Search Results (11,174)

The green renovation of existing residential buildings is a key way for the construction industry to achieve sustainable development and the dual carbon goals of China, which makes it urgent to make collaborative decisions among multiple stakeholders. However, because of divergent interests and risk perceptions among governments, energy service companies (ESCOs), and owners, the implementation of green renovation is hindered by numerous obstacles. In this study, we integrated prospect theory and evolutionary game theory by incorporating core prospect-theory parameters such as loss aversion and perceived value sensitivity, and developed a psychologically informed tripartite evolutionary game model. The objective was to provide a theoretical foundation and analytical framework for collaborative governance among stakeholders. Numerical simulations were conducted to validate the model’s effectiveness and explore how government regulation intensity, subsidy policies, market competition, and individual psychological factors influence the system’s evolutionary dynamics. The findings indicate that (1) government regulation and subsidy policies play central guiding roles in the early stages of green renovation, but the effectiveness has clear limitations; (2) ESCOs are most sensitive to policy incentives and market competition, and moderately increasing their risk costs can effectively deter opportunistic behavior associated with low-quality renovation; (3) owners’ willingness to participate is primarily influenced by expected returns and perceived renovation risks, while economic incentives alone have limited impact; and (4) the evolutionary outcomes are highly sensitive to parameters from prospect theory, The system’s evolutionary outcomes are highly sensitive to prospect theory parameters. High levels of loss aversion (λ) and loss sensitivity (β) tend to drive the system into a suboptimal equilibrium characterized by insufficient demand, while high gain sensitivity (α) serves as a key driving force for the system’s evolution toward the ideal equilibrium. This study offers theoretical support for optimizing green renovation policies for existing residential buildings in China and provides practical recommendations for improving market competition mechanisms, thereby promoting the healthy development of the green renovation market. Full article

Objective: This study aimed to investigate the impact of depression and anxiety disorders on mortality in women diagnosed with gynecologic cancers, utilizing nationwide retrospective cohort data. Methods: Data from the Korean National Health Insurance Service (NHIS) database, covering women diagnosed with cervical, endometrial, or ovarian cancers between 2007 and 2014, were analyzed. Women diagnosed with depression or anxiety disorders within one year after cancer diagnosis were identified and compared with a control group comprising patients with gynecologic cancers who did not develop either disorder during the same post-diagnosis period. Mortality was evaluated as the primary outcome. Results: Of 85,327 women analyzed, 784 (0.9%) were diagnosed with depression or anxiety disorders. Patients with depression or anxiety exhibited significantly higher mortality (38.4% vs. 29.9%; p < 0.001). Multivariate analysis indicated that depression significantly increased mortality risk (OR 1.46, 95% CI 1.27–1.66), whereas anxiety alone showed no significant effect (OR 0.97, 95% CI 0.74–1.27). Combined depression and anxiety showed the highest mortality risk (OR 1.47, 95% CI 1.31–1.65). Conclusions: Depression and anxiety disorders are significant predictors of increased mortality in women with gynecologic cancers, emphasizing the necessity for integrated mental health assessment and interventions in oncologic care to improve both survival and quality of life. Full article

In recent years, online streaming has encountered the challenge of retaining its user base. This study considers the role of transaction cost economics theory in consumer choices to continue subscribing. Participants respond to their top three streaming services, resulting in 797 responses, accounting for multiple selections by each respondent. Respondents could choose their top three services from a list of Netflix, Disney, Hulu, Amazon Prime Video, HBO Max, and Apple TV+. The study’s conclusions highlight the impact of uncertainty, a negative measure of streaming quality, on online subscription-based video streaming. Additionally, asset specificity, reflecting uniqueness and exclusive content, is found to be positively related to continuing a subscription. This research distinguishes itself by examining individuals who are already subscribers to provide insights and guidance through the lens of Transaction Cost Economics, to help marketing professionals seeking a deeper understanding of consumer behavior in the online streaming landscape. Full article

