Search Results (6,650)

Life-cycle cost assessment has gained increasing relevance across sectors related to urban and building development. In real estate and public procurement decision-making, it offers a comprehensive view of property costs beyond the initial investment, which aligns with European Sustainable Development policies and new taxonomies in sustainable investment. Life-cycle cost assessment supports sustainable design decisions by integrating multiple perspectives and methodologies, including Whole Life Costing and Net Present Value calculations. This approach enables a comprehensive evaluation of long-term costs and benefits, assessing their impact on economic viability and profitability throughout the investment life cycle. However, several challenges persist in standardizing methodologies, developing comprehensive data inventories, and ensuring consistency in result interpretation. The absence of universally accepted frameworks and guidelines introduces additional limitations for practitioners, including estimation inaccuracies, biased assessments, unreliable probability judgments, and the neglect of indirect consequences in decision-making. This review particularly emphasizes the need for interdisciplinary research to advance the integration of costs and benefits of externalities and intangibles associated with social and environmental criteria. Full article

Background/Objectives: Given the high incidence and generally favorable prognosis of papillary thyroid microcarcinomas (PTMs), the Porto Proposal aims to refine the management of these tumors. It designates tumors lacking certain risk factors as papillary microtumors (PMTs) to avoid overtreatment and reduce patient stress. The updated Porto Proposal (uPp) suggests criteria for reclassifying incidental PTMs as PMTs. This study seeks to validate these criteria using data from a university hospital in Catalonia, Spain, and assess the clinical and pathological characteristics of PTMs. Methods: This retrospective study analyzed patients diagnosed with PTM (≤1 cm) at a university hospital from 2000 to 2024. The study examined variables, including lymph node positivity, incidental diagnosis, tumor location, histological type, treatment, multifocality, age at diagnosis, tumor size, and survival. The uPp criteria were applied to reclassify PTMs into PMTs or PMCs (true papillary microcarcinomas). Student’s t-test and chi-square tests were used to evaluate the associations between these variables and the uPp classification. Results: The cohort comprised 107 patients, with 77 (72%) women and 30 men. The mean age at diagnosis was 54.5 years. Out of the total, 77 (72%) cases were reclassified as PMTs and 30 (28%) as PMCs according to the uPp criteria. PMC tumors were larger (mean size 4.5 mm vs. 3.3 mm for PMT, p = 0.014) and were significantly associated with multifocality (52.2%; p = 0.004). Most lymph node-positive cases were classified as PMCs (69.2%; p < 0.001) and were multifocal and bilateral more commonly. However, no significant differences in outcomes between PMCs and PMTs were found (p = 0.188). Follicular histology was significantly more common in PMTs (87.0%, p < 0.001) and rarely had lymph node metastases (4.6%; p = 0.047). Conclusions: The updated Porto Proposal (uPp) effectively identifies PTMs with minimal malignant potential, distinguishing between PMT and PMC. The findings support the protocol’s use in reducing unnecessary treatments and psychological stress for patients. The study highlights significant clinical and pathological differences between PTM subtypes, reinforcing the protocol’s applicability in daily pathological practice. Full article

Urban thermal environment challenges in China have made outdoor thermal comfort a key factor in evaluating spatial quality and livability. Building layout not only affects internal performance but also shapes the microclimate of surrounding outdoor spaces. The climatic characteristics of temperate monsoon climate regions significantly impact residents’ outdoor activities. Most existing studies focus solely on either the external thermal environment or the buildings themselves in isolation. This study focuses on Beijing, a representative city in the temperate monsoon climate zone, and explores block-scale spatial optimization using computational typology. The objective is to balance architectural performance with outdoor thermal comfort in both winter and summer. Optimization targets include the Universal Thermal Climate Index (UTCI), winter sunshine duration, and summer solar radiation. Results show winter UTCI can be optimized to −6.13 °C to −1.18 °C and summer UTCI to 28.19 °C to 29.17 °C, with greater optimization potential in winter (23.5% higher). Synergistic relationships are observed between winter comfort and sunshine duration (coefficient: 0.777) and between summer comfort and solar radiation (coefficient: 0.947). However, trade-offs exist between seasonal comfort indicators, with strong conflicts between winter and summer objectives. Two distinct form types—“low-south-high-north enclosed” for winter and “high-rise point-type low-density” for summer—are identified as effective for seasonal adaptation. The study proposes an integrated method combining data-driven generation, multi-objective optimization, and clustering-based decision-making. This approach moves beyond traditional empirical design, offering a quantitative and adaptable strategy for climate-responsive urban block planning and supporting low-carbon urban transformation. Full article

