Search Results (165)

This study examines the extent to which smart cities are expressions of nationally homogeneous development trends by way of an analysis of their structural characteristics from a multivariate viewpoint. Drawing on data from the International Institute for Management Development IMD Smart City Index 2024, we find a sample of 102 cities across the world clustering along six key dimensions of smartness: mobility, environment, government, economy, people, and living. The aim is to examine if cities within a country have similar profiles and, if so, to what degree such similarity translates to other macro-level institutional, political, and cultural conditions. Our results verify a tight correspondence between city profiles and national contexts, implying that macro-level governance arrangements, policy coordination, and institutional capacity are pivotal in influencing local smart city development. Planned centralised countries possess more uniform city characteristics, while decentralised nations possess more variant urban policies. This study contributes to international debate regarding smart cities by empirically identifying national directions of urban innovation. It offers pragmatic inputs for policymakers that aim to align local efforts with overall sustainable development agendas. Moreover, this study introduces a novel application of Linear Discriminant Analysis (LDA) to classify smart city profiles based on national models. While the analysis yields high classification accuracy, it is important to note that the sample is skewed toward cities from the Global North, potentially limiting the generalisability of the results. Full article

Care-experienced young people often face considerable challenges due to a personal history of trauma and disruption and have a higher risk of homelessness, mental ill health, and involvement with the criminal justice system. A stubborn trend of achieving fewer qualifications than non-care-experienced peers persists, with greater likelihood of becoming NEET (Not in Education, Employment or Training). Accessible and sustainable pre-employment programmes should be a priority for national initiatives designed to generate improved outcomes for vulnerable youth. The I-CAN (Initiating and Supporting Care Leavers into Apprenticeships in Nursing) programme offers young people in England (aged 18–30) a person-focussed pathway to training and employment. However, robust research is needed to evidence the effectiveness of this type of small-scale and short-term funded programme. The current paper reports qualitative findings from a pilot study exploring the perceptions and experiences of (N = 27) young people who attended the 8-week I-CAN programme delivered at a Higher Education Institution. Data were collected from four focus groups and thematically analysed. The findings captured young people’s personal trajectories and exposed underpinning processes as well as unique, shared, and intersectional factors that can either facilitate or impede progression to education, employment and training. Crucially, care-experienced young people are not a homogenous group and capturing their authentic, diverse voices in evaluation research is essential for not only assessing if a programme works but for whom, and why. Furthermore, findings can help to inform meaningful strategies and socially valid interventions to support care-experienced young people navigate the transition ‘cliff edge’. Full article

Background: Oral leukoplakia (OL) and proliferative verrucous leukoplakia (PVL) remain challenging entities due to the absence of reliable prognostic biomarkers. All-trans retinoic acid (atRA), a pivotal modulator of epithelial differentiation and mucosal integrity, has been proposed as a candidate biomarker. This study sought to quantify plasma RA levels in patients with OL and PVL compared to healthy controls, assessing their potential clinical utility. Methods: A cohort of 40 participants was recruited, comprising 10 patients with OL, 10 with PVL, and 20 healthy controls. This nested case–control study was derived from previously characterized institutional databases of oral potentially malignant disorders. Plasma samples were analyzed for atRA concentration using high-precision mass spectrometry. Statistical comparisons were conducted to evaluate differences between groups and associations with clinical outcomes. Results: Patients with homogeneous OL exhibited significantly reduced plasma atRA concentrations (mean 2.17 ± 0.39 pg/mL) relative to both PVL patients (2.64 ± 0.56 pg/mL) and healthy controls (2.66 ± 0.92 pg/mL), with p-values of 0.009 and 0.039, respectively. No statistically significant difference was found between PVL patients and controls. Furthermore, atRA levels demonstrated no correlation with clinicopathological variables or malignant progression within the PVL cohort. Conclusions: These preliminary findings indicate that diminished plasma atRA levels may serve as a prognostic marker for homogeneous oral leukoplakia, whilst its role in PVL appears limited. However, effect estimates were imprecise, and additional studies are warranted. Full article

