ABSTRACT This article explores why destinations find the transition to sustainable tourism challenging. Through a composite and layered approach drawing together complexity theory, transition management and path dependency theory, the conditions that cause resistance to sustainability, including within policymaking, are identified. Two Mediterranean destinations having the highest tourism intensity act as case studies: coastal Croatia and Malta. The study, first, using the lens of complexity theory, historical policy and performance data, determines that both destinations have complex tourism systems. Through transition management theory, it then examines the destinations’ typology of transition. Complementing the historical data, themes from stakeholder focus groups inform the categorisation of transition and identify Croatia’s and Malta’s persistent problems. This directs the study to the root causes for the slow transition, imposing path dependency or triggering path plasticity. No evidence was found for path creation to sustainability. These findings, informed by the theoretical lenses, shed light on four main conditions: path-dependence, inconsistent transition policies, extractive approaches for growth prioritization, and persistent problems that make the shift to sustainability challenging, compounded by policy-makers’ assumptions. The study signals broader governance issues for the sustainable management of Mediterranean destinations.

Abstract Torrefaction is a mild thermo-chemical pretreatment technology that enhances the fuel characteristics of biomass by changing physicochemical characteristics of biomass to produce a high-quality solid biofuel. The present study evaluated the performance of a continuous screw-auger type torrefaction system for upgrading agricultural residues rice husk and wheat straw into energy-dense, hydrophobic biomass suitable for co-firing applications. Torrefaction experiments were conducted at three temperatures such as 250 ℃, 275 ℃, and 300 ℃ with a total residence time of 12 minutes. The results revealed that the mass yield decreased with temperature, from 85.60 % to 75.00 % and from 83.20 % to 70.80 % for rice husk & wheat straw respectively. Higher heating value increased significantly with torrefaction severity, reaching 19.26 MJ/kg for rice husk and 20.25 MJ/kg for wheat straw when torrefied at 300 ℃, representing a 22–25 % improvement over raw biomass. Moisture uptake dropped substantially from 38.6 % to 1.9 % and from 41.5 % to 2.1 % for rice husk & wheat straw respectively, indicating the enhanced hydrophobicity. Combustion indices have also showed desirable trends, fuel ratio increased to 0.54 and 0.57, and volatile ignitability exceeded 15 MJ/kg for both biomass samples torrefied at 300 ℃, indicating improved ignition characteristics suitable for co-firing. Techno-economic analysis revealed a net profit of 1,38,520 INR/year, with a payback period of 5 years and a benefit-cost ratio of 1.27, supporting the economic feasibility of the system. Overall, the study confirms that torrefied biomass presents improved fuel characteristics and combustion behaviour, making it viable solution for clean energy transition and sustainable waste management.

This literature review examines the role of transformative leadership in empowering entrepreneurs as change agents for sustainable communities and cities. Drawing on Urban Regime Theory, Transition Management Theory, the Quintuple Helix Model, and Leverage Points Theory, the analysis reveals two essential pathways through which entrepreneurial leadership contributes to sustainability transformation: direct problem-solving and systemic institutional change. Through systematic analysis of 87 publications, a framework has been developed categorizing entrepreneurial interventions as resource-based, transactive, organizational, and value-based—targeting leverage points of increasing transformative potential. Organizational interventions create new governance structures and hybrid organizational forms that challenge conventional boundaries between sectors, while value interventions address the deepest leverage points by redefining the fundamental goals and paradigms guiding development. This study highlights the importance of sustainability intent, inclusive entrepreneurial ecosystems, and multi-stakeholder collaboration in fostering transformative leadership. The findings suggest that entrepreneurship education should integrate systems thinking with practical business knowledge, preparing leaders who can transcend apparent trade-offs between economic and environmental goals through creativity and innovation.

