Polytechnic Institute of Leiria

Economic geographers, industrial economists and innovation scholars have long debated the impact of agglomeration externalities on innovation, often with conflicting results. We argue that rather than focusing on which agglomeration externality most influences innovation, we should gain a deeper understanding of how agglomeration externalities influence innovation. Drawing on the concept of national systems of innovation (NSI), we examine the role of industrial diversity and domestic competition as contingency factors that affect the relationship between national innovation inputs and outputs. Using secondary data from 86 countries, we developed interaction models, and our findings indicate that industrial diversity positively influences the relationship between innovation inputs and outputs. Additionally, we found that the relationship between innovation inputs and outputs is strengthened at higher levels of diversity and competition. Also, the positive effects of institutions on innovation outputs increase with high industrial diversity and medium to high domestic competition. Similarly, the positive marginal effect of human capital and research on innovation outputs is strengthened by increasing industrial diversity, although a medium-low level of competition can undermine this effect. This study contributes to the ongoing debate on agglomeration externalities and the NSI literature by highlighting the role of industrial diversity and competition in shaping national innovation outcomes.

Despite substantial advances in cardiovascular pharmacotherapy and devices in recent years, prevention and treatment of many cardiovascular diseases (CVD) remain limited, thus reflecting the need for more effective and safer pharmacological strategies. In this review, we summarize the most relevant studies in cardiovascular pharmacotherapy in 2024, including the approval of first-in-class drugs for the treatment of resistant hypertension and pulmonary arterial hypertension, label expansions for bempedoic acid and semaglutide, and the results of major randomised clinical trials (RCTs) that have met the prespecified primary endpoints, thereby filling some gaps in knowledge and opening new perspectives in the management of CVD, and those RCTs whose results did not confirm the proposed research hypotheses. We also include a section on drug safety, where we describe the newest data on adverse reactions and drug-drug interactions that may complicate treatment and/or reduce drug adherence with the consequent decrease in drug effectiveness. Finally, we present the most important ongoing phase 2 and phase 3 clinical trials assessing the efficacy and safety of cardiovascular drugs for the prevention and treatment of CVD.

Introduction Forensic Odontology plays a crucial role in medicolegal identification by comparing dental evidence in antemortem (AM) and postmortem (PM) dental records, including orthopantomograms (OPGs). Due to the complexity and time-consuming nature of this process, imaging analysis optimization is an urgent matter. Convolutional neural networks (CNN) are promising artificial intelligence (AI) structures in Forensic Odontology for their efficiency and detail in image analysis, making them a valuable tool in medicolegal identification. Therefore, this study focused on the development of a CNN algorithm capable of comparing AM and PM dental evidence in OPGs for the medicolegal identification of unknown cadavers. Materials and methods The present study included a total sample of 1235 OPGs from 1050 patients from the Stomatology Department of Unidade Local de Saúde Santa Maria, aged 16 to 30 years. Two algorithms were developed, one for age classification and another for positive identification, based on the pre-trained model VGG16, and performance was evaluated through predictive metrics and heatmaps. Results Both developed models achieved a final accuracy of 85%, reflecting high overall performance. The age classification model performed better at classifying OPGs from individuals aged between 16 and 23 years, while the positive identification model was significantly better at identifying pairs of OPGs from different individuals. Conclusions The developed AI model is useful in the medicolegal identification of unknown cadavers, with advantage in mass disaster victim identification context, by comparing AM and PM dental evidence in OPGs of individuals aged 16 to 30 years.

Introduction Age estimation in forensic science plays a crucial role in determining legal and criminal responsibilities for living individuals. When the age of an individual is uncertain, a forensic age estimation examination is required, typically involving radiographic evaluation of bone and dental development. This study aimed to estimate and classify bone and dental ages in a Portuguese population aged 6 to 21 years, using the Baccetti and Moorrees, Fanning, and Hunt methods. The results were compared to chronological age and between methods for medico-legal purposes, utilizing lateral cephalograms and orthopantomograms. Materials and methods A total of 466 lateral cephalograms and 767 orthopantomograms were analyzed. Baccetti stages were assigned to the lateral cephalograms, and cephalometric analysis was performed using ImageJ® software. For orthopantomograms, each tooth in the third quadrant was assigned a stage based on the MFH method. Results and discussion Cohen’s weighted kappa coefficients were 0.987 (intra-observer) and 0.977 (inter-observer) for the Baccetti method. Moorrees, Fanning, and Hunt method validations ranged from 0.655 to 1.00. Correlation coefficients for dental and bone regressions were 0.894 and 0.907, with adjusted determination coefficients of 0.798 and 0.822, respectively. The dental regression underestimated age, unlike the bone regression. The methods’ accuracy and reliability varied based on the age being classified. Conclusions Both regressions accurately estimated age, but the dental method was more appropriate due to its tendency to underestimate, high precision and consistency of results. No significant differences were found between males and females, and both methods, dental and bone, may be used together to classify legal ages.

