’s architecture. Specifically, XGBoost–SHAP is trained to predict a synthetically constructed Overall Performance Score (OPS), meaning that the resulting feature importance output constitutes an algorithmic consistency check—confirming that the pipeline correctly recovers importance signals deliberately embedded in the training target. For interpretability, suppliers were segmented into five performance profiles via K-Means: Strategic Partners (17.7%), Green Leaders (18.6%), Reliable Emergency Suppliers (18.2%), Balanced Performers (20.4%), and Developing Suppliers (25.1%). Carbon Footprint Score (0.408) and Emergency Response Capability (0.316) achieved the highest feature importance. FUCOM-derived weights prioritized On-Time Delivery Rate (0.272), Carbon Footprint Score (0.222), and Emergency Response Capability (0.220). The top supplier attained a TOPSIS closeness coefficient of 0.800, showing strong discrimination. Sensitivity analysis across four scenarios confirmed ranking robustness, maintaining Spearman correlations ρ ≥ 0.977. This ML–FUCOM–TOPSIS approach provides an auditable, scalable, and policy-relevant decision-support tool, enabling procurement managers to navigate high-dimensional data while ensuring operational continuity and environmental responsibility in healthcare supply chains. Full article

Background: Despite being considered a country with a larger health workforce in Africa, the South African health workforce continues to experience shortages and a maldistribution of health workers across regions and sectors. Current projections suggest that the workforce is expected to decline further, especially among doctors, nurses and midwives, in large part, due to attrition—which could compromise the delivery of primary health and maternity services. These health workforce shortages and uneven distribution threaten the sustainability and effectiveness of health services in South Africa and drives the need to investigate the factors that may be influencing career choice and change decisions among health professionals in South Africa. Methods: A qualitative exploratory study, making use of purposive sampling and semi-structured interviews, was conducted to investigate the factors influencing career choice and change decisions among health professionals in South Africa. The participants were qualified health professionals in the fields of medicine, nutrition, pharmacy, nursing, and psychology working in the private, public, and academic sectors. Data was collected until saturation was achieved and then thematically analyzed using MAXQDA 24. Results: A total of 10 participants made up of three males and seven females were interviewed. These participants worked in different employment sectors with some having dual roles in private practice, public sector, and academia. The analysis revealed three major themes that capture the nature of and factors influencing career choice and career changes occurring in South Africa. The first theme related to factors influencing career choice (including altruism, family influence, personal experiences, financial/job security, academic achievement, career guidance, and opportunity for change). The second theme focused on career change dynamics (nature of career changes and career transitions occurring in the form of specialization, switching health professions, exiting health professions, adding non-health interests, and shifting focus areas). The third theme revealed factors influencing career change. These were categorized into personal and individual factors, workplace or job-specific factors, and administrative factors. This study has contributed to understanding the career choices and career changes taking place within the health professions in South Africa. It has also revealed a need for reforms in policy and practice for the current health professionals who have no intention of changing their careers while highlighting implications for future training of health professionals. Also, addressing the challenges of poor working conditions, lack of support, unemployment and placement delays, and other administrative barriers will help mitigate some of the issues leading to health workforce shortages and inequities in the South African context. Conclusions: The strongest motivator for choosing a career in health professions is the desire to care for others, while retention of the health workforce is challenged by personal, workplace, and administrative factors. Enhancing workplace conditions and support systems, implementing policy reforms, and minimizing administrative barriers is essential for achieving universal health coverage and sustaining a resilient health workforce in South Africa. Full article

Oil and gas pipelines are critical infrastructures that require continuous and reliable monitoring to detect leaks, pressure anomalies, corrosion, and unauthorized activities. Wireless sensor networks (WSNs) have emerged as an effective solution for large-scale pipeline monitoring due to their low deployment cost and real-time sensing capabilities. However, the resource-constrained nature of sensor nodes and the open wireless communication environment expose pipeline monitoring systems to various routing attacks, for example, blackhole, sinkhole, selective forwarding, and false data injection attacks, while simultaneously demanding strict energy efficiency to prolong network lifetime. In this paper, we propose SEER-PM (Secure and Energy-Efficient Routing for Pipeline Monitoring): a novel protocol that integrates an Artificial neural network (ANN)-based trust mechanism with energy-aware routing metrics. SEER-PM dynamically evaluates node trustworthiness based on packet forwarding behavior, residual energy, and signal consistency. By training the ANN on historical behavioral data, the system accurately detects malicious nodes with high precision. Simulation results demonstrate that SEER-PM outperforms existing secure routing protocols (Sec-AODV and T-LEACH) in terms of packet delivery ratio (PDR) by 14%, detection rate by 9.5%, and network lifetime by 12% under heavy attack scenarios. The proposed protocol enhances the reliability, security, and sustainability of pipeline monitoring WSNs operating in harsh and remote environments. Full article

