Search Results (7,986)

Background/Objectives: Complex chronic patients represent a heterogeneous and high-risk population, for whom accurate prognostic tools are essential to guide clinical decision-making, optimize resource allocation, and support tailored interventions. The PROFUND index was developed for mortality prediction in polypathological patients, but its performance has not yet been evaluated in an ambulatory integrated care model. Methods: A retrospective observational study was conducted using two cohorts. Cohort H included complex chronic patients admitted to the Internal Medicine Department between March 2023 and February 2024. Cohort A comprised complex chronic patients followed by a multidisciplinary chronic care program between November 2016 and December 2023. PROFUND scores were derived from electronic health records. Discrimination for 12-month mortality was assessed using Kaplan–Meier curves, log-rank tests, and receiver operating characteristic curve analysis. Calibration was evaluated by comparing observed mortality with expected mortality based on the original PROFUND index and improved through intercept and slope recalibration. Results: A total of 660 patients were included in cohort H and 540 in cohort A. One-year mortality was 38.0% and 30.2%, respectively. Discriminatory performance was good in hospitalized patients (AUC 0.760; 95% CI 0.724–0.797) and moderate to good in ambulatory patients (AUC 0.705; 95% CI 0.656–0.754). Calibration analyses demonstrated systematic overestimation of mortality, particularly in the ambulatory cohort and intermediate–high risk strata, while recalibration improved agreement between predicted and observed risks. Conclusions: The PROFUND index provides useful risk stratification for 12-month mortality in CCP across care settings but overestimates absolute risk, particularly in ambulatory case management populations. Local recalibration may improve prognostic accuracy, support individualized care planning, and advance care planning discussions and allocation of multidisciplinary follow-up intensity. Full article

The concept of architecturally mediated allostatic overload has established that chronic exposure to stress-inducing built environments can elicit stress responses within the body, overwhelming regulatory systems and contributing to adverse health outcomes through sustained activation of stress response pathways. Recent advances in epigenetics, combined with emerging evidence of environmental stress-induced epigenetic modifications, suggest that the health impacts of chronic built environment stress may extend far beyond previously understood physiological consequences. This paper introduces the theoretical concept of “built environment-modulated epigenetics” (BEME), extending the framework of architecturally mediated allostatic overload to consider how chronic exposure to stress-inducing built environments may create lasting epigenetic modifications with potential transgenerational implications. We propose that prolonged activation of the hypothalamic–pituitary–adrenal (HPA) and sympathetic-adreno-medullary (SAM) axes by built environment stressors may result in maladaptive DNA methylation and histone modifications affecting stress-responsive genes, similar to documented effects of environmental toxins, air pollution, and psychosocial stressors. Given robust evidence that environmental stressors can create transgenerational epigenetic effects, this theoretical framework suggests that stress-inducing built environments may impact not only current occupants, but future generations through heritable epigenetic modifications. This extension of architecturally mediated allostatic overload theory fundamentally challenges traditional approaches to architectural design and urban planning, positioning the built environment as a potential determinant of long-term epigenetic programming. Full article

Background/Objective: Transitioning towards plant-based dietary patterns is essential to improve health and reduce environmental impact. Hospitals represent a key setting to implement such dietary shifts, yet data on the availability of plant-based meals in healthcare institutions remain scarce. Methods: A cross-sectional survey was conducted across Dutch-speaking hospitals in Belgium to assess the meal plans and whether vegetarian or fully plant-based meal options were available for patients. Besides availability, the frequency and perceived barriers were assessed. Furthermore, the meal plans were analyzed to get an overview of the vegetarian and plant-based food options that were offered in different types of Belgian hospitals. Results: The availability of plant-based meal options was limited across hospitals. No meaningful differences were observed between general hospitals and other hospital types, including psychiatric, rehabilitation, and specialized hospitals. While plant-based fats and oils were widely available, key protein-rich plant foods such as legumes and minimally processed meat alternatives were rarely offered in all types of hospitals. Knowledge gaps among food service staff were observed, and structural barriers—including the need to accommodate diverse dietary requirements—were reported. Conclusions: Belgian hospitals currently underutilize the potential of vegetarian and plant-based nutrition to support patient health and sustainability goals. Strengthening institutional food environments by increasing the availability of nutritionally adequate plant-based meals represents a feasible and impactful strategy to align hospital practice with dietary guidelines and preventive healthcare priorities. Full article

