Search Results (406)

Urban sustainability challenges demand integrated frameworks capable of addressing the dynamic, non-linear nature of cities. This study explores how the principles of the circular economy and complexity theory intersect to support systemic transformation in sustainable urban planning. Through a systematic literature review of 71 peer-reviewed articles published between 2015 and 2025, we analyze conceptual, methodological, and practical articulations across multiple thematic axes, including circular governance, urban metabolism, regenerative design, adaptive planning, digital integration, and environmental justice. Bibliometric and content analyses were conducted using Scopus metadata, VOSviewer for thematic clustering, and the StArt software (Version 3.4) to structure article selection. The findings reveal that circular economy provides practical tools for resource efficiency and regeneration, while complexity theory offers an adaptive framework to navigate uncertainty, emergent behaviors, and feedback dynamics. The synthesis suggests that their integration enables a more holistic and resilient approach to urban transformation. However, gaps remain in social inclusivity, long-term assessment, and the operationalization of complexity-informed planning. This study contributes to advancing a transdisciplinary agenda for circular and adaptive urban futures, offering insights for scholars, planners, and policymakers aiming to reconfigure cities within planetary boundaries. Full article

This study synthesizes the rapidly expanding evidence on how digital technologies reshape international trade, with a particular focus on small and medium-sized enterprises (SMEs). Guided by two research questions—(RQ1) How do digital tools influence the volume and composition of cross-border trade? and (RQ2) How do these effects vary by countries’ development level and firm size?—we conducted a PRISMA-compliant systematic literature review covering 2010–2024. Searches across eight major databases yielded 1857 records; after duplicate removal, title/abstract screening, full-text assessment, and Mixed Methods Appraisal Tool (MMAT 2018) quality checks, 86 peer-reviewed English-language studies were retained. Findings reveal three dominant technology clusters: (1) e-commerce platforms and cloud services, (2) IoT-enabled supply chain solutions, and (3) emerging AI analytics. E-commerce and cloud adoption consistently raise export intensity—doubling it for digitally mature SMEs—while AI applications are the fastest-growing research strand, particularly in East Asia and Northern Europe. However, benefits are uneven: firms in low-infrastructure settings face higher fixed digital costs, and cybersecurity and regulatory fragmentation remain pervasive obstacles. By integrating trade economics with development and SME internationalization studies, this review offers the first holistic framework that links national digital infrastructure and policy support to firm-level export performance. It shows that the trade-enhancing effects of digitalization are contingent on robust broadband penetration, affordable cloud access, and harmonized data-governance regimes. Policymakers should, therefore, prioritize inclusive digital-readiness programs, while business leaders should invest in complementary capabilities—data analytics, cyber-risk management, and cross-border e-logistics—to fully capture digital trade gains. This balanced perspective advances theory and practice on building resilient, equitable digital trade ecosystems. Full article

Aims/Background: Polypharmacy, or the concurrent intake of five or more medications, is a significant issue in clinical practice, particularly in multimorbid elderly individuals. Despite its importance for patient safety, medical education often lacks systematic training in recognising and managing polypharmacy within the framework of patient-centred care. We investigated the impact of a structured learning intervention introducing polypharmacy as a chronic condition, assessing whether it enhances medical students’ diagnostic competence, confidence, and interprofessional collaboration. Methods: A prospective cohort study was conducted with 50 final-year medical students who received a three-phase educational intervention. Phase 1 was interactive workshops on the principles of polypharmacy, its dangers, and diagnostic tools. Phase 2 involved simulated patient consultations and medication review exercises with pharmacists. Phase 3 involved reflection through debriefing sessions, reflective diaries, and standardised patient feedback. Student knowledge, confidence, and attitudes towards polypharmacy management were assessed using pre- and post-intervention questionnaires. Quantitative data were analysed through paired t-tests, and qualitative data were analysed thematically from reflective diaries. Results: Students demonstrated considerable improvement after the intervention in identifying symptoms of polypharmacy, suggesting deprescribing strategies, and working in multidisciplinary teams. Confidence in prioritising polypharmacy as a primary diagnostic problem increased from 32% to 86% (p < 0.01), and knowledge of diagnostic tools increased from 3.1 ± 0.6 to 4.7 ± 0.3 (p < 0.01). Standardised patients felt communication and patient-centredness had improved, with satisfaction scores increasing from 3.5 ± 0.8 to 4.8 ± 0.4 (p < 0.01). Reflective diaries indicated a shift towards more holistic thinking regarding medication burden. The small sample size limits the generalisability of the results. Conclusions: Teaching polypharmacy as a chronic condition in medical school enhances diagnostic competence, interprofessional teamwork, and patient safety. Education is a structured way of integrating the management of polypharmacy into routine clinical practice. This model provides valuable insights for designing medical curricula. Future research must assess the impact of such training on patient outcomes and clinical decision-making in the long term. Full article