In recent years, European cities have implemented numerous initiatives to reduce the use of resources and improve the resilience of climate change by promoting shifts toward the circular economy (CE). This comparative case study investigated the results of the applications of the CE model in the built environment from two different national approaches and perspectives of strategic planning in capitals that represent the “old” (Copenhagen) and “new” (Ljubljana) European Union (EU) member states. This paper introduces the original methodology to assess the implementation of the strategic approaches in the adaptation of the CE in architecture and urban design using a set of 10 selecting indicators. Although both cities have ambitious strategic goals and are undertaking actions aimed at shifting to the CE, they are driven by different motivations (climate crisis vs. urban revitalization and zero waste policy) and exhibit different implementation patterns (top-down systemic/institutional vs. gradual/sectoral). The results highlight the key role of a comprehensive approach to CE implementation, particularly the development of institutional frameworks and dedicated infrastructure and digital tools for transition management, the involvement of external stakeholders in the circular vision, wide-range educational activities, and the promotion of CE initiatives. However, limitations resulting from the lack of a comprehensive and standardized measurement framework pose a challenge to effectively accelerate progress in the shift toward a CE in the built environment. The main contributions of this study are: (1) to identify and verify the methods and strategies undertaken by European cities for the adaptation of a CE in the built environment and (2) demonstrate the different dimensions, levels, and the most relevant factors in the strategic management of the processes of transformation toward the CE. In addition, recommendations for future implementations based on CE systems are indicated.

Background and objectivesProgressive cerebral edema worsens prognosis in large hemispheric infarction (LHI). Ultrasonographic optic nerve sheath diameter (ONSD) measurement provides a non-invasive method for estimating intracranial pressure. This study aimed to evaluate the predictive value of affected- and unaffected-side ONSD for clinical deterioration at discharge in LHI patients and to provide reference data on factors linked to deterioration, follow-up outcomes, and longitudinal ONSD monitoring.MethodsThis retrospective study enrolled 35 LHI patients, classified into two groups: improved and deteriorated, based on clinical and imaging findings at discharge. Demographic and clinical characteristics were compared. Receiver operating characteristic (ROC) analysis evaluated the predictive performance of affected- and unaffected-side ONSD. Area under the curve (AUC) difference was compared using the DeLong test. Post-discharge follow-up at 30 and 90 days was conducted via telephone interviews. Longitudinal changes in affected- and unaffected-side ONSD were depicted using line graphs for patients with extended stays in the neuro-intensive care unit (NICU).ResultsStatistically significant variables included age (p = 0.002), female (p = 0.002), history of atrial fibrillation (p = 0.044), GCS score (p = 0.028), affected-side ONSD (p = 0.002), unaffected-side ONSD (p = 0.012), and duration of NICU stay (p = 0.002). A positive linear correlation was identified between ONSD values and discharge outcomes. The optimal cut-off for predicting deterioration was 5.54 mm for affected-side ONSD (sensitivity 81.3%, specificity 78.9%, AUC = 0.814) versus 5.57 mm for the unaffected-side (68.8, 78.9%, AUC = 0.757), with no significant AUC difference between sides. The overall 30-day post-discharge mortality was 39.29%. Longitudinal changes in bilateral ONSD showed remarkable overlap in both individual and group observations. Patients with improved outcomes exhibited decreasing ONSD trends, whereas those with deterioration displayed increasing trends.ConclusionPreoperative ONSD measurement is a feasible and practical predictor of discharge prognosis in LHI patients, with both affected and unaffected sides providing reliable monitoring. Factors including age, female, history of atrial fibrillation, GCS score, ONSD on either side, and NICU stay duration may influence outcomes. The high short-term mortality underscores the importance of the post-discharge transition management. The clinical value of longitudinal ONSD monitoring requires further investigation.