As urbanization accelerates and climate change intensifies, the ecological integrity of urban riparian forests faces growing threats, underscoring the need for a systematic framework to guide their sustainable management. To address this gap, we developed a causal framework by applying text mining and sentence classification to 1001 abstracts from previous studies, structured within the DPSIR (Driver–Pressure–State–Impact–Response) model. The analysis identified six dominant thematic clusters—water quality, ecosystem services, basin and land use management, climate-related stressors, anthropogenic impacts, and greenhouse gas emissions—which reflect the multifaceted concerns surrounding urban riparian forest research. These themes were synthesized into a structured causal model that illustrates how urbanization, land use, and pollution contribute to ecological degradation, while also suggesting potential restoration pathways. To validate its applicability, the framework was applied to four major urban streams in Seoul, where indicator-based analysis and correlation mapping revealed meaningful linkages among urban drivers, biodiversity, air quality, and civic engagement. Ultimately, by integrating large-scale text mining with causal inference modeling, this study offers a transferable approach to support adaptive planning and evidence-based decision-making under the uncertainties posed by climate change. Full article

With the arrival of an aging society and the continuous extension of the human lifespan, the quality of life has not improved in a corresponding manner. People’s demand for happiness and health is increasing. As a result, a model emerged that integrates tourism and medical services, which is health tourism. This growing demand has prompted many service providers to see it as a business opportunity and enter the market. Tourism can help travelers release work stress and restore physical and mental balance; meanwhile, health check-ups and disease treatment can help them regain health. Consumers have long favored health and medical tourism because it helps relieve stress and promotes overall well-being. As people age, some consumers experience a gradual decline in physical functions, making it difficult for them to participate in regular travel services provided by traditional travel agencies. Therefore, this study aims to explore the service needs of health and medical tourism customers (tourists/patients) and the interrelationships among these service needs, so that health and medical tourism service providers can develop more customized and diversified services. This study identifies four key drivers of medical tourism services: medical services, medical facilities, tour planning, and hospitality facilities. This study uses the APA (attention and performance analysis) method to assess each dimension and criterion and utilizes the DEMATEL method with the NRM (network relationship map) to identify network relationships. By combining APA and NRM techniques, this study develops the APA-NRM technique to evaluate adoption strategies and identify suitable paths for health tourism services, providing tailored development strategies and recommendations for service providers to enhance the service experience. Full article

With the rapid development of video streaming services, adaptive bitrate (ABR) algorithms have become a core technology for ensuring optimal viewing experiences. Traditional ABR strategies, predominantly rule-based or reinforcement learning-driven, typically employ uniform quality assessment metrics that overlook users’ subjective preference differences regarding factors such as video quality and stalling. To address this limitation, this paper proposes an adaptive video bitrate selection system that integrates preference modeling with reinforcement learning. By incorporating a preference learning module, the system models and scores user viewing trajectories, using these scores to replace conventional rewards and guide the training of the Proximal Policy Optimization (PPO) algorithm, thereby achieving policy optimization that better aligns with users’ perceived experiences. Simulation results on DASH network bandwidth traces demonstrate that the proposed optimization method improves overall Quality of Experience (QoE) by over 9% compared to other mainstream algorithms. Full article

Background/Objective: The COVID-19 pandemic profoundly transformed social life worldwide, indiscriminately affecting individuals across all age groups. Children have not been exempted from the risk of severe illness and death caused by COVID-19. Objective: This paper sought to describe the clinical findings, laboratory and imaging results, and hospital care provided for severe and critical cases of COVID-19 in unvaccinated children, with or without severe asthma, hospitalized in a public referral service for COVID-19 treatment in the Brazilian state of Pernambuco. Methods: This was a case series study of severe and critical COVID-19 in hospitalized, unvaccinated children, with or without severe asthma, conducted in a public referral hospital between March 2020 and June 2021. Results: The case series included 80 children, aged from 1 month to 11 years, with the highest frequency among those under 2 years old (58.8%) and a predominance of males (65%). Respiratory diseases, including severe asthma, were present in 73.8% of the cases. Pediatric multisystem inflammatory syndrome occurred in 15% of the children, some of whom presented with cardiac involvement. Oxygen therapy was required in 65% of the cases, mechanical ventilation in 15%, and 33.7% of the children required intensive care in a pediatric intensive care unit. Pulmonary infiltrates and ground-glass opacities were common findings on chest X-rays and CT scans; inflammatory markers were elevated, and the most commonly used medications were antibiotics, bronchodilators, and corticosteroids. Conclusions: This case series has identified key characteristics of children with severe and critical COVID-19 during a period when vaccines were not yet available in Brazil for the study age group. However, the persistence of low vaccination coverage, largely due to parental vaccine hesitancy, continues to leave children vulnerable to potentially severe illness from COVID-19. These findings may inform the development of public health emergency contingency plans, as well as clinical protocols and care pathways, which can guide decision-making in pediatric care and ensure appropriate clinical management, ultimately improving the quality of care provided. Full article

