Search Results (481)

This study investigates the factors influencing school trip mode choice among senior high school students in the Chiang Rai urban area, Chiang Rai, Thailand, under normal and adverse weather conditions. Utilizing data from 472 students across six extra-large urban schools, a Multinomial Logit (MNL) regression model was applied to examine the effects of socio-demographic attributes, household vehicle ownership, travel distance, and spatial variables on mode selection. The results revealed notable modal shifts during adverse weather, with motorcycle usage decreasing and private vehicle reliance increasing, while school bus usage remained stable, highlighting its role as a resilient transport option. Car ownership emerged as a strong enabler of modal flexibility, whereas students with limited access to private transport demonstrated reduced adaptability. Additionally, increased waiting and travel times during adverse conditions underscored infrastructure and service vulnerabilities, particularly for mid-distance travelers. The findings suggest an urgent need for transport policies that promote inclusive and climate-resilient mobility systems, particularly in the context of Chiang Rai, including expanded school bus services, improved first-mile connectivity, and enhanced pedestrian infrastructure. This study contributes to the literature by addressing environmental variability in school travel behavior and offers actionable insights for sustainable transport planning in secondary cities and border regions. Full article

Virtual reality (VR) can enrich neuropsychological testing, yet the ergonomic trade-offs of its input modes remain under-examined. Seventy-seven healthy volunteers—young (19–29 y) and middle-aged (35–56 y)—completed a VR Trail Making Test with three pointing methods: eye-tracking, head-gaze, and a six-degree-of-freedom hand controller. Completion time, spatial accuracy, and error counts for the simple (Trail A) and alternating (Trail B) sequences were analysed in 3 × 2 × 2 mixed-model ANOVAs; post-trial scales captured usability (SUS), user experience (UEQ-S), and acceptability. Age dominated behaviour: younger adults were reliably faster, more precise, and less error-prone. Against this backdrop, input modality mattered. Eye-tracking yielded the best spatial accuracy and shortened Trail A time relative to manual control; head-gaze matched eye-tracking on Trail A speed and became the quickest, least error-prone option on Trail B. Controllers lagged on every metric. Subjective ratings were high across the board, with only a small usability dip in middle-aged low-gamers. Overall, gaze-based ray-casting clearly outperformed manual pointing, but optimal choice depended on task demands: eye-tracking maximised spatial precision, whereas head-gaze offered calibration-free enhanced speed and error-avoidance under heavier cognitive load. TMT-VR appears to be accurate, engaging, and ergonomically adaptable assessment, yet it requires age-specific–stratified norms. Full article

“Coexpressivity” is the property of utterances that marshal multiple linguistic elements and modalities simultaneously to perform the distinct linguistic functions of Jakobson’s classic analysis (1960). This study draws on a longitudinal corpus of natural conversation recorded over six decades with an accomplished “master speaker” of Tsotsil (Mayan), adept at using his language to manage different aspects of social life. The research aims to elaborate the notion of coexpressivity through detailed examples drawn from a range of circumstances. It begins with codified emic speech genres linked to prayer and formal declamation and then ranges through conversational narratives to gossip-laden multiparty interaction, to emphasize coexpressive connections between speech as text and concurrent gesture, gaze, and posture among interlocutors; audible modalities such as sound symbolism, pitch, and speech rate; and finally, specific morphological characteristics and the multifunctional effects of lexical choices themselves. The study thus explores how multiple functions may, in principle, be coexpressed simultaneously or contemporaneously in individual utterances if one takes this range of modalities and expressive resources into account. The notion of “master speaker” relates to coexpressive virtuosity by linking the resources available in speech, body, and interactive environments to accomplishing a wide range of social ends, perhaps with a special flourish although not excluded from humbler, plainer talk. Full article

This paper investigates the optimal planning of high-speed rail (HSR) freight operations, pricing strategies, and government carbon tax policies. The primary objective is to enhance the market share of HSR freight, thereby reducing carbon dioxide (CO₂) emissions associated with freight activities. The modal shift problem is formulated as a bi-level multi-objective model and solved using a specifically designed hybrid algorithm. The upper-level model integrates multiple objectives of the government (minimizing tax while maximizing the emission reduction rate) and HSR operators (maximizing profits). The lower-level model represents shippers’ transportation mode choices through network equilibrium modeling, aiming to minimize their costs. Numerical analysis is conducted using a transportation network that includes seven major central cities in China. The results indicate that optimizing HSR freight services with carbon tax policies can achieve a 56.97% reduction in CO₂ emissions compared to air freight only. The effectiveness of the government’s carbon tax policy in reducing CO₂ emissions depends on shippers’ emphasis on carbon reduction and the intensity of the carbon tax. Full article

