Search Results (23)

As Artificial Intelligence systems increasingly surpass or replace traditional human roles, institutions founded on beliefs in human cognitive superiority, moral authority, and procedural oversight encounter a more profound challenge than mere disruption: expiration. This paper posits that, instead of being outperformed, many legacy institutions are becoming epistemically misaligned with the realities of AI-driven environments. To clarify this change, the paper presents the Expiration Theory. This conceptual model interprets institutional collapse not as a market failure but as the erosion of fundamental assumptions amid technological shifts. In addition, the paper introduces the AI Pressure Clock, a diagnostic tool that categorizes institutions based on their vulnerability to AI disruption and their capacity to adapt to it. Through an analysis across various sectors, including law, healthcare, education, finance, and the creative industries, the paper illustrates how specific systems are nearing functional obsolescence while others are actively restructuring their foundational norms. As a conceptual study, the paper concludes by highlighting the theoretical, policy, and leadership ramifications, asserting that institutional survival in the age of AI relies not solely on digital capabilities but also on the capacity to redefine the core principles of legitimacy, authority, and decision-making. Full article

Oil palm cultivation plays a critical role in rural livelihoods in Indonesia, yet previous research has often overlooked systematic institutional differences among smallholders. This study aims to analyze disparities in assets, strategies, and livelihood outcomes among three oil palm smallholder typologies—ex-Perkebunan Inti Rakyat (PIR) transmigrant smallholders who received land through government transmigration programs, independent smallholders who cultivate oil palm without formal partnerships, and plasma smallholders operating under corporate partnership schemes—in Central Mamuju Regency, West Sulawesi. A descriptive quantitative approach based on the sustainable livelihoods framework was employed, using chi-square analysis of data collected from 90 respondents through structured interviews and field observations. The results show that ex-PIR smallholders possess higher physical, financial, and social capital and achieve better income and welfare outcomes compared to independent and plasma smallholders. Independent smallholders exhibit resilience through diversified livelihood strategies, whereas plasma smallholders face asset limitations and structural dependency on partner companies, increasing their economic vulnerability. The study concludes that differentiated policy approaches are necessary to enhance the resilience of each group, including improving capital access, promoting income diversification, and strengthening institutions for plasma smallholders. Future research should expand geographical scope and explore factors such as technology adoption, gender dynamics, and intergenerational knowledge transfer to deepen understanding of sustainable smallholder livelihoods in tropical plantation contexts. Full article

This study investigates the upcycling of disposable face masks, which were produced in vast quantities during the COVID-19 pandemic and are now widely stockpiled in public institutions, destined for landfills after reaching expiration dates. The research focuses on incorporating shredded mask fibers into geopolymer matrices, evaluating the effects on mechanical and thermal properties to develop sustainable, high-performance materials. This approach addresses critical environmental, social, and economic challenges by transforming problematic waste into valuable resources while promoting sustainable building practices, such as developing insulating products for the construction industry. Mechanical testing demonstrated that adding shredded mask fibers (2 mm and 6 mm in size, up to 5 wt.%) enhanced the flexural strength of geopolymeric products. The optimal performance was achieved by adding 3 wt.% of 2 mm-length fibers, resulting in a flexural strength of 4.56 ± 0.23 MPa. Regarding compressive strength, the highest value (54.78 ± 2.08 MPa) was recorded in geopolymers containing 1 wt.% of 2 mm fibers. Thermal insulation properties of the materials improved with higher mask content, as evidenced by reductions in thermal conductivity, diffusivity, and specific heat. The lowest thermal conductivity values were observed in geopolymers containing 5 wt.% (0.4346 ± 0.0043 W·m⁻¹·K⁻¹) and 3 wt.% (0.6514 ± 0.0002 W·m⁻¹·K⁻¹) of 2 mm mask fibers. To further enhance thermal insulation, geopolymers with 5 wt.% mask fibers were foamed using H₂O₂ to obtain highly porous light materials, obtaining a reduction of thermal conductivity (0.3456 and 0.3710 ± 0.0007 W·m⁻¹·K⁻¹). This research highlights the potential of integrating fibrous waste materials into advanced construction technologies, offering solutions for waste reduction and development in the building sector toward sustainability. Full article