(1) The beach areas of Galveston, Texas, USA are heavily used for recreational activities and often experience elevated fecal indicator bacteria levels, representing a potential threat to ecosystem services, human health, and tourism-based economies that rely on suitable water quality. (2) During the span of 15 months (March 2022–May 2023), water samples that exceeded the U.S. Environmental Protection Agency-accepted alternative Beach Action Value (BAV) for enterococci of 104 MPN/100 mL were analyzed via microbial source tracking (MST) through quantitative polymerase chain reaction (qPCR) assays. The Bacteroides HF183 and DogBact as well as the Catellicoccus LeeSeaGull markers were used to detect human, dog, and gull fecal sources, respectively. The qPCR MST data were then utilized in a quantitative microbial risk assessment (QMRA) to assess human health risks. Additionally, samples collected in July and August 2022 were sequenced for 16S rRNA and matched with fecal sources through the Bayesian SourceTracker2 program. (3) Overall, 26% of the 110 samples with enterococci exceedances were positive for at least one of the MST markers. Gull was revealed to be the primary source of identified fecal contamination through qPCR and SourceTracker2. Human contamination was detected at very low levels (<1%), whereas dog contamination was found to co-occur with human contamination through qPCR. QMRA identified Campylobacter from canine sources as being the primary driver for human health risks for contact recreation for both adults and children. (4) These MST results coupled with QMRA provide important insight into water quality in Galveston that can inform future water quality and beach management decisions that prioritize public health risks. Full article

Smart cities are technologically advanced urban environments where interconnected systems and data-driven technologies enhance public service delivery and quality of life. These cities rely on information and communication technologies, the Internet of Things, big data, cloud computing, and other Industry 4.0 tools to support efficient city management and foster citizen engagement. Often referred to as digital cities, they integrate intelligent infrastructures and real-time data analytics to improve mobility, security, and sustainability. Ubiquitous sensors, paired with Artificial Intelligence, enable cities to monitor infrastructure, respond to residents’ needs, and optimize urban conditions dynamically. Given the increasing significance of Industry 4.0 in urban development, this study adopts a bibliometric approach to systematically review the application of these technologies within smart cities. Utilizing major academic databases such as Scopus and Web of Science the research aims to identify the primary Industry 4.0 technologies implemented in smart cities, assess their impact on infrastructure, economic systems, and urban communities, and explore the challenges and benefits associated with their integration. The bibliometric analysis included publications from 2016 to 2023, since the emergence of urban researchers’ interest in the technologies of the new industrial revolution. The task is to contribute to a deeper understanding of how smart cities evolve through the adoption of advanced technological frameworks. Research indicates that IoT and AI are the most commonly used tools in urban spaces, particularly in smart mobility and smart environments. Full article