With global warming and the increasing frequency of extreme heat events, heat health risk assessment (HHRA) has become a critical topic in climate change studies. However, the study themes, methods, and governance orientation of HHRA vary significantly across spatial scales, limiting the comparability and practical integration of assessment outcomes. This study conducts a review of the HHRA literature from 2007 to 2025, analyzing publication trends and evolving research paradigms. The results indicate the following: (1) rapid growth in the field with a notable shift from identifying static vulnerabilities to adopting “Hazard–Exposure–Vulnerability–Adaptability” (HEVA) frameworks, particularly at the micro-scale; (2) a clear scale-dependent hierarchy in assessment focus, where macro-scale studies identify regional trends, meso-scale research targets urban spatial heterogeneity and green–blue infrastructure, and micro-scale assessments emphasize housing conditions and individual perceptions; and (3) machine learning has been widely applied to capture complex nonlinear mechanisms and threshold effects. Finally, this study further emphasizes the importance of establishing a full-process feedback mechanism from macro-level early warning to meso-scale planning and micro-scale intervention, bridging the gap between regional policy and community-level action and providing a theoretical foundation for building climate-resilient cities. Full article

Evapotranspiration (ET) is a fundamental process within the water cycle and the agricultural water balance, optimizing resource allocation, maintaining soil health, and enhancing ecosystem resilience to climate change. Because ET represents a primary consumptive use of irrigation on agricultural lands, enhancing water-use efficiency and sustainable water management requires accurate estimation of evapotranspiration to support long-term sustainability and productivity. This study offers an effective means to visualize spatial and temporal patterns of reference evapotranspiration (ETo) across various vegetation management practices. This study examined the impacts of agroforestry buffers (ABs), grass buffers (GBs), biofuel crops in an agroforestry watershed (BCa), and biofuel crops in a grass buffer watershed (BCg) on ETo, compared to a corn (Zea mays L.)–soybean (Glycine max L.) rotation (RC) for claypan soil in Northern Missouri, USA. The experimental watersheds were located at the Greenley Memorial Research Center, Missouri, USA. Campbell Scientific sensors and Photosynthetically Active Radiation (PAR) smart sensors were installed to measure net radiation, anemometers, humidity, and air temperature. All instruments were mounted on masts at a height of 2 m above ground level in crop, tree, grass, and biofuel areas. Measured meteorological data were recorded hourly from April to October during 2017 and 2018. Daily ETo predictions were calculated using the Penman–Monteith model. These ETo predictions were displayed across the landscape using Python-based GIS for selected dates (each Saturday) for the watersheds. The methodology was implemented using the software programs of Python 2.7.10 and ArcGIS 10.3.1. The results indicated that ETo increased by 11%, 17%, 18%, and 25% in 2017, and by 7%, 9%, 14%, and 20% in 2018 for AB, BCa, BCg, and GB, respectively, compared to RC management. This process may improve soil water recharge in perennial management systems. Accurate estimation of ET in agricultural regions is critical for understanding water balance, hydrological and ecosystem processes, and climate variability. Given that agriculture constitutes the majority of global water consumption, precise ET estimation is particularly significant for sustainable water management, especially in regions experiencing water scarcity. These outcomes may support effective planning and management of agricultural water resources by enabling optimized irrigation and agricultural production. Full article

This article examines how kindness can be understood, expressed and enacted through intercultural citizenship education in higher education, with particular attention to equity, diversity and inclusion (EDI). Situated within a theoretical framework that brings together intercultural citizenship and EDI, the study argues that these fields are mutually reinforcing and that their integration is enriched by foregrounding kindness. Empirically, the article reports on a qualitative multiple case study conducted in 2023, involving university students from Argentina and the United Kingdom who collaboratively designed English language teaching materials focused on kindness. Data consisted of student-generated textual and artistic artefacts, including lesson plans, teachers’ notes, drawings, comics and other teaching materials, which were analysed using a multimodal approach. Across cases, kindness functioned as a relational disposition, ethical compass, emotional anchor and intentional action, serving as a pedagogical response to issues of gender inequality, mental health and disability inclusion. The study argues that a structured grammar of intercultural kindness offers a vocabulary that makes visible the relational, ethical, emotional and action-oriented dimensions through which kindness shapes the pedagogical enactment of intercultural citizenship and EDI. This approach demonstrates that kindness can be taught; however, its transformative potential depends on a deliberate political orientation. Full article