The long-term preservation of heritage structures relies on effective Structural Health Monitoring (SHM) systems, where sensor placement is key to ensuring early damage detection and guiding conservation efforts. Optimal Sensor Placement (OSP) methods offer a systematic framework to identify efficient sensor configurations, yet their application in historical buildings remains limited. Typically, OSP is driven by numerical models; however, in the context of heritage structures, these models are often affected by substantial uncertainties due to irregular geometries, heterogeneous materials, and unknown boundary conditions. In this scenario, data-driven approaches become particularly attractive as they eliminate the need for potentially unreliable models by relying directly on experimentally identified dynamic properties. This study investigates how the choice of input data influences OSP outcomes, using the Church of Santa Ana in Seville, Spain, as a representative case. Three data sources are considered: an uncalibrated numerical model, a calibrated model, and a data-driven set of modal parameters. Several OSP methods are implemented and systematically compared. The results underscore the decisive impact of the input data on the optimisation process. Although calibrated models may improve certain modal parameters, they do not necessarily translate into better sensor configurations. This highlights the potential of data-driven strategies to enhance the robustness and applicability of SHM systems in the complex and uncertain context of heritage buildings. Full article

This study is titled “Success Factors in Transport Interventions: A Mixed-Method Systematic Review (1990–2022)”. The purpose of the systematic review is to (1) identify effective interventions for transitioning individuals from private car reliance to sustainable transport, (2) summarise psychosocial theories shaping transportation choices and identify enablers and barriers influencing sustainable mode adoption, and (3) determine the success factors for interventions promoting sustainable transport choices. The last search was conducted on 18 November 2022. Five databases (Scopus, Web of Science, MEDLINE, APA PsycInfo, and ProQuest) were searched using customised Boolean search strings. The identified papers were included or excluded based on the following criteria: (a) reported a modal shift from car users or cars to less CO₂-emitting modes of transport, (b) covered the adoption of low-carbon transport alternatives, (c) comprised interventions to promote sustainable transport, (d) assessed or measured the effectiveness of interventions, or (e) proposed behavioural models related to mode choice and/or psychosocial barriers or drivers for car/no-car use. The identified papers eligible for inclusion were critically appraised using Sirriyeh’s Quality Assessment Tool for Studies with Diverse Designs. Inter-rater reliability was assessed using Cohen’s Kappa to evaluate the risk of bias throughout the review process, and low-quality studies identified by the quality assessment were excluded to prevent sample bias. Qualitative data were extracted in a contextually relevant manner, preserving context and meaning to avoid the author’s bias of misinterpretation. Data were extracted using a form derived from the Joanna Briggs Institute. Data transformation and synthesis followed the recommendations of the Joanna Briggs Institution for mixed-method systematic reviews using a convergent integrated approach. Of the 7999 studies, 4 qualitative, 2 mixed-method, and 30 quantitative studies successfully passed all three screening cycles and were included in the review. Many of these studies focused on modelling individuals’ mode choice decisions from a psychological perspective. In contrast, case studies explored various transport interventions to enhance sustainability in densely populated areas. Nevertheless, the current systematic reviews do not show how individuals’ inner dispositions, such as acceptance, intention, or attitude, have evolved from before to after the implementation of schemes. Of the 11 integrated findings, 9 concerned enablers and barriers to an individual’s sustainable mode choice behaviour. In addition, two integrated findings emerged based on the effectiveness of the interventions. Although numerous interventions target public acceptance of sustainable transport, this systematic review reveals a critical knowledge gap regarding their longitudinal impact on individuals and effectiveness in influencing behavioural change. However, the study may be affected by language bias as it only included peer-reviewed articles published in English. Due to methodological heterogeneity across the studies, a meta-analysis was not feasible. Further high-quality research is needed to strengthen the evidence. This systematic review is self-funded and has been registered on the International Platform of Registered Systematic Review and Meta-analysis Protocols (INPLASY; Registration Number INPLASY202420011). Full article