Background/Objectives: Borderline Personality Disorder (BPD) involves emotional dysregulation, interpersonal instability and impulsivity. Although treatments have advanced, evaluating the latest innovations remains essential. This rapid review aimed to (1) identify and classify recent therapeutic innovations for BPD, (2) assess their effects on clinical and functional outcomes, and (3) highlight research gaps to inform future priorities. Methods: Employing a rapid review design, we searched PubMed/MEDLINE, PsycINFO, and Embase for publications from 1 January 2019 to 28 March 2025. Eligible studies addressed adult or adolescent BPD populations and novel interventions—psychotherapies, pharmacological agents, digital tools, and neuromodulation. Two independent reviewers conducted screening, full-text review, and data extraction using a standardised form. Results: Sixty-nine studies—predominantly from Europe and North America—were included. Psychotherapeutic programmes dominated, ranging from entirely novel models to adaptations of established treatments (for example, extended or modified Dialectical Behavior Therapy). Pharmacological research offered fresh insights, particularly into ketamine, while holistic approaches such as adventure therapy and digital interventions also emerged. Most investigations centred on symptom reduction; far fewer examined psychosocial functioning, mortality, or social inclusion. Conclusions: Recent innovations show promise in BPD treatment but underserve the needs of mortality and societal-level outcomes. Future research should adopt inclusive, equity-focused agendas that align with patient-centred and recovery-oriented goals, supported by a coordinated, integrated research strategy. Full article

Background/Objectives: Legislative changes in educational systems have influenced how student learning is understood and promoted. In physical education (PE), there has been a shift from behaviorist models to more holistic approaches. In this context, physical literacy (PL) is presented as an emerging pedagogical model in school PE, aimed at fostering students’ motor competence in a safe, efficient, and meaningful way. The aim of this study is to analyze the origins, foundations, methodological elements, and educational value of PL, highlighting its potential to promote holistic and inclusive learning as the basis for an emerging PL model. Methods: A narrative review was conducted through a literature search in the Web of Science, PubMed, Scopus, and SportDiscus databases up to June 2025, focusing on scientific literature related to PL and PE. The analysis included its historical background, philosophical and theoretical foundations, and the key methodological elements and interventions that support its use as a pedagogical model. Results/Discussion: The findings indicate that the PL model can be grounded in key principles, such as student autonomy, teacher training, connection with the environment, inclusion, and collaboration. Additionally, motivation, enjoyment, creativity, and continuous assessment are identified as essential components for effective implementation. Moreover, this model not only guides and supports teachers in the field of PL but also promotes comprehensive benefits for students at the physical, cognitive, affective, and social levels, while encouraging increased levels of physical activity (PA). Conclusions: PL is understood as a dynamic and lifelong process that should be cultivated from early childhood to encourage sustained and active participation in PA. As a pedagogical model, PL represents an effective tool to enhance student learning and well-being in PE classes. Full article