Free-floating bike-sharing (FFBS) systems play a valuable role in alleviating traffic congestion and reducing carbon emissions, making them vital to sustainable urban transportation. Although extensive research has investigated the relationship between the built environment and cycling behavior, the adverse effects of air pollution and its interaction with the built environment remain insufficiently understood. In this study, multisource data from Shenzhen are used, and an XGBoost–SHAP model is employed to comprehensively investigate the nonlinear associations among the FFBS trip volume, built environment, and air pollution while considering the spatial heterogeneity in interaction effects. The results indicate that population density, road density, building density, and PM2.5 are the most influential factors. In addition, significant temporal heterogeneity is observed between weekdays and weekends. The effects of the built environment variables and their interactions are more pronounced on weekdays than on weekends. More importantly, an interaction analysis reveals that the positive influence of compact urban development on cycling is conditional: in high-density areas with elevated pollution exposure, the health risks associated with air pollution can offset or even outweigh the mobility benefits of compactness. Overall, this study identifies the complex, spatially heterogeneous mechanisms through which the built environment and air quality jointly shape FFBS usage. These findings provide important evidence for integrating environmental health considerations into compact city planning and offer practical insights for promoting cycling and sustainable urban mobility in high-density cities. Full article

The presence of vegetation in urban green areas is a factor that helps minimize urban environmental and human health problems. This study aimed to analyze the effect of different vegetation types and tree densities in green areas on thermal comfort and outdoor wind speed in a city with a tropical savanna climate. Computer simulations were used with the ENVI-Met software (version 5.1.1envi), with hypothetical scenarios where central green areas present different tree species defined by the Leaf Area Index (LAI), forming compositions calculated by different Vegetation Cover Indices (VCI). The results showed that scenarios with dense canopy tree vegetation (combined or not with sparse canopy species) and scenarios with the highest vegetation cover densities showed the greatest reductions in Physiological Equivalent Temperature (PET) values, while wind speed did not show a simple direct correlation with PET, although a diurnal relationship with the analyzed densities was observed. In light of the above, it was found that promoting thermal comfort outdoors requires prioritizing the maximization of vegetation cover so as not to create physical barriers to wind flow, especially in the afternoon. Full article

Introduction: Navigated transcranial magnetic stimulation (nTMS) is an advanced, noninvasive method for stimulation-based functional brain mapping. Its main clinical value in neurosurgery lies in preoperative identification of eloquent cortical areas and the integration of functional information into neuronavigation-based surgical planning. State of the Art: This narrative review with a structured literature search summarizes the historical and technical foundations of TMS/nTMS, but primarily focuses on neurosurgical applications, including motor and language mapping, comparison with functional MRI and direct cortical stimulation, safety considerations, and practical limitations. Broader neurological and therapeutic applications are discussed as contextual extensions rather than as a comprehensive disease-specific review. Clinical Implications: Current evidence is strongest for preoperative motor mapping in patients with tumors located in or near the motor–eloquent cortex. Language mapping, neurological diagnostics, and therapeutic repetitive TMS (rTMS) applications remain more heterogeneous and require careful interpretation according to the level of evidence, protocol standardization, and patient selection. Future Directions: Further multicenter studies, standardized mapping protocols, integration with advanced imaging and tractography, and health-system implementation strategies are needed to define the optimal role of nTMS in personalized neurosurgical and neurological care. Full article

Adverse Childhood Experiences (ACEs), which encompass a broad range of adverse events during childhood, are prevalent in rural China. However, help-seeking among adults with ACEs remains limited and underexplored. This study aims to examine the barriers to help-seeking behaviors among adults with ACEs in rural China. Qualitative interviews were conducted with 20 adults affected by ACEs in rural mainland China between October 2024 and December 2024. Data were collected through semi-structured interviews in Mandarin, and transcripts were analyzed using the Theory of Planned Behavior (TPB) framework, focusing on behavioral beliefs, normative beliefs, and perceived behavioral control. The findings reveal barriers to help-seeking among individuals with ACEs in rural China, categorized into three key dimensions: (1) Behavioral Beliefs: Beliefs that corporal punishment is the responsibility as well as love of parents, and misconceptions attributing ACEs to personal faults significantly hindered help-seeking. (2) Normative Beliefs: Respect for parental authority in China culture context hinder help-seeking for adults with ACEs. Moreover, gender differences were evident, with men avoiding help-seeking due to perceived shame, while women were more likely to confide in friends and family. Finally, stigmatization of mental health services further inhibited help-seeking behaviors. (3) Perceived Behavioral Control: The lack of formal and informal support systems in rural areas exacerbated the issue, highlighting significant gaps in resource accessibility and cultural acceptance of mental health support. Addressing these barriers through public education, destigmatization of mental health services, and improved resource allocation could facilitate help-seeking behaviors and improve outcomes for individuals affected by ACEs. Full article

