Search Results (1,554)

The treatment of oily wastewater represents a significant environmental challenge, requiring efficient separation technologies and waste valorization. This study evaluated different types of coagulants (ferric chloride 38% m/m, aluminum polychloride 18% m/m, aluminum sulfate 8% m/m, and ferrous sulfate 6% m/m) and anionic polymers (from six suppliers) for treating poultry slaughterhouse effluent, aiming to optimize both clarification and oil recovery from the floated sludge. Bench-scale jar tests (G = 300 s⁻¹ and 30 s⁻¹) were followed by full-scale validation in a dissolved air flotation unit (100 m³ h⁻¹) at a poultry processing WWTP. Recovered oil was extracted by hot cooking (95 °C) and tridecanter centrifugation, and its quality (moisture, acidity, saponification index) was assessed. A techno-economic analysis, including simple/discounted payback, NPV, IRR, Monte Carlo simulation (10,000 iterations, Python), and deterministic sensitivity analysis, was performed. Ferric chloride (38% m/m) produced the best technical results: treated effluent turbidity < 30 NTU, oil yield of 360 L day⁻¹ with moisture < 2% at the tridecanter outlet, and consistent sludge dewaterability (moisture 55–65%). Oil moisture increased dramatically (to >30%) after storage due to condensate contamination from an inefficient exhaust system, a critical operational flaw that must be corrected. No statistically significant effect of polymer type on oil recovery was observed, although high variability (CV > 50%) was noted during PAC tests. The simple payback period for ferric chloride was 60.7 months (discounted: 64.1 months), with a positive median NPV (USD 7925) under a 12% p.a. discount rate. Sensitivity analysis showed that the investment is most sensitive to oil price: a 20% drop in oil price leads to a negative NPV (−USD 21,727). Despite this risk, the project provides environmental compliance and waste-to-value benefits. The study demonstrates that ferric chloride enables effective oil extraction from poultry wastewater, but proper exhaust design is essential to maintain oil quality. Future work should focus on standardized test durations (≥72 h) and automated monitoring to reduce variability. Full article

Background: In modern office environments, maintaining adequate air quality is essential for cognitive performance and overall well-being. However, the physiological effects of ventilation (CO₂ control) during short daytime breaks, particularly midday naps, remain insufficiently explored. This study aimed to investigate the impact of ventilation on autonomic nervous system (ANS) activity using heart rate variability (HRV) metrics. Methods: A crossover experiment was conducted with six office workers (mean age: 28 ± 2 years). Two conditions were compared: Condition A (with ventilation/CO₂ control) and Condition B (without ventilation). The experimental protocol consisted of three phases: Phase 1 (desk work, 11:00–12:00), Phase 2 (nap, 12:00–13:00, including a 20–25 min nap), and Phase 3 (post-nap desk work, 13:00–14:00). HRV indices (SDNN, RMSSD, CVRR, LF, HF, and LF/HF) were calculated from 5-min segments within each phase. Results: A two-way mixed ANOVA revealed a significant main effect of ventilation on the LF/HF ratio during the post-nap phase (p = 0.0050, η²_p = 0.9901), indicating improved autonomic stability upon awakening. Furthermore, a three-way mixed ANOVA (Sex × Order × Condition) showed that pNN50, an index of parasympathetic activity, exhibited significant interactions during the nap phase, including Condition × Sex (p = 0.0092) and the three-way interaction (p = 0.0333). Significant Order effects were also observed for heart rate (HR) across all phases (p < 0.05), suggesting habituation to the experimental environment. Conclusions: These findings indicate that ventilation is a critical environmental factor influencing physiological recovery during midday naps. Optimizing air quality may enhance autonomic regulation and improve the restorative effects of short daytime sleep in office settings. These findings should be interpreted as exploratory due to the small sample size (n = 6). While LF/HF was used as an index of autonomic balance, its physiological interpretation remains debated and should be considered with caution. Full article