As a pivotal force in the development of hydropower and water conservancy, the evolution of China’s reservoir resettlement policies has garnered significant attention. Over the past seven decades, the nation has made remarkable strides in implementing resettlement initiatives, effectively contributing to poverty alleviation and water resource management. However, emerging challenges, including diminishing opportunities for new reservoir construction, the expiration of post-relocation support policies, and the current emphasis on high-quality development, reveal critical gaps in the existing research. Specifically, macro-level analyses of policy evolution remain scarce, particularly concerning the interrelation between two cornerstone components: land acquisition compensation policies and post-relocation support policies. To address this gap, this paper adopts a holistic historical perspective to analyze the evolution of China’s reservoir resettlement policies across four distinct stages, focusing on the development of two key policies and their interrelations. The findings reveal that each stage of China’s reservoir resettlement policies is characterized by unique thematic priorities, with their interrelations gradually evolving toward greater synergy. Nevertheless, challenges persist, including insufficient per capita farmland allocation and industrial decline in resettlement areas. Accordingly, this paper proposes optimization strategies that encompass policy innovation, multi-stakeholder participation, digital management, and the enhancement of resettlement agencies. China’s experience in fostering policy synergy offers critical insights into institutional evolution while providing valuable references for other countries seeking to refine their reservoir resettlement frameworks. Full article

Effective medical waste management is crucial for minimizing environmental contamination, protecting occupational health, and advancing sustainability goals in healthcare systems. However, microbiology laboratories remain underexplored in waste characterization studies, despite their potential to contribute to sustainable healthcare operations. This study assessed waste generation patterns, classification accuracy, and the impact of training on regulatory compliance in a university hospital microbiology laboratory. Over 45 days, waste from six specialized units was categorized and weighed daily. A survey of 304 healthcare professionals evaluated their knowledge of medical waste handling. Statistical analyses revealed that training frequency (R² = 0.72, p < 0.01) was the most significant predictor of compliance, while years of experience had no measurable impact. On average, the laboratory generated 22.78 kg/day of medical waste, 11.67 kg/day of liquid waste, and 5.61 kg/day of sharps waste, with the bacteriology unit being the largest contributor. Despite adequate general awareness, 15% of staff misclassified hazardous waste—particularly expired pharmaceuticals and cytotoxic vials—indicating critical gaps in practice. The findings support the need for recurring training programs, stricter monitoring systems, improved waste labeling, and the integration of digital tracking tools. These interventions can reduce environmental burdens, enhance healthcare sustainability, and support the development of more resilient waste management systems in medical institutions. Future research should explore how AI and automation can further strengthen sustainable healthcare waste strategies. Full article

This paper addresses the need to improve the understanding of how integrated water resources management (IWRM) can be more effective in addressing diverse water challenges globally. The emphasis is on the use of systems methods to clarify IWRM and create support for it among the academic community for emphasis after the Sustainable Development Goals (SDGs) expire in 2030. The importance of using IWRM is apparent in frequent reports about challenges like access to water supply and sanitation, water-related disasters, water stresses, water pollution, and ecosystem losses. These affect the SDGs, especially Goal 6 for implementation of IWRM. Among competing paradigms for water resources management practice, IWRM has a more organized advocacy base than others, and sustaining it can support all of them. However, IWRM has been supported for more than 20 years and is still difficult to understand and criticized. Despite this, sustained support for it indicates that it meets an important need. Systems concepts of problem archetypes, skeletonization, and the concept of emergence were used to create a model to explain IWRM as a framework of institutional arrangements and a cooperative problem-solving process. A set of four synthesized problem archetypes was developed, and stakeholder analysis was used to identify key disciplines for its implementation and to identify the knowledge, skills, and abilities needed among them. These point the way for academics to develop clear explanations while retaining comprehensive perspectives of IWRM. Building and sustaining a viable academic community to support IWRM will face barriers because academics focus mainly on their disciplines where they are rewarded and recognized. This is also evident in the smaller membership bases of interdisciplinary water associations compared to disciplinary or sector-based water associations. IWRM as an organizing platform for cross-sector water resources management has a long-term future if academics focus on it and its support by international partners continues. By explaining IWRM better and marshalling greater support for it among the academic community, the same approach of clarifying ambiguous concepts and providing better ways to engage academia may help other SDG areas. Full article

