Search Results (883)

In alignment with global educational trends, Australia has adopted a pluralistic approach to initial teacher education (ITE), encompassing traditional university-based programs, employment-integrated models and vocational training routes. This diversification of pathways has emerged as a strategic response to persistent workforce challenges, including chronic shortages, uneven distribution of qualified educators, and limited demographic diversity within the profession. Rather than supplanting conventional ITE models, these alternative pathways serve as complementary options, broadening access and enhancing system responsiveness to evolving societal and educational needs. The rise in non-traditional routes represents a deliberate response to the well-documented global teacher shortage, frequently examined in comparative educational research. Central to their design is a restructuring of traditional program elements, particularly duration and delivery methods, to facilitate more flexible and context-sensitive forms of teacher preparation. Such approaches often create opportunities for individuals who may be excluded from conventional pathways due to socioeconomic constraints, geographic isolation, or non-linear career trajectories. Significantly, the diversity introduced by alternative entry candidates has the potential to enrich school learning environments. These educators often bring a wide range of prior experiences, disciplinary knowledge, and cultural perspectives, contributing to more inclusive and representative teaching practices. The implications for student learning are substantial, particularly in disadvantaged communities where culturally and professionally diverse teachers may enhance engagement and academic outcomes. From a policy perspective, the development of flexible, multifaceted teacher education pathways constitutes a critical component of a sustainable workforce strategy. As demand for qualified teachers intensifies, especially in STEM disciplines and in rural, regional and remote areas, the role of alternative pathways is likely to become increasingly pivotal in achieving broader goals of equity, quality and innovation in teacher preparation. Full article

Background: Acute Stanford Type A aortic dissection (ATAAD) often requires total arch replacement (TAR) with frozen elephant trunk (FET) to address entry tears and support aortic remodeling. In select cases, AMDS may provide a simpler option. The present meta-analysis aims to compare surgical outcomes between these two approaches. Methods: A comprehensive search in the Pubmed, ScienceDirect, SciELO, DOAJ, and Cochrane library databases was performed until February 2025. We included studies that reported the outcomes of patients with ATAAD undergoing TAR with AMDS or FET. To enable a meaningful comparison, we only included FET studies where patients met the same inclusion criteria as those with the AMDS. Results: Thirty-eight articles met our inclusion criteria, with a total of 319 patients in the AMDS group and 4129 in the FET group. Patients undergoing an AMDS procedure experienced significantly higher bleeding requiring surgery (21.2% vs. 6.4%, p < 0.001) and a higher hospital mortality (14.5% vs. 10.0%, p = 0.037) compared to FET. The individual patient data of 1411 patients were constructed. Overall survival at 1 and 3 years was 81.9% ± 3.3% vs. 88.8% ± 0.9% and 81.9% ± 3.3% vs. 85.2% ± 1.0% between AMDS and FET, respectively. A flexible parametric survival model demonstrated a significant mortality drawback for AMDS compared to FET up to 31 days, beyond which the difference was no longer evident. Conclusions: The comparison between AMDS and FET for ATAAD treatment remains debated, with FET favored for its lower mortality and stronger long-term evidence. AMDS, as a newer technique, shows promise but lacks sufficient data to confirm its safety and efficacy. Full article

The presented research is focused on the development of the bus rapid transit (BRT) system, combining the high capacity of rail transport with the flexibility of bus routes. Classic BRT systems have certain limitations, particularly concerning a single rolling stock capacity. The main motivation of the work is to find efficient and cost-effective solutions to increase passenger traffic in the BRT system while optimizing fuel consumption. The main contribution of this study is the comprehensive analysis and optimization of various configurations of trailer bus trains, which represent a flexible and cost-effective alternative to traditional single or articulated buses. Based on two schemes, four possible options for using trailer bus trains are offered, which differ in the number of sections and working engines. Among the suggested schemes of trailer bus trains, the two-section and three-section schemes with all engines running and the three-section scheme with one engine turned off are appropriate for use due to improved fuel efficiency indicators with better or acceptable traction and speed properties. Calculations carried out on a mathematical model show that, for example, a two-section bus train can provide a reduction of specific fuel consumption per passenger by 6.3% compared to a single bus at full load, while a three-section train can provide even greater savings of up to 8.4%. Selective shutdown of one of the engines in a multi-section train can lead to an additional improvement in fuel efficiency by 5–10%, without leading to a critical reduction in the required traction characteristics. Full article

