Public Health and Healthcare

Abstract: Human fertility has declined sharply since 1950, and a growing body of evidence suggests that conventional socioeconomic explanations do not fully account for the timing and breadth of this trend. This review examines the Circadian-Light Hygiene hypothesis, which proposes that daily light exposure is a fundamental regulator of reproductive health. We synthesize findings from photobiology, endocrinology, reproductive medicine, and epidemiology to evaluate how artificial light at night, insufficient daytime light, and irregular light-dark patterns may disrupt the hormonal timing systems that support reproduction. The available evidence indicates that such disruption can alter melatonin signaling, circadian gene regulation, and neuroendocrine rhythms, with downstream effects on ovulation, sperm quality, endometriosis, polycystic ovary syndrome, pregnancy outcomes, and developmental programming. Urbanization, screen use, and shift work appear to amplify these effects, while genetic variation may modify individual susceptibility. Although direct causal evidence in humans remains limited for several endpoints, the convergence of observational, experimental, and translational data supports circadian light misalignment as a plausible and potentially modifiable contributor to fertility decline. Optimizing daily light exposure may therefore represent a low-cost and scalable strategy for improving reproductive health.

Abstract: Road traffic accidents represent a critical road safety problem whose severity depends on the complex interaction of multiple factors. The study of these factors and their interrelationship has therefore long been a focus of scientific literature. The objective of this study is to analyze the factors that determine the severity of road accidents, identifying the most important ones and their correlations. An accident dataset incorporating variables related to infrastructure, location, time, and vehicle type was used to predict the Injury Severity Index (ISI), applying Association Rules to identify latent correlations and an Optimized Decision Tree (CART) model for hierarchical risk classification. The results reveal that the Type of Collision is the primary predictor of severity; collisions with objects or pedestrians showed a 100% confidence in resulting in low severity, while maximum severity is associated with heavy traffic and head-on or side-impact collisions. Critical scenarios were also identified during the early morning hours and in rural areas, primarily linked to trucks. The combined use of both tools provides a solid scientific basis for designing interventions on highly vulnerable road segments and during high-risk time periods.

Abstract: In this review, the occurrence in the environment and human surrounding, as well as toxic action of perfluorooctanoic acid (PFOA) and its selected short-chain analogs – perfluorohexanoic acid (PFHxA) and perfluorobutanoic acid (PFBA) has been described. These substances belong to a group of polyfluoroalkyl substances (PFASs) widely represented in various compartments of the environment, including air, water and soil. They are also present in dust, drinking water and food, which are main sources of the exposure of humans to these compounds. Due to physico-chemical properties PFASs are strongly resistant to degradation in the biosphere and therefore, effectively accumulate in biota, including humans. PFOA has been produced from decades, but due to its toxicity it has been successively replacing by PFASs of shorter chain, including PFHxA and PFBA, which presence in the environment, as well as risk of human exposure and toxicity has been poorly investigated. It has been proven that PFOA reveals hepatotoxic and endocrine-disrupting activities, as well as exhibits prooxidative, immunotoxic, epigenetic and carcinogenic potential. Hitherto conducted researches have shown that PFHxA and PFBA are less toxic than PFOA, nevertheless additional extensive studies should be conducted in order to determine environmental and toxicological status of these compounds.

Abstract: Rainfall and groundwater fluctuations may influence the migration or dilution of contaminants from US Superfund sites. This pilot study was designed to provide empirical data on relationships between rainfall and contaminant concentrations in water near Superfund sites. Four Superfund sites on Long Island, New York were selected to represent a range of contaminant profiles and hydrogeologic conditions. Baseline samples were collected in December 2022, with subsequent samples obtained following major storms and seasonally through September 2023. Samples were collected on 11–24 different days across the sites and measured for metals and 1,4-dioxane. Overall, we observed few consistent associations between rainfall and contaminant concentrations across sites. Two trends, however, were noted: (1) At Gowanus Canal, a surface water site, there was a negative association between rainfall and contaminant concentrations using same-day or prior-day rainfall; and (2) in a treatment well near Lawrence Aviation, negative associations were observed between prior month’s rainfall and contaminant concentrations. Rainfall appeared to dilute contaminant concentrations at two of the four Superfund sites. Given the increased frequency and intensity of extreme rainfall events, it is important to continue probing links between rainfall and contaminants near Superfund sites.

