Search Results (8,513)

Background: Healthcare systems contribute significantly to environmental pollution, energy consumption, and resource depletion, making sustainability an increasingly important environmental and public health priority. Nurses, as frontline healthcare professionals, play a critical role in promoting environmentally responsible practices and advocating for sustainable healthcare within clinical settings. Objective: The study aimed to examine the associations between nurses’ sustainability consciousness, green advocacy, and work grit in hospital settings. Methods: A descriptive cross-sectional correlational study was conducted among 377 nurses working in two university-affiliated hospitals in Egypt. Data were collected using validated instruments assessing sustainability consciousness, green advocacy, and work grit. Descriptive statistics were calculated to summarize participant characteristics and study variables. Associations among sustainability consciousness, green advocacy, and work grit were examined using Pearson correlation analysis. Multiple linear regression analysis was conducted to identify significant predictors of green advocacy, while noting that the study design allows for identification of associations rather than causal relationships. Results: The findings indicated generally high levels of sustainability consciousness among nurses. Significant positive associations were observed between sustainability consciousness, green advocacy, and work grit (p < 0.01). Multiple linear regression analysis identified sustainability consciousness and work grit as significant predictors of green advocacy, explaining 34.2% of its variance. Conclusions: These findings highlight the interconnected roles of sustainability awareness, advocacy behaviors, and psychological resilience in promoting environmentally sustainable healthcare practices. Strengthening nurses’ sustainability consciousness and work grit may enhance green advocacy and contribute to the development of sustainable healthcare systems, supporting global environmental and public health goals aligned with the United Nations Sustainable Development Goals. Full article

Water scarcity and pollution from anthropogenic activities are major challenges, increasing the need for sustainable wastewater treatment solutions. Constructed wetlands mimic natural wetland ecosystems using macrophytes and substrates, representing a possible nature-based solution aligned with circular economy principles and the United Nations Sustainable Development Goals. So, this revision integrates recent literature, providing an overview of natural wetlands and examining the design and operation of constructed wetland systems. Also, incorporates a case study that focuses on a constructed wetland implemented at an eco-friendly dog shelter in Portugal—a unique example globally—demonstrating practical wastewater treatment and small-scale water reuse, and offering insights for sustainable management. Performance assessment based on previous work indicates that the system effectively reduces most water quality parameters to levels compliant with national and European irrigation standards. Removal efficiencies exceeded 97% for chemical oxygen demand, total suspended solids, and turbidity, while maintaining low energy consumption and minimal maintenance. Overall, constructed wetlands emerge as a sustainable alternative to conventional wastewater treatment systems; however, several challenges remain to be addressed. Future research should focus on improved aeration strategies, optimized substrate–macrophyte combinations, and long-term monitoring under climate variability, with floating wetlands offering promising opportunities to further enhance treatment efficiency. Full article

In the last decade, as cities increasingly seek sustainable development pathways within the cultural and creative economy, cultural-creative events have gained prominence as strategic instruments for urban transformation. Among them, city design weeks have emerged as complex service systems that connect creative industries, urban governance, and tourism development. This research aims to understand how cultural-creative events (represented by design weeks) facilitate sustainable tourism development from a service design perspective. Adopting a qualitative comparative research design, the study examines 30 design weeks selected through a cross-validated process with the World Design Weeks global network and UNESCO City of Design network. Data from 2020 to 2025 is collected primarily through expert interviews, official reports, and media materials in relation to the United Nations Sustainable Development Goals (SDGs). Grounded in the service design perspective, four Service Design Levels are summarized into 17 assessment dimensions, and experts applied Likert scale to evaluate the relative service intensity of each case. Through cross-case analysis, the findings reveal four distinct models of design weeks, reflecting different configurations of service intensity and strategic orientation. The study contributes theoretically by extending service design theory to cultural-creative tourism research, and practically by providing guidance for the organizers of cultural-creative events seeking to support sustainable city tourism development. Future research may incorporate quantitative impact assessments to further refine these models. Full article

Adverse childhood experiences (ACEs) are a public health concern in the United States. Using the 2019 National Survey of Children’s Health, this cross-sectional secondary analysis examined associations between cumulative ACEs (0, 1, 2, and 3 or more) and three health behaviors among children ages 6 to 17, including physical activity, recreational screen time, and sleep. Interaction models were also estimated by child sex and race/ethnicity (White non-Hispanic, Black non-Hispanic, and Hispanic) to assess whether these associations differed across groups. Nearly half of children experienced at least one ACE, and about one in eight experienced three or more. In adjusted models, higher numbers of ACEs were associated with a lower likelihood of meeting recreational screen time guidelines and sleep recommendations, while no statistically significant association was observed for meeting physical activity recommendations. Interaction analyses by child sex and race/ethnicity found no statistically significant differences in these associations across groups. These findings suggest that children with higher numbers of ACEs may be less likely to meet recommended sleep and recreational screen time guidelines, underscoring the potential value of trauma-informed strategies that strengthen sleep routines and healthy media practices. Full article