Pharmaceutical waste management represents a global issue. There is a significant gap in consumers’ education regarding the proper disposal of pharmaceutical waste. A significant amount of pharmaceutical waste is generated in health care facilities, including expired medicines, unused doses, and contaminated materials. Inadequate disposal of pharmaceutical waste can have effects on human health and on the environment. Managing pharmaceutical waste requires coordinated efforts from policymakers, health care providers, pharmaceutical manufacturers, waste management companies, and consumers. The purpose of this paper is to examine the current state of activities that may impact the efficiency of Romanian pharmacists in collecting and disposing of pharmaceutical waste, as well as the intentions of pharmacists/technicians to recycle this type of waste. Furthermore, this paper aims to identify institutional and behavioral barriers that affect effective waste management. This research was conducted using quantitative and qualitative research methods. An exploratory factor analysis was used to identify the elements of satisfaction and their attribution levels in the pharmaceutical industry. The statistical significance of the differences across different occupations regarding satisfaction with pharmacists’ activities to reduce waste at each stage was tested using an analysis of variance. Cross-tabulation and a Pearson’s chi-square test were used to analyze the relationship between occupational segments and intention regarding recycling and reusing pharma waste. This research was augmented using qualitative analysis based on the Delphi technique, focused on the barriers to waste management in the pharmaceutical sector. This study presents a general perspective on the current situation of pharmaceutical waste in Romania. The results indicate that the selection of appropriate pharmaceutical waste practices is primarily determined by the attitude of individuals and organizations, followed by regulatory, economic, and technical criteria. In developing sustainable pharmaceutical waste policies, this research provides practical implications for governments, organizations, and citizens. A comprehensive approach to overcoming barriers in pharmaceutical waste management was developed by combining institutional strategies that focus on organizational policies and infrastructure with behavioral strategies that target individuals and communities. Full article

In China’s rural land system, the collective owns the land, and farmers, as members of the collective, can acquire land contractual management rights through land contracting. With the second round of land contracts nearing expiration, the central government has announced that the term should be extended for 30 years. This paper introduces the theory of psychological ownership to explore the implementation paths of the 30-year extension policy. The study finds that (1) farmers generally exhibit strong psychological ownership towards the contracted land. (2) The Household Contract Responsibility System satisfies the three routes for the formation of psychological ownership—control, intimate knowledge, and self-investment. As the duration of farmers’ possession of contracted land extends, their psychological ownership gradually forms and strengthens. (3) Farmers’ psychological ownership has both positive and negative effects. The 30-year extension policy must adhere to the path dependence formed by the evolution of the land contract system, comply with the institutional constraints imposed by rural land collective ownership, and simultaneously meet the practical demands posed by urban–rural integration and agricultural development. Drawing on the complex effects of farmers’ psychological ownership and considering the historical, institutional, and practical contexts of policy implementation, this study proposes the dual necessity of facilitating and restraining farmers’ psychological ownership when extending for another 30 years and offers corresponding policy suggestions. Facilitation requires empowering farmers with more stable land possession and stronger land rights. Restraint requires preventing the permanent locking of rural land allocation patterns to achieve fair and efficient land allocation. Full article

