Search Results (1,733)

The growing complexity and dynamism of industrial and organizational projects require management approaches that can effectively adapt to uncertainty and rapidly changing operational environments. In this context, this study proposes a methodology to identify the most suitable management approach—predictive, agile, or hybrid—in complex projects. Building on the “Approach suitability tool” of the Project Management Institute’s (PMI) , the methodology integrates quantitative assessments of complexity and systemic risk. This is achieved through the analysis of stakeholder and risk networks, using metrics such as cyclomatic complexity and the coevolution parameter g, which allow for a deeper understanding of interactions and the evolution of project elements. The methodology was validated in three peacekeeping missions of the United Nations: UNMISS in South Sudan, MONUSCO in the Democratic Republic of Congo, and MINUSTAH in Haiti. The results confirm that the methodology accurately identifies the most appropriate management approach, emphasizing the effectiveness of hybrid approaches in complex and volatile environments. The proposed methodology serves as a valuable tool for optimizing project management in diverse contexts, enabling a quantitative and systematic evaluation of complexity and risk. It is adaptable and applicable to a wide range of complex projects, improving decision-making and planning in uncertain settings. Furthermore, by incorporating resilience as a cross-cutting principle, the methodology strengthens the ability of projects and their teams to maintain functionality and sustain learning even in highly volatile environments, where continuous adaptation becomes a critical success factor. In this sense, resilience emerges as the property that allows projects to absorb disruptions, reorganize, and preserve their core purpose without losing cohesion or direction. Full article

With socioeconomic development, cities face increasingly complex and diverse disaster risks, making the construction of resilient cities an inevitable choice. However, the driving forces and tactical approaches behind urban resilience development remain unclear for urban safety development, thus posing challenges to cities urgently needing to enhance their resilience. Therefore, this paper investigates this issue, covering the following aspects: (1) Eighteen influencing factors within the complex system of urban resilience were identified and summarized from five perspectives: Economic, Social, Environmental, Infrastructure, and Organizational & Institutional. The attributes of the influencing factors were analyzed using the Decision-Making Experimentation and Evaluation Laboratory (DEMATEL) method, and key factors were identified accordingly. (2) The Total Adversarial Interpretive Structure Model (TAISM) method was applied to construct a multi-perspective adversarial recursive structural model with integrated impact values. This model illustrates the interrelationships among the influencing factors and clarifies their hierarchical structure. (3) A Fuzzy Reachability Matrix (FR) was introduced to handle uncertain relationships between factors in the comprehensive influence matrix, enabling an explicit analysis of the hierarchical structure of the urban resilience complex coupling giant system, clearly showing the impact of factor hierarchical changes on the system structure. (4) Building upon the analysis of factors affecting urban resilience, the specific pathways and mechanisms were articulated, followed by recommended measures formulated from both internal (governmental) and external (community) perspectives. The results can provide theoretical support for resilient city construction and serve as a practical cornerstone. Full article

Background/Objectives: Postoperative Delirium (POD) is a frequent complication in older patients undergoing elective surgery. Although multicomponent interventions are effective, deficits in interdisciplinary communication and intersectoral collaboration persist. This study developed and evaluated the “Geriatric Delirium Pass (GeDePa)”, a paper-based tool to systematically document risk factors for POD across care settings. Methods: A multi-method design was applied, comprising (i) a structured literature review, (ii) semi-structured expert interviews, and (iii) a standardized online survey utilizing the RAND/UCLA Appropriateness Method (RAM). A total of 21 healthcare professionals (general practitioners, geriatricians, anaesthetists, surgeons, and nurses) were recruited from Salzburg, Austria, and South Tyrol, Italy (2023–2024). Results: Healthcare professionals confirmed the GeDePa’s practical applicability for early POD risk detection across care settings. The expert rating using the RAM Disagreement Index (DI) method deemed all 45 risk factors as sufficiently relevant and, with the exemption of two risk factors (alcohol use, intraoperative complications), feasible. A detailed analysis provided a more differentiated picture, with full consensus reached for only 18 items. Several factors with uncertain consensus (e.g., cognitive impairment and polypharmacy) were retained based on strong evidence in the literature. Others were excluded despite high ratings if they were considered redundant or impractical (e.g., detailed intraoperative complications). In total, 38 of the 45 risk factors were retained. Conclusions: The GeDePa is a feasible and relevant tool for structured delirium risk assessment and enhancing interdisciplinary communication between primary and hospital care. The finalized German and Italian versions are now available and will undergo further testing and implementation in clinical practice. Full article