The ongoing substance use crisis in the United States involves a broad range of illicit and prescription drugs, including opioids, stimulants, sedatives, and various psychoactive and non-psychoactive compounds. Traditional surveillance methods rely on self-reported data, which could lead to bias and recall inconsistencies. Wastewater-based epidemiology has emerged as a powerful, non-invasive tool for monitoring community-level drug use, offering near real-time estimates and the potential to serve as an early warning system. However, challenges such as analyte degradation, wastewater variability, and matrix effects can affect data quality and comparability across regions. This study presents a standardized, practical workflow for multi-drug (n = 52) detection in wastewater, aiming to minimize analyte loss and improve reproducibility. Composite samples were collected from multiple U.S. cities, transported on ice, and extracted using solid-phase extraction. Extraction efficiencies were compared using Oasis Hydrophilic-Lipophilic-Balanced and Mixed-mode Cation-Exchange (MCX) cartridges, with the MCX sorbent providing complementary reversed-phase and cation-exchange interactions that enabled the retention of chemically diverse compounds across multiple drug classes. Analysis was performed with an Ultra-High-Performance Liquid Chromatography system coupled to a triple quadrupole mass spectrometer, in which the instrument parameters and critical methodological considerations, including sample handling, transport, column selection, and method validation, are detailed. This work contributes to the development of a robust, scalable protocol for multi-drug surveillance in wastewater, supporting timely, data-driven public health responses and informing national drug policy efforts. Full article

In this study, we examined cross-cultural interest in sustainable brands in Saudi Arabia and the United Kingdom in 2015–2025 as a dynamic proxy of consumer behavior and public awareness through the Google Trends tool. Due to the increasing significance of sustainability marketing as a part of environmental, social, and governance (ESG) strategies, the research focuses on the evolution of sustainability discourse as influenced by cultural environment, language, and policy frameworks. Sustainability-related search terms in English and Arabic were gathered in Google Trends monthly and aggregated to eliminate short-term variability and were compared through nonparametric Wilcoxon rank-sum tests and time-stability tests. The findings demonstrate that there is more stable and higher public interest in issues that relate to sustainability in the UK, which is an indicator of a well-established ESG and regulatory climate. Contrarily, Saudi Arabia shows a significant upsurge in search transactions on sustainability-related topics that occurred after 2018, when the country started implementing reforms to Vision 2030 and launched more environmental programs. The results indicate the importance of policy context and language in the formation of sustainability awareness and show the usefulness of Google Trends as a useful cross-national sustainability and marketing research tool. Full article

Driven by global sustainable development and intelligent technological innovation, the geotechnical engineering industry is transforming toward the direction of “Intelligent technology + Low-carbon circulation + Ecological friendliness”, creating an urgent demand for interdisciplinary talents with corresponding professional capabilities and sustainable awareness. To address the deficiencies in traditional postgraduate education (e.g., disjointed knowledge systems, inadequate practice oriented to Sustainable Geotechnical Engineering (SGE), and superficial integration of Education for Sustainable Development (ESD), this study constructs a “Four-Dimensional and Four-Stage” integrated talent training model based on the Sustainable Development Goals (SDGs) of the United Nations. Taking “Intelligent Technology—Geotechnical Theory—SGE Scenarios—ESD Literacy” as its core framework and adopting a progressive path of “Basic Cognition—Collaborative Application—Innovative Development—Sustainable Transformation”, this model was piloted among 23 postgraduate students through the course titled “Intelligent Design and Construction of Geotechnical Engineering”. The results show that all the students obtained officially granted software copyrights, their core professional capabilities were significantly improved, 100% of them applied their research achievements to SGE-related practices, and their ESD literacy was notably enhanced. Breaking through the traditional “knowledge-practice” dualistic framework of engineering education, this model achieves the in-depth integration of professional training and sustainable awareness cultivation and thus provides a replicable paradigm for the ESD education of interdisciplinary postgraduate students in the intelligent age. Full article

Hydrogen energy has emerged as a strategic pathway for decarbonization, industrial transformation, and energy security across major economies. This study does not directly evaluate ex post policy outcomes. Instead, it develops a Four-Dimensional Governance Framework to assess the structural effectiveness and implementation-oriented capacity embedded within national hydrogen policy frameworks. The analysis examines G20 countries through four dimensions, namely policy objectives, policy intensity, policy tools, and policy subjects. Using the entropy weighted TOPSIS method, the study compares the relative coherence of hydrogen governance architectures across countries. The results show that countries such as the United States, the United Kingdom, Germany, France, Canada and Japan consistently rank among the leading group in the comparative evaluation, while other countries occupy intermediate or lower positions according to the composite index results. Policy subjects and policy objectives receive relatively higher weights in the empirical analysis, indicating their stronger contribution to cross-national differentiation within the constructed index. The study provides a structured basis for comparing hydrogen governance frameworks and offers a replicable method for future research linking policy design to implementation evidence. Full article