Grief reactions among relatives of palliative care patients are often overlooked, with most interventions targeting Prolonged Grief Disorder (PGD) rather than its prevention. Few interventions have been developed for individuals at risk. This study aimed to evaluate the efficacy of Empower-Grief, a selective intervention designed to address early problematic grief reactions and to explore predictors of its effectiveness. This exploratory randomized controlled trial (RCT) compared Empower-Grief with Treatment as Usual (TAU) among relatives or caregivers of palliative and oncological patients at risk of developing PGD. A total of 46 participants were assessed at baseline, post-intervention, and six months later. The primary outcome was PGD symptoms, with additional measures including anxiety, depression, coping strategies, attachment style, psychological flexibility, post-traumatic growth, social support, and therapeutic alliance. The final analyses indicate equivalence between Empower-Grief and TAU, suggesting that both interventions yielded comparable outcomes in reducing PGD symptoms and associated psychological distress. The initial symptoms and therapeutic alliance were predictors of the results in both post- and follow-up moments. This study contributes to the evidence on grief interventions in palliative care, highlighting the importance of structured support for bereaved caregivers. While Empower-Grief demonstrated comparable effectiveness to TAU, its lower intensity, ease of training, and application make it a promising treatment option. Full article

Background and objectives: Duloxetine is widely used for the treatment of major depressive disorder (MDD), generalized anxiety disorder (GAD), and various types of neuropathic pain. While its efficacy is well documented in clinical trials, less is known about how it is perceived and utilized in routine psychiatric practice. To address this knowledge gap, we conducted a cross-sectional observational study involving 80 psychiatrists from Spain to assess real-world clinical attitudes toward duloxetine. Methods: Participants completed a 20-item multiple-choice questionnaire that examined familiarity, perceived efficacy in multiple conditions (MDD, GAD, neuropathic pain, somatization, and quality of life), and perspectives on tolerability, safety, adherence, and overall satisfaction. Results: Survey results indicated that a large majority of psychiatrists frequently prescribe duloxetine, particularly for patients with MDD and comorbid chronic pain. Notably, 94% rated it as either “more effective” or “much more effective” for diabetic peripheral neuropathic pain. Psychiatrists reported a high perceived efficacy of duloxetine: 94% rated it as “more effective” or “much more effective” for diabetic peripheral neuropathy, and 93% gave similarly positive ratings for general neuropathic pain. For somatization, 70% found it “effective” or “very effective”, and 83% observed improvements in quality of life for many of their patients. Psychiatrists generally reported favorable perceptions of duloxetine’s tolerability profile: 97.5% rated it as the antidepressant associated with the least weight gain, and 82.5% perceived fewer sexual side effects compared to other options. Sedation and gastrointestinal side effects were generally considered mild or less severe. In terms of treatment adherence, 69% rated it as “better” or “much better” than other antidepressants, and 80% found its combination with other antidepressants to be “favorable” or “very favorable”. Overall satisfaction was high, with 99% of psychiatrists reporting being either “satisfied” or “very satisfied” with its use. The side effect profile was generally viewed as manageable, with low perceived rates of weight gain, sedation, and sexual dysfunction. Furthermore, 96% of respondents expressed a willingness to recommend duloxetine to their colleagues. Conclusions: Psychiatrists reported highly favorable attitudes toward duloxetine, viewing it as a flexible treatment option in routine care. However, these findings reflect clinicians’ subjective perceptions rather than objective clinical outcomes and should be interpreted accordingly. Full article