Background: Amyotrophic lateral sclerosis (ALS) progressively impairs motor function, compromising speech and limiting communication. Augmentative and alternative communication (AAC) is essential to maintain autonomy, social participation, and quality of life for people with ALS (PALS). This review maps technological developments in AAC, from low-tech tools to advanced brain–computer interface (BCI) systems. Methods: We conducted a scoping review following the PRISMA extension for scoping reviews. PubMed, Web of Science, SciELO, MEDLINE, and CINAHL were screened for studies published up to 31 August 2025. Peer-reviewed RCT, cohort, cross-sectional, and conference papers were included. Single-case studies of invasive BCI technology for ALS were also considered. Methodological quality was evaluated using JBI Critical Appraisal Tools. Results: Thirty-seven studies met inclusion criteria. High-tech AAC—particularly eye-tracking systems and non-invasive BCIs—were most frequently studied. Eye tracking showed high usability but was limited by fatigue, calibration demands, and ocular impairments. EMG- and EOG-based systems demonstrated promising accuracy and resilience to environmental factors, though evidence remains limited. Invasive BCIs showed the highest performance in late-stage ALS and locked-in syndrome, but with small samples and uncertain long-term feasibility. No studies focused exclusively on low-tech AAC interventions. Conclusions: AAC technologies, especially BCIs, EMG and eye-tracking systems, show promise in supporting autonomy in PALS. Implementation gaps persist, including limited attention to caregiver burden, healthcare provider training, and the real-world use of low-tech and hybrid AAC. Further research is needed to ensure that communication solutions are timely, accessible, and effective, and that they are tailored to functional status, daily needs, social participation, and interaction with the environment. Full article

Introduction: Nocturnal enuresis is defined as involuntary urination during sleep in children, particularly those aged 5 years or older. Primary monosymptomatic nocturnal enuresis (PMNE) involves nighttime wetting without daytime symptoms, and although factors like reduced bladder capacity, nocturnal polyuria, and impaired arousal contribute, predictors of long-term relapse remain uncertain. Methods: This retrospective cohort study included 227 children aged ≥5 years with strictly defined PMNE who achieved complete remission following a standardized 3-month treatment protocol (alarm therapy, desmopressin, or desmopressin plus oxybutynin). All children underwent ICCS-based assessment, including physical examination, urinalysis, ultrasonography, UFM, a 48 h frequency/volume (F/V) diary, and post-void residual measurement. One year after treatment discontinuation, patients were reassessed using a 14-day wet-night diary. Predictors of relapse were analyzed using comparative statistics. Result: At 1-year follow-up, 48.5% of children experienced relapse. Age, sex, treatment modality, family history, and baseline wet-night frequency were not associated with relapse (p > 0.05). Diary-based FBC was significantly higher than UFM-based capacity (p < 0.001). Reduced diary-based mean FBC/EBC ratios were significantly more common among relapsing children (p < 0.001), whereas UFM-derived ratios showed no significant difference (p = 0.052). ROC analysis demonstrated moderate discriminatory performance for diary-based FBC/EBC (AUC 0.671). A ratio > 79% predicted sustained remission with 83.6% specificity and a positive predictive value of 73.5%. Conclusions: Diary-derived bladder capacity is the strongest predictor of long-term relapse in PMNE and outperforms UFM-based assessment. A mean FBC/EBC ratio > 79% provides a clinically useful threshold for identifying children at low risk of recurrence. Those with reduced diary-based capacity may benefit from closer follow-up or extended maintenance therapy. Full article

Civil airplanes encounter unpredictable safety risks due to uncertain environmental disturbances, mechanical failures, and pilot mis-operations. This paper develops a virtual flight method (VFM) consisting of a series of techniques including flight motion simulation, flight command simulation, flight control simulation, and flight environment simulation. Moreover, a safety perception technique is established using fuzzy safety constraints, which transfers the decoupled analysis of micro-level aircraft state parameters to the coupled analysis of macro-level global system parameters. This integrated approach enables virtual flight operations and safety situation awareness for civil aircraft within the ‘Human–Machine–Environment’ triad under the influences of complex factors. The takeoff and climb scenario of the Cessna Citation 550 aircraft is selected as a case study to validate the feasibility of the proposed safety awareness technology. Results illustrate the capability to effectively capture the aircraft’s flight characteristics and safety status of the civil aircraft under various operational conditions. The safe operational envelope within specific scenarios is also determined. Full article