Previous studies on healthy controls suggest the added value of thigh-based Electrocardiography (ECG), which collects data using sensors embedded in a toilet seat for unobtrusive signal acquisition. However, further evidence regarding its clinical feasibility is needed; with this work, we investigated three complementary aspects: signal quality, morphological correlation with standard ECG leads, and the system’s potential for heart rate variability (HRV) analysis in patients undergoing aortic valve replacement. This work was divided into two main phases. In the first, 32 healthy volunteers underwent simultaneous ECG recordings using both a standard 12-lead ECG system and the thigh-based system. Signal Quality Index (SQI) analysis revealed that 56.25% of the experimental signals were classified as excellent, and over 62.5% of recordings showed a strong correlation with Lead I of the clinical ECG. These findings extend the state of the art by further characterising the quality and relevance of the captured signals. In the second phase, two patients with severe aortic stenosis were monitored before and after surgical valve replacement. HRV metrics derived from the thigh-based ECG captured distinct autonomic responses: one patient showed significant postoperative improvement in global and parasympathetic modulation (increased SDNN, RMSSD, and Sample Entropy), while the other exhibited reduced variability and complexity, potentially indicating impaired autonomic recovery. These results highlight the feasibility of thigh-based ECG data acquisition for passive, longitudinal cardiac health monitoring in everyday environments and its applicability for pre- and postoperative autonomic assessment. Full article

Underwater image enhancement is affected by light absorption, scattering, and non-uniform illumination, typically resulting in color shifts, contrast reduction, and blurred details. Existing diffusion-based underwater image enhancement methods possess strong generative capabilities but face three major issues: lack of explicit modeling of the underwater imaging process, unstable conditional input under complex degradation, and insufficient temporal consistency in consecutive frames. To address these challenges, this work proposes a physics-guided temporal diffusion framework for underwater image enhancement, PG-TIE, which integrates physics-guided priors, implicit reconstruction, and temporal diffusion within a unified framework. Specifically, we first design a physics-guided prior generation module (PGPG) to explicitly estimate transmission maps and background light, providing interpretable guidance for subsequent restoration. Next, the implicit neural reconstruction branch (INTR) constructs stable conditional features to reduce diffusion difficulty. Finally, the temporal physics-guided diffusion Transformer branch (TPDT) incorporates physics priors, conditional features, and temporal memory to enhance both single-frame quality and consistency across consecutive frames. Experimental results on the UIEBD, LSUI, and U45 datasets demonstrate that PG-TIE achieves superior performance across reference and non-reference metrics. On UIEBD, it achieves a PSNR of 24.14 dB, SSIM of 0.8905, LPIPS of 0.1015, and FID of 24.32; on LSUI, PSNR 27.93 dB, SSIM 0.9521, LPIPS 0.1007, and FID 26.38; and on U45, URanker 2.812, MUSIQ 52.152, UCIQE 0.606, UIQM 3.176, and NIQE 3.897. Additionally, PG-TIE achieves a tLPIPS, Warping Error, and Flicker Index of 0.031, 0.284, and 4.72, respectively, validating its temporal stability in consecutive frames. Ablation studies further confirm the effectiveness of PGPG, INTR, TPDT, and their key components. Full article

Background/Objectives: Financial toxicity (FT) is increasingly recognised as a critical dimension of the cancer care continuum, reflecting both objective financial burden and subjective financial distress arising from cancer-related care. Head and neck cancers (HNC) may be particularly vulnerable to FT because treatment often involves multimodal care, functional morbidity, prolonged rehabilitation, and disruption to employment. This scoping review mapped and synthesised the literature on FT in a focused subset of head and neck cancers (HNC), namely malignancies of the oral cavity, oropharynx, nasopharynx, sinonasal tract, and major and minor salivary glands. Methods: A scoping review was conducted in accordance with the methodological guidance of the Joanna Briggs Institute for scoping reviews to identify and synthesise studies addressing FT in the selected HNC subsites. Searches were undertaken in MEDLINE, Embase, Scopus, Web of Science, CINAHL, EconLit, and Global Index Medicus for English-language studies published between 1 January 2015 and 1 January 2025. The search window was restricted to this period to capture the more contemporary evolution of FT as a distinct research construct in oncology. Eligible studies included adult patients and reported patient-level FT outcomes, including direct costs, indirect costs, out-of-pocket expenditure, financial hardship, financial distress, employment disruption, or related economic strain. Findings were synthesised narratively and organised thematically. Results: Twenty-five studies published between 2015 and 2025 were included. The evidence base was dominated by cross-sectional and retrospective designs, with limited prospective follow-up and very little intervention-focused research. FT was conceptualised heterogeneously across studies, spanning direct expenditure, indirect and non-medical costs, subjective financial distress, and coping-related consequences. Questionnaire-based approaches were used in 13 studies, but only a smaller subset employed FT-specific instruments such as COST. Across the literature, FT was most commonly associated with lower income, weaker financial protection, employment disruption, rural residence in some settings, and more intensive treatment. Reported downstream associations included poorer quality of life, psychological distress, care alteration, and work-related burden, although evidence for treatment delay or survival effects was more limited and should be interpreted cautiously. Conclusions: In this focused HNC subset, FT appears multidimensional, socially patterned, and clinically relevant. However, the literature remains methodologically fragmented, with inconsistent measurement and sparse longitudinal evidence. Future work should prioritise validated and tumour-specific assessment strategies, prospective study designs, and evaluation of mitigation interventions that address both direct and indirect burden across the cancer continuum. Full article