The Professional Work Experience (PKP) program at RA Mawaddah Warahmah Medan was conducted to enhance students’ understanding of teachers’ strategies in fostering young children’s learning motivation. The objectives were to identify baseline learning motivation, design teacher strategies based on children’s needs, and evaluate their impact on classroom engagement. The methods applied included classroom observation, interviews with mentor teachers, documentation, and participatory assistance through a classroom action approach. The strategies implemented consisted of affirmative communication, the use of concrete media, play-based learning, positive reinforcement, and effective transition management. Findings revealed a significant increase in children’s attention, active participation, and positive expression. Average motivation scores improved by 38% from pre- to post-intervention. Children became more focused, enthusiastic, and actively involved in core learning activities. Teachers also benefited from more conducive classroom environments and new creative teaching ideas. These results emphasize the crucial role of teachers as key drivers of learning motivation and demonstrate that simple yet targeted strategies can generate meaningful impacts. The PKP program is expected to contribute to the advancement of educational knowledge, particularly in implementing innovative, contextual, and child-centered learning approaches in early childhood education.

Periparturient oxidative and inflammatory status and their relation to energy metabolism and performance in transition dairy cows.

Mechatronics, as an interdisciplinary field integrating mechanical, electrical, computer, and control engineering, provides innovative solutions for energy and environmental challenges in urban regions. This study conducts a systematic literature review and meta-analysis using open access datasets to evaluate solar energy potential, electricity reliability, and air quality in Medan, North Sumatra. Results show that the city has strong solar irradiance levels, averaging 5.75 kWh/m²/day, indicating substantial feasibility for photovoltaic deployment. Electricity reliability, assessed through SAIFI and SAIDI indicators, is more stable in Medan compared with other Indonesian cities, offering a favorable foundation for renewable integration. Air quality analysis reveals moderate conditions, with PM2.5 concentrations averaging 28 µg/m³, slightly above World Health Organization standards, yet lower than Jakarta and Pekanbaru. Across all dimensions, mechatronics applications, including smart grid automation, intelligent inverters, IoT-based environmental sensors, and robotics-assisted monitoring emerge as crucial tools to bridge research and implementation gaps. The study identifies limited adoption of techno-economic feasibility analysis, localized reliability assessments, and distributed sensor networks in Medan, which restricts practical deployment. Future research should emphasize mechatronic frameworks such as predictive control, cyber-physical systems, and stochastic modeling to improve resilience. Policy recommendations highlight the need for targeted incentives, pilot projects, and interdisciplinary collaboration. Overall, this work positions mechatronics as a key enabler for sustainable energy transition and environmental management in Medan, offering insights applicable to other rapidly urbanizing regions in Indonesia.

Introduction: globally, one in three people need rehabilitation care throughout their lives, especially older people or people with chronic conditions. The WHO's Rehabilitation 2030 agenda reinforces rehabilitation as an essential component of universal health coverage, person-centered, integrated, evidence-informed and supported by transformational leadership. Objective: to analyze how teaching in rehabilitation nursing can contribute to promoting transformational leadership and transforming the provision of care towards a person-centered model.Method: theoretical-reflexive analysis.Results: Rehabilitation Nursing plays a strategic role in promoting empowerment, functional autonomy and the management of transitions throughout the life cycle. The person-centered model values individual needs, preferences and decisions, promoting a more inclusive and participatory care approach. Transformational leadership leverages improved safety, clinical innovation and positive experience, enhancing leadership and person-centered care. Academic training in rehabilitation nursing should integrate the International Classification of Functioning, Disability and Health, person-centered metrics, leadership and translational research, promoting the inclusion of co-production with citizens and caregivers and aligning with the WHO's global agenda.Conclusions: Academic institutions are fundamental in training transformational leaders in Rehabilitation Nursing who are capable of making the transition to people-centered systems, measured by results that translate into gains in functionality, full participation and satisfaction with the care experience.