Background: Awake craniotomy (AC) surgeries are less common in the pediatric population in comparison to their adult counterparts. Nonetheless, they can be considered for selected cases whereby speech preservation is paramount during maximal safe resection of intracranial lesions. We describe a case of AC for the excision of a brain arteriovenous malformation (bAVM) with language mapping in a pediatric patient. Methods: A previously well 16-year-old male presented with a spontaneous left frontal intracranial hemorrhage. Neuroimaging confirmed the cause to be a left antero-temporal bAVM centered in the insula. A decision was made for AC bAVM excision with language mapping for speech preservation. Results: As part of the pre-operative preparation, the patient and his caregivers were reviewed by a multidisciplinary team. For the conduct of the AC, the asleep–awake–asleep technique was used with processed EEG to guide anesthesia management. Additional modifications to make the patient comfortable included the avoidance of rigid cranial skull pins, urinary catheterization and central line insertion at the start of the surgery. Conclusions: Our experience concurs with the evidence that AC in children is a feasible option for select individuals. To our knowledge, this is the first detailed case description of a pediatric patient undergoing AC with language mapping for a bAVM. Emphases include a strong rapport between the patient and the managing multidisciplinary team, flexibility to adjust conventional workflows and limitations of neuroimaging adjuncts. Full article

Dynamic Line Rating (DLR) technology is presented as a key solution to optimize the transmission capacity of power lines without the need to make investments in new infrastructure. Unlike traditional methods based on static estimates, DLR allows the thermal capacity of conductors to be evaluated in real time, considering the environmental and operational conditions. This article presents a state-of-the-art analysis of this technology, including a review of the main solutions currently available on the market. Likewise, the influence of variables such as ambient temperature, wind speed and direction or solar radiation in the determination of dynamic load capacity is discussed. It also reviews various pilot and commercial projects implemented internationally, evaluating their results and lessons learned. Finally, the main technological, regulatory, and operational challenges faced by the mass adoption of DLR are identified, including aspects such as the prediction of the dynamic capacity value, combination with other flexibility options, or integration with network management systems. This review is intended to serve as a basis for future developments and research in the field. Full article

The adjuvant treatment landscape for hormone receptor-positive (HR+), human epidermal growth factor receptor 2-negative (HER2–) early breast cancer (EBC) is rapidly evolving, with a diverse range of therapeutic options—including endocrine therapies, bisphosphonates, ovarian function suppression, olaparib, CDK4/6 inhibitors, and emerging agents such as immunotherapy. While these advances have markedly improved patient outcomes, they also introduce challenges related to implementation, monitoring, and resource allocation. Notably, therapies like CDK4/6 inhibitors require particularly close monitoring, creating logistical and capacity challenges for medical oncologists, whose workloads are already stretched due to rising cancer incidence and treatment complexities. These challenges underscore the need for innovative care delivery solutions to ensure patients with EBC continue to receive optimal care. This paper offers a comprehensive guide—a playbook—of multidisciplinary-team-based care models designed to optimize adjuvant treatment delivery in EBC. Drawing on real-world evidence and successful applications across Canadian centers, we explore models led by nurses, nurse practitioners (NPs), general practitioners in oncology (GPO), and pharmacists. Each model leverages the unique expertise of its team to manage treatment toxicities, facilitate adherence, and enhance patient education, thereby promoting effective and sustainable care delivery. Importantly, these models are not intended to compete with one another, but rather to serve as a flexible recipe book from which breast cancer care teams can draw strategies tailored to their local resources and patient needs. By detailing implementation strategies, benefits, and challenges—in many instances supported by quantitative metrics and economic evaluations—this work aims to inspire care teams nationwide to optimize the adjuvant management of patients with HR+, HER2– EBC. Full article