Binding affinity prediction in computational drug discovery is confounded by trivial correlations between molecular size and measured potency. We introduce cellular sheaf Laplacians as descriptors of ligand molecular geometry that quantify geometric frustration independent of system size. Sheaves are constructed over molecular graphs by assigning three-dimensional coordinate spaces to atoms and projection operators encoding ideal bonding geometry to edges; eigendecomposition of the resulting Laplacian yields spectral features measuring inconsistencies between local geometric constraints and global topology. Applied to 14,050 protein-ligand complexes from the PDBbind v2020 refined set, MW-residualized Sheaf features capture a statistically significant geometric signal ($r_{\mathrm{partial}} = 0.171$, $p<{10}^{-70}$) that is orthogonal to the Wiener index ($r=0.013$) and persists after controlling for both molecular weight and classical graph-theoretic descriptors ($r_{\mathrm{partial}} = 0.390$, $p<{10}^{-9}$). Sheaf spectral features alone achieve predictive performance ($R^2=0.403$) approaching that of fourteen classical cheminformatics descriptors ($R^2=0.446$), and their combination yields consistent improvements across the binding affinity spectrum (RMSE $=1.43$$p{K}_d$). Permutation importance analysis confirms the Sheaf Frobenius norm as the second most influential descriptor after molecular weight. We introduce Topological Binding Efficiency as a size-normalized quality metric identifying ligands that achieve potent binding through geometric complementarity rather than molecular bulk. Gaussian mixture analysis of the maximum eigenvalue distribution among strong binders reveals two distinct spectral modes corresponding to planar aromatic and three-dimensional sp3-rich scaffolds, confirmed by significant differences in fraction of sp3 carbons and aromatic ring counts ($p<{10}^{-8}$). As an intentionally ligand-centric framework, our approach complements rather than replaces protein-aware co-modelling architectures. This work establishes cellular sheaf theory as a principled framework for encoding molecular topology with statistically significant associations with binding affinity, providing interpretable geometric insights that are inaccessible to conventional molecular descriptors. Full article

Canola meal, with environmentally friendly attributes, lower cost, and previous studies, is an interesting proteic source to partially replace the soybean meal for poultry nutrition. For that, in this work we aimed to investigate canola meal as a partial replacement of soybean meal in finishing poultry diets (21 to 49 days) on the productive performance, also including the impact on the quality, nutritional attributes and antioxidative status of valuable cuts of meat. Ninety-six 21-day-old chickens were assigned to four experimental diets (24/diet), with increasing doses of canola meal (CM 0, 2.5, 5 and 10%). Daily consumption, weekly live weight and post mortem carcass weight and yield were determined. At 24 h post mortem, pH, color (CIE L, a*, b*) and drip loss were measured in the breast, drumstick and thigh cuts. Fatty acid composition and health lipid indexes were also determined in the fresh cuts. The oxidative status of lipids and proteins, polyphenol and flavonoids content in fresh and in stored (7 days-display at 4–6 °C) in vacuum packaged cuts were determined. Including CM, up to 10%, the feed intake and growth of birds was not affected (p = 0.74 and p = 0.87 respectively). In meat, CM significantly decreased the drip loss (p < 0.05), the pH in breast and thigh (p = 0.01 and p = 0.05 respectively), a lower L and b in thigh and increased PUFAs in more oxidative cuts, with a strong interaction between dose and muscle type. There was no effect on lipid oxidation while carbonyls decrease at a 2.5% dose in fresh and stored cuts but there is an increase with higher ones. Flavonoids raise the maximum deposition in meat at 5% CM. In conclusion, CM can be included in finishing poultry diets, but high doses must to be adequately managed if performance and quality of meat criteria are considered together. Full article