It has become an urgent problem to deal with the uncertain influence caused by the high proportion of new energy connected to the grid and improve the consumption level of new energy in the background of the new power system. Based on the constantly updated predicted information of wind power, photovoltaic power, and load power, a multi-time-scale coordinated scheduling model for a multi-energy complementary power generation system integrated with a high proportion of new energy, including an electricity-to-hydrogen system, is proposed. The complex nonlinear factors in the operation cost of thermal power and pumped storage power generation were converted into a mixed integer linear model for solving the problem. The results show that the participation of the pumped storage units in the power grid dispatching can effectively alleviate the peak regulation and reserve pressure of the thermal power units. The electricity-to-hydrogen system has the advantages of fast power response and a wide adjustment range. Pumped storage plant, together with the electricity-to-hydrogen system, enhances the flexible adjustment ability of the power grid on the power side and the load side, respectively. The coordinated dispatch of the two can take into account the safety and economy of the power grid operation, maintain the power balance of the high-proportion new energy power generation system, and effectively reduce green power abandonment and improve the consumption level of clean energy. Full article

Background: The Remnant Cholesterol Inflammatory index (RCII) has been proposed as a marker of insulin resistance and systemic inflammation. However, its associations with incident stroke, incident heart disease, and all-cause mortality among individuals with cardiovascular–kidney–metabolic (CKM) syndrome stages 0–3 remain uncertain. Methods: This longitudinal cohort study used data from the China Health and Retirement Longitudinal Study (CHARLS). The remnant cholesterol inflammatory index (RCII) was calculated as [RC (mg/dL) × hs-CRP (mg/L)]/10. Outcomes included incident stroke, incident heart disease, and all-cause mortality. Covariates were prespecified based on established risk factors. Cox proportional hazards models and restricted cubic spline (RCS) analyses were used to evaluate associations between RCII and each outcome. Long-term RCII patterns were identified using k-means clustering. Robustness was assessed using subgroup and sensitivity analyses. Results: The final study involved 6994 participants in the stroke and heart disease cohort and 7245 participants in the all-cause mortality cohort, all within CKM syndrome stages 0–3. Higher baseline RCII was associated with increased risks of stroke (HR = 1.55, 95% CI: 1.14–2.12) and all-cause mortality (HR = 1.67, 95% CI: 1.37–2.04) compared with the lowest quantile. Cumulative RCII showed a stronger association with all-cause mortality (HR for Q3 = 2.18, 95% CI: 1.54–3.11). RCS analysis suggested a J-shaped, non-linear association between cumulative RCII and all-cause mortality. (p for non-linearity < 0.05). K-means clustering further indicated that, relative to the reference group, cluster 2 (high-to-higher) had the highest risk of incident heart disease, whereas cluster 3 (high-to-moderate) had the highest risk of all-cause mortality. Conclusions: Higher RCII levels were associated with higher risks of stroke, heart disease, and all-cause mortality among individuals with CKM stages 0–3. RCII may serve as a promising biomarker for early risk stratification in clinic and prevention efforts in this population. Full article

Vascular endothelial growth factor receptor 3 (VEGFR3) assumes a pivotal role in regulating the development and maintaining the structural integrity of the lymphatic system. Decreased activity of VEGFR3 can precipitate aplasia or hypoplasia of lymphatic system components, culminating in primary lymphedema. To date, numerous genetic variants have been identified within the FLT4 gene, which encodes VEGFR3; however, the majority of these remain uncharacterised and are classified as ‘variants of uncertain significance’. In preceding investigations involving FLT4 sequence analysis conducted on individuals presenting with primary lymphedema, we identified several rare genetic variants that possess the potential to modulate the functional activity of VEGFR3, including the heterozygous variant c.3175G>C (p.A1059P). Preliminary assessments encompassing clinical characteristics, family history, and predictive computational algorithms indicated that this variant was likely pathogenic. Consequently, this study presents the results of functional evaluation of the mutant VEGFR3 activity in cell models overexpressing the FLT4 variant c.3175G>C. VEGFC-dependent VEGFR3 phosphorylation and FLT4 expression were reduced in cells with c.3175G>C FLT4 variant compared to wild-type, confirming the pathogenic role of c.3175G>C in primary lymphedema. Full article