We evaluated the feasibility of a new research methodology designed for conducting a future, large-scale randomized controlled trial (RCT). This future RCT is aimed at evaluating the effects of repeated aromatherapy footbaths on stimulating the onset of labor. Herein, we conducted a pilot RCT with two arms among low-risk pregnant women at or beyond 39 weeks of gestation before labor onset. These two arms consisted of a treatment group performing aromatherapy footbaths twice a day (n = 7) and a usual care group (n = 8). This study was prospectively registered in the Clinical Trials Registry of the University Hospital Medical Information Network in Japan (UMIN000037398). Feasibility was assessed across the domains of acceptability, demand, implementation, practicality, process, resources, and management using questionnaires, researcher records, and semi-structured interviews with the treatment group and midwives at the setting facility. The new research methodology was found to be feasible, although challenges were identified in the process and implementation. For process, the research participation rate was 55.5%. For implementation, the adherence rate among the multiparous participants in the treatment group ranged from 50% to 94%. An imbalance between both groups was found. Areas that need careful planning and methodological improvements include random allocation, treatment method, and participation criteria. Full article

University students are a vulnerable population for smoking initiation and continuation, often facing unique challenges in accessing cessation support. This scoping review aimed to map the existing literature on the barriers and facilitators to smoking cessation among university students using the Theoretical Domains Framework (TDF). Following the JBI methodology, six studies conducted in the United States, Jordan, and Qatar were included, employing both qualitative and quantitative designs. A total of 22 barriers and 20 facilitators were identified and mapped across relevant TDF domains. Key barriers included time constraints, financial limitations, low self-efficacy, and social smoking norms. Facilitators included access to flexible, low-cost interventions, peer support, and previous quit attempts. Digital interventions were preferred by students. The findings suggest that smoking cessation strategies targeting university students should be flexible, affordable, and embedded within campus health systems. Interventions that combine behavioral support, peer involvement, and accessible technology show strong potential in addressing the multifaceted barriers faced by this population. This review provides a theory-informed foundation for the development of tailored smoking cessation interventions and identifies key directions for future research. Full article

Background: This systematic review examined factors associated with psychological flexibility in higher education students. Objectives: This study aims to provide a comprehensive understanding of factors associated with psychological flexibility among higher education students. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology, a systematic search was conducted in the Web of Science and Scopus databases. Several inclusion criteria were employed in the study, such as sample characteristics and study design. As a synthesis method, the qualitative narrative synthesis method was used. Results: Thirty-one studies were included in the review for detailed analysis. Our findings indicated positive associations between psychological flexibility and numerous variables that enhance the mental health and academic success of university students. In addition, individuals characterized by high psychological flexibility demonstrated better adjustment to university life and experienced higher levels of well-being. In the meantime, some studies found negative associations between psychological flexibility and several variables that hinder student success and negatively impact their mental health. Among them, the screened studies reported COVID-19 burnout, disordered eating cognitions, severity of posttraumatic stress symptoms, anxiety and depressive symptoms, and others. Discussion: Examining psychological flexibility in such a broad review provides insights into this construct and its potential applications in enhancing student success and contributing to economic and social sustainability by reducing dropout rates, lowering the costs of psychological and medical care, and fostering a more resilient human capital. The main limitations in the reviewed articles were the absence of studies employing longitudinal designs, small sample sizes, and the limited investigation of relationships in online and hybrid learning models. Full article