Intimate partner violence (IPV) is a significant global public health issue that requires accessible, scalable, and contextually appropriate interventions. Mobile health (mHealth) technologies provide a promising platform to deliver support, information, and safety planning tools for individuals at risk of IPV. This study aimed to develop and pilot-test iCanPlan, a mobile application designed to support IPV prevention in Thailand. The application evaluates IPV risk, identifies indicators of danger, and provides a countrywide list of assistance sources. iCanPlan consists of four main components: (1) an IPV risk assessment tool, (2) a list of support resources, (3) educational materials presented in the form of infographics, and (4) encouraging quotes from well-known public figures. The app features a clean, user-friendly interface with intuitive navigation and color-coded components to enhance usability. In addition, a preliminary study was conducted with 30 experts from multidisciplinary fields, including gender-based violence research, social work, psychology, public health, and non-governmental organizations. Participants used the application for one month and subsequently evaluated it using a structured questionnaire based on heuristic evaluation principles. The questionnaire assessed usability, safety features, content quality, cultural appropriateness, language clarity, ethical considerations, and overall evaluation using a five-point Likert scale. Data was analyzed using descriptive statistics (mean and standard deviation) in SPSS. The findings demonstrated excellent performance across all domains, with high mean scores for usability (M = 4.93), safety features (M = 4.73), and content quality (M = 4.82), while cultural appropriateness, language clarity, ethical considerations, and overall evaluation achieved perfect scores (M = 5.00). These results indicate strong agreement among experts regarding the application’s usability, safety, and relevance. The study highlights the potential of iCanPlan as a culturally appropriate and user-friendly digital intervention for IPV prevention. Further research involving the target population is needed to evaluate its effectiveness and long-term impact on help-seeking behavior and IPV-related outcomes. Full article

This Editorial introduces the Special Issue “Spatial Planning and Land-Use Management: 2nd Edition” and discusses the eight articles published in it. Taken together, these contributions demonstrate that contemporary spatial planning and land-use management can no longer be understood as narrowly regulatory or sector-specific activities. Rather, they must be approached as integrative and adaptive practices capable of mediating between ecological integrity, territorial cohesion, infrastructure provision, social justice, public health, and participatory governance. The Special Issue brings together case studies from China, the United States, Australia, Iran, Portugal, Slovakia, and Belgium, as well as comparative evidence from peri-urban landscapes, and spans a wide range of spatial scales, from neighbourhoods and urban forests to metropolitan green belts, urban agglomerations, peri-urban territories, and ecoregions. Several major lines of inquiry emerge across the volume. First, the articles reaffirm the need for multiscale planning frameworks able to connect local action with regional and supra-regional structures. Second, they broaden the understanding of infrastructure by including not only transport and urban facilities, but also ecological, green, and even nocturnal infrastructures. Third, they show that many of today’s most difficult planning questions arise in spaces of transition and overlap, especially peri-urban areas, where conflicts among land uses, ecosystem services, development pressures, and governance arrangements become particularly acute across sectors and across spatial and temporal scales. Fourth, they underline that planning effectiveness increasingly depends on participation, co-design, and cooperation among diverse actors, including civic initiatives and local communities. Overall, the Special Issue highlights spatial planning as a strategic field of action through which societies can address land-use conflicts, reconcile environmental and social objectives, and design more sustainable, resilient, and liveable territories. Full article

