Search Results (1,249)

China recently became the 155th country to provide free vaccination to all 13-year-old girls with two doses of a domestic bivalent HPV vaccine in October 2025. Such a policy change aligns with the Immunization Agenda 2030, which expects more investment of domestic resources into immunization rather than heavily depending on external donor funding support. This review examines the policy-making evolution process and analyzes how the final decision was made at the national level, using the Multiple Streams Framework. Unlike traditional NIP expansion, which adopts a top-down decision-making strategy, China’s free HPV vaccination policy evolved with a distinct bottom-up strategy originating from local pilots, which is demonstrated to be instrumental for national policy-making. The extensive local pilots of free HPV vaccination have served as a powerful engine that drives a rapid and substantial increase in HPV vaccination rate, played a pivotal role in shaping the market of HPV vaccines, and contributed to achieving the economies of scale, which triggered a substantial price reduction. It also fostered a national consensus on the critical role of HPV vaccination in cervical cancer prevention and control, a principle now enshrined in the core public health knowledge repository across the country. A potential strategy to introduce new vaccines into the NIP could be piloting first and expanding incrementally with the bottom-up strategy, leveraging a comprehensive platform under the framework of the national policy, and then making use of the effect of scale and peer pressure, high level engagement, cross-departmental collaboration, and multiple financing mechanisms. Full article

Background/Objectives: The Leiden University Medical Center (LUMC) and the Medical University of Vienna (MUV) both implemented video recording and review in their neonatal intensive care unit (NICU). The two centers initiated collaborative, multicenter video review sessions to facilitate international knowledge exchange. Methods: In this exploratory, descriptive study, collaborative video review sessions were organized with the interprofessional NICU staff of the LUMC and the MUV. We aimed to describe our experience with organizing these sessions and to report procedural variations, and document lessons learned that led to new perspectives on care. Results: We conducted five sessions using recordings of different patients undergoing intubation, less invasive surfactant administration, umbilical, central-catheter insertion and physiologically based cord clamping after birth. The videos were selected to ensure technical and clinical comparability. Sessions were attended by a mean of eight providers per center. A total of 19 relevant differences were described, of which seven (37%) prompted changes in practice or new insights for one or both centers. Finally, we developed a roadmap for organizing multicenter video review sessions. Conclusions: This study shows that multicenter video review may represent a feasible and innovative educational approach for identifying practice variations and fostering cross-institutional clinical refinement. Full article

Although the European Union positions the bioeconomy at the core of its sustainability transition and the European Green Deal, the cross-country distribution of bioeconomy value-added associated with mission-oriented public R&D support remains highly uneven. This paper investigates how national researcher capacity (as a proxy of absorptive capacity) shapes the macroeconomic effectiveness of bioeconomy-oriented public R&D support, and how societal climate-oriented environmental concern acts as a direct structural driver of bioeconomy value-added. Using a panel dataset of 27 EU Member States from 2008 to 2020, the study constructs an original bioeconomy-specific measure of government budget appropriations for R&D (GBARD) and estimates two-way fixed-effects models with Driscoll–Kraay standard errors to account for cross-sectional dependence. The findings reveal a clear capacity-dependent conditional moderation effect: public R&D support is significantly associated with higher bioeconomy value-added only when a critical mass of researcher capacity is present. Sectoral disaggregation demonstrates that business enterprise researcher capacity acts as the primary transmission channel linking public funds to the market, whereas higher-education capacity shows no statistically significant short-to-medium-term moderating effect, consistent with the academic research commercialisation time lags documented in the literature. Additionally, societal climate-oriented environmental concern is positively associated with bioeconomy value-added in the baseline models, consistent with its role as a demand-side factor fostering receptive conditions for bio-based transitions. The study concludes that increasing mission-oriented R&D funding alone is likely insufficient; to successfully cross the “valley of death,” public R&D should be accompanied by complementary policies that build private-sector absorptive capacity and cultivate green market demand. Full article