Plant functional traits serve as vital tools for understanding vegetation adaptation mechanisms in changing environments. As the primary organs for nutrient acquisition from soil, fine roots are highly sensitive to environmental variations. However, current research on fine-root adaptation strategies predominantly focuses on tropical, subtropical, and temperate forests, leaving a significant gap in comprehensive knowledge regarding fine-root responses in rocky-desertification habitats. This study investigates the fine roots of Pseudotsuga sinensis across varying degrees of rocky desertification (mild, moderate, severe, and extremely severe). By analyzing fine-root morphological and nutrient traits, we aim to elucidate the trait differences and correlations under different desertification intensities. The results indicate that root dry matter content increases significantly with escalating desertification severity. Fine roots in mild and extremely severe desertification exhibit notably higher root C, K, and Mg concentrations compared to those in moderate and severe desertification, while root Ca concentration shows an inverse trend. Our correlation analyses reveal a highly significant positive relationship between specific root length and specific root area, whereas root dry matter content demonstrates a significant negative correlation with elemental concentrations. The principal component analysis (PCA) further indicates that the trait associations adopted by the forest in mild- and extremely severe-desertification environments are different from those in moderate- and severe-desertification environments. This study did not account for soil nutrient dynamics, microbial diversity, or enzymatic activity—key factors influencing fine-root adaptation. Future research should integrate root traits with soil properties to holistically assess resource strategies in rocky-desertification ecosystems. This study can serve as a theoretical reference for research on root characteristics and adaptation strategies of plants in rocky-desertification habitats. Full article

Background: Cancer is one of the leading causes of morbidity and mortality worldwide and in Spain. Individuals with cancer are at a higher risk of suicide compared to the general population due to both general and disease-specific risk factors. Objective: To update knowledge on nursing care measures to address the risk of suicide in cancer patients. Methods: A narrative review was conducted by searching PubMed, WOS, Scopus, and CINAHL during February and March 2025. The inclusion criteria comprised original qualitative, quantitative, and/or mixed-methods studies related to the topic of the review. Results: Of the 289 identified studies, 23 were selected. Twelve studies of cancer patients, ten studies of healthcare professionals, and one study of caregivers and survivors were included. Regarding suicide risk factors, eight studies addressed demographic aspects, fifteen socio-economic factors, twenty-one psycho-emotional factors, and seventeen physical factors. Key risk factors included male sex, advanced age, social isolation, lack of social support, hopelessness, and physical deterioration. Seventeen studies highlighted the need for continuous and comprehensive nursing care using validated tools for systematic assessment of suicide risk. Eight emphasised the importance of ongoing training in suicide prevention, which is essential for developing communication skills and improving therapeutic relationships. Five studies underscored the relevance of a holistic approach that addresses the physical, emotional, social, and spiritual dimensions of patient care. Six extended this approach to include family members and caregivers. Conclusions: Suicide risk in cancer patients is associated with multiple risk factors. Emotional support and a comprehensive, continuous nursing approach—based on systematic assessments, specialised training, and a holistic focus—are key to effective suicide prevention. Full article

Nursing students encounter several challenges as they progress through their educational journey, particularly in integrating theoretical knowledge with practical applications using simulation-based learning (SBL). This study aimed to comprehensively assess the effects of SBL on nursing competence, self-efficacy, and overall satisfaction among undergraduate nursing students at Tabuk University, Saudi Arabia. A total of 136 students participated in this study, which employed a mixed-methods sequential explanatory design including a quantitative cross-sectional survey complemented by qualitative interviews to capture a holistic view of their experiences with SBL. The findings revealed high levels of satisfaction and self-confidence among students participating in SBL, indicating its effectiveness as an academic tool for enhancing learning outcomes. Significant positive correlations were observed among nursing competence, satisfaction, and self-confidence in the SBL context. This suggests that successful engagement in this educational approach can lead to improved clinical skills and preparedness for real-world challenges. The qualitative findings further illuminated the emotional and cognitive engagement experienced by students during the SBL sessions. The participants emphasized the importance of skill mastery in a safe and controlled environment and the positive impact of advanced technologies, such as virtual simulations, on their learning experiences. Full article