Background: Local networks have been recognized for their potential to govern collaborative action toward a low-carbon future in urban areas, yet there is a need to learn more about the strengths and weaknesses of such governance structures. In this paper we assess the Local Roadmap for a Climate Neutral Building & Construction Industry in Malmö 2030 (LFM30) network which was initiated in 2018 with the ambition to accelerate the transition toward a climate neutral construction and building industry in the city of Malmö in Sweden. The initiative can be seen as a form of network governance facilitating the formulation and implementation of coordinated actions to mitigate climate change. Based on the transition management literature and the concepts of collaboration, transition agenda, experimentation, and learning as a theoretical starting point, the assessment provides reflection on the early stages of LFM30 and its ability to mobilize change at a local level. The results indicate that the network has proved successful in building transformative governance, by supporting collaboration, contributing to a robust transition agenda, facilitating innovation and experimentation, and stimulating learning among participating actors. Still, the study indicates challenges in the balance between strategic business opportunities and a shared transformative approach toward a climate neutral building and construction sector.

BackgroundRectal cancer is a highly prevalent malignant tumor, and surgery is one of the main treatment methods. Although preventive ileostomy can reduce postoperative complications, it is also prone to cause malnutrition and other problems.ObjectiveTo construct and validate an early postoperative home dietary management program for patients with preventive ileostomy for rectal cancer, aiming to improve their nutritional status and mitigate clinical ileostomy complications.MethodsAn evidence-based dietary management program was developed, covering dietary transition, nutrient intake, and fluid management. A non-concurrent controlled study was conducted with 66 patients at the Affiliated Hospital of Nanjing University of Chinese Medicine. The intervention group received personalized one-on-one dietary guidance (including pre-discharge assessment of dietary habits, individualized meal planning, and weekly WeChat-based follow-up for food diary reviews) in addition to routine health education, while the control group received routine education only.ResultsAt 1 month postoperatively, the intervention group showed significantly better outcomes than the control group in serum albumin (41.00 g/L vs. 38.00 g/L, p = 0.010, r = 0.368), lymphocyte count (1.30 × 10?/L vs. 1.10 × 10?/L, p = 0.009, r = 0.374), and PG-SGA scores (9.85 vs. 10.94, p = 0.037, Cohen's d = 0.525). The intervention group had lower incidences of high-output stoma (HOS; 6.06% vs. 18.18%, OR = 0.29, 95% CI = 0.05–1.56, p = 0.258) and peristomal moisture-associated skin damage (PMASD; 18.18% vs. 24.24%, OR = 0.69, 95% CI = 0.21–2.29, p = 0.547), with positive clinical trends despite no statistical significance.ConclusionThis home dietary management program can effectively improve short-term postoperative nutritional status in patients, and also plays a positive role in reducing the occurrence of HOS and PMASD.

Prepartum metabolic profiles as predictors of postpartum health in dairy cows.

Nigeria faces a critical developmental crisis characterized by severe rural energy poverty, accelerating deforestation, and significant hindrances in achieving sustainable development. This study analyzes the intricate interdependencies among these elements, demonstrating how the pervasive inadequate access to clean and affordable energy in rural areas directly fuels dependency on unsustainable biomass, leading to widespread deforestation. This environmental degradation, in turn, intensifies climate change impacts, thereby compromising public health and undermining socio-economic stability of the society. This study conducted a comprehensive review of 77 published articles, selecting 50 for their direct relevance and contemporaneity. Investigating into the intricate connections among the key issues of the research. The analysis reveals that this complex situation is not merely a consequence of resource inadequacy but rather an indicative of deeper systemic problems, such as governance failures, a substantial policy-implementation gap, and entrenched historical factors. However, the study also highlights the transformative potential of integrated policy interventions, particularly those centered on a strategic clean energy transition and community-driven sustainable forest management. Such approaches offer synergistic benefits across environmental, health, and socio-economic parameters, addressing the disproportionate burden on vulnerable populations and fostering multiple Sustainable Development Goals (SDGs). The findings underscore the imperative for holistic, equity-focused, and governance-strengthening strategies to handle this complex situation effectively.