Driven by the digital transformation of territorial spatial governance, traditional urban planning is irreversibly shifting towards a data-driven empirical paradigm. However, constrained by mimetic isomorphism and path dependence, many geography-based regional universities remain trapped in an educational dilemma: they overemphasize morphological representation while marginalizing quantitative decision-making, fostering a structural mismatch between graduate competencies and industry demands. To explore a systematic pathway out of this dilemma, this study chronicles a three-year pedagogical intervention utilizing a mixed-methods design with a historical control cohort (N = 275) within the urban planning program of Gansu Agricultural University—a regional institution situated in a less-developed frontier where territorial renewal demands macro-spatial synthesis over aesthetic forms. The intervention strategically redefined the graduate competency profile as “spatial data analysts”, constructing a pedagogical model comprising foundational algorithmic training, cross-disciplinary faculty collaboration, and real-world Project-Based Learning (PBL), coupled with a restructured, evidence-based evaluation system. Longitudinal tracking and quantitative analyses indicate a structural alignment with elevated educational efficacy. At the macro level of employment trajectories, the proportion of graduates securing knowledge-intensive data positions experienced a structural shift, rising from a baseline of 14.5% to 42.5%, reflecting an enhanced capacity to capitalize on expanding societal demands. At the meso level of practical competence, the award rate in high-level professional competitions increased by 35.4%. At the micro cognitive level, the new evaluation mechanism is associated with a successful redirection of students’ cognitive resources toward algorithmic logic and policy translation (p < 0.001) while highly significantly enhancing their self-efficacy in tackling complex, wicked engineering problems (p < 0.001). Rather than isolating pure causal mechanics, this study interprets these systemic gains as a contextual realignment of academic supply. It provides a context-sensitive, reproducible methodological reference for cultivating professional distinctiveness and reshaping the spatial planning education system in the digital era. Full article

This research analysed how circular economy practices in the cacao value chain foster socio-economic empowerment and create sustainable employment for Awajún women in Imaza, Amazonas. The overall objective was to determine the association of circular practices with the empowerment and economic benefits of women producers. A quantitative approach was used, employing a non-experimental cross-sectional design and a sample of 55 women, who were administered a structured questionnaire; the data were processed using Spearman’s correlations and multiple linear regression models with robust standard errors. The main results showed a positive and significant correlation between circular economy practices and income and employment generation (rho = 0.702; p < 0.001). Furthermore, the econometric models confirmed that these practices are positively associated with socio-economic empowerment and economic benefits. It is concluded that the circular economy constitutes a viable strategy for improving the living conditions of Awajún women, although its scale up requires overcoming financial, technical and time-related barriers. Full article

The Positive Youth Development (PYD) framework provides a strengths-based perspective, paying greater attention to positive indicators of youth health. This article aimed to examine the relationship between the 5Cs of PYD (i.e., Character, Competence, Confidence, Connection and Caring) and three indicators of alcohol consumption in youth (use, drunkenness and drunken driving). A cross-sectional design was employed with a convenience sample of 1779 undergraduates aged 18 to 29 years (Mean = 20.32, SD = 1.84), recruited from ten universities across Andalusia (Spain). Data was collected during Spring 2023 through an online self-report questionnaire composed of PYD-SF, three questions to assess alcohol consumption, and demographics. Results underlined the protective association of Character and the paradoxical associations of Competence and Connection with alcohol consumption. The higher alcohol consumption scores in men (especially in the indicator of drunken driving) were associated with their lower scores in Character and their higher perceived Competence. These results underlined the importance of promoting positive contexts for developing both Competence and Connection, and the need to foster Character to increase awareness about the risk of alcohol consumption. Full article