Background: Over the season, competitive swimmers experience a progressive imbalance in rotator cuff strength, predisposing them to a significant risk factor for a swimmer’s shoulder injury. Objectives: Verify the effectiveness of two 12-week preventive programs on the shoulder rotators’ peak torque and conventional/functional ratios. Design: A care provider- and participant-blinded, parallel, randomized controlled trial with three groups. Participants: Competitive swimmers aged 16 to 35 years with no prior clinical issues related to their shoulders. Interventions: Twice a week, over 12 weeks, the two experimental groups performed five exercises where the only difference was executing the program with weights or elastic bands, and the control group performed a sham intervention. Main outcome measures: The concentric and eccentric peak torque of the internal and external rotators of the dominant shoulder were assessed before and after the intervention using an isokinetic dynamometer Biodex System 3, at 60°/s, 120°/s, and 180°/s. Results: Among the experimental groups, only one test indicated a reduction (p ≤ 0.05) in rotator peak torque, while the control group showed a decrease (p ≤ 0.05) in five tests. Swimmers who completed the prevention programs demonstrated less imbalance in conventional/functional ratios than controls. Conclusions: Implementing a 12-week preventive program minimizes the progressive shoulder rotational imbalance over the season in competitive swimmers. Clinical Trial Registration number: NCT06552585.

Sea cucumbers: the sustainability of emergent and historical resources Sea cucumbers (Holothuroidea) are a class of echinoderms found worldwide from the intertidal to the deep sea, from the tropics to the poles, and on both hard-and soft-bottom substrates. They have a variety of important ecological roles including nutrient cycling, redistribution and oxygenation of surface sediments, enhancement of benthic habitat through excretion of inorganic nitrogen and phosphorus, and amelioration of local ocean acidification impacts on coral reefs. They are fished worldwide as human food and for their various nutraceutical and pharmacological properties. Unfortunately, the fisheries for many species have not been professionally managed, leading to overfishing and population declines across many regions of the globe. Aquaculture of a few species has been developed in order to bolster wild populations and for commercial sale to meet increasing market demand. That has led to increasing research on fisheries and aquaculture of previously unfished or underutilized sea cucumber species. The present Research Topic brings together a number of papers that address the utilization of various holothuroid resources, with goals of conservation and stock management of wild populations and increased production of cultured species. Understanding the fundamental principles of sea cucumber biology and their ecological processes is crucial to deal with important holothuroid resources. With that in mind, Liu et al. reviewed papers on the fundamental principles, functions, and characteristics associated with various molecular markers employed across a number of both temperate and tropical sea cucumber species. Those markers serve pivotal roles in terms of genetic sex identification, germplasm resource evaluation, population structure assessment, as well as marker-assisted breeding in sea cucumber farming. Prata and Christoffersen assessed the knowledge on Brazilian sea cucumbers over the last 20 years, revealing asymmetries in the conducted studies, either geographical or biased towards specific subjects (i.e. taxonomy and molecular analysis) or species (i.e. Holothuria (Halodeima) grisea). Despite the progress, the authors concluded that much more information is required-especially on topics such as morphological variations, genetic distances between populations, population Frontiers in Marine Science CITATION Fé lix PM, Pombo A, Rakaj A and Pearce CM (2025) Editorial: Sea cucumbers: the sustainability of emergent and historical resources.