Background: Left bundle branch block (LBBB) and QRS prolongation are markers of electrical dyssynchrony in heart failure, but they do not fully reflect its mechanical consequences. Myocardial work (MW)-derived indices may provide a more comprehensive assessment of left ventricular (LV) mechanical dyssynchrony. We evaluated associations between LV MW parameters, QRS duration, and LBBB in patients with heart failure with reduced ejection fraction (HFrEF) referred for ICD/CRT implantation. Methods: In this single-centre observational cross-sectional study, 96 consecutive patients referred for ICD or CRT implantation were screened. All patients underwent standardized baseline comprehensive echocardiography followed by advanced MW analysis. Myocardial work index (MWI) dispersion was assessed using two complementary methods. MWI dispersion (SD) was calculated as the standard deviation of segmental MWI values across all LV segments, and MWI dispersion (IQR) was defined as the interquartile range (IQR) of segmental MWI values. We evaluated the associations between QRS duration and MW-derived dyssynchrony parameters (individual and composite), as well as their discriminative performance for LBBB. Seven patients were excluded from further analysis due to inadequate echocardiography image quality. Results: The final study group comprised 89 patients with HFrEF (median age 65.5 years), of whom 67.4% were assigned to CRT. LBBB was present in 41.6%, and the median QRS duration was 142 ms (112–162). All analyzed LV MW indices were significantly associated with QRS duration (all q < 0.01). The strongest correlations were observed for MWI dispersion (IQR) (r = 0.58), peak strain dispersion (PSD) (r = 0.54), lateral–septal work asymmetry (r = 0.53), and MWI dispersion (SD) (r = 0.52) (all q < 0.0001). All MW indices differed significantly between patients with and without LBBB (all q ≤ 0.0001). MWI dispersion (IQR) showed the best single-marker discrimination of LBBB (AUC = 0.852). Composite indices achieved AUC = 0.84 but did not significantly improve discrimination versus MWI dispersion (IQR) alone. Conclusions: Myocardial work-derived indices of left ventricular dyssynchrony are strongly associated with QRS duration and the presence of LBBB in patients with HFrEF. Among them, MWI dispersion (IQR) was shown to be the best-performing MW marker for identifying LBBB. These findings suggest that MW dispersion may serve as a robust echocardiographic marker of mechanical dyssynchrony and warrants further investigation as a potential tool for predicting CRT response. Full article

Background/Objectives: The American Heart Association Life’s Essential 8 (LE8) is a tool proposed to categorize overall cardiovascular health (CVH), ranging from 0 to 100 and classifies CVH as low (<50), moderate (50–79) or high (≥80), based on the following health behaviors (diet, physical activity, nicotine exposure and sleep) and health factors (body mass index—BMI, lipid levels, glycemic profile and blood pressure). Although used in the general population, it is not part of the health assessment routine in the workplace. We assessed CVH of healthcare workers using an LE8-based score through a mobile application. Methods: Cross-sectional pilot study with adults working at a tertiary hospital in Brazil. We used an app for self-reporting LE8 metrics. Additionally, data on age, sex, and mental health (10-item Perceived Stress Scale, PSS-10) were collected. Results: Sixty-five adults (58.5% female; mean age 36 ± 9.01 years) were included. The mean LE8 overall score was 69.39 ± 12.63. The proportion of participants in the low, moderate and high cardiovascular health categories were 6.2%, 69.2% and 24.6%, respectively. Diet quality (34.76 ± 24.3) and physical activity (45.38 ± 40.58) were in the “low cardiovascular health” category. “Health behaviors” had a significantly lower mean score than “health factors” (58.90 ± 20.53 vs. 79.88 ± 15.55, p < 0.001). The mean PSS-10 score was 19.01 ± 7.49, indicating moderate perceived stress. Overall LE8 and PSS-10 scores were not significantly correlated (r_s = −0,0.17; p = 0.161). There was no significant difference in the mean overall LE8 score in the linear regression model adjusting for age, sex and perceived stress. Conclusions: Among employees of a Brazilian tertiary hospital, the adapted LE8 score indicated overall moderate CVH. Health behaviors—particularly diet quality and physical activity—were the main vulnerable areas. Implementation of an LE8-based assessment in the workplace may be useful for targeted prevention strategies in Brazil. Future larger and longitudinal studies are warranted to confirm these findings. Full article