Reading has long been recognised as a central mechanism for second language development, particularly in English as a Foreign Language (EFL) contexts where exposure to the target language is limited. However, learners do not seem to benefit equally from comparable reading demands, suggesting that factors beyond linguistic competence influence developmental outcomes. This study examines the relationship between reading self-efficacy and English language proficiency among undergraduate students enrolled in a Degree in English Studies at a Spanish university. A cross-sectional quantitative design was employed with a sample of 141 participants and data were collected using the Reader Self-Perception Scale 2 (RSPS2) and a standardised multilevel English placement test aligned with the Common European Framework of Reference for Languages (CEFR). The results revealed a statistically significant positive relationship between reading self-efficacy and language proficiency, whereas literary epistemological beliefs did not show a comparable association. Among the RSPS2 dimensions, perceived Progress and Physiological States emerged as the strongest correlates of proficiency, indicating that learners’ sense of development and emotional comfort while reading is particularly relevant to language achievement. The study argues that reading self-efficacy is related to textual exposure and language development, shaping whether learners engage with texts in sustained and productive ways. By linking learner self-perception to measurable proficiency outcomes, the study contributes empirical evidence to current discussions on affective variables in language learning and offers pedagogical implications for fostering engagement in higher education EFL contexts. Full article

Background/Objectives: Promoting psychological well-being is a central goal in healthy aging research. While leisure has been widely recognized as an important contributor to well-being in later life, the underlying psychological mechanisms remain insufficiently understood. This study aims to examine the relative roles of cognitive and experiential mechanisms in shaping psychological well-being among older adults. Methods: A cross-sectional survey was conducted with 200 older adults participating in community-based leisure programs in South Korea. Data were analyzed using confirmatory factor analysis and structural equation modeling. A dual-pathway model was tested, in which leisure attitude represents a cognitive mechanism and leisure satisfaction reflects an experiential mechanism. Results: Leisure attitude significantly influenced both leisure satisfaction and psychological well-being, while leisure satisfaction also had a positive but comparatively weaker effect on well-being. Mediation analysis confirmed that leisure satisfaction partially mediates the relationship between leisure attitude and psychological well-being. Notably, the direct effect of leisure attitude (β = 0.368) was substantially stronger than that of leisure satisfaction (β = 0.150), providing preliminary support for differences in the relative associations of cognitive and experiential pathways. Conclusions: These findings suggest that cognitive appraisal may play a relatively important role in psychological well-being among older adults and provide preliminary support for the relevance of cognitive mechanisms alongside experiential factors in aging research. Interventions aimed at promoting healthy aging should therefore focus not only on improving the quality of leisure experiences but also on fostering positive cognitive orientations toward leisure. Full article

As bridge infrastructure globally transitions from theoretical monitoring toward intelligent digital management, Machine Learning (ML) has emerged as a transformative tool for data-driven lifecycle decision-making. This study presents a systematic and critical review of ML applications across the entire bridge lifecycle, integrating a PRISMA-based scientometric analysis (2020–2025) with a rigorous technical synthesis of 3 major domains. The research reveals a clear hierarchy in deployment readiness; while Design & Optimization and Seismic Fragility Assessment have achieved “High” readiness by leveraging deep learning surrogates to achieve up to a 50-fold computational speedup over traditional simulations, Vibration-Based Damage Identification remains at a “Low–Medium” level due to environmental noise sensitivity and low Signal-to-Noise Ratios (SNR). Technical findings indicate that vision-based models (e.g., ViT, YOLOv8) show strong and promising performance for surface defect detection in controlled or semi-controlled settings, though broader field deployment remains constrained by lighting variability, dataset diversity, and validation at scale. In deterioration modeling and Remaining Useful Life (RUL) prediction, temporal architectures (e.g., LSTM) effectively capture non-linear trends, though operational risks such as “model drift” and “domain shift” in simulation-dependent models necessitate periodic retraining. This review identifies critical bottlenecks, including the “small data” paradox and the “black-box” dilemma. The work concludes by outlining a strategic roadmap centered on Physics-Informed Neural Networks (PINNs), Federated Learning for cross-agency collaboration, and Explainable AI (XAI) to foster professional trust in safety-critical infrastructure management. Full article

