Search Results (25,501)

Cities are currently facing increasing challenges related to climate change, demographic pressure, and urban expansion. In this context, urban resilience has emerged as a strategic approach to anticipate, withstand, and adapt to environmental and social disturbances. The city of Salamanca, a UNESCO World Heritage Site, has implemented several green infrastructure strategies and climate adaptation initiatives, including the Integrated Sustainable Urban Development Strategy (EDUSI Tormes+), the Special Plan for the Protection of Green Infrastructure and Biodiversity (PEPIVB), and the programs SAVIA Red Verde Salamanca and LIFE Vía de la Plata. This study assesses the contribution of these initiatives to urban governance focused on response capacity by examining their level of implementation and the coherence among different municipal planning instruments. The analysis reveals that the municipal green infrastructure framework is explicitly planned and strategically designed with the objective to mitigate the urban heat island effect, regenerate the urban fabric, and establish structural pathways targeted to foster local biodiversity pathways. Overall, the results provide evidence that nature-based territorial management instruments can strengthen the adaptive capacity of heritage cities to climate change, offering a replicable model for other territories with similar characteristics. Full article

Objective: We aimed to elucidate the epidemiological characteristics and co-infection status of HBoV in Guangzhou and to investigate the potential recombination events and alterations in antigenic properties among circulating HBoV strains. Methods: Utilizing respiratory specimens collected from patients at sentinel surveillance hospitals in Guangzhou between August 2023 and December 2025, multiplex pathogen detection was performed. We describe the temporal and demographic distribution of HBoV in Guangzhou and determine its co-infection patterns. Subsequent sequence analysis focused on identifying potential recombination events and characterizing antigenic properties. Results: The epidemiological features of HBoV in Guangzhou exhibited a primary epidemic peak around the autumn season, followed closely by a secondary peak. HBoV infection was predominantly observed in children under three years of age. Co-infections with rhinovirus and parainfluenza virus were common. Whole-genome sequencing yielded 15 complete HBoV genome sequences. Recombination analysis and verification suggested potential recombination events in two of these sequences. A comparative analysis of the antigenic characteristics of one identified recombinant strain, GZ-2024-20891, against its putative parental strains and domestic prevalent strains revealed potential alterations in its antigenic characteristic. Conclusions: Bocavirus is highly prevalent among young children under 3 years of age, with a secondary peak following the main epidemic peaks around autumn in Guangzhou. Genetic recombination and potential antigenic alteration were detected in bocavirus. Full article

AI-enabled infrastructure systems increasingly govern access to emergency services, disaster relief, and utility restoration, yet they routinely produce inequitable outcomes even when allocation algorithms apply procedurally neutral rules. The standard explanation locates the cause inside the algorithm. This paper argues instead that inequity arises from the interaction between the algorithm and the physical environment in which it operates: network topology, resource locations, and demand distribution jointly constrain what any policy can achieve, and when those constraints are sufficiently binding, ethical infeasibility is structural rather than algorithmic. We introduce a constraint-based formulation that embeds ethical requirements into the feasible region, and a hierarchical Irreducible Infeasible Subsystem (IIS) procedure that attributes infeasibility to rule design, algorithmic choice, or physical infrastructure. We further establish the Structural Infeasibility Theorem, deriving closed-form bounds on inter-group disparity across all feasible policies. The framework was applied to zone-decomposable infrastructure allocation problems generally, with a metropolitan ambulance-dispatch system serving as a concrete instantiation. The study delivers four findings. First, the minimum-service violation may not be caused by the allocation algorithm itself; rather, it may arise from the physical layout of the infrastructure. Second, the observed efficiency–equity trade-off may not be an unavoidable feature of equitable allocation, but may instead reflect the difficulty of achieving equity within an underbuilt system. Third, before new infrastructure is added, improvements in equity may represent harm redistribution rather than harm reduction. Fourth, the IIS certificate can be translated into a concrete capital-investment requirement, showing what physical change may be needed to restore ethical feasibility. Full article