Background: Esophagectomy remains the definitive curative treatment for esophageal cancer but is historically burdened by significant procedure-related morbidity. Anastomotic leakage (AL) is still the “Achilles’ heel” of esophageal surgery, serving as a primary benchmark for surgical quality due to its profound impact on patient recovery, healthcare costs, and long-term oncological outcomes. While surgical expertise and perioperative care have matured, reported AL rates remain persistently high. This necessitates a shift in focus from purely technical modifications toward integrated, data-driven preventive strategies. Purpose: Five years after our initial review, this update synthesizes the rapid evolution in AL prevention. We evaluate the transition from empirical surgical pragmatism to evidence-based protocols, integrating recent breakthroughs in real-time perfusion monitoring, prophylactic endoluminal technologies, and multidisciplinary patient optimization. This work provides a contemporary “roadmap” for navigating the complexities of esophageal reconstruction. Conclusions: The prevention of AL has evolved into a multimodal “bundle” that begins well before the index operation. This review highlights the critical shift toward quantitative perfusion assessment via indocyanine green fluorescence angiography, which is increasingly replacing subjective visual inspection as the standard for anastomotic site selection. We discuss the emerging role of gastric ischemic preconditioning as a biological strategy to enhance conduit vascularity, alongside the paradigm of proactive management using preemptive endoluminal vacuum therapy to mitigate septic sequelae in high-risk cases. Furthermore, we examine technical refinements in conduit construction and conditioning—focusing on the ‘tension-perfusion’ relationship—and the essential role of structured prehabilitation within enhanced recovery after surgery frameworks. While the quality of evidence remains heterogeneous, the move toward standardized reporting and objective monitoring marks a new era of precision in esophageal surgery. Full article

Background/Objectives: LINAC-based, single-isocenter, non-coplanar, stereotactic radiotherapy (SRT) is an effective treatment for patients with multiple brain metastases (BMs). Within such a treatment plan, individual beams can be assigned to treat a subset of the metastases, this is referred to as multi-target beam setup (MTBS). This work evaluates and compares several strategies for MTBS. Methods: A planning study was performed, comparing plan quality parameters for plans resulting from several MTBS strategies, including two automated approaches. Each BM was individually prescribed a dose depending on its volume, resulting in treatment plans with multiple prescription doses. Paddick conformity index and Paddick gradient index were adapted to work with multiple prescription doses. Results: Given the same number of treatment beams, distributing BMs over treatment beams gave statistically significant improvements over targeting the BMs with all beams by 2% CI, 9% GI, 15% V15Gy, and 10% V5Gy. No statistically significant difference was found between different methods to distribute BMs over treatment beams. Increasing the number of treatment beams gave a further statistically significant improvement in plan quality at the cost of increased treatment time. Conclusions: MTBS is an important tool to increase the quality of non-coplanar LINAC-based stereotactic treatment plans for multiple brain metastases with individual dose prescriptions. MTBS can be automated to save planners a significant amount of time. The MTBS algorithm should be restricted in terms of the number of beams it can generate, to limit treatment times. Full article

Terahertz (THz) metasurface biosensors still encounter difficulties in simultaneously achieving high spectral resolution and stable readout across different refractive-index regimes. In this work, an all-liquid-crystal-polymer (LCP) THz metasensor supporting dual quasi-bound states in the continuum (quasi-BIC) resonances is proposed for regime-dependent refractive-index sensing. By introducing structural asymmetry into a periodic LCP cubic-cluster metasurface, two pronounced resonances are generated with quality factors (Q factors) of 6811 and 2526, respectively. Near-field distributions and multipole decomposition analysis indicate that the two resonances possess distinct electromagnetic features, which result in different responses to surrounding dielectric perturbations. In the low-refractive-index range of 1.0–1.5, the two resonance frequencies exhibit a linear variation with refractive index, yielding sensitivities of 122 GHz/RIU and 179 GHz/RIU, respectively. These dual-mode linear responses further offer a foundation for concentration- and temperature-related evaluation through analyte refractive-index mapping. In the higher-refractive-index range of 1.5–1.8, the intermodal frequency difference shows improved linearity with refractive index compared with the individual resonance frequencies, enabling a differential readout scheme with enhanced robustness against common perturbations. The results demonstrate that the proposed all-LCP dual-quasi-BIC metasensor not only enables high-resolution THz refractive-index sensing, but also establishes a regime-dependent spectral readout approach for different dielectric-response intervals. Full article