Pre-service teachers’ (PTs) beliefs about young children’s cognitive abilities shape both their instructional practices and their developing understandings of teaching and learning. This study examined PTs’ beliefs about preschool children’s cognitive abilities, focusing on cognitive operations, conceptual change, and learning processes, in relation to emerging professional identity development. A cross-sectional comparative design was employed with a convenient sample of 241 students from Early Childhood Education Departments who completed the Childhood and Cognitive Abilities Questionnaire. The findings revealed statistically significant differences between participants with and without practicum experience, with the former reporting more sophisticated beliefs, aligned with constructivist learning approaches. However, many participants simultaneously endorsed child-centered perspectives and traditional transmission-based conceptions of teaching, indicating the coexistence of contradictory beliefs. Correlation and cluster analyses further suggested that participants’ beliefs formed broader but only partially coherent belief systems rather than consistent conceptual profiles. These findings may reflect tensions within PTs’ emerging professional identities and suggest that practicum-related experience may coincide with opportunities for reflection on and restructuring of prior beliefs, processes associated with a coherent professional identity. Overall, this study highlights the importance of teacher education programs systematically addressing misconceptions about children’s cognitive abilities, while fostering coherent, research-informed professional identities and evidence-based instructional practices in early childhood education. Full article

Urban shrinkage has evolved from a localized phenomenon into a systemic challenge within China’s rapid urbanization, rendering traditional growth-oriented planning paradigms increasingly obsolete. However, existing research often treats shrinkage as either a passive outcome or an isolated shock, lacking a holistic perspective on how complex urban systems can adapt and reorganize under prolonged decline. This study constructs a coupling framework integrating urban shrinkage with Social–Ecological System (SES) resilience to bridge this theoretical gap. Drawing on a systematic literature review of 76 peer-reviewed articles following the PRISMA guidelines, we identify six core dimensions that drive this coupling. These dimensions consist of distinct physical and social elements. Our analysis reveals that the interactions between rigid physical environments and highly fluid social elements trigger nonlinear cascading feedback loops. While demographic contraction amplifies systemic risks, the subsequent structural release provides crucial spatial and institutional room for right-sizing. To translate these mechanisms into actionable governance strategies within the Chinese context, we propose a dual-track paradigm. Regionally, strategies emphasize collaborative risk monitoring, cross-boundary factor substitution, and industrial functional complementarity to mitigate vulnerability spillover. Locally, planning needs to pivot toward systemic downsizing and social empowerment, integrating proactive spatial reduction with agile service provision and community capacity-building. Ultimately, integrating structural reconfiguration with grassroots social learning enables shrinking cities to establish a new resilient equilibrium. While anchored in the Chinese context, this dual-track governance paradigm offers transferable insights for global shrinking cities seeking to overcome structural lock-in and foster adaptive SES resilience. Full article

Despite growing recognition that nurses must be equipped with sustainability competencies to address climate-related health challenges, the psychological mechanisms through which nursing education fosters sustainability attitudes are not yet fully understood. This study examined the mediating role of clinical performance self-efficacy in the relationship between simulation-based learning quality and sustainability attitudes among undergraduate nursing students. A cross-sectional correlational design was employed with a main sample of 679 nursing students from four Egyptian universities. Data were collected using the CHEST, SECP Scale, and SANS_2. Mediation analysis used Hayes’ PROCESS macro with 5000 bootstrap resamples. Simulation-based learning quality significantly predicted both self-efficacy (β* = 0.772) and sustainability attitudes (β* = 0.613). Self-efficacy partially mediated this relationship, accounting for 68.34% of the total effect (indirect β* = 0.419, Boot 95% CI [0.343, 0.494]). Nursing educators should design simulation curricula that deliberately cultivate self-efficacy while embedding sustainability content, producing clinically competent and environmentally responsible graduates. Full article

