Search Results (2,522)

Hospital readmission among stroke survivors is frequent, especially in contexts of social vulnerability, compromising recovery and overburdening health services. This study aimed to develop a predictive model of hospital readmission among socially vulnerable stroke survivors, based on the Chronic Conditions Care Model (CCCM). Machine learning algorithms were applied, specifically decision tree and logistic regression, with data split into training (70% and 80%) and testing (30% and 20%) sets. Analyses were conducted using Python, with accuracy evaluated through ROC curves, AUC, and the confusion matrix in Analyse-it^®, adopting a 5% significance level. The decision tree with an 80/20 partition achieved an accuracy of 92.45%. The variables most associated with readmission were falls, time since the first stroke, presence of a caregiver, and difficulty sleeping. In logistic regression, falls increased the risk by 235%, ischemic stroke by 155%, complications by 153.53%, COVID-19 by 132%, and time since stroke by 11.5% per year. The model proved to be feasible and robust, with the decision tree standing out, highlighting its potential to support preventive strategies and enhance care management. Full article

Background: Asymmetrical load carrying can impair balance and increase fall risk, especially in older adults. This study compared postural control in 33 older (mean age 72.2 ± 11.0 years) and 27 younger (mean age 33.5 ± 15.8 years) adults. Methods: Participants performed three 20 s quiet standing trials on a force plate: no load, 3 kg left shoulder load, and 3 kg right shoulder load. Center-of-pressure (COP) variability, range, mean velocity, and sample entropy were computed. This was a quasi-experimental study with a mixed-design ANOVA (Group as between-subjects factor; Load and Plane as within-subjects factors). Results: Younger adults showed better overall stability than older adults across conditions. Older adults had larger COP range than younger adults with no load and with the right-sided load. Notably, no significant difference in COP range was found between groups with the left-sided load. Key statistical findings included the significant Load × Group interaction (F(2, 116) = 3.9, p = 0.024, η_p² = 0.06) for COP range. Conclusions: A small asymmetrical load on the left side may be associated with postural control in older adults, possibly through familiar sensory cues. Conversely, a right-sided load appears to negatively impact their balance. These findings highlight the differential effects of load side on postural control in older individuals. Full article

Approximately 27.6% of Italian beaches are currently affected by erosion, despite the widespread implementation of coastal defence structures. Around 10,500 installations—mainly groins and detached breakwaters—occupy nearly 24.6% of the national shoreline. Although primarily designed to protect tourist beaches, these hard-engineered structures often degrade coastal landscapes, alter nearshore circulation, and pose risks to swimmers. Nevertheless, beaches remain a fundamental asset for the “3S” (Sun, Sea, Sand) tourism sector, which contributes approximately 2.2% to Italy’s GDP, accounting for over 175 million tourists’ overnight stays in 2024, frequently concentrated near protected coastal zones. In this study, drowning incidents along the Italian coastline were analyzed using press reports complemented by official statistics. Between 2016 and 2021, an average of 145 fatalities occurred per bathing season. Sudden drownings following medical emergencies accounted for 41% of cases, non-swimmers for 18%, accidental falls into the water for 3%, and water sports activities for an additional 3%. Rip currents on natural beaches were responsible for 22% of drownings, whereas those generated by coastal defence structures accounted for 12%. A further 12% of non-swimmer fatalities are suspected to have resulted from falls into depressions or channels formed in proximity to these structures. Evidence from previous studies and seabed morphology analyses indicates that coastal defence structures can generate rip currents through two main mechanisms: (1) hydraulic pressure exerted against groins, which drives offshore flow, and (2) water outflow between pairs of breakwaters resulting from wave setup behind them. Both processes, though often less intense, are also observed near submerged structures. The erosional channels formed by these currents may persist well beyond storm events, maintaining dangerous conditions for bathers. As Italy continues to rely predominantly on hard coastal protection measures, improving the understanding of drowning dynamics associated with these structures is crucial. This should be accompanied by regulatory updates requiring designers and coastal managers to systematically assess related hazards and to propose effective mitigation and safety strategies. Full article