Aims: Low-carbohydrate diets (LCDs) are associated with metabolic benefits, but their long-term effects remain uncertain, particularly in Asian populations with traditionally high carbohydrate intake. This study examined LCD patterns and their association with metabolic syndrome (MetS) in Korean adults using nationally representative data from the 2022–2023 Korea National Health and Nutrition Examination Survey (KNHANES). Methods: Among 9617 adults aged ≥20 years with complete dietary and health data, LCD score was calculated from the percentage of energy derived from carbohydrates (reverse-scored), fats, and proteins, and participants were categorized into high-carbohydrate, moderate-carbohydrate, and low-carbohydrate groups. MetS was defined using an Adult Treatment Panel III and Korean criteria. Survey-weighted logistic regression was applied to assess associations between LCD score and MetS across sequentially adjusted models. Results: MetS prevalence differed significantly across LCD decile groups (LCD1: 9.6%, LCD2: 5.8%, LCD3: 9.7%; p < 0.001). In a minimally adjusted model, LCD decile 3 was associated with higher odds of MetS (OR, 1.14; 95% CI: 1.02–1.27). However, this association was attenuated and became non-significant after further adjustment for key metabolic risk factors. Obesity, blood pressure, fasting glucose, triglycerides, and high-density lipoprotein cholesterol were all strongly associated with MetS (all p < 0.001), and income-related disparities were evident, with lower-income groups showing higher carbohydrate and lower fat and protein intakes. Conclusions: These findings suggest that LCD patterns are not independently associated with MetS once underlying metabolic factors are considered. Public health strategies in Korea would be emphasized by improving nutrient quality, promoting balanced macronutrient intake, and reducing socioeconomic inequalities in diet to mitigate metabolic risk among adults. Full article

To address the complex and uncertain causes of safety accidents in chemical enterprises, this study applied text mining techniques to systematically extract 29 causative factors from 422 accident reports. These factors were classified into five categories: personnel issues, resource management deficiencies, adverse organizational atmosphere, organizational process flaws, and inadequate supervision. Based on the extracted factors, a complex network model of accident causation was constructed. Using degree centrality, betweenness centrality, and eigenvector centrality, seven core causative factors were identified, along with multiple peripheral factors closely linked to them. Bayesian network-based sensitivity analysis further revealed the factors that exert the greatest influence on accident occurrence, and subsequent path analysis uncovered several critical accident propagation paths. The findings reveal core causative factors and critical propagation paths, which may inform the prioritization of risk control measures under conditions of limited resources. Full article

Soils represent the largest reservoir of organic carbon (OC) in terrestrial ecosystems, storing approximately 1500 Gt C. Forest and grassland ecosystems contribute 39% and 34% to global terrestrial carbon stocks, with soils holding about 44% and 89% of forest and grassland carbon, respectively. Land-use changes, such as the conversions between forest and grassland ecosystems, can strongly influence soil carbon accumulation, though the direction and magnitude remain uncertain. Comparative data from paired-plot studies of forest and grassland soils are still limited. In this study, we conducted pairwise comparisons of total OC and total nitrogen (TN) stocks in mature forest and climax grassland soils along a climatic and pedogenic gradient encompassing Retisols, Luvisols, and Chernozems. Relationships between OC and TN stocks (0–10 cm) and soil physicochemical properties—OC and TN contents, bulk density, pH, clay content, and humus fractional composition, as well as biological indicators—the abundance of culturable fungi and bacteria, microbial biomass carbon, potential metabolic activity, and activities of laccase and dehydrogenase, were evaluated. Strong positive correlations were found between OC and TN stocks and OC and TN contents (r = 0.62–0.99), pH (r = 0.79–0.81), clay content (r = 0.70–0.87), and the fraction of humic acids bound with calcium (r = 0.73). OC stocks also correlated strongly with dehydrogenase activity (r = 0.85–0.95). At 0–10 cm depth, OC stocks were higher in grassland soils than in forest soils by factors of 1.6–1.7 in Retisols and 1.4–1.5 in Chernozems. Similarly, TN stocks were 1.6–2.0 times greater in grasslands across all soil types. Community-level physiological profiling revealed higher potential metabolic activity in forest soils compared with grasslands, with the strongest differences in Retisols and Luvisols, while contrasts were attenuated in Chernozems. Overall, the results highlight the fundamental role of organo-mineral interactions and calcium binding in OC stabilization, as well as the likely involvement of dehydrogenase activity in the biogenic formation of calcium carbonates that contribute to this process. Full article