Environmental consciousness has become increasingly important in the professional sports industry as it often hosts large-scale events that have significant environmental impacts. While the economic benefits of locating stadiums in city centers have been discussed, especially in terms of neighborhood revitalization, there has been limited empirical research on whether stadium relocation affects the transportation choices of spectators and reduces carbon dioxide emissions. Through a case study of a Japanese professional football club that relocated its home stadium from the suburb to the city center, this study quantitatively elucidated the change in spectators’ transportation choices and resulting reductions in carbon emissions achieved by the stadium relocation. Analysis indicated variations in behavioral changes among groups based on their loyalty levels to the club. It also highlighted the varying influence of the different residential areas within the metropolitan area on the modal choice. This study demonstrates the potential contribution of stadium relocation to sustainable urban planning by providing empirical evidence of these behavioral changes and policy implications for restructuring the urban public transportation network. Full article

In this review, we summarize current insights into the treatment of functional constipation (FC) in children. Constipation is a global issue in the pediatric population, with a prevalence of approximately 9.5%. Initial management involves a combination of non-pharmacological and pharmacological interventions. However, a significant number of children continue to experience therapy-resistant FC despite optimal non-pharmacological and pharmacological treatments. While studies on novel pharmacological options in children are limited, adult trials have shown promising results. New agents such as lubiprostone, prucalopride, linaclotide, and plecanatide have demonstrated improved outcomes compared to placebo or conventional therapies, particularly in increasing spontaneous bowel movements. Neurostimulation presents an additional treatment modality. Posterior tibial nerve stimulation appears to be a promising new option, offering high treatment satisfaction and a favorable safety profile with a low rate of severe adverse events. For children who do not respond to optimal conservative therapy, the impact on quality of life can be substantial. In such cases, surgical interventions may be considered, including intrasphincteric botulinum toxin injections, antegrade continence enema surgery, and, in severe cases, colonic resection or a diverting ostomy. The choice of surgical treatment remains a subject of ongoing debate. Therapy-resistant FC in children is a complex and impactful condition. An individualized, stepwise approach is essential, with surgical options such as colonic resection reserved as a last resort. Full article

Background: Prostate cancer (PCa) remains a major health concern worldwide, although improved screening and treatments have reduced its incidence and mortality. MRI-targeted biopsies, especially using MRI–ultrasound fusion, enhance detection of clinically significant prostate cancer (CsPCa) and reduce unnecessary procedures. Transperineal biopsies offer the same diagnostic performance and reduce the risk of infection while limiting the need for antibiotic prophylaxis. However, they tend to be more painful under local anaesthesia and require greater operator experience. Methods: This study prospectively assessed the tolerability and effectiveness of transperineal targeted biopsies under local anaesthesia in a monocentric cohort of 51 patients. Results: Immediate pre-biopsy anxiety showed a clinically significant association with pain experienced during biopsies, and greater expected pain resulted in greater experienced pain. Overall patient tolerability was high. Local anaesthesia provided procedural flexibility, reduced resource utilisation, was cost-effective, and did not compromise precision. Conclusions: The results support local anaesthesia as a viable option, offering precision, patient satisfaction, and reduced healthcare resource utilisation. These results emphasise the importance of personalising the choice of anaesthesia modality for transperineal prostate biopsies, tailoring it to the patient’s anxiety. Larger studies are required to confirm these findings and validate the observed trends. Full article

Against the backdrop of China’s “public-to-railway” freight policy that has led to railway yard congestion and imbalanced modal capacity utilization, this study develops a Dual-Channel Cargo-Transportation Service (DCTS) system model using queuing theory to optimize freight flow allocation and pricing strategies. Integrating the behavioral decisions of governments, carriers, and cargo owners, the research employs M/M/1 queuing models and the Logit choice framework to analyze the dynamic equilibrium between goods waiting times and carrier profits, exploring objectives of minimizing system-average waiting time and maximizing carrier profits. Key findings show that regulating highway pricing can effectively divert freight flows to reduce railway congestion and improve system efficiency, with optimal pricing intervals for highways identified based on service capacity to balance congestion relief and profitability. The model quantifies the trade-off between transportation costs and waiting times to guide cargo owners’ mode choices, and numerical simulations validate that strategic highway price adjustments alleviate bottlenecks and enhance modal synergy. This paper provides a theoretical basis for the government to formulate freight-transportation policies and optimize freight flow allocation. At the same time, it also provides a practical, theoretical basis and methodological reference for carrier pricing decisions, as well as for solving the problem of freight flow congestion and optimizing the pricing of transportation services. Full article