Abstract: Background/Objectives: Prolonged smartphone use is associated with musculoskeletal and neurological hand symptoms; however, specialized tools for bilateral assessment remain limited. This study aimed to develop and evaluate the psychometric properties of the Smartphone-Related Hand Symptoms (S-HAND) scale. Methods: A total of 456 participants (mean age: 21.8 ± 6.65 years) were included. The sample was randomly divided into two independent subsamples for Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA). Internal consistency was assessed using Cronbach’s alpha and McDonald’s omega coefficients. Test–retest reliability was evaluated in 75 participants using Intraclass Correlation Coefficients (ICC). Measurement precision was determined using the standard error of measurement (SEM) and minimal detectable change (MDC95). Concurrent validity was examined using correlations with general hand pain intensity scores. Results: EFA and CFA supported a three-factor structure consisting of Pain Symptoms, Numbness Symptoms, and Functional Impact. The final CFA model demonstrated excellent fit (CFI = 0.991, TLI = 0.986, RMSEA = 0.049, SRMR = 0.033). Standardized factor loadings ranged from 0.685 to 0.932. Internal consistency was high (Cronbach’s α = 0.857–0.940; McDonald’s ω = 0.863–0.942), and test–retest reliability was excellent (ICC = 0.800–0.907). SEM and MDC95 for the total score were 4.67 and 12.95, respectively. Significant positive correlations with pain intensity scores supported concurrent validity (r = 0.61–0.73, p < 0.001). Conclusions: The S-HAND scale is a reliable and valid instrument for assessing smartphone-related hand symptoms in clinical and research settings.

Abstract: Background: E-waste is one of the fastest-growing waste streams globally, with India emerging as a major contributor. Despite existing regulatory frameworks, safe e-waste management remains suboptimal, particularly in vulnerable urban populations. This study aimed to assess knowledge, attitude, and practices (KAP) related to e-waste management and to examine the knowledge–practice gap in an urban slum of Delhi. Methods: A community-based cross-sectional study was conducted among 425 adults in an urban slum of Delhi using a stratified random sampling technique. Data were collected using a pretested, and semi-structured questionnaire assessing KAP domains. Multivariable linear regression, Spearman correlation, and mediation analyses were performed to identify determinants and pathways influencing practice. Results: Only 20.24% of participants demonstrated adequate knowledge, 43.29% had a positive attitude, and 11.29% reported good practices. Higher education was associated with better knowledge (p = 0.002), more positive attitudes (p = 0.001), and better practice scores ( p = 0.013). In hierarchical regression analysis, Knowledge emerged as a strong independent predictor of practice (β = 0.48, p < 0.001) and remained significant after further adjustment for attitude (β = 0.45, p < 0.001). Correlation analysis demonstrated significant positive associations between knowledge and attitude (ρ = 0.52), knowledge and practice (ρ = 0.38), and attitude and practice (ρ = 0.33) (all p < 0.001). Mediation analysis revealed that knowledge had both direct and indirect effects on practice through attitude, indicating partial mediation. Conclusion: The present study found that the levels of knowledge, attitude, and practices related to e-waste management remained low among residents of an urban slum in Delhi. While knowledge plays a central role in influencing behavior, the absence of accessible disposal systems and limited dissemination of policy information hinder translation into safe practices. Strengthening community-based awareness programs alongside improving and is essential for effective e-waste management.