Seismic risk assessment in megacities requires a high-resolution spatial framework that can capture the intrinsic heterogeneity of local geology, building distribution, and population characteristics beyond conventional administrative boundaries. This study develops a hazard-independent seismic susceptibility framework for the Seoul Metropolitan Area, a megacity of approximately 9.5 million residents (as of 2024), where historical and instrumental earthquake records are limited. The proposed framework integrates nine standardized indicators across geotechnical, structural, and social domains within a vulnerability–exposure model, analyzed on a 250 m grid—approximately 300 times finer than district-level assessments. Domain-specific indices and the integrated Seismic Susceptibility Index (SSI) were derived using Analytic Hierarchy Process (AHP)-based weighting to quantify the relative importance of indicators. Results show a highly concentrated spatial pattern of susceptibility: only 2.2% of Seoul (229 grids, 14.3 km²) falls within the high-to-very-high categories, primarily in northern and southwestern residential zones characterized by soft soils, aging buildings, and vulnerable populations. The proposed framework supports targeted risk-reduction strategies by providing a practical basis for pre-disaster decision-making and efficient allocation of mitigation resources in data-scarce urban environments. Full article

Intensifying urbanization in Central Europe is increasingly pushing flood retention areas onto private farmland, yet the agronomic and socio-economic trade-offs remain poorly quantified. We conducted a narrative review of published field data and post-event assessments from 2014–2023 along the transboundary Sava River. Information was collected from research articles, case studies, and environmental monitoring reports, and synthesized in relation to national and EU regulatory thresholds to evaluate how floods altered soil functions and agricultural viability. Water erosion during floods stripped up to 30 cm of topsoil in torrential reaches, while stagnant inundation deposited 5–50 cm of sediments enriched with potentially toxic elements, occasionally causing food crops to exceed EU contaminant limits due to uptake from the soil. Flood sediments also introduced persistent organic pollutants: 13 modern pesticides were detected post-flood in soils, with several exceeding sediment quality guidelines. Waterlogging reduced maize, pumpkin, and forage yields by half where soil remained submerged for more than three days, with farm income falling by approximately 50% in the most affected areas. These impacts contrast with limited public awareness of long-term soil degradation, raising questions about the appropriateness of placing additional dry retention reservoirs—an example of nature-based solutions—on agricultural land. We argue that equitable flood-risk governance in the Sava River Basin requires: (i) a trans-boundary soil quality monitoring network linking agronomic, hydrological, and contaminant datasets; (ii) compensation schemes for agricultural landowners that account for both immediate crop losses and delayed remediation costs; and (iii) integration of strict farmland protection clauses into spatial planning, favoring compact, greener cities over lateral river expansion. Such measures would balance societal flood-safety gains with the long-term productivity and food security functions of agricultural land. Full article

Manhole shafts in urban drainage systems are prone to accumulating trapped air pockets during intense rainfall, which can lead to sudden bounce of hinged covers and pose significant near-field risks. However, threshold criteria at the prototype scale remain unavailable. To obtain quantitative evidence of cover bounce under full-scale conditions and to clarify the effects of counterweight, dual-shaft coupling, and pressure–displacement phase lag, a series of experiments have been conducted on a prototype platform consisting of two shafts with hinged covers. Tests have been repeated under various counterweight conditions ranging from 0 to 30 kg. Pressure data from multiple transducers and high-speed video recordings have been synchronously acquired, filtered, and temporally aligned. Based on these, the critical overpressure at initial lift-off was identified, and oscillation characteristics and coupling effects have been analyzed. The critical overpressure was found to increase monotonically with added counterweight. When the counterweight was large, the system transitioned into a decaying response, with negligible subsequent bounce. The single-peak “rise–fall” pattern observed in single-shaft conditions no longer appeared when both covers lifted simultaneously. Notably, the critical overpressure did not coincide with the pressure peak, and a significant phase lag was observed between the pressure maximum and the moment of maximum displacement. These findings provide actionable support for the identification, modeling, and rapid mitigation of manhole cover bounce risks in urban drainage systems. Full article