The landscapes of China’s multi-ethnic areas are rich in natural and cultural value, but they are threatened by homogenization and urbanization. This study aims to establish a method for identifying and classifying the landscape characters in China’s multi-ethnic areas to support the protection and sustainable development of the landscape in these areas. Taking the Miao Frontier Corridor as an example, the study optimized a parameterization method of landscape character assessment (LCA), integrated relevant cultural and natural elements, and used the K-means clustering algorithm to determine the landscape character types and regions of the Miao Frontier Corridor. The results show that (1) the natural conditions, ethnic exchanges, and historical institutions of the Miao Frontier Corridor have had a significant impact on its overall landscape; and (2) using ethnic group culture as a cultural element in LCA helps to reveal the unique cultural value of areas with different landscape characters. This study expands the LCA framework and applies it to multi-ethnic areas in China, thereby establishing a database that can serve as the basis for cross-regional landscape protection, management, and development planning in these areas. The research methods can be widely used in other multi-ethnic areas in China. Full article

Background: In advanced heart failure patients implanted with a fully magnetically levitated HeartMate 3 (HM3) Abbott left ventricular assist device (LVAD), it is unknown how the role of the LVAD outpatient clinic may affect the long-term survival after hospital discharge. Our objective is to share our standardized protocol for outpatient care, to describe the role of the LVAD outpatient clinic in postoperative long-term care after LVAD implantation, and to report survival. Methods: We retrospectively reviewed all patients implanted with HM3 LVAD in our institute between September 2015 and January 2025. Patients who received HeartWare Ventricular Assist Device (HVAD) and HeartMate 2 LVAD devices were excluded from our study, to ensure a homogenous cohort focusing on the latest and the only currently used LVAD device generation. We included a total of 48 patients. After LVAD patients are discharged from our center, they are followed in our outpatient clinic in 3-month intervals. During visits, bloodwork, EKG, wound inspection, and echocardiography are performed in addition to LVAD analysis. The role of the outpatient clinic is to detect early signs of deterioration or problems and act accordingly to prevent serious complications. Results: Thirty-three patients (68.7%) are still alive in 2025; two patients (4.2%) had a successful heart transplantation; and thirty-one patients (64.5%) are still on LVAD support. There were 210 total patient years of support. The mean time on device is 4.4 years. During the follow-up period we noticed 15 deaths (31.3%). Notably, there was no technical device-related death. Kaplan–Meier analysis estimated an overall survival rate of 97.9%, 92.8%, 83.7%, and 51.1% at 1, 2, 4, and 8 years, respectively. Conclusion: Strict control of patients after discharge in an outpatient clinic is essential for the long-term survival of these patients. A well-structured outpatient program is of utter importance to avoid LVAD-related complications and should be a cornerstone for the treatment, especially in non-transplant centers. Full article

Background/Objectives: The Bentall procedure represents the gold standard therapy in patients with ascending aorta or aortic root aneurysm combined with aortic valve disease precluding a valve-sparing procedure. The aim of this study was to compare early and late outcomes in patients undergoing a Bentall procedure with either a biological or a mechanical valved conduit. Methods: All patients undergoing the Bentall procedure with either a biological or a mechanical valved conduit at our institution between 2001 and 2022 were retrospectively reviewed. A propensity-score (PS) matching analysis was performed to account for imbalances between the two groups. Clinical outcomes of interest included mortality and reintervention. Results: 548 patients underwent the Bentall procedure with a biological (n = 356, 65%) or a mechanical (n = 192, 35%) valved conduit during the study period. After PS-matching, two homogeneous groups of 154 patients were obtained, and no difference was observed in mean survival time between patients with mechanical Bentall and patients with biological Bentall (16 ± 0.8 vs. 16.3 ± 0.7 years, respectively; p = 0.72). Patients with a mechanical Bentall had a significantly higher mean survival time free from reintervention compared to patients with a biological Bentall (23.6 ± 0.4 vs. 21.4 ± 0.7 years, respectively, p = 0.02). PS-adjusted Cox regression showed that age >65 years, postoperative ECMO, and CVA were predictive risk factors of mortality. Conclusions: Bentall operation is a safe procedure for the treatment of ascending aorta and aortic root disease with good early and long-term survival and a low rate of reintervention. PS-matched analysis showed no difference in mortality between patients with a mechanical Bentall and patients with a biological Bentall; however, patients with a mechanical Bentall had a lower rate of reintervention. Full article