The Netherlands has established climate-adaptive strategies shaped by its long history of water-related climate events, such as the floods in 1421 and 1953. UNESCO World Heritage (WH) properties in The Netherlands reflect centuries of human intervention and natural processes to adapt and mitigate climate challenges, including spatial design and hydraulic engineering. The Dutch Climate Research Initiative also highlights cultural heritage as an integral component in preparing for the 2026 National Climate Adaptation Strategy. This article aims to unveil climate-adaptive World Heritage management strategies (CAWHMSs), using WH properties in The Netherlands as a case study. It collects textual data from Statements of Outstanding Universal Value, State of Conservation Reports by the State Parties and management plans. Through qualitative coding and keywords aggregation of the documents, the visualised results of a Sankey diagram and two semantic networks confirmed two CAWHMSs: conservation and developing WH properties as collaborative knowledge hubs. Conservation supports regulating urban climate and sustainable water management. As collaborative knowledge hubs, multidisciplinary sectors explore opportunities to align WH properties with broader sustainable development initiatives. They also deepen younger generations’ awareness of cultural and natural significance relevant to mitigating climate threats. The results emphasise WH as a contributor to climate adaptation. Cross-sectoral stakeholders can advance holistic climate adaptation efforts using CAWHMSs. Full article

The present study addresses the need for valid and reliable tools to assess employability thinking among young people in training. In a labor market increasingly shaped by transversal skill demands, the objective was to construct and validate a scale adapted for secondary and post-secondary non-tertiary students. Grounded in strategic frameworks such as the Europe 2020 Strategy, the European Skills Agenda, and relevant Spanish legislation, an abbreviated version of the Graduate Skills and Attributes Scale (GSAS) was administered to a representative sample of 949 Andalusian students enrolled in compulsory secondary education, baccalaureate, or vocational training. A cross-sectional and exploratory research design was adopted, with all procedures conducted in accordance with ethical and legal standards and approved by the University of Granada’s ethics committee. Exploratory and confirmatory factor analyses were performed, leading to a refined 28-item version of the instrument. Items were grouped into four well-defined factors: ethical self-regulation and achievement orientation, effective communication and collaborative working, proactivity and commitment to learning, and analytical thinking and information handling. The factors demonstrated high internal consistency and structural validity. These findings indicate that the scale is a clear and effective tool for assessing employability-related competencies and may assist in the design of educational interventions aimed at improving students’ professional development. Full article

With the increase in prices of correctives and fertilizers, the investigation of the interactions between plants and plant growth-promoting bacteria shows an economically viable and sustainable alternative, and the use of Azospirillum brasilense has shown an increase in efficiency of nitrogen use and increased pasture yield. This study, conducted in the Brazilian Amazon, aimed to evaluate the effect of different inoculation techniques of Azospirillum brasilense associated with the dose of nitrogen topdressing on the productive performance of Brachiaria brizantha cv. Paiaguás is a grass species commonly cultivated in this region. The experiment was conducted in the Experimental Forage Sector of the Federal Rural University of the Amazon, Parauapebas city, Brazil. The experimental design was a randomized block design in a 3 × 3 factorial arrangement, with three inoculation methods (control, seed, and foliar) and three nitrogen fertilization doses (0, 75, and 150 kg ha⁻¹ of N), with four replicates. An effect was observed in interaction between inoculation and nitrogen fertilization (p ≤ 0.05) for the variables total forage green mass, total forage dry mass, dry mass of leaf blade, dry stem mass, and number of tillers m⁻². The dose of 150 kg ha⁻¹ of N promoted a positive effect of N on the total forage dry mass and LAI (leaf area index). Inoculation with Azospirillum brasilense, especially foliar application, efficiently increased Brachiaria brizantha cv. Paiaguás yield, potentially reducing the use of nitrogen fertilizers, promotes greater sustainability in pasture management. Full article