Background/Objectives: Infective prosthesis endocarditis (IE) following transcatheter aortic valve implantation (TAVI) presents significant management challenges, marked by high mortality rates. This study reviews our center’s experience with surgical interventions for IE in patients post-TAVI, focusing on outcomes, challenges, and procedural complexities, and providing an overview of the limited literature surrounding this subject. Methods: This study was executed as a comprehensive retrospective analysis, targeting the clinical outcomes of surgical treatment in patients presenting with PVE following TAVI procedures at our institution. From July 2017 to July 2022, we identified five patients who had previously undergone transfemoral transcatheter aortic valve implantation and were later diagnosed with PVE needing surgery, strictly adhering to the modified Duke criteria. Results: All surgical procedures were reported successful with no intra- or postoperative mortality. Patients were predominantly male (80%), with an average age of 76 ± 8.6 years, presenting mostly with dyspnea (NYHA Class II). The mean follow-up was between 121 and 1973 days, with outcomes showing no occurrences of stroke, myocardial infarction, or major bleeding. One patient expired from unrelated causes 3.7 years post-surgery. The operative and postoperative protocols demonstrated effective disease management with enhanced survival and minimal complications. Conclusions: The surgical treatment of IE following TAVI, though challenging, can be successfully achieved with careful patient selection and a multidisciplinary approach. The favorable outcomes suggest that surgical intervention remains a viable option for managing this high-risk patient group. Our study also highlights the scarce literature available on this topic, suggesting an urgent need for more comprehensive research to enhance understanding and improve treatment strategies. Future studies with larger cohorts are needed to further validate these findings and refine surgical strategies for this growing patient population. Full article

Maintaining an active lifestyle is a key health behavior in people with type 2 diabetes (T2D). This study assessed the feasibility and acceptability of a socio-ecological Nordic walking intervention (SENWI) to enhance healthy behaviors in primary healthcare settings. Participants included individuals with T2D (n = 33; age 70 (95% CI 69–74)) and healthcare professionals (HCPs, n = 3). T2D participants were randomly assigned to a SENWI, active comparator, or control group for twelve weeks. Feasibility and acceptability were evaluated based on a mixed methodology. Quantitative data reported adherence information, differences between follow-up and dropout participants and pre- and post-intervention on physical activity, sedentary behavior, and health outcomes. Qualitative data acquisition was performed using focus groups and semi-structured interviews and analyzed using thematic analysis. Thirty-three T2D invited participants were recruited, and twenty-two (66.7%) provided post-intervention data. The SENWI was deemed acceptable and feasible, but participants highlighted the need to improve options, group schedules, gender inequities, and the intervention’s expiration date. Healthcare professionals expressed a lack of institutional support and resources. Nevertheless, no significant difference between the SENWI follow-up and dropout participants or pre- and post- intervention was found (only between the active comparator and control group in the physical quality of life domain). Implementing the SENWI in primary healthcare settings is feasible and acceptable in real-world conditions. However, a larger sample is needed to assess the program’s effectiveness in improving healthy behaviors and its impact on health-related outcomes in the long term. Full article

The dynamic growth and evolution of tourism in recent times and its growing importance for the economies of many countries has been drastically hampered by the COVID-19 pandemic. The pandemic has not only affected tourism through travel restrictions and the associated difficulties faced by the tourism industry, but it has also changed people’s tourism preferences (mass tourism has been replaced by more sustainable tourism), as well as their motives for undertaking tourism. The aim of this study is to assess students’ views on the role of the COVID-19 pandemic in shaping their tourism experiences and beliefs about the future of tourism in the perspective of the pandemic and its global implications. The issue is of interest given the young age of the study participants and the belief that they are key influencers in shaping the image of global tourism in the post-pandemic period. The participants of this study were 196 students from higher education institutions in Gdansk, representing both tourism- and non-tourism-related majors. The aim of this study was achieved using the diagnostic survey method, collecting information about the respondents’ beliefs based on a research tool in the form of a survey questionnaire. The results suggest that tourism activities and students’ motives for engaging in them may change after the pandemic expires compared to before COVID-19. In general, studying tourism is associated with moderate attitudes towards the aftermath of the coronavirus compared to the more radical responses of students who do not study tourism. A limitation of this pilot study was the geographical restriction of the respondents to the Polish population, which makes it difficult at this stage to draw more generalized conclusions. Full article