Abstract: The use of spot-on pet parasiticides has risen substantially. Imidacloprid, a commonly used active ingredient (AI), was removed from outdoor agricultural use in 2018 due to evidenced environmental risks. Imidacloprid is an AI in certain spot-on pet parasiticides and, with its metabolites, is now a domestic contaminant. We report two studies of dust and surface contamination in >50 homes in London, UK. In study 1, a time series pre-and-post spot-on application, imidacloprid rapidly contaminates the home at concentrations far exceeding the environmental quality standards that exist. Seven days post-application, imidacloprid concentration in domestic mop water exceeded the acute toxicity maximum acceptable concentration (MAC) by 600-fold and rinsate from fabric on which animals frequently sat was almost 5000-fold the MAC. In study 2, of dust in 50 homes, the 10 homes without resident pets had the lowest imidacloprid concentration. Homes using spot-ons had much higher concentrations (38+/-17 µg/g), comparable to days 5-7 in Study 1. The imidacloprid acceptable daily intake (ADI) for humans applies to the gastric route (residues in food). Multiple routes of human contamination exist; transdermal and inhalation have no standards. There is evidence that imidacloprid is associated with cardiac, neurological and endocrine disruption in mammals, including humans. A precautionary approach is advisable, with responsive use rather than prophylactic use which maintains high levels of domestic contamination.

Abstract: Vocational integration (VI) services aim to support sustainable employment for persons with disabilities. However, in individuals with spinal cord injury (SCI), evidence on effective intervention targets and the evaluation of sustainable integration remains limited. The Work-Life Study aims to build an evidence base for supporting sustainable employment in Switzerland, by: (1) identifying typical work-life trajectories; (2) examining key work-life transitions and their predictors; (3) establishing a multi-state model for intervention targets; (4) exploring individual work-life narratives; and (5) developing guidelines for personalized VI practice. The study combines a mixed-methods design with a collaborative Integrated Knowledge Translation approach, actively involving VI professionals and individuals with SCI. Participants are recruited from the Swiss SCI Cohort Study (SwiSCI). Work-life history data are collected through a Biographical Survey and Biographical Interviews and analyzed alongside SwiSCI data. Guideline development includes a stakeholder meeting with representatives from the Swiss Paraplegic Group, SCI clinics, individuals with SCI, employers, and disability insurers. Of 2,041 eligible SwiSCI participants, 478 (23.4%) completed the Biographical Survey (median age 57.5 years; median time since SCI 19.1 years), with responders and non-responders showing comparable characteristics. Work-life data closely matched existing SwiSCI data (rho > 0.8), indicating good recall. The resulting guidelines will help VI providers coordinate rehabilitation services to optimally promote sustainable employment for individuals with SCI.

Abstract: Background: In 2016, the World Bank Group estimated that health costs related to PM2.5 pollution totalled approximately $5.7 trillion worldwide. Information on the estimated health costs from the environmental burden of disease caused by ambient air pollutant PM2.5 in Malaysia is limited. Therefore, this study aimed to estimate the environmental health costs associated with PM2.5 for all-cause and respiratory mortality at the national level. Methods: The population-weighted exposure level (PWEL) of PM10 concentrations across all Malaysian states for 2000, 2008, and 2013 was calculated using publicly available remote sensing data, air quality data from the Department of Environment, and burden-of-disease mortality statistics from the Institute of Public Health. The PWEL was then converted to PM2.5 using the World Health Organization's ambient air conversion factors. The AirQ+ 2.2.4 software was used to calculate mortality proportions for all-cause mortality, chronic obstructive pulmonary disease (COPD), lung cancer (LC), and acute lower respiratory infection (ALRI) in children under five, based on the National Burden of Disease data from 2000, 2008, and 2013. Results: The cost per disability-adjusted life-year (DALY) ranged from one (low estimate) to three times the Gross Domestic Product (GDP) per capita (high estimate). These costs were projected for 2022 using a GDP deflator. The estimated PWEL for PM2.5 in 2000, 2008, and 2013 was 22µg/m³, 18µg/m³, and 24µg/m³, respectively. The mortality cost of all-cause deaths increased from MYR 3.3 billion in 2000 to MYR 5.1 billion in 2008, and then to MYR 12.8 billion in 2013, accounting for nearly 1% of Malaysia's 2013 GDP. Conclusions:This indicates a rise in disease burden and mortality costs due to ambient air PM2.5 levels. Therefore, policymakers should remain highly vigilant.