A smart city can be defined as an urban ecosystem that combines new technologies related to digitalization in infrastructure, governance models, and everyday life, as well as inclusivity and stakeholder participation for achieving effectiveness and long-term sustainability. Although many frameworks and co-creative governance approaches emphasize the importance of integrating diverse perspectives in urban innovation, the practical implementation of stakeholder engagement remains a significant challenge in the development of digital strategies. This persistent difficulty often stems from factors such as varying levels of digital literacy, power asymmetries among stakeholders, and insufficient mechanisms for meaningful participation. As a result, there is a risk that smart city initiatives may fall short of their potential to deliver inclusive and sustainable outcomes, ultimately undermining both the legitimacy and the long-term effectiveness of urban digital transformation processes. This is especially relevant in the Italian context. Indeed, despite the relevant number of papers dedicated to stakeholder engagement in smart cities, few studies have explored how municipalities implement these innovative strategies, and even fewer have within the Italian context. This research aims to fill this gap by analyzing the stakeholder engagement in Rome’s smart city strategy and the effectiveness of participatory and co-creative approaches in transforming a city into an effective smart city. The research results reveal that the experience of the Rome Smart City Lab (RSCL) creates a model of participatory governance where the stakeholders can co-create the digital innovation strategies of a municipality and where the stakeholder techniques are fully implemented. The research results provide interesting results useful for both academics and policymakers involved in the digital transformation of a smart city, since the RSCL’s approach confirms that digitalization initiatives become more effective and efficient when they are shaped by the very individuals and groups responsible for their implementation. This participatory process seems to enhance the adaptability and sustainability of digital strategies over time, ultimately contributing to the realization of truly inclusive smart cities. Full article

This study focuses on the assessment of the ecological vulnerability of lands in the western regions of Kazakhstan (WKR) using the MEDALUS (Mediterranean Desertification and Land Use) model in combination with satellite remote sensing data. Particular attention is given to the influence of climatic factors, soil properties, vegetation condition, and anthropogenic pressure. As part of the analysis, key indicators were calculated, including the Soil Quality Index (SQI), Vegetation Quality Index (VQI), Climate Quality Index (CQI), and Management Quality Index (MQI). Based on these parameters, an Environmental Sensitivity Area (ESA) index was developed, allowing the classification of the territory into five vulnerability classes ranging from low to critical sensitivity. The results indicate that 52.7% of the territory of the WKR falls within the high-risk zone for land degradation. The most pronounced changes were observed in the southern oblasts of the region, particularly in Mangystau oblast (MAN), where 98.7% of the land is classified as degraded and 74.3% of the territory falls under the category of extremely high ecological vulnerability. In addition, a steady decline in precipitation levels has been identified, contributing to the intensification of aridization processes across the region. Correlation analysis showed that the strongest relationships with the final ESA index were observed for the Vegetation Quality Index (VQI) and Climate Quality Index (CQI), both with correlation coefficients of r = 0.93 and an average coefficient of determination R² = 0.87. The Soil Quality Index (SQI) also demonstrated a strong correlation (r = 0.86). In contrast, the Management Quality Index (MQI) exhibited a generally weak correlation, except in the MAN oblast, where within the Very Low Quality (VLQ) class areas, it showed a moderate correlation (r = 0.68, p < 0.0001). The results highlight the critical role of natural factors—particularly vegetation condition, climate, and soil quality—in shaping the ecological vulnerability of the region. Findings emphasize the need for a comprehensive, multi-criteria approach in developing strategies for sustainable land management under conditions of ongoing climate change. Full article

Construction accidents continue to threaten worker safety despite advances in management systems. Existing research catalogs accident attributes but rarely explains how triggers like human error, equipment failure, or procedural lapses interact with project types and tasks. This limits recognition of high-risk scenarios and hampers targeted prevention. To address this, a two-step framework combining Multiple Correspondence Analysis (MCA) and Association Rule Mining (ARM) is proposed. Using the Korean Construction Safety Management Integrated Information (CSI) database, MCA reduces dimensionality and clusters similar accident cases, while ARM extracts context-specific rules linking accident types, causes, and activities. The analysis reveals the following key patterns: (i) worker negligence during setup or formwork often leads to tool-related cuts; (ii) poor judgment or inadequate waste removal during excavation heightens hit or stuck incidents; and (iii) negligence frequently triggers hit and fall accidents during transportation, dismantling, and finishing. By mapping causes to operational risk factors, the framework supports actionable guidance for daily risk assessments. Safety professionals can align planned tasks with identified risks, enabling proactive interventions such as focused training, stricter supervision, and engineering controls. Thus, the MCA–ARM method establishes a data-driven foundation for improving safety decision-making and reducing construction accidents. Full article