The article analyses studies on the impact of the COVID-19 pandemic on outpatient services in a large hospital, aiming to provide insights for resource management amidst disruptive events. The objectives include identifying challenges and proposing solutions to optimize service delivery and address spatial constraints using discrete-event simulation. Utilizing a case study approach, the research employs simulation as a key methodology to analyse outpatient service scenarios. Scenarios are generated by combining different probabilities of patient return to check-in with various team parameterizations. The researchers analysed historical data and key performance indicators from the simulation. The study focuses on a collaborative approach with the hospital team to ensure the relevance and applicability of proposed solutions. The research identifies bottlenecks induced by social distancing measures, particularly in patient reception and check-in areas. Uneven service distribution throughout the day leads to a misallocation of resources and reduction of available physical space. Telemedicine emerges as a significant response, effectively addressing both service optimization and physicians’ workload despite spatial constraints. Additionally, the study underscores the role of simulation in crisis decision-making for hospital operations management. Practical applications emanating from the study emphasize the need for healthcare institutions to adopt adaptable strategies and leverage simulation tools for effective resource management during disruptive events. Hospital administrators can draw insights to inform resource reallocation and workflow optimization, with a focus on negotiating flexible scheduling and exploring telemedicine to enhance service delivery.

In the context of freshwater scarcity, effective water resource management is essential. This study explores techniques to optimise the use of local water sources and promote conservation, proposing a model to balance the supply and demand of non-potable water in urban environments. The model serves as an alternative or complement to public water supplies, particularly in drought-prone regions. Through a qualitative analysis of national and international regulations, specifications, and technical standards, this research identifies key trends in the use of alternative water sources and highlights knowledge gaps in urban water management, which are addressed through the proposed model. The study emphasises the transition from Nearly Zero Water Buildings (NZWBs) to Urban Water Communities (UWCs) as a sustainable and resilient solution, integrating decentralised water management approaches and resource recovery from wastewater. Additionally, a case study in a Portuguese urbanisation area illustrates the application of these principles and assesses their potential in real-world scenarios. The findings contribute to the development of comprehensive guidelines and public policies for sustainable urban water management, supporting the implementation of decentralised and integrated solutions that enhance resilience, water security, and resource efficiency.

Introduction Age estimation is vital in dentistry and legal contexts to determine minors’ criminal responsibility. This study aimed to estimate and classify bone and dental age in a Portuguese population, using the Greulich-Pyle method and the Moorrees Fanning and Hunt method, comparing the accuracy of both methods. Materials and methods 597 left hand and wrist radiographs and 184 orthopantomographs were selected, and the methods were applied. Results Cohen’s weighted kappa coefficient ranged between 0.890 and 1. Both methods underestimate age. The linear regression formulas showed strong correlations between estimated and real age (0.902 for bone age assessment and 0.894 for dental age assessment). For the bone assessment the accuracy is highest at 14 and 18 years, with similar values to those at 12 and 16. The AUC shows that the method is more reliable at 12 and 14 years. For the dental age assessment, a lower sensitivity value was observed for the age of 12 (73.91%) and a higher for 18 years (91.03%), increasing with age. The accuracy was higher at 12 years (89.62%) and lowest at 18 years (83.02%). Specificity values were higher for ages 12 and 14 (93.98% and 95.24%, respectively). The lowest AUC value was recorded for 18 years (0.889), while for ages 12, 14, and 16, the values were similar, indicating lower reliability for the legal age of 18. Conclusion For individuals under 12, 14, 16, and 18 years old, the bone method is the most effective. However, combining both methods allows greater accuracy and consistency in age estimation for medico-legal applications.

Perinatal depression (PND) refers to a complex mental health condition that can occur during pregnancy (prenatal period) or in the first year after childbirth (postnatal period). Prediction of PND holds considerable importance due to its significant role in safeguarding the mental health and overall well-being of both mothers and their infants. Unfortunately, PND is difficult to diagnose at an early stage and thus may elevate the risk of suicide during pregnancy. In addition, it contributes to the development of postnatal depressive disorders. Despite the gravity of the problem, the resources for developing and training AI models in this area remain limited. To this end, in this work, we have locally curated a novel dataset named PERI DEP using the Patient Health Questionnaire (PHQ-9), Edinburgh Postnatal Depression Scale (EPDS), and socio-demographic questionnaires. The dataset consists of 14,008 records of women who participated in the hospitals of Lahore and Gujranwala regions. We have used SMOTE and GAN oversampling for data augmentation on the training set to solve the class imbalance problem. Furthermore, we propose a novel deep-learning framework combining the recurrent neural networks (RNN) and long short-term memory (LSTM) architectures. The results indicate that our hybrid RNN-LSTM model with SMOTE augmentation achieves a higher accuracy of 95% with an F1 score of 96%. Our study reveals the prevalence rate of PND among women in Pakistan (73.1%) indicating the need to prioritize the prevention and intervention strategies to overcome this public health challenge.