Quality assurance programs are critical to ensuring the consistency and reliability of point-of-care surveillance test results. In 2022, we launched Laos’ inaugural quality control (QC) and external quality assessment (EQA) program for national HIV recent infection surveillance. Our study aims to implement the first QC and EQA program for national HIV recent infection surveillance in Laos, utilizing non-infectious dried tube specimens (DTS) for quality control testing. This initiative seeks to monitor and assure the quality of HIV infection surveillance. We employed the Asante HIV-1 Rapid Test for Recent Infection (HIV-1 RTRI) point-of-care kit, using plasma specimens from the Thai Red Cross Society to create dried tube specimens (DTS). The DTS panels, including HIV-1 negative, HIV-1 recent, and HIV-1 long-term samples, met ISO 13528:2022 standards to ensure homogeneity and stability. These panels were transported from the Thai National Institute of Health (Thai NIH) to the Laos National Center for Laboratory and Epidemiology (NCLE) and subsequently shipped to 12 remote laboratories at ambient temperature. The laboratory results were electronically transmitted to Thai NIH 15 days after receiving the panel for performance analysis. The concordance results with the sample types were scored, and laboratories that achieved 100% concordance across all sample panels were considered to have satisfactorily met the established standards. Almost all laboratories demonstrated satisfactory results with 100% concordance across all sample panels during all three rounds of QC: 11 out of 12 (92%) in June, 10 out of 12 (83%) in July, and 11 out of 12 (91%) in August. The two rounds of EQA performed in June and August 2022 were satisfied by 8 out of 11 (72%) and 5 out of 10 (50%) laboratories, respectively. QC and EQA monitoring identified errors such as testing protocol mistakes and insufficient DTS panel dissolution, leading to improvements in HIV recency testing quality. Laboratories that reported errors were corrected and implemented further preventive actions. The QC and EQA program for HIV-1 RTRI identified errors in HIV recent infection testing. Implementing a specialized QC and EQA program for DTS marks a significant advancement in improving the accuracy and consistency of HIV recent infection surveillance. Continuous assessment is vital for addressing recurring issues. Full article

Amidst global efforts toward sustainable development, this research addresses underexplored academic dimensions by evaluating the transformative potential of intelligent, sustainable architecture. Employing bibliometric techniques and Citespace 6.4.R1, we analyze two decades (2005–2024) of the Web of Science literature to identify patterns and challenges. Findings demonstrate rising scholarly output, dominated by themes like energy-efficient design, Building Information Modeling integration, and circular economy principles in urban contexts. While Europe and North America lead research activity, systemic limitations persist—including duplicated methodologies, fragmented institutional networks, and incompatible smart technologies. This study advocates for three strategic priorities: fostering interdisciplinary innovation to break homogeneity, establishing cross-sector collaboration frameworks, and accelerating industry–academia knowledge transfer. Intelligent, sustainable architecture emerges as a dual solution—technologically enabling carbon-neutral construction practices while redefining human-centric spatial quality. This dual advantage positions the International Sustainability Alliance as critical infrastructure for achieving UN Sustainable Development Goals, reconciling ecological responsibility with evolving societal demands for resilient, adaptive built environments. Full article