Study design: The advent of the Matrix Wave^TM System (Depuy-Synthes)—a bone-anchored Mandibulo-Maxillary Fixation (MMF) System—merits closer consideration because of its peculiarities. Objective: This study alludes to two preliminary stages in the evolution of the Matrix Wave^TM MMF System and details its technical and functional features. Results: The Matrix Wave^TM System (MWS) is characterized by a smoothed square-shaped Titanium rod profile with a flexible undulating geometry distinct from the flat plate framework in Erich arch bars. Single MWS segments are Omega-shaped and carry a tie-up cleat for interarch linkage to the opposite jaw. The ends at the throughs of each MWS segment are equipped with threaded screw holes to receive locking screws for attachment to underlying mandibular or maxillary bone. An MWS can be partitioned into segments of various length from single Omega-shaped elements over incremental chains of interconnected units up to a horseshoe-shaped bracing of the dental arches. The sinus wave design of each segment allows for stretch, compression and torque movements. So, the entire MWS device can conform to distinctive spatial anatomic relationships. Displaced fragments can be reduced by in-situ-bending of the screw-fixated MWS/Omega segments to obtain accurate realignment of the jaw fragments for the best possible occlusion. Conclusion: The Matrix Wave^TM MMF System is an easy-to-apply modular MMF system that can be assembled according to individual demands. Its versatility allows to address most facial fracture scenarios in adults. The option of “omnidirectional” in-situ-bending provides a distinctive feature not found in alternate MMF solutions. Full article

Robotic arms are used in a wide range of industrial and medical applications. However, for research and education, users often face a trade-off between costly commercial solutions with no adaptability and open-source alternatives that lack usability and functionality. In education, this problem is exacerbated by the prohibitive cost of commercial systems or simplifications that distort learning. Thus, we present HELENE, an open-source robot with six degrees of freedom, closed-loop position control, and robot operating system (ROS) integration. The modular design of the robot, printed on a commercial 3D printer, and its integrated custom electronics allow for easy customization for research purposes. The joints are driven by standard stepper motors with closed-loop position control using absolute encoders. The ROS integration guarantees widespread control options and integration into existing environments. Our prototype, tested in accordance with ISO 9283, has a small positional accuracy error of 8.4 mm and a repeatability error of only 0.87 mm with a load capacity of 500 g at a reach of 432 mm. Ten prototypes were built and used in various research and education applications, demonstrating the versatile applicability of this open-source robot, closing the gap between reliable commercial systems and flexible open-source solutions. Full article

The sustainable development of geotechnical infrastructure necessitates using durable, efficient, and environmentally resilient reinforcement materials. This study investigates the pullout performance of geostraps to assess their potential as a sustainable alternative to conventional geosynthetics. This study focuses on the pullout performance of geostraps, flexible, polymeric reinforcement materials. There has not been a thorough study of their pullout resistance, which directly affects the stability and durability of reinforced soil structures. Pullout tests were conducted on sandy soil in a controlled environment. The experimental findings from the pullout test were then validated in a numerical model. The model was used to determine the pullout resistance of different grades of geostraps for comparative analysis. This helped to identify the possible application areas based on the pullout capacity of various grades. The results obtained for the geostraps were then compared with those in the established literature on geogrids. Initially, the pullout resistance of the M65 geostrap was up to 20% higher than that of a biaxial geogrid. This makes it a suitable option for reinforced earth applications. However, the maximum pullout resistance of geogrids was up to 8% higher than that of geostraps when subjected to a surcharge of 17 kN m⁻² in poorly graded sand. This study highlights the potential of geostraps as reinforcement materials, particularly in challenging environments where conventional geosynthetics may underperform. Future research may explore their behaviour with different soil types and other controlled environmental factors to establish their broader applicability and design charts. Full article

Alternative fuels obtained from renewable sources, providing low greenhouse gas emissions and high energy efficiency, offer significant advantages in terms of sustainability. In addition, the wide applicability of these fuel types in sectors such as housing, transportation, and industry creates significant opportunities in terms of reducing dependence on fossil fuels. Alternative fuels should be evaluated not only according to their environmental contributions but also based on multi-dimensional criteria such as economic cost, technical suitability, sustainability level, fuel properties, infrastructure requirements, and social acceptance. In this context, a comparative analysis of alternative fuel types in terms of various basic parameters is no longer optional, but a necessity. These parameters generally include symmetrical relationships such as balanced trade-offs between economic and environmental dimensions or mutual effects between technical and social criteria. However, they also show variability and uncertainty depending on the fuel type. Therefore, Spherical Fuzzy Multi-Criteria Decision Making (SF-MCDM) methods, which can effectively represent symmetry in membership and hesitation degrees, have been used to achieve more realistic and reliable results in uncertain decision environments. The proposed model provides a systematic and flexible evaluation structure that helps decision makers determine the most appropriate alternative fuel options and contributes to the formation of sustainable energy policies. Full article