Plain language summary Purpose: We research the social interaction between actors of the advisory board. We used a family holding company during the strategy formation process to explore the phenomenon. We used the theoretical lenses of Strategy-as-Practice (S-as-P) from the Structurationist perspective to analyze the strategic conduct of the social actors during the organizational structuration process. Design/methodology/approach: We performed non-participant observation, video and audio recording, in-depth interview and document content analysis to analyze 1 year of advisory board strategy formation meetings in a large family holding company. Findings: Results revealed the complexity and paradoxical social behavior (manipulation) that occurred during the practitioner’s meetings to the formation of strategies. We highlight the elements of structural properties in dimensions of practice and praxis reproduced through recursive actions of the practitioners during the social process of strategic formation. Originality: As a contribution, we present a model of four propositions that seek to direct future studies of S-as-P in advisory boards with the assumptions of Structuration Theory. Practical implications: The managerial contribution of this study was to identify and describe the gaps between the formal practices of organizational actors and their real social behavior during the structuration of the organizational process to make corporate dynamics clearer and more transparent since they often still appear obscure.

Cyber ranges have evolved into indispensable environments for training personnel in the field of cyber defense. A critical aspect of improving the authenticity of these simulations involves the use of traffic generators that accurately replicate real network traffic patterns. This article delves into the crucial role traffic generators play within cyber ranges, highlighting their pivotal contribution to equipping personnel with the skills needed to respond effectively to cyber threats. To address the modeling and validation of traffic generators in a comprehensive way, diverse approaches must be considered in cyber range training. To shed light on this topic, this review adopts a modified Scopus-based search methodology, providing in-depth insight into the methodologies and validation methods associated with traffic generator modeling and validation. The analysis showed that the traffic generators used for computer network security training purposes can be broadly categorized into three main methodologies: model-based, trace-based, and hybrid approaches. Each of these methodologies has its own set of applications, limitations, and advantages. These factors have a direct influence on the validation parameters associated with these methodologies.

3D (three-dimensional) food printing has emerged as a transformative technology, offering exceptional adaptability and customization across various industries. This review explores its potential to enhance environmental sustainability by minimizing food waste, improving portion control, and promoting eco-friendly practices. Key technological foundations, such as rheological assessments for material flow optimization, colorimetric analysis for accurate color representation, and advanced material handling techniques for consistent texture and nutrition, are critically examined. Moreover, it highlights the synergy between mechanical precision, algorithmic control, and material science, illustrating how these elements collectively ensure adherence to high-quality and safety standards in food engineering. The study also reviews 3D food printing technologies, methods, materials, and applications, emphasizing the pivotal role of customization in addressing diverse dietary, cultural, medical, and aerospace needs. A SWOT (strengths, weaknesses, opportunities, and threats) analysis evaluates the current capabilities and limitations of the technology, identifying challenges and future prospects. This comprehensive analysis underscores the potential of 3D food printing to revolutionize food production, offering valuable insights for researchers, practitioners, and policymakers.

This paper explores the application of Symbolic Regression (SR) to data derived from the Okumura propagation model for predicting path loss in wireless systems. Traditional machine learning techniques, such as artificial neural networks and support vector regression, lack the ability to provide mathematical expressions, limiting physical insights. In contrast, SR can generate analytical expressions, offering a more interpretable model. The study compares the SR-derived expression with the Hata model, which also originates from Okumura. Results indicate that the SR model achieves a better fit to the Okumura data, with a RMS error at least 2 dB smaller than that of the Hata model. This demonstrates the potential of SR in enhancing the accuracy and interpretability of path loss predictions.

This study builds upon the resource-based view (RBV) and uses the exploration–exploitation dichotomy to understand how these two different capabilities influence the Industry 4.0 (I4.0) adoption in small and medium-sized enterprises (SMEs). The microfoundations perspective and managerial cognition remain under-developed and under-theorized. In this study, we examine managers’ cognitive systems as a critical microfoundation. Specifically, we explore how these systems contribute to international organizational ambidexterity, which includes both exploration and exploitation. By employing structural equation modeling (SEM) on a sample of 116 internationalizing SMEs, the study demonstrates that managerial cognition is a significant microfoundation of international organizational ambidexterity in the context of I4.0 adoption. The findings also reveal that under early internationalization, neither international exploration nor exploitation has succeeded in creating new opportunities for SMEs to introduce a technology-based model. However, a post-hoc analysis revealed that for more experienced SMEs internationalizing earlier, international exploitation is more beneficial than international exploration to trigger the adoption of I4.0 technologies.