Global growth in antimicrobial resistance (AMR) has accelerated the need for novel therapy beyond the scope of conventional antibiotics. In the last decade, polydopamine (PDA), a mussel-inspired polymer with redox capability, remarkable adhesion, and biocompatibility, has emerged as a universal antimicrobial coating with widespread uses. At the same time, extracellular vesicles (EVs) and particularly exosomes have gained prominence for their intrinsic cargo delivery and immune-modulating properties. Here, we summarize the synergistic value of PDA and exosome integration into multifunctional antimicrobial nanoplatforms. We discuss the inherent antimicrobial activity of PDA and exosomes; the advantages of PDA coating, including increased exosome stability, ROS generation, and surface functionalization; and current methodologies towards designing PDA-exosome hybrids. This review also mentions other antimicrobial polymers and nanocomposites that may be employed for exosome modification, such as quaternized chitosan, zwitterionic polymers, and polymer–metal composites. Most significant challenges, such as the maintenance of exosome integrity, coating uniformity, biocompatibility, scalability, and immunogenicity, are addressed. Finally, future research directions are highlighted, with emphasis on intelligent, stimulus-responsive coatings, AMP incorporation, and clinical translation. Collectively, this review underscores the promise of PDA-coated exosomes as potential antimicrobial therapeutics against AMR with potential applications in wound healing, implant protection, and targeted infection control. Full article

Background: Competency in providing high-quality, comprehensive patient care is essential for newly qualified dentists. Dental curricula are designed to equip graduates with necessary skills to develop competencies. Outplacement training has been incorporated into most dental curricula to provide broader clinical experience in a real-world situation. Methods: This cross-sectional study aimed to assess (1) the perceived confidence of final-year dental students (FYDSs) at an Australian university with reference to the Australian Dental Council (ADC) professional competencies for newly qualified dentists; (2) the association between perceived confidence and the timing of outplacement training; and (3) students’ perceptions on outplacement training in developing their competencies. Two online surveys were administered to a cohort of FYDSs at the end of the first and second trimesters. ‘Survey 1’ was based on the ADC competency requirements (2022) and assessed aims 1 and 2. The five domains assessed were (1) communication and leadership; (2) critical thinking; (3) health promotion; (4) scientific and clinical knowledge; and (5) person-centred care. ‘Survey 2’ assessed students’ perception on outplacement training and was administered towards the completion of their outplacement to assess aim 3. Results: Students’ perceived competency levels were high across all domains. Those with prior tertiary education were more confident in communication and leadership, health promotion, and scientific and clinical knowledge than students with secondary qualifications. The perceived confidence in professional competencies among FYDSs had no significant association (p > 0.05) with the location or the sequence of outplacement. The thematic analysis of survey 2 responses reported the guidance and constructive feedback received from supervisors while managing cases in a real-life setup as a significant contributor to their confidence development. Conclusions: FYDSs reported a satisfactory level of perceived confidence in professional competencies. Both in-house training and outplacement equally improve the levels of competency development. FYDSs perceive outplacement training as a positive integral component in the development of skills. Full article

As autonomous vehicles (AVs) are gradually integrated into existing traffic systems, understanding their impact on freeway operations becomes essential for effective infrastructure planning and policy design. This study explores how AV penetration rates, behavior profiles, and freeway geometry interact to influence traffic performance and safety. Using microscopic simulations in VISSIM (a high-fidelity traffic simulation tool), four typical freeway segment types—basic sections, weaving zones, on-ramp merging areas, and AV-exclusive lanes—were modeled under diverse traffic demands and AV behavior settings. The findings indicate that, while AVs can improve flow stability in simple environments, their performance may deteriorate in complex merging scenarios without supportive design or behavior coordination. AV-exclusive lanes offer some mitigation when AV share is high. These results underscore that AV integration requires context-specific strategies and cannot be universally applied. Adaptive, behavior-aware traffic management is recommended to support a smooth transition toward mixed autonomy. Full article