Background: Tinnitus is a common and potentially distressing phenomenon for which no broadly effective curative treatment exists. Self-management skills and empowerment are crucial for coping with chronic conditions, but empirical studies investigating the association of these on individuals burdened by tinnitus are scarce. The primary aim of this cross-sectional study was to investigate the association between the use of an online self-help platform for people with tinnitus and self-perceptions of empowerment, self-management skills, and the cognitive and emotional representations of tinnitus. Methods: One hundred and fifty-two adult participants were recruited from an online self-help platform for people with tinnitus, resulting in a self-selected convenience sample. Self-management skills were assessed using the Patient Assessment of Chronic Illness Care (PACIC) and the Partners in Health Questionnaire. The cognitive and emotional representations of tinnitus were measured with the Illness Perception Questionnaire. Finally, the Empowering Processes and Outcomes Questionnaire was used to evaluate empowerment associated with engagement in the self-help platform. The type and frequency of user activity on the self-help platform were used to explore the relationship between the nature of contributions to the platform and the measured outcomes. Results: The key findings include: (1) The representations of tinnitus were negatively related to their ability to self-manage the condition. (2) The duration of tinnitus did not correlate with improved self-management skills. (3) Comparing those who visited a healthcare provider for their tinnitus with those who did not, we found that treatment adherence was higher among participants with clinical visits. (4) Participants in this study scored lower on all aspects of self-management skills (as measured by the PACIC) compared to patients using primary healthcare services. (5) Participants who actively contributed to the self-help platform by posting scored higher in two empowering processes: helping others and sharing experiences. Conclusions: The present findings suggest that tinnitus self-management skills are independent of tinnitus duration, whereas those skills correlate negatively with illness perception. Further, clinical visits are associated with higher treatment adherence, and active self-help platform use increases feelings related to helping others and shared experiences. Taken together, these results highlight the need for fostering self-management skills and structured peer-to-peer support programs. Because this was a self-selected convenience sample of users of an online tinnitus self-help platform, the findings should be interpreted in light of this recruitment context and not generalized to the broader tinnitus population. Full article

Sustainable regional development requires understanding how entrepreneurship and unemployment co-evolve. This study investigates this relationship across Türkiye’s 26 Nomenclature of Territorial Units for Statistics 2 regions over the 2007–2024 period, testing the Schumpeter (pull) and Refugee (push) effects with controls for regional economic and financial determinants. Using the Dynamic Common Correlated Effects estimator, which accounts for cross-sectional dependence and slope heterogeneity across regions, the analysis provides evidence supporting both effects, while revealing that neither effect emerges instantaneously. The Schumpeter effect operates with an approximately one-year lag, reflecting the time new ventures require to complete organizational formation and generate net labor demand, with a creative destruction dynamic appearing from the second year onward. The Refugee effect materializes within one to two years, as unemployed individuals exhaust formal job search alternatives before turning to necessity entrepreneurship. Critically, the findings identify banking sector intermediation efficiency, rather than aggregate credit volume, as a more consistent financial channel for sustainable labor market outcomes, and document a pattern consistent with jobless growth, in which regional output expansion has not systematically translated into unemployment reduction. These results call for employment- and entrepreneurship-linked policy instruments that are timed to the lag structure of both effects and targeted at transforming necessity-driven activities into sustainable, high-value-added structures, rather than merely incentivizing firm entry. Aligning regional financial intermediation with employment creation can foster long-term socio-economic sustainability and promote sustainable regional development. Full article

Parent–child sexual communication plays a central role in adolescents’ sexual socialization, yet little research has examined whether frequent communication fosters adolescent disclosure of sexual behaviors and how disclosure relates to sexual debut. This study investigated whether the frequency of parent–child sexual communication is associated with adolescent disclosure and examined relationships between disclosure and age at first intercourse. Data from the Healthy Sexuality Pilot Study included 2044 adolescents (1030 males, 1014 females). Structural equation modeling with multi-group comparison revealed parent-specific pathways: maternal communication frequency was associated with disclosure to mothers (β = 0.66–0.69, p < 0.001), and paternal communication was associated with disclosure to fathers (β = 0.83–0.90, p < 0.001). Cross-parent effects were minimal, suggesting disclosure develops through specific parent–child dyadic communication. Invariance testing supported equivalent model functioning across male and female adolescents. Unexpectedly, greater disclosure to mothers was associated with earlier age at first intercourse for both males (β = −0.08, p < 0.05) and females (β = −0.15, p < 0.05). One possibility is that adolescents who become sexually active subsequently seek parental support, increasing disclosure after debut. Findings indicate that frequent sexual communication is associated with disclosure through parent-specific relational pathways but suggest the disclosure–behavior relationship is more complex than protective models predict. Results underscore the importance of promoting not only communication frequency but also quality and effective parental responses. Full article