Bangladesh is an extremely climate-exposed country, with erosion, accretion, tidal surges, and cyclones continuously modifying coastal districts. Shoreline change in Bangladesh is crucial for sustainable coastal management and disaster resilience. Therefore, the objectives of this research are as follows: (i) to assess accretion- and erosion-based shoreline changes of the Bangladesh delta adjacent to the Bay of Bengal for 2021–2025 using a fixed 2021 reference shoreline and a 2025 shoreline proxy extracted from Landsat 8/9 imagery, and (ii) to explore onshore change dynamics from satellite-derived NDVI, NDBI, and NDWI for 2022–2025. The study covers 14 coastal districts and integrates the 2021 baseline shoreline, Survey of Bangladesh geospatial datasets, and 17,055 Ground Reference Points (GRPs) to support geometric consistency and spatially explicit reporting at the delta scale. Three spectral indices—Normalized Difference Vegetation Index (NDVI), Normalized Difference Water Index (NDWI), and Normalized Difference Built-up Index (NDBI)—were applied to assess vegetation health, surface water distribution, and built-up/exposed land characteristics. Results indicate spatial variability in coastal change, with 383.49 km² of land gained through accretion and 124.12 km² lost to erosion, resulting in a neat accretion of 259.37 km² between 2021 and 2025; 8747.91 km² remained geomorphologically stable. Spectral index trends show minimal inter-annual NDVI and NDWI variability, suggesting stable vegetation cover and no long-term expansion of surface water. In contrast, a slight increase in NDBI indicates localized exposure of new sediments or small-scale land-use transitions along emerging coastal zones. Spearman correlation analysis highlights consistent negative relationships between NDVI and NDWI and moderate contrasts between NDVI and NDBI, reinforcing the coexistence of vegetation recovery, water withdrawal, and sediment-driven land emergence. The novelty of this study lies in the provision of consistent, near-real-time coastal change inventory for the full ~710 km Bangladesh delta coastline by combining a common 2021 baseline shoreline with harmonized Landsat 8/9 OLI surface reflectance (2022–2025) and linked onshore spectral-index dynamics over the same period. Overall, this short-term assessment reveals a sedimentary system that is active but balanced, with accretion surpassing erosion despite cyclone-affected disturbances, underscoring the value of operational satellite monitoring for coastal management, hazard preparedness, and climate-adaptive planning. Full article

In response to inherent occupational and operational stress in public safety personnel (PSP), multiple policies and interventions have been implemented, often with sparse or low-quality research. The National Standard of Canada for Psychological Health and Safety in the Workplace (the Standard) is a comprehensive framework aimed at promoting mental health and preventing psychological harm in Canadian workplaces. This longitudinal multiple-cohort implementation science project describes mental health strategies implemented and associated organizational outcomes across five PSP organizations implementing change within the standard framework. Data were collected at two levels over a three-year span from the five public safety organizations that identified priority areas for improvement within the Standard based on local data and consultations. The organization selected and implemented a range of proactive mental health interventions, including resiliency training. Individual pre-post surveys assessed a variety of mental health disorders and work-related items. Annual organizational data included sick leave hours and extended health benefits for psychological services. Survey responses were aggregated at the organizational level. Rank-based correlation analyses (Kendall’s tau) described associations among occupational stress, work engagement, stigma, and organizational indicators. Organizations demonstrated multiple indicators of progress in meeting the Standard. Post-mental health symptom scores were positively correlated with extended health costs. Higher organizational stress scores were associated with higher extended health costs (psychological) (τ = 1.0 at pre-intervention; 0.67 post-intervention). Positive changes in organizational stress scores and higher engagement scores over the implementation process were both associated with lower average extended health costs (τ = 1.0/−1.0 respectively). Resilience scores were inversely related to health costs (τ = −0.67), consistent with the protective role of resilience. The Standard can serve as a framework for improving workplace health and safety when integrated with multi-modal action plans and structured resilience programs. Full article

Background/Objectives: Patients awaiting total hip arthroplasty (THA) may have a preoperative period for home-based exercise. However, the benefit of prehabilitation may depend on programme completion. This study assessed the association between compliance with home-based prehabilitation and postoperative course after THA, particularly hospital stay and self-assessed health status at discharge, and explored associations between compliance and changes in clinical and functional outcomes. Methods: In this prospective single-centre observational cohort pilot study, 40 adults scheduled for elective THA were included in a planned 60-day home-based prehabilitation programme as standard preoperative care. Assessments were performed before prehabilitation, preoperatively, and at discharge. Compliance was recorded using a daily checklist and expressed as a compliance index. Associations were analysed using non-parametric tests and Spearman correlation. Results: Median compliance index was 32.41%. Higher compliance was observed in participants reporting improvement or marked improvement at discharge than in those reporting slight improvement or no improvement (p = 0.0076). Compliance was inversely correlated with postoperative length of stay, median 6 days (rho = −0.593, p < 0.001). Compliance was lower in participants who reported pain during exercise (p = 0.0127). No significant associations were found between compliance and postoperative symptoms or changes in hip muscle strength, mechanical muscle properties, pain intensity, or functional test performance between baseline and preoperative assessments. Conclusions: Greater compliance with home-based prehabilitation was associated with shorter postoperative hospitalization and more favorable self-assessed health status at discharge. These findings support strategies to improve programme completion and minimize exercise-related pain. Full article