Objectives: Although hippocampal-sparing whole-brain irradiation (HS-WBI) offers potential neurocognitive benefits, it poses challenges in treatment planning. This study aimed to compare the dose distributions of biaxially rotational dynamic radiation therapy (BROAD-RT) with a novel O-ring-type linear accelerator (OXRAY) and conventional non-coplanar volumetric modulated arc therapy (VMAT) planning (Conv-VMAT) in HS-WBI treatment plans. Methods: This study included 10 patients with brain metastases from lung cancer at our institution. The hippocampus was contoured using gadolinium-based contrast-enhanced magnetic resonance imaging, and hippocampal-sparing regions were created using a 5 mm margin around the hippocampus. Two virtual plans (BROAD-RT and Conv-VMAT) with 30 Gy in 10 fractions were created to compare the dose distributions in the planning target volume (PTV), hippocampus, eyes, and lens. All plans were analyzed using a paired t-test. Results: The mean (standard deviation [SD]) hippocampus-Dmax, -Dmean, -D100%, and -V10 were 11.10 (0.61), 7.95 (0.20), 7.01 (0.19), and 0.42 (0.34) for BROAD-RT and 16.10 (0.57), 9.89 (0.75), 8.24 (0.34), and 39.05 (25.89) for Conv-VMAT, respectively. All hippocampal parameters were significantly better with BROAD-RT than with Conv-VMAT (p < 0.01). The PTV-D98, -D50, -D2, -V35, and -homogeneity index did not exhibit significant differences between BROAD-RT and Conv-VMAT. Although lens-Dmax was significantly better in BROAD-RT than in Conv-VMAT (p < 0.01), no significant differences were observed in the eye-Dmax and chiasm-Dmax between BROAD-RT and Conv-VMAT. The mean (SD) BROAD-RT beam delivery time was 313.60 (34.91) s. Conclusions: BROAD-RT improved hippocampal sparing with acceptable PTV coverage and PTV homogeneity in HS-WBI planning. In addition, BROAD-RT has a clinically acceptable treatment duration. Full article

Background: There is limited data on somatostatin receptor (SSTR) expression of metastatic gastroenteropancreatic neuroendocrine tumors (GEP-NETs) using modern imaging techniques and stratifying by primary site and tumor grade (G). Understanding patterns of SSTR expression and tumor heterogeneity is essential when determining the relevance of cold and radiolabeled somatostatin analog treatments. Methods: A single-institutional retrospective analysis of metastatic well-differentiated G1-3 GEP-NET patients who underwent Gallium-68 ([⁶⁸Ga])-DOTATATE or Copper-64 ([⁶⁴Cu])-DOTATATE positron emission tomography (PET) imaging from September 2016 to June 2024 was performed. Results: A total of 1192 patients were considered eligible for this study. Among them, 26 (2.2%) were completely negative on SSTR PET/computed tomography (CT), and 27 (2.3%) had weak uptake (less or equal to the normal liver). Up to 40 (3.4%) had heterogeneous SSTR expression on PET/CT: 26 (2.2%) displayed the coexistence of strongly avid lesions with the absence or near absence of SSTR uptake in measurable tumors (heterogeneous strong), while 14 (1.2%) had a combination of absent and weakly expressing SSTR tumors (heterogeneous low). An additional nine cases with prior homogeneous expression (0.8%) developed new SSTR-negative tumors along with disease progression, potentially indicating dedifferentiation. The absent or heterogeneous SSTR expression rates were greater in NET G3 than G1/G2 and in tumors originating outside the small bowel (midgut). Most NETs with absent or heterogeneous SSTR expression were fluorodeoxyglucose-F-18 ([¹⁸F]FDG)-avid. Conclusions: The large majority of metastatic GEP-NETs demonstrate strong and relatively uniform SSTR expression, but approximately 8% are SSTR-negative, weak or heterogeneous on PET/CT. Higher than average rates of absent/heterogeneous/weak SSTR expression occur in G3 NETs and lower rates among small intestine primaries. Full article

Bitcoin’s role in global finance has rapidly expanded with increasing institutional participation, prompting new questions about its linkage to macroeconomic variables. This study thoughtfully integrates a Bayesian Markov Chain Monte Carlo (MCMC) covariate selection process within homogeneous and non-homogeneous Hidden Markov Models (HMMs) to analyze 16 macroeconomic and Bitcoin-specific factors from 2016 to 2024. The proposed method integrates likelihood penalties to refine variable selection and employs a rolling-window bootstrap procedure for 1-, 5-, and 30-step-ahead forecasting. Results indicate a fundamental shift: while early Bitcoin pricing was primarily driven by technical and supply-side factors (e.g., halving cycles, trading volume), later periods exhibit stronger ties to macroeconomic indicators such as exchange rates and major stock indices. Heightened volatility aligns with significant events—including regulatory changes and institutional announcements—underscoring Bitcoin’s evolving market structure. These findings demonstrate that integrating Bayesian MCMC within a regime-switching model provides robust insights into Bitcoin’s deepening connection with traditional financial forces. Full article