Rockfalls represent a widespread natural hazard that threatens infrastructures and settlements in mountainous and coastal areas. In Baunei (Sardinia, Italy), steep carbonate cliffs above the SS125 road frequently generate block detachments that endanger traffic and nearby urban areas. The present work adopts a quantitative risk assessment framework, consistent with the Swiss PLANAT guidelines, to evaluate the protective effectiveness of direct-protection forests in combination with engineered barriers. The framework integrates the key components of hazard, exposure, and vulnerability to quantify direct-impact risk and associated economic loss. Using Rockyfor3D simulations, three scenarios were analysed: bare slope, forest only, and forest plus protective works. The results demonstrate that vegetation markedly reduces both runout distance and kinetic energy of falling blocks, halving the direct-impact risk compared to bare-slope conditions. The addition of barriers further decreases residual exposure, with most trajectories intercepted and remaining impacts limited to low-energy classes. Monetised risk estimates confirm an 84% reduction with forest cover alone and near-complete mitigation when complemented by fences, except in short discontinuous segments. The proposed approach offers a replicable and cost-effective tool for rockfall risk management and sustainable protection forest planning in Mediterranean settings. Full article

The operation of modern power networks is increasingly exposed to overlapping climate extremes and volatile system conditions, making it essential to adopt scheduling approaches that are resilient as well as economical. In this study, a two-stage stochastic formulation is advanced, where indicators of system adaptability are embedded directly into the optimization process. The objective integrates standard operating expenses—generation, reserve allocation, imports, responsive demand, and fuel resources—with a Conditional Value-at-Risk component that reflects exposure to rare but damaging contingencies, such as extreme heat, severe cold, drought-related hydro scarcity, solar output suppression from wildfire smoke, and supply chain interruptions. Key adaptability dimensions, including storage cycling depth, activation speed of demand response, and resource ramping behavior, are modeled through nonlinear operational constraints. A stylized test system of 30 interconnected areas with a 46 GW demand peak is employed, with more than 2000 climate-informed scenarios compressed to 240 using distribution-preserving reduction techniques. The results indicate that incorporating risk-sensitive policies reduces expected unserved demand by more than 80% during compound disruptions, while the increase in cost remains within 12–15% of baseline planning. Pronounced spatiotemporal differences emerge: evening reserve margins fall below 6% without adaptability provisions, yet risk-adjusted scheduling sustains 10–12% margins. Transmission utilization curves further show that CVaR-based dispatch prevents extreme flows, though modest renewable curtailment arises in outer zones. Moreover, adaptability provisions promote shallower storage cycles, maintain an emergency reserve of 2–3 GWh, and accelerate the mobilization of demand-side response by over 25 min in high-stress cases. These findings confirm that combining stochastic uncertainty modeling with explicit adaptability metrics yields measurable gains in reliability, providing a structured direction for resilient system design under escalating multi-hazard risks. Full article

People with Down syndrome represent a highly vulnerable population, frequently showing vitamin D deficiency together with an elevated risk of metabolic and neuromuscular dysfunction. This susceptibility derives from several factors, including muscular hypotonia, excess body weight, thyroid abnormalities, and immune dysregulation. The coexistence of these conditions compromises bone and muscle health, increases cardiometabolic risk, and reduces motor abilities and coordination, thereby predisposing individuals to falls, sarcopenia, sarcopenic obesity, and long-term disability. Vitamin D, traditionally known for its essential role in bone health, is now recognized as a pleiotropic hormone regulating immune responses, metabolic balance, and muscle performance. Its deficiency is increasingly linked to obesity, insulin resistance, diabetes mellitus, dyslipidemia, and metabolic syndrome. These adverse outcomes are mediated through mechanisms involving chronic inflammation, oxidative stress, mitochondrial impairment, and disrupted adipokine signaling. This review integrates current molecular, cellular, and clinical evidence on the multifaceted actions of vitamin D in Down syndrome. Particular emphasis is placed on its effects on insulin signaling, adipose tissue metabolism, inflammatory regulation, and muscle strength. Finally, vitamin D is discussed as a biomarker and therapeutic target to guide personalized interventions aimed at improving metabolic health, maintaining muscle function, and promoting long-term independence in this high-risk population. Full article