Background: Optimal coping with chronic pain (CP) has a positive impact on minimizing the barriers to patients’ quality of life. Mindfulness-based approaches have been shown to improve emotional regulation and coping strategies in CP management, promoting a greater acceptance of pain and reducing psychological distress. Given that personality traits may influence the adjustment to chronic pain, this study aimed to investigate whether specific personality dimensions, based on Cloninger’s model of temperament–character dimensions, affect the enrolment and the response to pain treatment in an innovative hybrid arts-based CBT-CP group intervention for patients with non-malignant CP. Methods: A pre-and-post assessment design was implemented in a non-randomized control trial. A total number of 100 outpatients at a University Pain Management Unit were allocated through self-selection in either an arts-based CBT-CP group intervention (N = 50) or a treatment-as-usual (TAU) control group (N = 50). All participants completed the Brief Pain Inventory (BPI), the Orbach and Mikulincer Mental Pain Scale (OMMP), the Tolerance for Mental Pain Scale (TMPS), and the Temperament and Character Inventory (TCI-140). The assessment took place at baseline and at the end of the intervention, after a 10-week period. The statistical analyses included a t-test for independent samples, Chi-square, and linear regression analyses. Results: At baseline, the arts-based CBT-CP intervention group had a higher score in the novelty seeking character dimension (M = 64.04; SD = 9.56), whereas the TAU group was found to have higher scores in self-directedness (M = 74.34; SD = 11.22) and self-transcendence (M = 51.42; SD = 6.61). The arts-based CBT-CP group reported a lower loss of control (M = 22.94; SD = 6.70) and higher belief in the ability to cope with pain (M = 21.10; SD = 3.76) after the intervention, compared to the control group. Self-transcendence was found to be a significant predictor of average pain as well as of patients’ belief in their ability to cope with pain. Conclusions: The current study provides practice-based evidence suggesting that an arts-based CBT-CP group intervention is a promising treatment for non-malignant CP. Personality dimensions affect patients’ enrolment and response to pain treatment. Furthermore, integrating mindfulness-based strategies within such interventions may further enhance treatment outcomes by fostering acceptance, improving coping mechanisms, and reducing the emotional burden associated with chronic pain. Full article

In this article, we document our experiences as teacher educators as we designed and implemented two courses that scaffold primary preservice teachers to engage critically with postmodern picture books and to explore a range of pedagogical practices for using postmodern picture books in classrooms with young children. Initially, our preservice teachers told us they did not have many experiences with postmodern picture books. Postmodern picture books are a special form of children’s literature that showcase some unique characteristics such as breaking boundaries, excess, indeterminacy and parody. In this article, our research investigation includes two case studies which draw on Schon’s classical approach to exploring the epistemology of our own practice through a reflective lens that brings together academic theory and professional practice. Firstly, we each recount our preservice teachers’ most adverse reactions to postmodern picture books. In response, we use the multiliteracies framework of the New London Group, that of situated practice, overt instruction, critical framing and transformed practice, to describe how we designed the learning activities and assessment tasks at two different universities in Australia. We do not attempt to generalise from our findings; rather, we explore the pedagogical framework that takes our preservice teachers from places of not knowing, resistance, and critique to one where they can articulate their understandings of postmodern picture books as social and cultural commentary and demonstrate a range of effective pedagogical applications. Full article

This paper develops and presents a system for museums to evaluate behavioural and experiential gains of older adult visitors when engaging with digital interpretation exhibits. The evaluation system is based on the Analytic Hierarchy Process (AHP), utilising existing evaluation methods for museum visitors and refining them into an approach suitable for investigating older visitors. Innovatively, it incorporates the universal design (UD) in museum digital exhibits, injecting strong momentum into creating inclusive museums. An in-depth evaluation was conducted on seven exhibitions across three newly constructed Chinese cultural tourism museums with different digital characteristics, presenting the results and findings through eighty-eight digital interpretation exhibits. Qualitative and quantitative data provide a nuanced picture of digital interpretation and interaction from the perspective of older visitors. The results demonstrate the factors influencing older adults’ engagement with digital interpretation exhibits in museums and how digital interpretation items attract or deter older visitors’ engagement in complex exhibition environments. This study utilised universal design principles to identify the limitations and barriers in digital interpretation for older visitors, analysed the correlation between UD and digital attraction power, explored the reasons behind these outcomes, and identified design recommendations for inclusive museum digital interpretation. Full article