The “Golden Triangle” area of the Kuitun River Basin is a typical arid irrigated region where limited surface-water supply and intensive groundwater abstraction have caused persistent groundwater decline and overexploitation. This study developed a one-way semi-loosely coupled GWAS–GMS/MODFLOW framework for allocation optimization, spatial projection, groundwater simulation, and effectiveness evaluation. An improved NSGA-II-S algorithm was used to optimize multi-source water allocation, and the resulting management-unit outputs were projected into MODFLOW source–sink terms using area-weighted transformation and mass conservation. GWAS satisfactorily reproduced monthly runoff at the Jiangjunmiao station, and GMS/MODFLOW reasonably matched observed groundwater heads at six national monitoring wells (R² = 0.952–0.998; RMSE = 0.15–0.355 m; MAE = 0.12–0.315 m). Three 2030 scenarios were compared: baseline, optimized allocation, and combined pumping restriction with allocation adjustment. Under the baseline scenario, groundwater storage remained in deficit. The optimized allocation scenario expanded the quasi-stable zone (−0.1 to 0.1 m/a), whereas the combined scenario most effectively suppressed severe decline hotspots, reducing the proportion of the −3 to −2 m/a zone from 11.22% to 2.68%. These results indicate that recharge reallocation and pumping restriction play complementary roles in groundwater overexploitation control. The framework provides a quantitative basis for coordinated multi-source water management in arid irrigated basins. Full article

This paper presents a comparative analysis of unconventional roundabouts, commonly referred to as third-generation roundabouts, based on case studies from the United States and Europe, specifically Croatia and Italy. These intersection designs deviate from traditional circular geometries to overcome limitations in safety, capacity, and spatial integration, especially in constrained or high-demand environments. The study focuses on three major typologies: raindrop, turbo, and two-geometry roundabouts (TGRs), examining their geometric characteristics, operational principles, and context-specific implementations. Based on real-world examples and qualitative assessments, each national section investigates design rationale and performance considerations in relation to local traffic dynamics. The paper contributes to the understanding of adaptive and context-sensitive intersection design, offering a conceptual framework for comparing unconventional roundabout typologies across different regulatory environments. The comparative analysis reveals that each typology responds to specific operational and spatial constraints rather than representing a universally optimal solution. In particular, raindrop and dog-bone roundabouts are most effective in interchange contexts, turbo roundabouts enhance safety and capacity in regulated multilane environments, while TGRs provide greater adaptability in constrained and irregular urban settings. These findings highlight the importance of context-dependent design strategies and support the need for flexible and context-sensitive evaluation frameworks. Full article

Background: Pediatric surgical care in Germany is delivered within a highly decentralized system, and training structures vary considerably between institutions. Adequate operative exposure is essential for competency-based training. The specialty requires a high number of operative procedures during training, yet concerns have been raised that residents may not achieve the required case numbers within the standard training period. The German Model Training Regulations (Musterweiterbildungsordnung, MWBO) define 22 procedural categories with specific case number targets for pediatric surgery. However, the extent to which current training structures allow for the fulfillment of these requirements remains unclear. This study examines the distribution of procedures and residents across different hospital types and estimates whether the available procedural volume may be sufficient under simplified allocation assumptions. Methods: We conducted a nationwide analysis of pediatric surgical training capacity in Germany using procedural data from hospital quality reports published by the Federal Joint Committee (Gemeinsamer Bundesausschuss, G-BA) between 2012 and 2023. A total of 3440 OPS codes were assigned to 22 training categories, and case volumes were analyzed across different hospital types. The estimated training capacity was calculated assuming even distribution of cases among residents, and that all eligible procedures are performed with full resident access. Results: Data from an average of 82.3 pediatric surgical departments per year were analyzed, including 29.7% university hospitals, 58.7% non-university departments, and 11.7% other institutions. Most departments reported fewer than five residents. Between 2012 and 2023, the mean number of residents increased slightly across all hospital types, while inpatient numbers declined. Consequently, inpatient exposure decreased from 469.8 to 354.0 cases per resident per year. Patient exposure differed significantly by institutional category (p < 0.001), with higher exposure in non-university departments compared with university hospitals. Across all hospital types, the mean number of fulfilled procedural training categories declined over time. No institution met the target numbers for all categories without cooperation with other units. Thoracic surgery procedures were least frequently covered, whereas appendectomies and inguinal hernia repairs were most consistently fulfilled. Distinct patterns of subspecialization emerged, with trauma procedures less frequently reported at university hospitals and thoracic procedures less frequently reported at non-university departments. Although the overall national procedural volume appears sufficient for most training requirements, low-volume and highly specialized procedures were concentrated at selected centers, limiting their accessibility for trainees. Conclusions: Even though there are sufficient pediatric surgical procedures in Germany, they are unevenly distributed between hospitals. Under a simplified allocation model, many pediatric surgical departments in Germany currently lack sufficient procedural volume to meet training requirements in the defined training timeframe for all trainees. Structural reforms—including mandatory national documentation, minor MWBO adjustments and the creation of training networks—are necessary to ensure comprehensive and equitable pediatric surgical education. Without these changes, extended training durations and reduced trainee satisfaction may contribute to workforce shortages and limit the future quality of pediatric surgical care in Germany. Full article