Background: An aortic disease diagnosis can be perceived by patients as a stressful and often life-altering event. In addition, an acute event, such as aortic rupture or dissection—and the surgical intervention that will be required to address it—can be viewed as potentially life-threatening and traumatic. Serious health conditions, including stroke and acute coronary syndromes, have been described in the literature to correlate with trauma-like symptoms. Post-traumatic stress disorder (PTSD) is well described in connection with external traumatic events, such as war, assault and similarly catastrophic events. A key element of this type of PTSD is that its occurrence arises secondary to an external traumatizer. However, recent work has suggested that internal events—such as a catastrophic medical event (e.g., acute cardiovascular event and/or surgery)—can trigger PTSD symptoms. An important question is whether medical event-initiated PTSD can (or should) be treated similarly to traditionally defined PTSD, when the triggering threat may persist rather than having been confined to a past event. This systematic review will summarize the literature on the occurrence of PTSD as a consequence of an acute cardiovascular event and attempt to identify effective treatments using meta-analysis, if the literature quantity and quality support it. Methods: The search strategy will include publicly available electronic databases, including MEDLINE via PubMed and OVID, EMBASE via Elsevier, Cumulative Index for Nursing and Allied Health Literature (CINAHL) via EBSCOhost, SCOPUS, PsychInfo, and the Cochrane Library, to identify publications that report the development and/or treatment of PTSD as a consequence of an acute cardiovascular event, which include cardiac arrest, acute coronary syndromes, and acute aortic syndromes. Identification of publications, article classification, methodological review/quality assessment, and data extraction will be performed by two trained experts in cardiovascular epidemiology, with the resolution of disagreements carried out by a third independent reviewer. The review conduct and meta-analysis will follow PRISMA and MOOSE guidelines. Data will be aggregated using random effects models when quantitative data are reliable and heterogeneity is reasonable. If a quantitative synthesis is not possible due to data quality, a narrative synthesis will be conducted. Statistical heterogeneity will be assessed by I² statistics. The quality of evidence will be assessed using the GRADE criteria. Ethics and Dissemination: This study did not require an institutional review board or human subjects protection committee approval given the nature of the study design. The results will be published in a peer-reviewed journal, along with recommendations for future research. Full article

Electromagnetically induced transparency-like effects in silicon metasurfaces have attracted considerable interest due to their capability to manipulate optical resonances and improve sensing performance. In this work, a U-shaped silicon metasurface is proposed, consisting of a horizontal nanopillar supporting bright mode and two vertical nanopillars supporting dark mode. The coupling and coherent interference between the bright and dark modes lead to a pronounced EIT-like effect at specific wavelengths. By introducing nanoscale gaps between the horizontal and vertical silicon pillars, a U-shaped silicon metasurface with gap mode (UG metasurface) is formed, which induces strong near-field enhancement and is associated with reduced radiative losses, thereby improving the quality factor of the EIT-like resonance of UG metasurfaces. Two silicon metasurface samples are fabricated, and their transmission spectra are experimentally measured, showing good agreement with numerical simulations. In addition, the refractive index sensing performance of silicon metasurfaces is numerically investigated. The results show that the UG metasurface design significantly enhances the sensing capability, increasing the figure of merit from 6 RIU⁻¹ to 60 RIU⁻¹. The proposed silicon metasurfaces and near-field enhancement with the gap-mode mechanism provide a promising strategy for realizing high-performance optical sensing and offer valuable insights into the manipulation of electromagnetic responses. Full article

Indoor environmental quality (IEQ) significantly impacts people’s comfort, health, and productivity in buildings, and modern green rating systems are primarily focused on energy efficiency rather than the direct user experience. This paper analyses the relationship between IEQ and the perceived quality of life (QoL) of certified and conventional office buildings in Malaysia using a mixed-methods design. The questionnaires were completed by 162 employees working in four open-plan offices: two were certified under the Green Building Index (GBI) established in Malaysia, and two were traditional. This was supplemented by 14 semi-structured interviews and 2 focus groups. The factors of IEQ were divided into ambient, designed, and behavioral environments. It was statistically determined that behavioral factors, such as visual privacy, personalization, ergonomics, and control, exhibited the strongest correlations with overall QoL, compared to ambient factors such as air quality or thermal comfort. Green buildings performed better in terms of daylighting and esthetics than conventional buildings, though they did not always deliver higher occupant satisfaction. The results indicate that current green certification frameworks pay insufficient attention to occupant-centered aspects. The proposed research adds a validated IEQ-QoL framework that predicts the incorporation of subjective user experience into building performance indicators, which can be important for certification reform, post-occupancy evaluation (POE), and human-centered sustainable design approaches. Full article