Objective: To evaluate the efficacy of NADPH oxidase 4 and miR-146a-5p in current treatment planning for ascending aortic aneurysms, independent of aortic diameter, and to develop protocols that will ensure the treatment of ascending aortic aneurysms, which pose a risk for aortic dissection, without complications. Methods: Patients who met the inclusion criteria and underwent surgery at Dr. Siyami Ersek Chest, Heart, and Vascular Surgery Training and Research Hospital for ascending aortic aneurysms and coronary artery disease between 2023 and 2024 were included in the study. This study was designed as a prospective study. Demographic, biochemical, radiological, and echocardiographic data were collected, and NOX4 mRNA and miR-146a-5p expressions were examined and compared in tissue samples. Results: The study was conducted on a total of 50 patients, with 25 patients in the aneurysm group and 25 patients in the control group. miR-146a-5p expression levels were found to be significantly decreased in the patient group compared to the control group (p = 0.001). When NOX4 mRNA expression levels were examined, no significant difference was found between the control and aneurysm groups. No correlation was found between NOX4 mRNA and miR-146a-5p levels (p = 0.764). When the relationship between ascending aorta diameter and both NOX4 mRNA and miR-146a-5p was examined, it was found that miR-146a-5p expression was negatively correlated with ascending aorta diameter (p = 0.036) and did not show a significant correlation with NOX4 mRNA levels (p = 0.318). A similar correlation was also found with ascending aorta length. The correlation of NOX4 mRNA and miR-146a-5p expression levels with age, gender, and ejection fraction was investigated separately. No significant correlation was found for all three variables. The optimum cut-off value to be used to separate the patient group from the control group using miR-146a-5p expression levels, as well as the sensitivity and specificity of miR-146a-5p expression levels when this cut-off value was used, was calculated using an ROC curve. Specificity for miR-146a-5p expression was found to be 88%, and sensitivity was found to be 66%. Conclusions: The study found promising results indicating that NOX4, shown to be a determinant of vascular oxidative stress, is not involved in the development of ascending aortic aneurysms; however, miR-146a-5p, which functions in the regulation of many inflammatory responses, including the regulation of NOX4 expression, may help prevent the development of ascending aortic aneurysms. Further studies aimed at elucidating the genetic and biochemical processes involved in aneurysm development suggest that miR-146a-5p could be a therapeutic target for preventing aneurysms. Full article

Background: Stroke significantly increases morbidity and mortality in patients receiving extracorporeal membrane oxygenation (ECMO). This study evaluates the prognostic impact of stroke subtypes, acute ischemic stroke (AIS) and hemorrhagic stroke (HS), and neurologic injury severity in a contemporary adult population. Methods: We conducted a retrospective cohort study using the TriNetX federated electronic health record network, including adult patients who underwent ECMO between 1 October 2015 and 31 December 2025. Stroke was defined as a first-instance diagnosis of AIS, HS, or unspecified cerebrovascular event occurring within 24 h of ECMO cannulation during the index hospitalization. Propensity score matching (1:1 nearest neighbor) was performed to balance baseline demographics, comorbidities, anticoagulant use, and ECMO modality between the stroke and non-stroke cohorts. Primary outcomes included all-cause mortality at 30 days, 90 days, and 1 year. Secondary outcomes included cardiac arrest, seizures, palliative care utilization, and hospital readmission. Kaplan–Meier survival analysis and multivariable Cox proportional hazards modeling were performed. Results: Among 18,981 ECMO patients, 1481 (7.8%) developed a stroke within 24 h of ECMO cannulation, including 814 AIS (54.9%), 454 HS (30.6%), and 213 unspecified cerebrovascular events (14.4%). After propensity score matching, stroke was associated with significantly higher all-cause mortality at 30 days (RR 1.16), 90 days (RR 1.18), and 1 year (RR 1.18), all p < 0.05. Stroke was also associated with higher rates of cardiac arrest, seizures, hospital readmission, and palliative care utilization (all p < 0.001). AIS was associated with significantly lower mortality than HS at 30 days, 90 days, and 1 year (all p < 0.0001). In multivariable Cox regression, only HS was independently associated with increased 30-day mortality compared with no stroke. Markers of neurologic injury severity, including cerebral edema, brain compression, and coma, were among the strongest independent predictors of mortality. Conclusions: Stroke occurring early after ECMO cannulation is associated with substantially worse short- and long-term survival, with hemorrhagic subtype and markers of neurologic injury severity driving the strongest prognostic signals. These findings support early stroke recognition and subtype-informed prognostic discussions in ECMO patients. Full article