The Stability Toolkit for the Appraisal of Bio/Pharmaceuticals’ Level of Endurance (STABLE) is introduced and proposed as a comprehensive tool and software to evaluate the stability of active pharmaceutical ingredients (APIs) under various stress conditions. In the pharmaceutical industry, stability testing is a critical step in the drug development process, ensuring the quality, safety, and efficacy of APIs. Traditional stability tests—such as real-time, accelerated, and forced degradation testing—often face challenges, including inconsistent interpretation and implementation across different regions and organizations. STABLE addresses these challenges by providing a standardized and holistic approach to assessing drug stability across five key stress conditions: oxidative, thermal, acid-catalyzed hydrolysis, base-catalyzed hydrolysis, and photostability. Beyond its role as an evaluation tool, STABLE also serves as a practical guide for chemists, encouraging a more complete and thoughtful approach to stability studies. While many investigations focus solely on acid- and base-catalyzed hydrolysis, other critical conditions—such as photostability—are often underexplored or entirely omitted. By highlighting the importance of evaluating all relevant degradation pathways, STABLE promotes more robust and informed stability testing protocols. The index utilizes a color-coded scoring system to quantify and compare stability, facilitating consistent assessments across different APIs. This paper discusses the methodology of STABLE, including the scoring system and specific criteria applied under each condition. This tool is introduced to reflect intrinsic degradation susceptibility under forced conditions. The software is freely available as an open-source tool at bit.ly/STABLE2025, enabling broader accessibility and implementation across the pharmaceutical research community. Full article

Addressing resource depletion and minimizing construction waste requires closing the material loop through circular economy practices. However, the lack of comprehensive material information remains a significant barrier. The materials passport (MP) has become an essential tool for documenting material properties and dynamically updating information throughout its lifecycle. Despite recent advancements, existing MP frameworks remain static and lack a holistic approach, limiting their effectiveness in assessing material quality and supporting high-value recovery and reuse. As a result, the industry remains reluctant to adopt secondary materials due to concerns about their performance and quality in structural applications where assurance of reliability is essential. Therefore, this study aims to address this gap by (1) defining the conceptual boundary of the MP framework by examining current MP practices, key functions, and existing limitations and (2) developing a standardized framework using concrete as demonstration material. An extensive literature review was conducted to define the conceptual boundary. Literature and relevant standards were reviewed to identify essential attributes. The study identified three core MP functions, including material tracking and management, circularity assessment, and sustainability assessment, while proposing an additional function of quality assessment. These four functions collectively informed the development of a unique standardized and holistic MP framework. Thus, this study contributes by enabling practitioners to make quality-based, data-driven decisions that support the effective secondary use of materials. Full article

Background/Objectives: Melanoma is a skin cancer that can lead to a poor prognosis. Unlike other oncologic diseases, there is scarce evidence regarding sexual function in melanoma patients, as well as factors associated with sexual dysfunction (SD). The aim of this study was to evaluate SD in a cohort of melanoma patients, as well as to describe associated factors. Methods: A cross-sectional analysis was conducted in individuals diagnosed with melanoma. Data regarding sociodemographic characteristics, clinical stage of the disease, quality of life, and sexual functioning were obtained through the use of validated assessment tools. The duration of the study was from 1 January 2023 to 1 January 2024. Results: Seventy-five patients were included. The mean age was 52.70 ± 14.07 years, and 61.33% (46/75) were females. Melanomas at stages III or IV comprised 18.67% (14/75) of the sample. A negative impact of the melanoma on sexual function was reported by 29.33% (22/75) of patients, with low sexual desire being the most frequent cause. Female SD was associated with older age, shorter disease duration, greater depression rates, and visible scar location after melanoma surgery (p < 0.05). Male SD correlated with higher anxiety and depression rates and worse quality of life (p < 0.05). No association was found for melanoma stage in any case (p > 0.30). Conclusions: Melanoma patients may suffer from SD, which can be associated with mood status disturbances, poor quality of life, and older age. Since the most frequent causes of a negative impact on sexuality are a reduction in sexual desire and the side effects of melanoma surgery, patients should be specifically asked about sexuality to improve holistic care of the disease, irrespective of disease stage. Full article