Abstract: Background Short-term exposure to PM2.5 has been associated with respiratory infections, yet evidence on the health effects of its chemical components remains limited. Moreover, as PM2.5 components coexist as complex mixtures, it is unclear whether differences in compositional profiles contribute additional influenza-like illness (ILI) risk beyond the independent effects of individual components. Methods We analyzed weekly ILI surveillance data from 111 sentinel hospitals in 17 cities of Hubei, China (2021-2024), together with weekly PM2.5 concentrations and chemical components (sulfate, nitrate, ammonium, organic matter, and black carbon) from the TAP dataset and meteorological variables from ERA5-Land. To evaluate the associations of individual PM2.5 components and overall compositional profiles with ILI, we applied K-means clustering to identify distinct PM2.5 profiles and fitted city-specific quasi-Poisson models, which were then pooled using DerSimonian-Laird method. Results Among 2,804,416 ILI cases, PM2.5 mass was positively associated with weekly ILI, with a pooled RR of 1.041 (95% CI: 1.028-1.054) per 10 µg/m3 increase. Positive associations were also observed for sulfate, nitrate, ammonium, OM, and BC. Three compositional profiles were identified (SID: secondary inorganic-dominated, MOD: mixed organic-dominated; ORM: Other-rich mixed). After adjustment for PM2.5 and its component concentrations, exposure to ORM was associated with an extra 19.6% higher ILI risk than SID (RR = 1.196, 95% CI: 1.096-1.305), while exposure to the MOD was associated with an 8.9% higher ILI risk (RR = 1.089, 95% CI: 1.008-1.176). Conclusions These findings suggest that PM2.5 related ILI risk may depends not only on overall mass concentration and individual components, but also on compositional profiles. Incorporating PM2.5 mixture heterogeneity may improve assessment of air pollution related respiratory health risks.

Abstract: Healthy and sustainable food consumption implies not only making conscious food choices but also limiting waste. In fact, interventions targeting choices are effective only if the healthier food selected is not wasted on the plate. The aims of the study were: to quantify plate and service waste in hospital canteens; to characterize plate waste (PW) composition and environmental indicators; to compare PW before and after an intervention to improve food choices. Trays of users who gave consent were photographed (N=1,624) in three hospital canteens in Italy. PW was quantified visually, and energy, nutrients, and environmental indicators were estimated using portion sizes and recipes provided by canteen staff. PW was 4.7% (2.0-6.1% by canteen), corresponding on average to 33.1 g/tray, 43.6 kcal/tray, 69.6 gCO2 eq./tray and 61.8 LH2O/tray. Side dishes contributed the most to total PW (30%). The canteen where PW had decreased significantly (median among wasters: -48.9 g/tray) was the one with the poorest result in food choices. PW increased, though not significantly, in the other two canteens. Service waste analysis revealed considerable variability, probably driven by canteen management. In conclusion, the present study highlights the importance of including plate and service waste in public health campaigns.

Abstract:

Background: Highly educated migrants in Norway often experience prolonged delays before accessing employment that matches their qualifications. During this period, many participate in compulsory education, language training, or work in jobs unrelated to their professions. This study explores how the introductory program for migrants and work outside one’s professional field shape health, identity, and the broader integration process. Methods: We conducted semi‑structured interviews with eight highly educated migrants enrolled in the introductory program in Kristiansand municipality in Norway. Interviews focused on experiences with the program and employment unrelated to the participants’ professional backgrounds. All interviews were transcribed verbatim and analyzed using reflexive thematic analysis and informed by Social Identity Theory. Findings: Participants described employment, and particularly their former professions, as central to their self-esteem, sense of meaning, and social belonging. Prolonged credential recognition processes and limited opportunities for meaningful social contact due to employment status loss, contributed to feelings of stagnation, exclusion, and weakened professional identity. Many participants emphasized a strong desire to contribute to society and regain their professional status. While the introductory program offered valuable peer support and facilitated language learning, it was not experienced as a direct pathway to inclusion in Norwegian society and professional work life. The findings indicate that early access to work-based integration opportunities, such as internships or relevant job placements, may enhance well‑being, foster language acquisition, and strengthen social inclusion for highly educated migrants. Conclusion: The study findings suggest that policymakers and practitioners should prioritize measures that streamline credential recognition and expand early, relevant work-based integration opportunities. Such approaches can improve language development, support identity reconstruction, strengthen social belonging, and ultimately promote better health and integration outcomes for highly educated migrants.

