Lebanese American University

• New carbon policy is introduced to agricultural contexts with limited MRV capacity. • DEA is used to classify farms by carbon-equivalent performance and efficiency levels. • A cooperative Nash game is developed to model group-level adoption of the policy. • A hybrid metaheuristic–gradient based optimization computes stable Nash equilibria. • A Türkiye maize case is presented to demonstrate policy impacts and feasibility. Effective agricultural carbon policy requires reliable monitoring and frameworks that consider efficiency, welfare, and adoption. Although monitoring systems are typically stronger in developed countries, they are costly to maintain, whereas in developing countries they are often limited or insufficient. We hypothesize that a performance-based carbon policy integrated with welfare and farm decision behavior improves suitability for heterogeneous agricultural settings under limited emissions data. This paper proposes a Forward-Looking Cooperative Cap-and-Trade Carbon Pricing (FCTCP), policy that assesses farms’ carbon performance using carbon-equivalent resource, operational, and agrochemical inputs instead of direct carbon emission data, while integrating farm-level decision-making, cooperative carbon trading, and a welfare indicator aligned with emission performance. In this framework, farms are classified using Data Envelopment Analysis into efficient, near-efficient, and inefficient categories, and their policy participation is modeled through a cooperative Nash game. Nonlinear strategic interactions are solved using a hybrid optimization scheme consisting of four metaheuristic algorithms, including Particle Swarm Optimization, Artificial Bee Colony, Grey Wolf Optimizer, and Genetic Algorithm, and a nonlinear quasi-Newton optimization method, L-BFGS-B, to identify robust Nash equilibria. A case study of 104 maize farms in Türkiye shows green welfare improvements of 9.65% for near-efficient farms and 15.23% for inefficient farms while achieving the low-carbon benchmark. Key determinants of adoption include efficiency-based caps, asymmetric trading rules, and carbon exchange without discounting. The results demonstrate that FCTCP is a practical, welfare-linked, and forward-looking policy mechanism capable of guiding early-stage carbon transitions in agricultural systems lacking mature carbon monitoring infrastructure.

Health-related quality of life (HRQoL) is a central outcome in epilepsy care, but existing tools are either lengthy, too brief, or lack sensitivity to epilepsy-specific concerns. This study developed and validated the 15-item Quality of Life in Epilepsy Scale (QOLIE-15) and examined sociodemographic, socioeconomic, clinical, and psychosocial determinants of HRQoL. A cross-sectional study was conducted among adult patients with epilepsy recruited from community pharmacies and a primary healthcare center. Participants completed the QOL assessment alongside established measures of medication adherence, adverse events, cognition, anxiety, and stigma. The dataset was randomly split for exploratory and confirmatory factor analysis (EFA and CFA). Reliability, convergent, concurrent, and criterion validity were assessed. Measurement invariance was tested across gender, seizure characteristics, and seizure control. Multivariable linear regression identified independent predictors of QOLIE-15 scores. The study included 649 patients. EFA supported a stable 5-factor structure, with sampling adequacy confirmed by KMO = 0.875 and Bartlett’s test (P < 0.001). CFA demonstrated excellent fit (CFI = 0.978, TLI = 0.972, RMSEA = 0.041, SRMR = 0.034). Internal consistency was high (α = 0.906, ω = 0.929). The QOLIE-15 correlated strongly with QOLIE-31 (r = 0.875) and showed excellent criterion validity, with a cut-off of 44.5 yielding sensitivity of 88.8% and specificity of 82.0%. Measurement invariance was established across key subgroups. In multivariable analysis, lower QOL was independently associated with uncontrolled seizures (B = − 1.53), adverse drug effects (B = − 0.10), stigma (B = − 0.38), cognitive complaints (B = − 0.28), anxiety (B = − 0.52), and higher household crowding (B = − 0.77). The QOLIE-15 is a valid, reliable, and practical instrument capturing epilepsy-specific HRQoL. It balances brevity with multidimensionality, and its invariance and robust psychometric properties support application in clinical practice and research. Independent determinants highlight the importance of addressing seizure control, treatment tolerability, stigma, cognition, and anxiety in epilepsy care.

Abstract Objectives To assess how often adult spinal deformity (ASD) surgery achieves preoperative sagittal alignment goals, whether corrections are durable, and the impact of planning frameworks and enabling technologies. Methods A PRISMA-guided search of MEDLINE, EMBASE, Web of Science, Cochrane Library, and Scopus through June 2025 identified studies of adults undergoing ASD surgery where alignment targets were defined by numeric thresholds (for example SVA, PI–LL, PT), algorithmic frameworks (for example Roussouly, GAP), or technology-assisted modalities (for example virtual planning, patient-specific rods, robotics, custom implants). Outcomes included plan-to-achieved fidelity, durability, complications, and PROMs. Random-effects meta-analyses were performed when data were sufficiently homogeneous (SVA &amp;lt; 5 cm, PI–LL ≤10°, PT ≤20°). Results Fifteen studies (2006–2025) with ∼1980 patients were included. Cohort sizes ranged 15–608; mean age was 65 years (58–72) and 68% female. Mean follow-up was 20 months (immediate to 5 years). Most patients met early postoperative targets for SVA, PI–LL, and/or PT, though durability attenuated at longer follow-up. Algorithm-driven planning—especially restoration to a Roussouly-consistent profile—was associated with fewer mechanical complications. Technology-assisted approaches improved plan-to-achieved fidelity but showed inconsistent PROM gains. Study quality varied: small single-center series were higher risk, while larger prospective cohorts showed lower but heterogeneous risk. Conclusions ASD surgery often achieves sagittal targets initially, but long-term durability is variable. Algorithmic frameworks predict fewer complications, and enabling technologies improve fidelity without consistent PROM gains. Future studies should standardize goals, assess durability beyond two years, and link alignment fidelity to patient-centered outcomes and cost.