As the United Nations Sustainable Development Goals advance rapidly, grasping the development status and differences in carbon neutrality across China’s provincial regions is crucial for interpreting the regional collaborative governance pattern under the circular economy initiative and promoting responsible production and consumption transformation. This paper constructs a research framework for the comprehensive evaluation and collaborative strategy of carbon neutrality. Using the Entropy Weight-TOPSIS, K-means clustering, and obstacle factor diagnosis models, the development status of carbon neutrality in 30 Chinese provinces is revealed from the perspectives of green economy, green politics, green culture, green society, and green ecology. Regional differences and critical obstacle factors are identified. Guided by the “Five-sphere Integrated Plan,” this study refines the carbon neutrality evaluation framework and fills an existing gap in the literature regarding the diagnosis of heterogeneous obstacles. It provides empirical evidence for the coordinated advancement of carbon neutrality. We find that (1) China’s overall carbon neutrality capability is relatively weak, showing a spatial pattern of “high in the east and low in the west” and a Matthew effect of “the strong getting stronger and the weak getting weaker.” The development levels of the subsystems vary markedly, with excellent and underperforming subsystems coexisting across different provinces. (2) The 30 provinces are classified as comprehensive leading, balanced-developing, policy-economy dual-driven, ecology-driven, and potential-oriented. (3) Overall, the key obstacle factors are low-carbon transportation, technology, and philosophy, yet these factors vary across the groups. To foster collaborative carbon neutrality promotion, policies should be implemented in the future based on different characteristics. Full article

Sociotechnical imaginaries are collectively held and institutionally stabilised visions of desirable futures that link scientific and technological development with social and political order. Developed within Science and Technology Studies, the concept highlights the co-production of knowledge, technology, and governance, showing how ideas of progress are embedded in cultural values, moral assumptions, and political priorities. These imaginaries function as normative horizons that orient innovation, legitimise policy, shape regulation, and guide clinical practice. In health and biomedicine, sociotechnical imaginaries are particularly salient, as medical innovations directly affect life, death, and embodiment. Within medical sociology, the concept has been used to analyse how technologies such as assisted reproductive technologies (ARTs), genomics, regenerative medicine, and digital health are framed through narratives of hope, responsibility, risk, and transformation. These imaginaries shape what counts as legitimate knowledge, who accesses treatment, and how ethical debates are structured, from autonomy in ARTs to individualised care in precision medicine. Imaginaries are also shaped by national and institutional contexts. Comparative research shows that the United States, Europe, and East Asia produce distinct biomedical futures, reflecting different political traditions and governance models. As an analytical lens, sociotechnical imaginaries reveal health and biomedicine as domains where futures are imagined, contested, and enacted. Full article

This paper presents a holistic development model for South African schools that aims to ensure inclusive and equitable quality education and promote lifelong learning opportunities for all, as defined by the United Nation’s Sustainable Development Goal 4: Quality Education, by 2030. It addresses critical gaps in private secondary schools, including unclear performance objectives, inadequate monitoring, and limited data-driven decision-making. To meet these needs, the study proposes a new performance management model based on Kaplan and Norton’s balanced scorecard framework, combining four perspectives: Students, Academic excellence, Learning and growth, and Resources. Using a positivist approach, the model was validated by confirmatory factor analysis of 244 respondents across 12 private schools in Durban. The Comparative Fit Index, Normed Fit Index, and Tucker–Lewis Index confirmed its structural validity, while the Root Mean Square of Error Approximation indicated excellent absolute fit. Several intercorrelations emerged within the Learning and growth perspective, particularly regarding staff respect for students and their value to students. Implementation revealed an overall satisfactory performance rating of 3.85 on a 5-point scale. The Student perspective scored lowest (3.39), highlighting inadequate student preparation as a key issue, with learners’ pre-class reading of material scoring just 2.81. These findings underscore the model’s utility in identifying areas for improvement, particularly in student engagement, academic excellence, and organisational culture within the Learning and Growth dimension. Full article