Abstract: Occupational Geroscience is proposed here as a new scientific discipline at the intersection of geroscience and occupational medicine. It studies how chronic occupational exposomes activate the hallmarks of aging in workforces with defined biological hazards. The primary outcome is the slope of multi-clock estimators of biological age over a career-length follow-up in an exposed cohort versus a matched unexposed comparator. Hallmark-specific markers (γ-H2AX, telomere length, SASP cytokines, cf-mtDNA) are measured alongside, and each worker's lifetime dose record is linked to the biomarker series.Existing exposome aging studies measure population scale environmental drivers without isolating defined occupational cohorts. Existing occupational radiation cohorts measure cancer mortality without measuring biological aging. What is missing is a longitudinal outcome that spans systems, is anchored in the hallmarks of aging, and is tied to a defined occupational exposome with prospective dose data; such an outcome has not yet been established. That gap motivates naming the field.The founding case is fluoroscopy guided interventional medicine. Scatter ionising radiation, biomechanical loads, psychological strain, and material co-exposures plausibly activate several hallmarks of aging across careers that involve thousands of procedures. Cell and animal studies support key elements of the mechanism. Working populations have not yet been studied prospectively, and a cohort study is needed to test the prediction directly.This paper defines Occupational Geroscience by its object, methods, and predictions, and sets inclusion and exclusion criteria. The research agenda begins with a population-level registry and a modular longitudinal biomarker cohort. Shielding analyses can then be nested within the cohort, while tiered radiosensitivity profiling and biological mitigation trials, including the antioxidant pre-exposure trial (Study 5), should follow only after feasibility, safety, and primary cohort signals are established. The interventional studies are hypotheses to be tested, not proven preventive methods.

Abstract: Fatigue is a leading contributor to maritime accidents, yet recreational sailors lack the regulatory frameworks and fatigue management tools available to commercial mariners. Peer-reviewed research published in Nature demonstrates that after 17 hours of sustained wakefulness, cognitive performance degrades to a level equivalent to a blood alcohol concentration of 0.05% — the legal driving limit in most countries (Dawson & Reid, 1997). After 24 hours, this rises to 0.10%, well past the threshold for legal intoxication. These findings have been independently replicated (Williamson & Feyer, 2000) and confirmed in field studies aboard racing yachts (Hurdiel et al., 2014). This paper synthesises more than three decades of peer-reviewed research spanning chronobiology, sleep medicine, occupational health, and maritime safety into a biomathematical fatigue model calibrated specifically for pleasure boat passage-making. The model integrates sleep-wake homeostasis, circadian rhythm modulation, sleep fragmentation effects, environmental sleep degradation from sea state, and cumulative multi-day sleep debt into a single framework that outputs impairment as a BAC (blood alcohol concentration) equivalence — an intuitive metric that any sailor can understand. Critically, the model is not merely theoretical. It has been implemented as a freely available, openaccess passage fatigue calculator for mobile and web platforms, making it accessible to the widest possible population of recreational mariners. The application faithfully reproduces every formula, constant, and coefficient described in this paper, allowing sailors to simulate any passage plan — varying crew size, watch schedule, departure time, pre-departure sleep, and sea state — and see the predicted fatigue trajectory hour by hour. The purpose is to bridge the gap between laboratory science and practical seamanship: to give pleasure boat crews the same evidence-based fatigue awareness that professional mariners receive through regulation.