The study aimed to determine the effect of acute, one-time physical effort performed under different environmental temperature conditions on erythrocyte deformability in healthy young men. This exploratory randomized parallel-group study involved 30 men randomly assigned to an experimental group exercising at −10 °C in a climatic chamber and a control group exercising under thermoneutral outdoor conditions. Erythrocyte deformability was assessed using the elongation index (EI), reflecting erythrocyte elasticity and the ability to pass through microcirculation vessels. Participants performed an incremental 20 m shuttle run test. Venous blood samples were collected before and immediately after exercise, and erythrocyte deformability was analyzed using a Lorrca analyzer across a shear stress range of 0.30–60.00 Pa. A two-factor repeated-measures analysis of variance was applied. An increase in EI after exercise was observed in both groups, predominantly at higher shear stress values, indicating enhanced erythrocyte deformability under conditions of increased shear forces. However, the magnitude of post-exertion changes differed between groups. At lower shear stress levels (0.30 Pa and 0.58 Pa), EI tended to decrease after exercise. These findings indicate that a single bout of physical effort influences erythrocyte deformability, while the potential effects of cold exposure on this response remain uncertain and warrant further investigation. Full article

Obstructive sleep apnea (OSA) is a prevalent disorder characterized by repeated upper airway collapse during sleep, significantly impacting quality of life. Orthodontists are increasingly recognized for their role in screening and managing anatomical factors contributing to airway obstruction. One such intervention is rapid maxillary expansion (RME), originally developed to address transverse maxillary deficiencies but now also studied for its influence on nasal and oropharyngeal airway dimensions. This literature review evaluates the effects of maxillary palatal expansion on airway volume and respiratory function. Evidence consistently shows increases in nasal cavity volume and reductions in nasal airway resistance, particularly in patients treated before the peak of skeletal growth. Some studies reported improvements in sleep outcomes and enhanced oxygen saturation following MARPE in adults with OSA. Results regarding changes in oropharyngeal volume were more variable, with several studies showing significant expansion. Factors influencing outcomes include patient age, skeletal maturity, appliance type, and aging modality. Hybrid and bone-borne expanders generally demonstrated greater skeletal effects compared to tooth-borne devices, though statistical significance was not always reached. While MARPE has shown promising results in non-obese adults with OSA, long-term stability of airway improvements and translation into consistent functional respiratory benefits remain uncertain. Overall, maxillary expansion demonstrates measurable skeletal and airway changes, with the greatest respiratory improvements in growing patients and selected adult populations. Incorporating patient-reported outcomes and standardized polysomnographic measures in future trials will be critical to determine whether these structural gains consistently translate into durable improvements in sleep-disordered breathing and quality of life. Full article

As an important plant immune inducer, Dufulin has long been thought to enhance plant resistance to multiple plant viruses through activating the salicylic acid (SA) pathway. However, whether this immune inducer responds to tomato brown rugose fruit virus (ToBRFV) infection in the same way remains uncertain. In this study, we systematically analyzed the multiple effects of Dufulin treatment on the physiological, biochemical and gene expression patterns in tomato under ToBRFV infection. The results showed that the application of Dufulin could significantly increase the chlorophyll content; elevate the activities of superoxide dismutase (SOD), peroxidase (POD), and catalase (CAT); reduce the ToBRFV viral load; and enhance plant growth. Moreover, we found that Dufulin treatment could increase both SA and abscisic acid (ABA) contents. However, SA-related genes were not strongly activated as the genes involved in ABA biosynthesis and signal transduction pathways. This suggested that ABA likely plays an unrecognized role in the formation of this induced resistance. Through weighted gene co-expression network analysis (WGCNA) and cis-element analysis of the target gene promoters, we identified that SlABI5-like and SlWRKY4 might be the key potential transcription factor genes for Dufulin-induced tomato resistance to ToBRFV, and constructed their molecular regulatory network. We also conducted qRT-PCR assay to verify the gene expression patterns involved in this study. These findings potentially provide new insights into the mechanism of Dufulin-induced antiviral resistance, and enlarge important molecular targets for ToBRFV prevention and control. Full article