The quality of water in households can be affected by plumbing design and materials, water usage patterns, and source water quality characteristics. These factors influence stagnation duration, disinfection residuals, metal release, and microbial activity. In particular, stagnation can degrade water quality and increase lead release from lead service lines. This study employs numerical modeling to assess how combined corrosion control and flushing strategies affect lead levels in household taps with lead service lines under reduced water use. To estimate potential health risks, the U.S. EPA model is used to predict the percentage of children likely to exceed safe blood lead levels. Lead exceedances are assessed based on various regulatory requirements. Results show that exceedances at the kitchen tap range from 3 to 74% of usage time for the 5 µg/L standard, and from 0 to 49% for the 10 µg/L threshold, across different scenarios. Implementing corrosion control treatment in combination with periodic flushing proves effective in lowering lead levels under the studied low-consumption scenarios. Under these conditions, the combined strategy limits lead exceedances above 5 µg/L to only 3% of usage time, with none above 10 µg/L. This demonstrates its value as a practical short-term strategy for households awaiting full pipe replacement. Targeted flushing before peak water use reduces the median time that water remains stagnant in household pipes from 8 to 3 h at the kitchen tap under low-demand conditions. Finally, the risk model indicates that the combined approach can reduce the predicted percentage of children with blood lead levels exceeding 5 μg/dL from 61 to 6% under low water demand. Full article

Rural roads are critical for connecting isolated communities to essential services such as education and health and administrative services, as well as production and market opportunities in low-income countries. More than 70% of movements of people and goods in Sub-Saharan Africa are heavily reliant on rural transport systems, using both motorised but mainly alternative means of transport. However, rural roads often suffer from poor construction due to the use of low-strength, in situ soils and limited financial resources, leading to premature failures and subsequent traffic disruptions with significant economic losses. This study investigates the use of rice husk ash (RHA), a waste byproduct from rice production, as a sustainable supplement to Ordinary Portland Cement (OPC) for soil stabilisation in order to increase durability and sustainability of rural roads, hence limit recurrent maintenance needs and associated transport costs and challenges. To conduct this study, soil samples collected from Mulungushi, Zambia, were treated with combinations of 6–10% OPC and 10–15% RHA by weight. Laboratory tests measured maximum dry density (MDD), optimum moisture content (OMC), and California Bearing Ratio (CBR) values; the main parameters assessed to ensure the quality of road construction soils. Results showed that while the MDD did not change significantly and varied between 1505 kg/m³ and 1519 kg/m³, the OMC increased hugely from 19.6% to as high as 26.2% after treatment with RHA. The CBR value improved significantly, with the 8% OPC + 10% RHA mixture achieving the highest resistance to deformation. These results suggest that RHA can enhance the durability and sustainability of rural roads and hence improve transport systems and subsequently improve socioeconomic factors in rural areas. Full article

Situated in the southern hilly-mountain belt of China’s “Three Zones and Four Belts Strategy”, Gannan region is a critical ecological shelter belt for the Ganjiang River. Decades of intensive mineral extraction and irrational agricultural development have rendered it into an ecologically fragile area. Consequently, multiple restoration initiatives have been implemented in the region over recent decades. However, it remains unclear how relationships among ecosystem services have evolved under these interventions and how future ecosystem management should be optimized based on these changes. Thus, in this study, we simulated and assessed the spatiotemporal dynamics of five key ESs in Gannan region from 1990 to 2020. Through integrated correlation, clustering, and redundancy analyses, we quantified ES interactions, tracked the evolution of ecosystem service bundles (ESBs), and identified their socio-ecological drivers. Despite a 31% decline in water yield, ecological restoration initiatives drove substantial improvements in key regulating services: carbon storage increased by 6.9 × 10¹² gC while soil conservation rose by 4.8 × 10⁸ t. Concurrently, regional habitat quality surged by 45% in mean scores, and food production increased by 2.1 × 10⁵ t. Critically, synergistic relationships between habitat quality, soil retention, and carbon storage were progressively strengthened, whereas trade-offs between food production and habitat quality intensified. Further analysis revealed that four distinct ESBs—the Agricultural Production Bundle (APB), Urban Development Bundle (UDB), Eco-Agriculture Transition Bundle (ETB), and Ecological Protection Bundle (EPB)—were shaped by slope, forest cover ratio, population density, and GDP. Notably, 38% of the ETB transformed into the EPB, with frequent spatial interactions observed between the APB and UDB. These findings underscore that future ecological restoration and conservation efforts should implement coordinated, multi-service management mechanisms. Full article