This study presents an optimization framework for a utility-scale hybrid power plant (HPP) that integrates wind power plants (WPPs), solar power plants (SPPs), and battery energy storage systems (BESS) using historical and probabilistic weather modeling, regulatory incentives, and multi-objective trade-offs. By employing multi-objective particle swarm optimization (MOPSO), the study simultaneously optimizes three key objectives: economic performance (maximizing net present value, NPV), system reliability (minimizing loss of power supply probability, LPSP), and operational efficiency (reducing curtailment). The optimized HPP (283 MW wind, 20 MW solar, and 500 MWh BESS) yields an NPV of $165.2 million, a levelized cost of energy (LCOE) of $0.065/kWh, an internal rate of return (IRR) of 10.24%, and a 9.24-year payback, demonstrating financial viability. Operational efficiency is maintained with <4% curtailment and 8.26% LPSP. Key findings show that grid imports improve reliability (LPSP drops to 1.89%) but reduce economic returns; higher wind speeds (11.6 m/s) allow 27% smaller designs with 54.6% capacity factors; and tax credits (30%) are crucial for viability at low PPA rates (≤$0.07/kWh). Validation via Multi-Objective Genetic Algorithm (MOGA) confirms robustness. The study improves hybrid power plant design by combining weather predictions, policy changes, and optimizing three goals, providing a flexible renewable energy option for reducing carbon emissions. Full article

This study presents a comprehensive multi-objective optimization framework specifically designed for micro-electromechanical systems (MEMS). The framework integrates both traditional and adaptive optimization techniques, named Surrogate-Assisted Multi-Objective Optimization (SAMOO) and Adaptive-SAMOO (A-SAMOO), respectively. By addressing key limitations of traditional approaches, such as the consideration of objective constraints and the provision of multiple design options, the proposed framework enhances both flexibility and practical applicability. Results show that adaptive optimization outperforms traditional offline methods by delivering a greater number and higher quality of optimal solutions while requiring fewer finite element method simulations. The adaptive approach showed a significant advantage by attaining high-quality solutions while requiring only 2.8% of the finite element method (FEM) evaluations compared to traditional methods that do not incorporate surrogate models. This performance boost highlights the advantages of online learning in enhancing the accuracy, speed, and diversity of solutions in MEMS optimization. These optimization schemes were tested on multiple MEMS devices with varying physics and complexities, specifically the U-shaped Lorentz force actuator, serpentine Lorentz force actuator, and thermal actuator. The results highlight the robustness and versatility of the proposed methods, particularly in addressing cases involving discrete design variables and strict objective constraints. This comprehensive, step-by-step framework serves as a valuable resource for researchers and practitioners aiming to optimize MEMS designs from the ground up, providing a reliable and effective approach to multi-objective optimization in MEMS applications. Full article

Background: Autogenous tooth transplantation is a valuable option for dental rehabilitation, particularly in young patients. Template-guided approaches, using 3D-printed replicas of donor teeth, have recently emerged as a method to increase precision and reduce extraoral time—two critical factors in maintaining periodontal ligament (PDL) vitality, which is essential to improve long-term outcomes. Methods: This report presents the case of a 12-year-old patient who underwent autotransplantation of tooth 18 to the site of tooth 75, which exhibited ankylosis. Patients exhibiting unfavorable root anatomy and morphology, systemic conditions, or completed root development were not considered for this technique. A patient-specific donor tooth replica was digitally designed and 3D-printed via CAD/CAM manufacturing to preoperatively shape the recipient site. The transplanted tooth 18 was then inserted with an extraoral time of less than one minute and subsequently stabilized using a flexible titanium trauma splint (TTS). Results: Longitudinal clinical and radiographic follow-up over 12 months confirmed favorable healing without signs of complications. Conclusions: This case illustrates the practical advantages of a fully digital, template-guided workflow in managing anatomically complex cases. Full article