This descriptive cross-sectional study aimed to assess the knowledge and practices of pharmacy and nursing students at a medical college in Kosovo concerning unused and expired medications. A self-administered questionnaire was distributed to 500 randomly selected students of pharmacy (200 questionnaires) and nursing students (300 questionnaires). Overall, 336 returned the filled forms and the response rate was 67.2. SPSS version 26.0 was utilized for statistical analysis. The results showed that 89.2% of pharmacy students and 82.2% of nursing students check the expiration date of medications before purchasing them and a considerable number of students stated that they possess unused medicines at home (78.4% of pharmacy and 74% of nursing students). Regarding disposal practice, over 50% of both nursing and pharmacy students dispose of unused and expired medications in the trash. A small proportion of students returned unused or expired medicines to the pharmacy (11.4% of pharmacy students and 10.7% of nursing students return unused medications, whereas 14.4% of pharmacy respondents and 10.1% of nursing respondents reported returning expired medicines). There was a statistically significant difference in the ways pharmacy and nursing students purchase pharmaceuticals and in their opinions regarding institutions in charge of disposing of unused and expired medicines (p = 0.000). Students are aware of the detrimental effects improper disposal of unused and expired medicines has on the environment and public health, but lack information regarding the return of unused and expired medicines to the pharmacy. To change the existing practice the most appropriate method would be to add additional lectures on safe disposal practices into existing modules. It is recommended for involved stakeholders in Kosovo to organize training, seminars, and workshops for health professionals especially pharmacists and nurses, since they pass the information to patients/consumers as well as the government to make amendments to current legislation to ameliorate the returning procedures for patients/consumers in pharmacies. Full article

Mucopolysaccharidosis type IVA (MPS IVA or Morquio A), a lysosomal storage disease with an autosomal recessive inherited pattern, is induced by GALNS gene mutations causing deficiency in N-acetylgalactosamine-6-sulfatase activity (GALNS; EC 3.1.6.4). Currently, intravenous (IV) enzyme replacement therapy (ERT) with elosulfase alfa is employed for treating MPS IVA patients. A systematic literature review was conducted to evaluate the efficacy and safety of IV elosulfase alfa for MPS IVA by searching the National Center for Biotechnology Information, U.S. National Library of Medicine National Institutes of Health (PubMed), Excerpta Medica dataBASE, and Cochrane Library databases, limited to clinical trials. Four cohort studies and two randomized controlled trials, with a total of 550 participants (327 on ERT treatment versus 223 on placebo treatment), satisfied the inclusion criteria. Pooled analysis of proportions and confidence intervals were also utilized to systematically review clinical cohort studies and trials. Per the pooled proportions analysis, the difference in means of urinary keratan sulfate (uKS), 6-min walk test, 3-min stair climb test, self-care MPS-Health Assessment Questionnaire, caregiver assistance and mobility, forced vital capacity, the first second of forced expiration, and maximal voluntary ventilation between the ERT and placebo treatment groups were −0.260, −0.102, −0.182, −0.360, −0.408, −0.587, −0.293, −0.311, and −0.213, respectively. Based on the currently available data, our meta-analysis showed that there is uKS, physical performance, quality of life, and respiratory function improvements with ERT in MPS IVA patients. It is optimal to start ERT after diagnosis. Full article