Context: Many patients at the end of life receive antibiotics to alleviate symptoms and improve quality of life; however, clear guidelines supporting decision making about the use of antibiotics are still lacking. Objectives: This study aimed to evaluate the benefits and harms of antibiotic use among patients under a palliative care community support team in Portugal. Methods: An observational, cross-sectional, retrospective study was conducted on 249 patients who died over a two-year period, having been followed for at least 30 days prior to their death. Data included patient demographics, clinical diagnoses, antibiotic prescriptions, and symptomatic outcomes. The effects of commonly prescribed antibiotics—amoxicillin + clavulanic acid, cefixime, ciprofloxacin, and levofloxacin—were compared using statistical analyses to assess survival, symptom intensity, and functional scales. Results: Adverse events, primarily infections and secretions, occurred in 57.8% of cases, with 33.7% receiving antibiotics. No significant difference in survival was observed across the antibiotic groups (p = 0.990). Symptom intensity significantly reduced after 72 h of treatment (p < 0.05), with ciprofloxacin demonstrating the greatest symptom control. The Palliative Outcome Scale decreased uniformly, with higher scores associated with amoxicillin + clavulanic acid (p = 0.004). The Palliative Performance Scale declined post-treatment, with significant changes noted for cefixime and ciprofloxacin (p < 0.05). Conclusions: Antibiotics may improve symptom control and quality of life in the end-of-life stage. While second-line antibiotics may offer additional benefits, the heterogeneity of the sample and limited adverse effect data underscore the need for further research to guide appropriate prescription practices in palliative care. Full article

Attention deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterised by inattention, hyperactivity, and impulsivity, frequently observed in juvenile offenders. This systematic review explores the interplay between ADHD and juvenile delinquency, focusing on behavioural, psychological, and social dimensions. Following the PRISMA guidelines, a systematic literature review was conducted using EBSCO Discovery Service, Science Direct, PubMed, and snowballing techniques. Studies meeting specific inclusion criteria, including juvenile offenders diagnosed with ADHD and comparisons to non-offender or non-ADHD control groups, were analysed. The methodological quality of studies was assessed using the Joanna Briggs Institute appraisal tools. A total of 21 studies were included, highlighting significant associations between ADHD and juvenile delinquency. ADHD symptoms, especially impulsivity and emotional dysregulation, were linked to an earlier onset of offending and higher rates of property crimes. Comorbidities such as conduct disorder, substance use disorder, and depression exacerbated these behaviours. Sociodemographic factors like low education levels and adverse family environments were also critical modifiers. Early intervention and tailored treatment approaches were emphasised to address these challenges. The findings underscore the need for early diagnosis, individualised treatment, and integrative rehabilitation programmes within the juvenile justice system to mitigate long-term risks and promote social inclusion. Full article

In today’s dynamic and highly uncertain environment, organizations, particularly in the aviation sector, face increasing challenges that demand resilient, flexible, and data-driven change management decisions. Responding to the growing need for structured approaches to managing complex uncertainties—geopolitical tensions, economic volatility, social shifts, rapid technological advancements, environmental pressures and regulatory changes—this research proposes a theoretical change management model for aviation service providers, such as airports. Integrating three analytical approaches, the model offers a robust, multi-method approach for supporting sustainable transformation under uncertainty. Normative analysis using Bayesian decision theory identifies influential external environmental factors, capturing probabilistic relationships, and revealing causal links under uncertainty. Prescriptive planning through scenario theory explores alternative future pathways and helps to identify possible predictions, offer descriptive evaluation employing fuzzy comprehensive evaluation, and assess decision quality under vagueness and complexity. The proposed four-stage model—observation, analysis, evaluation, and response—offers a methodology for continuous external environment monitoring, scenario development, and data-driven, proactive change management decision-making, including the impact assessment of change and development. The proposed model contributes to the theoretical advancement of the change management research area under uncertainty and offers practical guidance for aviation organizations (airports) facing a volatile external environment. This framework strengthens aviation organizations’ ability to anticipate, evaluate, and adapt to multifaceted external changes, supporting operational flexibility and adaptability and contributing to the sustainable development of aviation services. Supporting aviation organizations with tools to proactively manage systemic uncertainty, this research directly supports the integration of sustainability principles, such as resilience and adaptability, for long-term value creation through change management decision-making. Full article