Featured Application Cost-effective strategy for accurately diagnosing and monitoring auditory pathologies through applied artificial intelligence methodologies. Additionally, the production of customized hearing aids tailored for various medical and non-medical applications, including but not limited to sports, music, and military use. Abstract In the current landscape of hearing rehabilitation, ear mold manufacturing typically involves the injection of silicone into the external ear canal (EEC) of each patient. This invasive procedure poses several risks, including the potential for silicone residue retention and tympanic membrane perforation, which may necessitate surgical intervention. To mitigate these risks, we present the design of a video otoscope that integrates a scanner capable of capturing high-precision, real-time images of the EEC’s geometry. The developed device allows (i) the generation of a 3D CAD model leading to the direct, quick, and low-cost production of customized hearing aids using 3D printing and (ii) the establishment of medical protocols for carrying out diagnoses and monitoring of hearing pathology evolution using methodologies based on Artificial Intelligence. Furthermore, the use of customized hearing aids that allow the application of Rhythmic Auditory Stimulation (RAS) and music therapy enhances audiology as an alternative and innovative way to treat cognitive and degenerative diseases, as well as pathological disorders.

Heat stress mitigation actions must be carefully planned in order to achieve effective outcomes. By integrating urban planning guidelines with urban climate knowledge, substantial benefits can be achieved for the community. In Lisbon, the study area, urban planning guidelines are strict in relation to the tree species which should be used for planting. This study examined these species environmental contributions to the community, especially in regard to heat stress mitigation in two urban canyons previously found as UTCI hotspots. For this, microclimatic Envi-met simulations were run which allowed recalculation of the UTCI hotspot analysis and to assess individual species contribution to possible mitigation efforts. Results demonstrated the ability of these trees to lower air temperature and the Universal Thermal Climate Index (UTCI). By reducing UTCI temperatures between 3.19 °C and 6.27 °C on a hot summer’s day, these trees were also able to transform an identified UTCI hotspot into a coldspot. From the studied species, Pyrus calleryana was found to be the most effective species for mitigating thermal stress, although all three species performed well. Regarding community services, according to the iTree tool, Cercis siliquastrum had the greatest overall impact. These results give to the municipal urban planning which tree species should be prioritized in terms of climate action, as well as a methodological framework to assess at local scale which areas should be intervened.

Background: Evidence indicates that pediatric burns are a significant form of trauma. They affect not only children but also their parents, who often experience short and long-term psychopathological symptoms. The body of knowledge on the impact of hospitalization on parents has expanded; however, there is a dearth of evidence on the dynamics of parental relationships, parental experiences, and how these experiences affect their parenting. Objectives: This study aims to map and summarize the available literature on the repercussions of trauma associated with pediatric burns and hospitalization on parental and family dynamics. Methods: A scoping review will be carried out in accordance with the JBI methodology, based on the PCC. Studies involving hospitalized children (up to the age of 18) who have suffered accidental burns and their parents or caregivers will be included. The literature study will examine the effects of pediatric burn-related trauma on family and parental dynamics, emphasizing interventions and adjustment strategies that support children and families affected by this injury. Studies related to hospital settings and returning home will be included and analyzed by two independent reviewers using a standardized form developed for this study. The databases consulted will be Academic Search Complete, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed/Medline, Collection of Psychology and Behavioral Sciences (via EBSCO), PsycInfo, Cochrane Library, Embase, and Web of Science (Clarivate). Results: The results will be summarized narratively, presented in tables or diagrams, to highlight key findings related to parental experiences with burned children, the trauma associated with this episode, and its impact on parenting. In addition, strategies developed within the framework of the care partnership will be highlighted. Conclusions: Understanding how family dynamics change after a child suffers a burn injury and goes through the hospitalization process is crucial for nurses to improve their practice. We hope that this review will promote partnership-oriented, family-centered nursing practice in the care of child burn victims and their families, as well as assist in the identification of knowledge gaps in the literature and potential areas for future research and development.