The impact of intellectual capital on green innovation has been extensively studied at the firm level. However, the influence of moderating factors on this dynamic at the national level remains underexplored in previous studies. This study examines the role of institutional quality in moderating the relationship between national intellectual capital and green innovation across seventeen Asia–Pacific economies over the last twenty years, starting from 2000. Various techniques are employed to account for cross-sectional dependence and slope homogeneity in panel data analysis, enabling the examination of this relationship over the long and short term. The study also considers the marginal effects of national intellectual capital on green innovation at different degrees of institutional quality. Overall findings indicate that increasing national intellectual capital and institutional quality increases green innovation. Interestingly, the effects of national intellectual capital on green innovation intensify with a greater degree of institutional quality. We also find that enhancing economic growth and the efficient exploitation of natural resources appear to stimulate green innovation in Asia–Pacific economies. Findings imply that policies to improve green innovation should align with traditional economic growth strategies and effectively leverage intangible resources, particularly national intellectual capital. This unique empirical study examines the moderating role of institutional quality in the national intellectual capital–green innovation nexus in Asia–Pacific economies. Full article

As an important component of China’s conservation strategy, the Northeast China Tiger and Leopard National Park faces conflicts between environmental protection and community development. Taking the Hunchun area as a case study, here a choice experiment is employed to construct a policy-scenario model encompassing participation mechanisms, benefit-sharing models, and industrial development. Our analysis of farmers’ heterogeneous policy preferences reveals the following. (1) Farmers significantly prefer cooperative organization participation, ecological industry, and ecological compensation while showing less acceptance of agricultural deep processing. (2) Heterogeneity analysis indicates that middle-aged, educated, and low-income male farmers have stronger preferences for policy optimization. (3) Existing homogeneous policies do not satisfy diversified stakeholder demands. We propose a governance framework integrating ecology, industry, and institutions, suggesting practical pathways such as optimizing interest distribution mechanisms, innovating green industry models, and establishing cross-regional ecological compensation mechanisms. This study provides theoretical and practical support for reconciling conservation and development in protected areas. Full article

The competitiveness of rural tourism destinations holds significant implications not only for local livelihood sustainability and regional development but also for the preservation and continuity of human civilization. However, developing countries face a critical challenge where rural tourism destination competitiveness is being progressively undermined by the pervasive homogenization of tourism products. The existing literature demonstrates limited engagement with mitigation strategies for tourism product homogenization in examinations of rural destination competitiveness. This study conceptualizes tourism product homogenization as a manifestation of the tragedy of tourism commons, proposing that self-governance can foster rural tourism destination competitive advantages through resolving such collective action dilemmas. Employing a combined IAD-SES framework, the investigation analyzes interview data from Yuanjia Village in Shaanxi Province, China. The analysis delineates how self-governance dynamically enhances and sustains rural tourism destination competitiveness through four institutional mechanisms: provision rules, appropriation rules, monitoring protocols, and sanctioning systems. Furthermore, the findings reveal that the competitiveness driven by self-governance demonstrates the capacity to align individual interests with collective societal benefits. This research contributes to tourism scholarship by identifying novel institutional determinants of tourism destination competitiveness and proposing a policy framework for addressing product homogenization challenges throughout the rural tourism area life cycle. Full article

Currently, residual frying oil has three purposes: it is used again in the preparation of fried foods, mixed with new vegetable oil, which can cause cardiovascular disease in the consumer; it is collected by government institutions, without having an exclusive use; or it is thrown into the drain, causing serious pollution problems to water resources. An alternative is to transform it into biodiesel, through transesterification with methanol, to be used in internal combustion engines, biodiesel-diesel mixtures of 10:90, 15:85 and 20:80 (v/v), according to international regulations in such a way that, in the combustion process, less CO₂ and greenhouse gas emissions are generated. Residual frying oil served as raw material, which was collected, mixed and homogenized to evaluate physicochemical properties before transformation. The biodiesel generated had a density of 0.886 g L⁻¹, an acidity of 0.516%, a viscosity of 7.535 mm² s⁻¹, a flash point of 166.8 °C and an oxidative stability of 49 days at 25 °C. Additionally, the content of functional groups characteristic of biodiesel formation was evaluated by Infrared Spectroscopy. The Biodiesel obtained is of good quality for use in internal combustion engines and agricultural machinery, thus validating its continuous production and complying with the standard values of international regulations. Full article