Abstract: In Europe, travel-associated Legionnaires’ disease (TALD) cases require timely environmental investigations to support risk assessment, rapid control measures, and prompt reporting of investigation findings to the European Legionnaires’ Disease Surveillance Network (ELDSNet). This study evaluated TALD-related environmental investigations conducted during 2025 and early 2026 in Crete, Greece, following notifications through ELDSNet. Overall, 30 notifications corresponded to 24 unique confirmed TALD cases with illness onset in 2025 and 24 implicated hotels, with some cases involving stays in multiple hotels and Regional Units and clusters identified in some implicated hotels. The investigation framework combined microbiological, physicochemical, and operational data, focusing on delays from symptom onset, notification, sampling, and laboratory reporting. Overall, 516 environmental samples were collected, of which 503 yielded valid analytical results. Among the 503 analyzed samples, Legionella spp. was detected at ≥50 CFU/L in 127 samples (25.25%). This included 123 samples positive for L. pneumophila (24.45%), of which 31 were serogroup 1 (6.16%). Concentrations exceeding the >1000 CFU/L threshold were recorded in 53 samples (10.54%). Operational indicators varied, with median values of 31.0 days for reporting delay (RD), 14.5 days from notification to first sampling (TTF), 47.5 days from symptom onset to first sampling (TDS), and 67.0 days from symptom onset to first laboratory result (OELR). These findings support documenting response delays, strengthening inspector capacity and cross-regional coordination, and integrating microbiological results with operational indicators for timelier source attribution, faster reporting, and TALD public health action.

Abstract: Introduction: Extreme weather events are increasing in frequency and intensity due to climate change, contributing to substantial morbidity and mortality globally, particularly among vulnerable populations. In the UK, climate adaptation within health systems remains insufficiently developed. However, there is limited understanding of the tools currently available for the identification and management of populations at risk during extreme weather. This study aims to systematically characterise UK-based climate adaptation tools used in healthcare settings. Methods: Environmental scanning was conducted, because no centralised database exists for climate adaptation tools in healthcare, and many relevant resources are not captured in traditional academic or grey literature repositories. Structured Google searching by two independent reviewers enabled identification of publicly available and practice-oriented tools accessed in real-world settings. Eligible resources included UK-based tools designed for healthcare professionals, local authorities, or patients that incorporate meteorological data to mitigate climate-related health risks. Results: Nine tools met inclusion criteria, comprising e-learning platforms, online dashboards, integrated clinical software, and structured workflows. Most targeted healthcare professionals, with few targeting local authorities and none targeting patient self-management. Data inputs and outcomes measures were heterogeneous, spanning risks related to heat, cold, flooding, and air pollution. Reporting was inconsistent, as nearly half the tools were not publicly accessible and all demonstrated limited transparency. Conclusion: The current landscape of UK climate adaptation tools in healthcare is fragmented, with variability in accessibility, evidence, and scope. Clearer reporting and greater coordination in how such tools are catalogued may support more consistent and equitable responses to climate-related health risks.

Abstract: Auto rickshaw drivers face significant occupational health risks due to prolonged sedentary behaviour, poor ergonomics, and exposure to environmental pollutants, yet systematic longitudinal assessments of their health deterioration remain scarce. We conducted a cross-sectional study involving 102 auto rickshaw drivers in Agartala, India, to evaluate longitudinal trends in mapping Eco-health inequities in the urban informal sector. This study conducted a cross-sectional survey of 102 auto-rickshaw service provider in the urban informal sector of Agartala, to assess and mapping of health inequalities. This study was involving body mass index (BMI), vital capacity and scoliosis prevalence. Participants/Samples were selected via/through incidental convenience sampling and data were collected through/following structured interviews, anthropometric measurements, spirometry, and spinal curvature assessments using a baseline inclinometer. The results revealed a concerning trend of increasing BMI with driving tenure, rising from 25.1±3.03 for drivers with 0–9 years of experience to 29.36±2.94 for those with ≥20 years, indicating a high prevalence of overweight and obesity. Moreover, vital capacity declined from 3.3±0.49 litres in novice drivers to 3.2±0.61 litres in veterans, suggesting a decline in respiratory function over time. Scoliosis was prevalent in 91% of participants, with 74% showing severe curvature (≥5°), and lateral deviations were predominantly left-sided (55.72% cervical, 70% thoracic, 64.29% lumbar), likely due to asymmetric driving postures. These findings highlight the cumulative health deterioration associated with prolonged occupational exposure, emphasising the urgent need for ergonomic interventions and lifestyle modifications. The study also provides novel longitudinal insights into the health challenges faced by auto rickshaw drivers, laying the foundation for targeted public health strategies to mitigate occupational hazards and improve their overall well-being. The study also provides novel longitudinal insights into the health challenges faced by auto rickshaw drivers. Findings suggested the inclusive foundation for targeted public health strategies to mitigate occupational health hazards and improve their overall well-being.

