Malignant gastric outlet obstruction (MGOO) is a disabling complication of advanced gastrointestinal cancers, accounting for 50–80
Digital twins (DTs) have become key enablers of industrial digitalization by supporting real-time monitoring, predictive capabilities, and data-driven decision-making across manufacturing systems. Despite rapid technological advances, the literature still lacks structured and replicable approaches to assess DT quality and support acquisition and selection processes in industrial contexts. Existing studies tend to address isolated aspects (e.g., data accuracy, interoperability, cybersecurity), limiting comparability and reproducibility across applications. This study proposes a structured and decision-oriented DT quality evaluation framework for acquisition and selection contexts, defined as the first stage of a broader DT lifecycle validation perspective. The proposed approach organizes heterogeneous quality criteria into a coherent evaluation structure tailored to pre-deployment analysis in industrial environments. A hybrid multi-criteria decision-making (MCDM) approach combining the Analytic Hierarchy Process (AHP) and the Technique for Order Preference by Similarity to Ideal Solution (TOPSIS), implemented as TOPSIS-2N (two-step normalization), is applied to compute criteria weights and rank four generalized industrial DT platform categories (A₁–A₄). The framework comprises six core dimensions: accuracy of digital representation, interoperability, operational integration, data integrity and security, accessibility, and cost-effectiveness. The results show that combining hierarchical weighting with ideal-solution ranking provides a transparent and consistent prioritization of DT quality characteristics. In addition, the proposed approach enhances traceability between expert judgments, criteria weighting, and ranking outcomes, supporting industrial stakeholders in comparing and selecting DT solutions. The proposed framework addresses a relevant gap by providing a structured, decision-oriented, and reproducible approach to DT quality evaluation in industrial acquisition contexts.
Gastroesophageal reflux disease (GERD) is a common condition in children requiring surgical intervention when medical therapy fails. Nissen (total) and Toupet (partial) fundoplications are the most frequently performed antireflux procedures; however, their comparative effectiveness and safety in the pediatric population remain uncertain. A systematic literature search was conducted in PubMed, Embase, and Cochrane CENTRAL from database inception to 2025. Eligible studies included randomized controlled trials and observational studies comparing total and partial fundoplication in patients younger than 18 years with GERD. Pooled risk ratios (RR) with 95
With over 5 million attributed deaths per year, physical inactivity is a major global public health issue. Although the importance of physical activity is well recognized within the scope of obesity and cardiometabolic disease prevention and control, its broader benefits for the health of individuals and societies are yet to be fully harnessed. Furthermore, the role of active leisure, active transport and active labor-primary domains of physical activity-in supporting or hindering social and health equity has been largely overlooked. Here we (1) used a health equity lens to describe global domain-specific physical activity inequalities through an analysis of World Health Organization STEPwise approach to NCD risk factor surveillance (WHO STEPS) data from 68 countries; (2) summarized evidence linking physical activity with health outcomes beyond cardiometabolic disease, including immunity and infectious disease, depression and cancer; and (3) developed a new model reconceptualizing physical activity to better respond to 21st-century public health challenges. Our global, intersectional analysis of gender and socioeconomic physical activity inequalities revealed a 40-percentage-point gap in active leisure-the only domain consistently driven by choice-between historically privileged groups (wealthy men in high-income countries) and historically disadvantaged ones (poor women in low-income countries). Robust evidence supports the benefits of physical activity for immunity and infectious disease, depression and cancer. Our reconceptualized model recognizes the influence of social identities, norms, policies and structures on physical activity for health and wellbeing and emphasizes the urgent need to develop and roll out policies and programs that disseminate and harness the full benefits of physical activity for human, societal and planetary health.
This study explores the optimization of building envelopes to achieve Zero Energy Building (ZEB) performance in social housing located in humid subtropical climates. Using the BEopt simulation tool, multiple envelope configurations were generated and assessed based on energy demand, thermal comfort, and initial cost. The ELECTRE III multi-criteria decision method was applied to rank optimal solutions for three Brazilian bioclimatic zones. Results show that optimized envelopes can reduce air-conditioning energy consumption by up to 30%, increase comfort hours by 35%, and decrease the number of photovoltaic modules required to reach energy balance by one-third. The best-performing solutions combined moderate wall insulation, light-colored roofs and fa & ccedil;ades, controlled window-to-wall ratios, and predominantly south-facing orientations. These findings highlight the importance of coupling optimization algorithms with decision-support models to identify cost-effective and climate-responsive design strategies. The proposed approach provides a replicable framework for advancing energy-efficient and affordable housing in developing countries. The results are primarily applicable to humid subtropical (Cfa) climates, based on case studies located in three Brazilian bioclimatic zones within the state of Rio Grande do Sul.