Objectives: The present study was conducted to examine the effects of a one-year multicomponent exercise training (MCET) program on the physical function and cardiovascular risk factors of community-dwelling older adults at risk of sarcopenic obesity. Methods: Data of 78 Brazilian community-dwelling older adults at risk of sarcopenic obesity, identified as the simultaneous presence of probable sarcopenia and overweight, were examined. The MCET program was performed twice a week over one year. Physical performance evaluations included (i) a timed “up-and-go” (TUG), (ii) one-leg stand, (iii) walking speed (WS) at normal pace and fast pace, (iv) a 5-time sit-to-stand (5STS) test, and (v) isometric handgrip strength (IHG). Cardiovascular risk factors involved blood pressure (BP) values and waist-to-hip ratio. Results: Significant improvements in balance and WS at a normal pace were observed following the MCET program, while no changes were noted in other physical performance markers. Additionally, a significant reduction in diastolic BP was recorded. Conclusions: Findings indicated significant improvements in mobility and balance, as well as a notable reduction in diastolic BP, among community-dwelling older adults at risk of sarcopenic obesity following a one-year MCET program. These improvements may play a critical role in reducing the risk of adverse outcomes such as falls, disability, cardiovascular events, hospitalization, and mortality. However, the quasi-experimental design of the present study, the absence of a control group, and other methodological limitations restrict the generalizability of the results. Future research using more rigorous study designs is necessary to confirm and expand upon these findings. Full article

The thermal coal supply chain serves as core infrastructure for ensuring the safe and stable supply of electricity in China. Effective risk management and control of this supply chain are therefore critical to national energy security and socio-economic development. However, the thermal coal supply chain involves multiple complex risk dimensions, including cross-regional multi-entity coordination, a complex network structure, and a dynamic policy environment. Traditional risk analysis methods often fall short in depicting the concurrent events and dynamic propagation characteristics inherent to such a system. This necessitates systematically investigating the thermal coal supply chain within the Coal–Electricity Joint Venture (CEJV) operational framework, which primarily involves equity-based consolidation and long-term contractual coordination between coal producers and power generators, to comprehensively analyze its critical risk factors and transmission mechanisms. Initially, based on the integration of coal-fired power joint operation policy evolution and industry characteristics, 28 risk factors were identified across three dimensions: internal enterprise, external environment, and overall structure. These encompassed production fluctuation risks, thermal coal transport process risks, and insufficient supply chain flexibility. A dynamic behavior model for the thermal coal supply chain was constructed by analyzing the causal relationships among these risk factors, based on the operational processes of each link. Utilizing Petri net simulation technology enables a quantitative analysis of supply chain risks, facilitating the identification of bottleneck links and potential risk points. Through model simulation, 18 key risk factors were determined, providing a theoretical basis for optimizing supply chain resilience within CEJV enterprises. The limitations of traditional methods in dynamic process modeling and industrial applicability were addressed through a Petri net-based methodology, thereby establishing a novel analytical paradigm for risk management in complex energy supply chains. Full article

Concrete creep and shrinkage are critical factors affecting the long-term performance of extradosed bridges, leading to deflection, stress redistribution, and potential cracking. Predicting these effects is challenging due to uncertainties in empirical models and a lack of long-term data. While beam element models are common in design, they often fail to capture complex stress fields in disturbed regions (D-regions), potentially leading to non-conservative assessments of crack resistance. This study presents a computationally efficient probabilistic framework that integrates the First-Order Second-Moment (FOSM) method with a high-fidelity solid element model to analyze these time-dependent effects. Our analysis reveals that solid element models predict 14% higher long-term deflections and 64% greater sensitivity to creep and shrinkage parameters compared to beam models, which underestimate both the mean and variability of deformation. The FOSM-based framework proves highly efficient, with its prediction for the standard deviations of bridge deflection falling within 7.1% of those from the more computationally intensive Probability Density Evolution Method. Furthermore, we found that time-varying parameters have a minimal effect on principal stress directions, validating a scalar application of FOSM with less than 3% error. The analysis shows that uncertainties from creep and shrinkage models increase the 95% quantile of in-plane principal stresses by 0.58MPa, which is approximately 23% of the material’s tensile strength and increases the cracking risk. This research underscores the necessity of using high-fidelity models and probabilistic methods for the reliable design and long-term assessment of complex concrete bridges. Full article