Abstract: The AMA Guides to the Evaluation of Permanent Impairment; Sixth Edition have undergone a substantial transformation from a static publication to a continuously refined digital resource. This transition reflects both the rapid evolution of medical knowledge and longstanding concerns regarding the usability and reproducibility of impairment ratings. Central to this transformation was the establishment of the AMA Guides Editorial Panel in 2019, which introduced a structured, evidence-based framework for iterative revision. This review examines the development of AMA Guides Digital, the governance and methodological contributions of the Editorial Panel, and major system-specific refinements, with particular emphasis on the Nervous System chapter in 2023, the Musculoskeletal chapters in 2024, and the Pulmonary chapter in 2025. These developments demonstrate a shift toward transparency, methodological rigor, and alignment with contemporary clinical practice while maintaining continuity with the foundational principles of the Sixth Edition.

Abstract: People with disabilities face disproportionate climate-related risks, yet disability is rarely incorporated into composite climate vulnerability indices. To date, no exiting index — at any geographic scale — incorporates disability as a primary dimension. This study develops the Disability-Inclusive Climate Vulnerability (DICLIV) Index for Chile’s 16 regions, integrating four dimensions: disability and dependency vulnerability (D1), climate hazards and exposure (D2), adaptive capacity (D3), and resilience and response capacity (D4). Seventeen indicators were selected from Chilean regional data sources. A sensitivity analysis assessed the contribution of the disability dimension by re-estimating the index, excluding D1. Findings reveal a distinct south-central vulnerability cluster — Ñuble (0.391), Biobío (0.350), and the Metropolitan Region (0.318) — driven by high disability prevalence, climate hazard exposure, and limited adaptive capacity. Atacama (0.115) ranked least vulnerable, despite its harsh desert environment, reflecting low population density and stronger adaptive capacity. When D1 was excluded, the gap between the first and third-ranked region narrowed, confirming that disability indicators sharpen, but do not create a different geography of climate vulnerability. The DICLIV is the first composite index to treat disability as a core dimension, supporting disability-inclusive climate adaptation aligned with the UN Convention on the Rights of Persons with Disabilities and the Sendai Framework.

Abstract: Zucchelli and Smith described a biomathematical fatigue model for recreational passage-making — the Integrated Fatigue Model (IFM) — with output expressed as a blood-alcohol-concentration (BAC) equivalence anchored on Dawson and Reid (1997). The IFM reproduces the dose-response using simpler linear extrapolations for multi-day fatigue accumulation and a simpler pre-departure accounting; Zucchelli and Smith calibrated and validated the IFM primarily on passages of two days or less. This paper extends the scientific treatment to multi-day offshore passage-making: transits of 48 hours and longer, non-rested departures, and short-handed watch-rotation choices. The engine is rebuilt on the McCauley–Ramakrishnan unified model — a two-state framework with fast homeostatic S and slow allostatic L — and recalibrated against the Dawson–Reid 17 h / 24 h anchors so the BAC output is preserved. Maritime tuning combines sea-state and fragmentation effects multiplicatively on the sleep time constant, yielding effective τ_s from 4.9 h (calm + deep at sea) to 25.5 h (storm + fragmented); the 4.2 h shore-laboratory baseline is not reachable at sea in the current calibration. A combinatorial consequence — the circadian-burden-distribution property of crew-rotation cycles whose length is coprime with the crew size — formalises the effectiveness of the Swedish watch system.