Background: Infectious diseases remain a leading cause of mortality in South Africa, compounded by a high HIV prevalence. This study aimed to delineate the spectrum and clinicopathological characteristics of fatal infectious diseases through a postmortem audit to inform clinical practice and public health strategy. Methods: A retrospective, cross-sectional descriptive study was conducted on all autopsies with a final cause of death attributed to infectious disease at a National Health Laboratory Service, in Northern Pretoria, Gauteng, South Africa, from 2012 to 2021. Using the Systematised Nomenclature of Medicine Clinical Terms (SNOMED) code and word search engines codes, 55 cases were identified. Data on demographics, clinical presentation, HIV status, antiretroviral therapy (ART), comorbidities, and final autopsy diagnosis were extracted from the laboratory information system. Histological confirmation was performed using standard stains. Descriptive statistical analysis was conducted using STATA-18. Results: The cohort (n = 55) had a median age of 31 years (IQR 19–45) and was predominantly female (67%). HIV prevalence was 35%, with 68% of those on ART. The leading cause of death was multilobar pneumonia (36%), followed by bronchopneumonia (22%). AIDS-defining illnesses were present in 27% of cases, with disseminated tuberculosis being the most common (46%). Septic shock was identified in 18% of decedents. A significant proportion (60%) of the cohort was HIV-negative. Conclusions: This autopsy series reveals a high burden of fatal community-acquired pneumonias and HIV-associated opportunistic infections, with a notable proportion of deaths occurring in HIV-negative individuals. The findings underscore diagnostic gaps and highlight the critical role of autopsy in accurate mortality surveillance, advocating for enhanced antemortem diagnostic protocols and targeted public health interventions. Full article

For students in animal science-related disciplines, animal welfare education may be associated with their understanding of human–animal relationships and willingness to pursue animal-related careers. However, empirical research from developing countries such as China remains limited. To address this gap, we conducted a survey among undergraduates at Northeast Agricultural University to examine the associations of demographic characteristics, educational exposure, and animal-related experiences with animal welfare awareness and career aspirations. A total of 346 valid responses were obtained. The results showed that students who encountered animal welfare through school demonstrated significantly higher levels of self-reported animal welfare awareness (p < 0.001). Binary logistic regression further confirmed that the channel remained significantly associated with the level of awareness (OR = 8.714, p < 0.001). Furthermore, gender and pet-keeping experience were significantly associated with career aspirations in both univariate and logistic regression analysis. In addition, although 50.00% of respondents considered primary school to be the optimal stage for animal welfare education, 81.48% of those exposed through school channels reported their first exposure at university. These findings highlight the need for a progressive animal welfare education framework, transitioning from life education and human–animal relationship training at the primary level to professional practice education in higher education. This approach may help students develop more stable and scientifically informed understanding of animal welfare, as well as a stronger sense of professional identity. Full article

Objective: To evaluate the impact of urban–rural health insurance integration on the health outcomes and financial burden of rural older adults. Methods: Utilizing panel data from the China Health and Retirement Longitudinal Study (CHARLS) spanning 2013 to 2018, we employed a staggered difference-in-differences model coupled with propensity score matching (PSM-DID) for rigorous causal identification. Results: The policy significantly reduced out-of-pocket medical expenditures for rural households by approximately 5.6% (p = 0.034). Concurrently, significant improvements were observed in both physical health (a 0.092-point reduction in ADL impairment scores) and mental health (a 0.725-point reduction in CES-D depression scores). Mechanism analyses revealed that the integration did not significantly increase the probability of outpatient or inpatient visits—thereby ruling out supplier-induced demand and moral hazard—while effectively reducing the incidence of catastrophic health expenditure by 1.9% (p = 0.004). Heterogeneity analyses indicated that while the financial relief was universally distributed across varying educational levels, the policy dividends were predominantly captured by the younger-old demographic. Notably, the reduction in financial burden was not statistically significant for the oldest-old cohort (aged 75 and older). Conclusions: The urban–rural health insurance integration has achieved a dual dividend of financial protection and health enhancement without triggering the overutilization of medical services. Nevertheless, the unmet care expenses for older adults with severe disabilities underscore the urgent necessity for a secondary safety net, such as long-term care insurance. Full article

Population ageing is reshaping the assumptions on which succession law has traditionally rested. This article examines how Spanish succession law responds to this demographic shift through two closely connected dimensions: testamentary capacity and the growing role of succession agreements. The analysis adopts a doctrinal and comparative perspective within the Spanish legal system, taking account of the coexistence of the Spanish Civil Code and several autonomous succession regimes. It argues that testamentary capacity remains governed by a deliberately low and functional threshold, centred on the testator’s actual ability to form and express a testamentary intention at the time of execution, and that notarial ex ante control is central to preserving both autonomy and legal certainty. At the same time, relational vulnerability in later life requires distinct safeguards aimed at preserving testamentary freedom. The article further shows that succession agreements, often viewed as restrictions on testamentary freedom, may also operate as instruments of anticipatory autonomy. The central challenge is to make autonomy effective across time without confusing vulnerability with incapacity, or protection with constraint. Full article