Objective: The development of a normal sleep–wake rhythm in the first weeks of life depends on the physiological sensory needs of the newborn as well as the environment surrounding them. This includes, for example, avoiding pain, exposure to bright light at night and high noise levels. In high-risk newborns, this process can be influenced by immaturity of the central and peripheral nervous systems, therapeutic strategies and the work organization of an intensive care unit. Methods: This study used a narrative review to examine the literature on the interrelationship of sensory modalities on sleep–wake behavior in the context of neonatal intensive care. The current Cochrane reviews on cycled lighting’s effect on premature infants’ circadian rhythm development and noise or sound management in the neonatal intensive care unit, as well as the World Health Organization (WHO) global position paper on kangaroo mother care, were included. Results: An extensive body of literature relates to fetal and neonatal development of the five sensory modalities: touch, taste, smell, hearing and sight. In contrast, there is a lack of evidence regarding the choice of optimal lighting and suitable measures for noise reduction. Since 2023, the WHO has recommended that, from the moment of birth, every “small and sick” newborn should remain in skin-to-skin contact (SSC) with their mother. Developmental support pursues a multimodal approach with the goal of fostering early parent–child bonding, including the child’s needs and environmental conditions. Discussion: The implementation of early SSC and attention to the sleep–wake cycle require systemic changes in both the obstetric and neonatal settings to ensure seamless perinatal management and subsequent neonatal intensive care. Since there is a lack of evidence on the optimal sensory environment, well-designed, well-conducted and fully reported randomized controlled trials are needed that analyze short-term effects and long-term neurodevelopmental outcomes. Full article

Background: Eosinophilic esophagitis is a chronic immune-mediated disease with increasing prevalence. In pediatric populations, it often coexists with IgE-mediated food sensitization. This dual diagnosis presents unique therapeutic challenges, including on the one hand both temporary and lifelong dietary restrictions, and on the other hand, therapeutic interventions with a potential impact on quality of life (QoL). Objectives: This study prospectively evaluated the prevalence of IgE-mediated food sensitization and allergy in children with EoE attending a tertiary center in Flanders, Belgium. Additionally, it prospectively documented dietary habits and restrictions in these children, with or without concomitant IgE-mediated food allergies, and assessed the impact of dietary management on quality of life compared to pharmacological treatment. Methods: We consecutively followed 30 children with biopsy-confirmed pediatric EoE (PedEoE) attending a tertiary referral center for at least 12 months. Patient demographics, allergy testing, dietary history, and treatment modalities were recorded. Symptom score and PedEoE QoL were assessed using validated Pediatric Eosinophilic Esophagitis Symptom Score (PEESS 2.0) and Pediatric Quality of Life Inventory (PedsQL 3.0) questionnaires. Statistical analysis was performed using the Mann–Whitney U test and Kruskal–Wallis test with Dunn’s test as a post hoc test. Results: Among 30 children with EoE (60% male, median age 8 years), 60 PedEoE QoL (PedsQL) and 39 symptom (PEESS) questionnaires were collected at one or more time points over a median follow-up of 14.5 months. IgE sensitization to common dietary triggers was observed in multiple patients, with varying clinical reactivity. Symptom scores tended to be higher in children without histological remission, though differences were not statistically significant (median PEESS 23.75 vs. 17.50, p = 0.1934). Grouped by degree of dietary restriction, QoL scores showed significant differences (child p = 0.0102; parent p = 0.0203), with children in the 1–2 food elimination group reporting better QoL compared to the 0 food elimination and >6 food elimination groups. No clear statistically significant differences were observed between the 1–2 food elimination group and the 3–4 or 5–6 food elimination groups. Conclusions: IgE sensitization is prevalent among pediatric EoE patients and has significant clinical implications for disease management. Treatment choice can influence not only disease control but also the QoL of both patients and their families. Full article