ABSTRACTPrevious literature finds mixed evidence on the performance of emerging mutual funds and how investors are becoming more aware of investing in companies involved in low‐carbon emission activities. Given the opportunities that emerging markets and sustainable investing offer to active management, this study aims to fill a gap in the literature by considering their effect on the performance of emerging mutual funds. The study considers a large worldwide sample of equity mutual funds that invest in emerging countries from January 2000 to January 2024. We follow a robust multi‐method empirical approach. First, we analyze portfolios formed according to carbon risk score and the level of active management. We also perform cross‐sectional and panel data regressions. Results show that low‐carbon funds and more active funds achieve greater abnormal returns. Specifically, funds with lower carbon risks perform better among less active funds, while more active funds outperform among high‐carbon risk funds. These results are robust when controlling for other performance determinants and accounting for the variability of fund performance and other characteristics over time and across countries. The evidence emphasizes the role of strategic and tactical asset allocations on fund performance and entails that active managers, who take a holistic approach by integrating sustainable criteria in financial decisions, navigate towards the best investment opportunities while transitioning towards a low‐carbon world.

The transition from pediatric to adult healthcare is a critical stage for young individuals with chronic neurological disorders, particularly those with rare and complex epilepsies. This paper aims to explore the practice of transition by healthcare providers within EpiCARE. Through a comprehensive questionnaire, developed in collaboration with European Patient Advocacy Groups, this study investigates the current management of transition and identifies key barriers hindering stakeholders' needs. The questionnaire was completed by 60 EpiCARE members. Half of the respondents reported existing written transition procedures in their centers. Findings reveal significant hurdles in dedicated transition services, with nearly half of the respondents indicating their centers lack such pipelines. A critical gap exists in multidisciplinary team involvement, with inconsistent participation from key specialists like psychiatrists and social workers. The transition process typically begins at 16–18 years according to 70% of respondents; though 61% believe it should occur prior to the age of 17, highlighting the need for early planning to prevent gaps in care continuity. Furthermore, routinely used informal communication methods for clinical coordination underscore the need for standardized protocols and structured processes. This survey highlights the urgent need for tailored transition protocols that address the unique challenges of managing patients with rare and complex epilepsies, emphasizing the importance of integrating psychosocial support, optimizing comorbidity management, and ensuring coordination by experts in transitional care for these conditions. Fostering collaboration among healthcare providers, patients, and families is essential for refining transition strategies and ensuring comprehensive care for individuals with rare and complex epilepsies. Further initiatives are required to bridge the gaps between pediatric and adult healthcare systems, enhancing the overall quality of life for this vulnerable population.Plain Language SummaryMoving from child to adult healthcare is a key step for young people with rare and complex epilepsies. This study surveyed EpiCARE centers to understand how transitions are managed. Only half have written procedures, and many lack dedicated services or full specialist teams. Most start the transition at ages 16–18, but many believe it should begin earlier. Communication is often informal, without clear protocols. The results highlight the urgent need for structured, personalized transition plans that include psychological support and expert coordination to ensure continuous, high‐quality care into adulthood.

We investigate application of nonlinearity management (NM, i.e., periodic variation of the strength of the intercomponent repulsion) to the miscibility-immiscibility (MIM) transition across the critical point of a two-component Bose-Einstein condensate, both with and without linear mixing [Rabi coupling (RC)] between the components. To this end, we first identify, by means of a variational approximation and numerical solution, diverse stationary domain-wall (DW) structures supported by the system in the absence of management. The approximate analytical solutions for the DWs are found to be in excellent agreement with their numerical counterparts. An analytical estimate is also produced for the upshift of the MIM transition caused by the pressure of the trapping potential in the case of a confined system. An exact DW solution is produced for the system including the Pöschl-Teller potential, which is stable (unstable) if the potential is repulsive (attractive). Further, we find the spectrum of linear excitations in the spatially uniform mixed state, and thus establish parameter regions where the system is stable or unstable against demixing. In particular, RC upshifts the critical strength of the intercomponent repulsion for the onset of the MIM transition. Eigenfrequencies of excitations on top of DW states are identified from numerical simulations through monitoring the evolution of perturbed states. Weak NM applied at the DW eigenfrequency reveals features of the nonlinear resonance. Stronger NM, under which the system periodically crosses the MIM-transition point, restricts the miscibility.