This study addresses critical Environmental, Social, and Governance (ESG) research gaps in Asia by developing a validated and holistic framework tailored to Taiwanese listed companies. Integrating the Resource-Based View (RBV), Institutional Theory, and Stakeholder Theory, the framework encompasses five key dimensions relevant to ESG commitment: Corporate Governance, Regulatory Pressure, Stakeholder Influence, Financial Performance, and ESG Implementation. This study adopts a two-round Delphi method involving 15 cross-sector ESG experts and uses a 7-point Likert scale questionnaire to validate 40 ESG sub-indicators. The research offers significant theoretical and practical contributions. Academically, it integrates multiple theoretical perspectives, providing a more comprehensive and enriched understanding of the key drivers influencing ESG commitment. It offers robust empirical validation within the specific Taiwanese context, thereby contributing to the body of knowledge in ESG research. Practically, it provides structured guidance for enhancing ESG readiness, empowering companies to implement more effective and impactful ESG strategies, and offers a practical tool for improving ESG performance. Furthermore, this framework’s adaptability positions it as a scalable model for ESG assessment and strategic alignment across Asia, providing valuable insights for policymakers and businesses seeking to advance sustainable development in the region. Full article

Various cardiac pathologies such as ischemic/non-ischemic heart disease, valvular heart disease and genetic heart disease may impair cardiac function and lead to heart failure (HF). Each individual condition but also the common endpoint of HF may involve the brain and the immune system next to the heart. The interaction of these systems plays an important role, particularly in the pathogenesis and prognosis of HF, and stress plays a pivotal role in this interaction. The stress system (SS) of the body can be activated by any stress factor exceeding a predefined threshold and all body structures including brain, heart and immune system can be affected. The SS is also responsible for body homeostasis. Both acute and chronic stress may lead to the development of acute and chronic heart disease. Magnetic Resonance Imaging (MRI) is the ideal noninvasive tool without radiation that can provide valuable information about the effect of the SS in various systems/organs using targeted protocols. A holistic approach provided by MRI has the potential to improve our knowledge regarding stress mechanisms on the axis of heart–brain–immune system in HF that may impact effective, individualized treatment. In this review paper, we describe how MRI can be used as a noninvasive tool to assess the effect of stress on the brain–immune system-heart-axis, discussing current possibilities, limitations and future directions. Full article

The assessment of company performance requires a holistic approach, encompassing both financial and non-financial metrics. Accordingly, we develop a comprehensive airline performance evaluation model utilizing the Balanced Scorecard (BSC)-based multi-criteria decision-making (MCDM) framework. Based on contingency theory, we use 30 Key Performance Indicators (KPIs) derived from the literature and develop a novel performance model by combining the BSC framework with the Method based on the Removal Effects of Criteria (MEREC) for KPI weighting and the Combined Compromise Solution (CoCoSo) for ranking. The focus on Turkish Airlines, serving as a comparative benchmark, over the period 2020–2023 reveals that while financial KPIs hold the greatest weight, non-financial KPIs have the most significant impact on performance. The lowest performance is recorded in 2020, most probably attributable to the COVID-19 pandemic, followed by a remarkable recovery in 2021. We offer a methodological contribution for managers, decision-makers, and scholars—an objective, data-driven tool to assess airline performance. Furthermore, we furnish policymakers with tangible data for more effective industrial incentives and convenient regulatory strategies. In contrast to most of the literature emphasizing financial indicators and subjective weighting approaches that might yield biased rankings, we suggest a novel integrated performance evaluation model tailored for the airline industry. Full article

This paper develops a comprehensive framework for the risk assessment of 115 kV power circuit breakers (PCBs) by evaluating their condition, replacement needs, and criticality to the electrical network. The primary objective is to create a risk assessment tool that enhances maintenance practices and improves operational efficiency. The framework begins with a condition assessment, quantified through the use of a health index, derived from historical diagnostic test results and routine checks. The next step involves a replacement assessment, using a replacement index that considers factors such as age, rating adequacy, and technological obsolescence to determine the necessity of replacement. Finally, a criticality assessment is performed using a criticality index, which evaluates the PCB’s role in the network by factoring in location, load importance, failure severity, and the consequences of failure on network operations. By integrating these indices, the framework offers a holistic view of the associated risks. The methodology is applied to assess the risk of 149 sample PCBs across 30 substations in Thailand, with relevant data collected for each unit. The resulting risk assessments support proactive maintenance, minimize downtime, optimize the allocation of limited resources, and enhance the overall efficiency, reliability, and safety of the electrical network. Full article