Cardiovascular disease (CVD) remains the leading cause of mortality worldwide, and residual inflammatory risk persists despite optimal lipid and glucose control. Emerging evidence indicates that metabolic reprogramming within immune cells constitutes a central driver of cardiovascular immune injury. In this review, we propose a unifying framework in which glyco-lipotoxicity acts as a primary metabolic trigger, inducing mitochondrial dysfunction, oxidative stress, and activation of the NLRP3 inflammasome and cGAS–STING pathways. Hyperglycaemia and dyslipidaemia reshape intracellular metabolic circuits, enhancing glycolysis and disrupting oxidative phosphorylation, thereby promoting sustained pro-inflammatory phenotypes. Crucially, metabolic intermediates function as cofactors for epigenetic remodelling. This establishes trained immunity in both circulating innate immune cells and haematopoietic stem/progenitor cells, which serves as the cellular basis for persistent metabolic memory. This persistent immunometabolic imprint amplifies sterile inflammation and accelerates vascular and myocardial remodelling. Furthermore, these processes are systemically propagated through cross-organ communication networks, including the heart–adipose, gut–heart, and cardio-hematopoietic axes, forming a multidimensional inflammatory amplification loop. We also summarise emerging therapeutic strategies targeting the metabolic–epigenetic axis, aiming to reverse maladaptive trained immunity and mitigate residual CVD risk. By integrating immunometabolism, epigenetic regulation, and organ crosstalk, this review highlights metabolic reprogramming as a pivotal mechanistic nexus and potential precision target for cardiovascular protection. Full article

Resource allocation for cognitive Vehicle-to-Everything (V2X) networks is challenging due to dynamic spectrum sharing, strong interference coupling, and stringent latency constraints for safety-critical Vehicle-to-Vehicle (V2V) traffic. Although recent Multi-Agent Reinforcement Learning (MARL) approaches report promising gains, many evaluations are conducted at limited and fixed network scales, which restricts insights into scalability under dense spectrum reuse. This paper investigates cooperative multi-agent learning for interference-aware and deadline-constrained V2X resource management. We propose a Q-value Transformation (QTRAN)-based value decomposition framework under centralized training with decentralized execution (CTDE) for joint resource-block and power allocation among V2V agents. The proposed approach is implemented in a realistic V2V/V2I simulator incorporating Manhattan grid mobility, fast fading, explicit cross-tier and co-channel interference, and per-link payload/deadline dynamics. Beyond communication-level performance, improved timely delivery of V2V safety messages can support cooperative maneuvering, collision avoidance, platooning, and infrastructure-assisted traffic management. Extensive simulations across varying numbers of V2V agents benchmark QTRAN against independent learning baselines including MARL and centralized single-agent learning (SARL). Results show that QTRAN improves performance compared with the selected learning baselines and enhances the throughput–reliability trade-off under interference-coupled spectrum reuse. For instance, at $N_{\mathrm{V}2\mathrm{V}}=20$, QTRAN achieves a V2V rate of $0.194\pm 0.004$ and a V2I rate of $9.117\pm 0.213$, while reaching a V2V success rate of $0.812\pm 0.017$ with a low Deadline Miss Ratio of $0.001\pm 0.000$. At higher density ($N_{\mathrm{V}2\mathrm{V}}=50$), QTRAN sustains strong reliability (V2V success rate of $0.719\pm 0.006$ and Completion Ratio of $0.716\pm 0.006$) while maintaining competitive infrastructure throughput (V2I rate of $9.251\pm 0.114$). These results indicate that QTRAN effectively captures non-linear interference interactions, enabling coordinated decentralized spectrum and power decisions under the adopted density-based evaluation setting, thereby enhancing V2V reliability and throughput in cognitive Internet of Vehicles. Full article

Urban green spaces (UGSs) are considered crucial for enhancing older adults’ subjective well-being. However, limited studies have explored the synergistic effects of UGS quality and quantity on satisfaction across green spaces, residential environments, and life domains, making it challenging to uncover the multifaceted sustainable benefits of UGSs on older adults’ subjective well-being. This study drew on multi-source data and place attachment theory to depict neighborhood-accessible UGS quantity (provision, accessibility, and visibility) and quality (cognition, behavior, and affect). Through the geographical visualization of bivariate SHapley Additive exPlanations (SHAP) interaction values extracted from the trained eXtreme Gradient Boosting (XGBoost) model, and the comparison of bivariate SHAP maps with univariate SHAP maps, the study revealed the nonlinear geographic associations between UGS quantity and quality and three types of satisfaction. The results showed that when UGS quantity and quality coexisted, variations in the impact of quantity on older adults’ satisfaction were associated with quality differences. The gain effect of quality on quantity was more significant in areas with limited green space within a 500 m buffer zone. UGSs made a direct contribution to green space satisfaction, while their indirect association with life satisfaction surpassed that of residential satisfaction due to their provision of emotional qualities. This study calls for neighborhood green planning aimed at improving older adults’ subjective well-being, which should shift focus from quantity to quality and balance the relationship between quantity and quality based on regional characteristics. Full article