Purpose Owing to the many involved stakeholders, major challenges in the transition to a circular construction (CC) sector have an organisational nature. This study aims to better understand how intra-organisational changes can advance the transition. Design/methodology/approach The Delft University of Technology’s (TU Delft) circular campus ambition serves as a single case study. Construction projects are examined through desk research and interviews. Barriers to circular strategies are analysed using a framework that combines the R-Ladder for hierarchies of CC practices with organisational levels used for transition management. Findings Most barriers occur on the operational and tactical level, while most possible interventions are located on the tactical to strategic level. Current endeavours mostly target mid-R-Ladder strategies at the operational and tactical level. The linear accounting and project development frameworks remain significant tactical barriers within the campus real estate and facility management (CRE&FM) department. Moreover, strategic tooling such as consistent monitoring and forward dashboarding is lacking. Furthermore, CRE&FM is leading the implementation but is dependent on its parent organisation, in which measurable goals, understanding of their implications, as well as a circular financial framework, are largely missing. Practical implications The study provides valuable insight and practical recommendations for (semi-)public RE owners to support the CC transition from within their organisation. Originality/value This study advances knowledge on intra-organisational transition management and offers a new analysis framework that combines circular strategies and different management levels.

Positive impact of a menopause website - MyMenoplan.org - on treatment intentions, knowledge, and decision making: A randomized controlled trial.

<p>Career transition is a process of transition from school education to adulthood that involves various processes of needs, skills and knowledge to prepare students with disabilities to enter the world of work. However, the career transition program is not new, but there are still a few lecturers who do not understand the implementation of the program and lack preparation and knowledge in the management of the transition program. This study explores the readiness of lecturers in the implementation of career transition for students with special needs. A semi-structured interview session was conducted with six northern community college participants under the management of the special education department. Findings show that various factors influence the implementation of career transition management for students with disabilities. The knowledge of lecturers in managing career transition programs is still lacking. In addition, there are challenges in collaboration with stakeholders to understand the importance of the career transition of students with disabilities for future marketability. Finally, this study provides significant findings that need to be followed and used as reference material by other researchers in the future.</p>

The transition in cities toward environmental sustainability requires transforming urban subsystems such as energy, transport, and waste infrastructure. Based on the frameworks of strategic spatial planning (SSP) and urban transition management (UTM), the urban transition is conceptualized as a long‐term process in which stakeholders co‐create a vision and a strategic plan, which is subsequently implemented in multiple relatively short‐term projects transforming these urban subsystems. While co‐creation is emerging in urban planning, ambiguity remains regarding the development and use of co‐creation instruments in transforming urban subsystems. This article therefore has two aims: first, to develop a typology of co‐creation instruments for urban transition planning and management; and second, to examine the institutionalization of their development and use. The article follows an iterative inductive‐deductive search method to make an inventory of instruments, after which four main types are identified: participatory planning and communication tools, expert planning support systems, urban living labs, and virtual transformation labs. Several challenges in using these instruments are identified, including the need to acquire governance and digital skills, and to keep tools and data up to date. This article subsequently examines the capabilities that need to be institutionalized to support the use and development of these instruments across multiple projects. Capabilities needed are stakeholder engagement and collaborative governance, the participatory design and updating of digital tools, maintenance of urban subsystem and city development models, definition of transition scenarios and experiments, and interpretation of (simulation) results. Additional capabilities are needed to manage the project portfolio and facilitate learning within and across projects. Ultimately, a “Transition Planning Office” is proposed to institutionalize these capabilities and, by doing so, to complement UTM’s focus on independent vision and agenda formulation with sustained involvement in long‐term planning, and to support SSP’s call for more strategic urban planning through project portfolio management and instrument use and development.