Background and objectives: COVID-19 patients exhibit a broad range of manifestations, presenting with a flu-like respiratory tract infection that can advance to a systemic and severe disease characterized by pneumonia, pulmonary edema, severe damage to the airways, and acute respiratory distress syndrome (ARDS, causing fatality in 70% of COVID-19 cases). A ‘cytokine storm’ profile is found in most severely influenced COVID-19 patients. The treatment protocol of the disease also includes tocilizumab, which is a humanized monoclonal antibody used to treat autoimmune and inflammatory conditions. This study was designed (1) to assess the role of tocilizumab in COVID-19 patients regarding therapeutic efficacy through evaluation of cytokine release syndrome (CRS) resolution and anticoagulant effect, analyzing clinical safety via monitoring of associated adverse effects profile; and (2) to compare the clinical safety and therapeutic efficacy of institutional treatment regimen (alone) versus tocilizumab added to an institutional treatment module in COVID-19 patients. Materials and Methods: In this study, the endpoints parametric assessment of severely diseased patients of COVID-19 was performed (total n = 172, control group (institutional protocol treatment provided), n = 101 and test group (tocilizumab provided), n = 71) at the Khyber Teaching Institution, MTI, Peshawar. The assessments were compared using non-parametric analyses at baseline and after a follow-up of 12–18 days until the patient discharged or expired. Results: Results of the study revealed an insignificant difference among the control vs. test group in resolving inflammatory parameters (C-reactive protein (CRP) 21.30 vs. 50.07; p = 0.470, ferritin 482.9 vs. 211.5; p = 0.612, lactate dehydrogenase (LDH) 29.12 vs.18.8; p = 0.0863, and D-dimer 464 vs.164.4; p = 0.131). However, a statistically significant difference was found between the control group and test group regarding coagulation parameters (international normalized ratio (INR) 0.12 vs. −0.07; p ≤ 0.001; activated partial thromboplastin time (aPTT) 0.42 vs. −1.16; p ≤ 0.001; prothrombin time (PT) 0.31 vs. −0.96; p ≤ 0.001; platelet count −12.34 vs. −1.47; p = 0.012) and clinical survival rate (89.10 vs. 90.14; p < 0.001). Furthermore, there was significantly higher infection rates and raised alanine aminotransferase (ALT) and alkaline phosphatase (ALP) associated with the tocilizumab group as compared to those receiving institutional treatment (bacterial infections: 0.99% vs. 15.49%; p ≤ 0.01, ALT: 3.96% vs. 28.16%; p ≤ 0.01, ALP: 1.98% vs. 22.53%; p ≤ 0.01). Conclusions: From this study, it was concluded that tocilizumab can be a better drug of choice in terms of efficacy, particularly in resolving coagulopathy in severe COVID-19 patients. Full article

This study tests the hypothesis of Cretaceous Turn of Geological Evolution (CTGE). It uses the large dataset on mineral deposits of NE Asia compiled by the US Geological Survey in collaboration with Russian, Mongolian, Korean, and Japanese geological institutions. As predicted, the Triassic–Early Jurassic and Late Cretaceous–Paleogene geodynamic activities in NE Asia were simple, producing a relatively small amount of mineral deposits (94 and 132, respectively). In contrast, the greatly increased geodynamic activity around CTGE produced a huge amount of mineral deposits (288). The Jurassic–Early Cretaceous superplume-related melts were injected into accretionary wedges that formed along the Pacific–Eurasian margins, whereas adakitic and granitic magmas derived from the shallow slab and lower crust were intruded into the huge intracontinental region. The characteristic mineral deposits are represented by the unique Jurassic–Early Cretaceous plume-related Ti-Fe-V (+P + Cr-PGE + Au + diamond) ores. Other CTGE representatives are the porphyry Cu-Mo and Au (+Ag)-vein deposits, which formation, however, continued into the Late Cretaceous–Paleogene epoch. These deposits were generated by the slab- and crust-derived adakitic and granitic melts formed under influence of the expiring superplume and intensifying subduction. The Late Cretaceous–Paleogene epoch is indicated by a decreasing metallogenic activity in general, and an increasing role of subduction-related deposits in particular. Full article