Background/Objectives: The image guidance of choice for the combination therapy of radiofrequency ablation (RFA) and vertebral augmentation (VA) in the context of vertebral disease from spinal metastases are fluoroscopy and computer tomography (CT). Here, we aimed to assess the roles of both imaging modalities and if adoption of either would influence clinical outcomes of pain, physical function, and quality of life (QoL). RFA has been favored as a minimally invasive option for managing painful spinal metastases, and it is often coupled with VA to treat underlying osseous structural instability. This combination therapy of RFA with VA, which could be performed under CT or fluoroscopy, has in recent years been recognized as highly successful for pain control and functional restoration of metastatic spine lesions. Methods: Our scoping review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). The databases accessed were Medline and Embase, and the time frame of the search was set from database inception to 2 January 2025. The inclusion eligibility included primary research studies utilizing clearly defined imaging modalities of interest with measurable clinical end points of pain, quality of life (QoL), analgesic use, or complications. Results: Twenty-two articles were identified after screening fifty-eight papers using the databases. Fluoroscopy alone was the more frequently adopted imaging modality (n = 17/22, 77.3%). Almost all of the papers, regardless of the imaging modality used, consistently demonstrated reduction in pain, improvement in QoL, as well as a decrease in analgesia use. Complications were present but had minimal clinical implications, aside from a single article which appeared to demonstrate significantly higher cement leak rates with a singular case of resultant paraplegia. Conclusions: Fluoroscopy- and CT-guided RFA with VA have both proven to be efficacious in reducing patient discomfort and improving functionality while keeping risks of permanent neurological injuries to a minimum. Full article

Background: Femoroacetabular impingement (FAI) is a complex hip disorder characterized by abnormal contact between the femoral head and acetabulum, often leading to joint damage, chronic pain, and early-onset osteoarthritis. Despite MRI being the imaging modality of choice, diagnosis remains challenging due to subjective interpretation, lack of standardized imaging criteria, and difficulty differentiating symptomatic from asymptomatic cases. This study aimed to develop and externally validate radiomics-based machine learning (ML) models capable of classifying healthy, asymptomatic, and symptomatic FAI cases with high diagnostic accuracy and generalizability. Methods: A total of 82 hip MRI datasets (31 symptomatic, 31 asymptomatic, 20 healthy) from a single center were used for training and cross-validation. Radiomic features were extracted from four segmented anatomical regions (femur, acetabulum, gluteus medius, gluteus maximus). A four-step feature selection pipeline was implemented, followed by training 16 ML classifiers. External validation was conducted on a separate multi-center cohort of 185 symptomatic FAI cases acquired with heterogeneous MRI protocols. Results: The best-performing models achieved a cross-validation accuracy of up to 90.9% in distinguishing among healthy, asymptomatic, and symptomatic hips. External validation on the independent multi-center cohort demonstrated 100% accuracy in identifying symptomatic FAI cases. Since this metric reflects performance on symptomatic cases only, it should be interpreted as a detection rate (true positive rate) rather than overall multi-class accuracy. Gini index-based feature selection consistently outperformed F-statistic-based methods across all the models. Conclusions: This is the first study to systematically integrate radiomics and multiple ML models for FAI classification for these three phenotypes, trained on a single-center dataset and externally validated on multi-institutional MRI data. The demonstrated robustness and generalizability of radiomic features support their use in clinical workflows and future large-scale studies targeting standardized, data-driven FAI diagnosis. Full article

Background/Objectives: Focal therapy (FT) and technology are closely connected. Advanced imaging allows for precise identification of the index lesion, enabling the targeted use of various thermal and non-thermal energy sources through different approaches, with specific techniques tailored to lesion location and operator expertise. This personalized approach enhances both safety and effectiveness, facilitating customized treatment planning. Methods: The International Consultation on Urological Diseases formed a committee to review the current literature on FT for prostate cancer (PCa), focusing specifically on the technique. Following in-depth discussions, the committee chose a “by lesion” approach rather than the traditional “by energy” approach to structure the review. A comprehensive PubMed search was conducted to gather relevant articles on the various energy modalities and procedural approaches used in FT for PCa. Results: Lesions in the apex, anterior, and posterior regions of the prostate can be accessed through several FT approaches, each associated with specific energy modalities and techniques. The transrectal approach utilizes high-intensity focused ultrasound (HIFU) and focal laser ablation (FLA), while the transperineal approach is compatible with energy sources such as cryotherapy, irreversible electroporation (IRE), brachytherapy, and FLA. The transurethral approach supports methods such as transurethral ultrasound ablation (TULSA). Each approach offers distinct advantages based on lesion location, treatment area, and energy modality. The choice of technique evaluated the safety and efficacy of each energy source and approach based on specific treatment areas within the prostate, highlighting the need for robust research across lesion locations and modalities, rather than focusing solely on each modality for a specific region. Conclusions: FT is rapidly advancing with new energy sources, technological improvements, and increasing operator expertise. To further optimize FT, research should prioritize evaluating the safety and effectiveness of different energy sources for various lesion locations, focusing on the treatment area rather than the energy modality itself. Full article