Background/Objectives: Acute subdural hematomas (aSDH) represent a frequent and potentially life-threatening form of traumatic intracranial hemorrhage. This study aims to assess prognostic factors associated with mortality and clinical outcome, with particular emphasis on coagulation-related parameters, especially international normalized ratio (INR). Methods: A single-center retrospective cohort study was performed. We included 151 patients with traumatic aSDH, admitted between January 2020 and June 2025 to the Department of Neurosurgery of the Clinical Emergency Hospital “Saint Pantelimon”. Demographic, clinical, laboratory, and imaging parameters obtained at admission were analyzed. Univariate and multivariable regression analyses were performed to identify predictors of in-hospital mortality. Internal validation included bootstrap resampling, calibration analysis, penalized regression and spline modeling. Results: The cohort had a mean age of 67.4 years and was predominantly male (72.8%). Overall, in-hospital mortality was 36.4%, while 58.3% of patients underwent surgical intervention. Admission Glasgow Coma Scale (GCS) score represented the strongest predictor of mortality. Hematoma thickness was significantly associated with midline shift, mortality, and surgical intervention. Elevated INR was significantly associated with increased hematoma thickness, greater midline shift, lower GCS, and increased mortality. In multivariable analysis, INR ≥ 1.4 remained independently associated with mortality (OR 4.08, 95% CI 1.56–11.29, p = 0.005), together with lower GCS. The final model demonstrated very good discrimination (AUC 0.887) and good calibration. Conclusions: Outcome in traumatic aSDH appears to be influenced by neurological severity, hematoma burden, and coagulation status. Admission GCS remained the strongest predictor of mortality, while elevated INR independently predicted poor outcome. Full article

Background/Objectives: Iron deficiency remains a prevalent condition, needing specific laboratory tests for diagnosis. This study aimed to evaluate whether routine complete blood cell count (CBC) parameters can be used within a machine learning framework to predict low ferritin and low transferrin saturation, used as biochemical markers of altered iron status, potentially supporting more targeted laboratory test utilization. Methods: In this single-center retrospective outpatient study, we analyzed 32,437 records from subjects undergoing both complete blood cell count and iron metabolism testing between 2023 and 2026. Low ferritin and low transferrin saturation were defined using sex-specific thresholds. Low ferritin was present in 14,344 subjects (44.2%), whereas low transferrin saturation was present in 7791 subjects (24.0%). After cleaning data and excluding incomplete records, demographic variables and CBC indices were tested as potential predictors. The dataset was split into training and test sets with stratified sampling. Multiple supervised machine learning models, including logistic regression, decision tree, random forest, XGBoost, support vector machine, k-nearest neighbors, and Naive Bayes, were trained. Hyperparameter tuning and model selection were performed using repeated stratified 10-fold cross-validation, optimizing the area under the curve (AUC). Model performance was assessed by AUC, sensitivity, and specificity, and validated on an independent test set. Results: All models showed predictive capability for low ferritin and low transferrin saturation using CBC parameters alone. Ensemble methods, especially random forest and XGBoost, reached the best performance (AUC values of 0.80–0.87 for ferritin and 0.85–0.96 for transferrin saturation). Sensitivity and specificity were balanced, supporting clinical screening applicability. Results were maintained across validation and confirmed in the test set. Prediction of transferrin saturation showed slightly higher accuracy than ferritin. Feature importance analysis identified mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), and red blood cell distribution width (RDW) as key predictors. Conclusions: CBC-based machine learning models may help identify subjects with low ferritin or low transferrin saturation, supporting subsequent targeted assessment of iron status. Full article

Background: With increasing life expectancy, older adult populations worldwide are growing rapidly. Falls are among the most prominent problems that older adults face. This study aimed to assess the educational components of the Stopping Elderly Accidents, Deaths, & Injuries (STEADI) program for improving knowledge, skills, and behavioral intentions for fall prevention among older adults. Methods: A quasi-experimental study was conducted with a non-equivalent control group pretest–posttest design, involving 128 older women (≥60 years) in a community center in Riyadh. Data were collected using a structured questionnaire. Descriptive statistics were used to summarize the data. Pearson’s chi-square test was performed to compare demographic and physical characteristics between the groups. Independent-sample t-tests, effect size calculation (Cohen’s d), and ANCOVA-adjusted analyses were used to compare post-intervention outcomes between groups. Within-group changes were compared using a paired t-test. Additionally, one-way analysis of variance (ANOVA) was performed to compare the demographic, health, and physical characteristics of the participants. Statistical significance was set at p ≤ 0.05. Results: The intervention group showed improved knowledge (t = 11.654), skills (t = 7.961), and intention to perform preventive behaviors (t = 3.785), with a significant p-value of <0.0001. Large intervention effects were observed for knowledge (Cohen’s d = 2.30) and skills (Cohen’s d = 1.57). ANCOVA-adjusted analyses confirmed significant intervention effects for knowledge (adjusted mean difference = 5.06, 95% CI 4.46–5.66, p < 0.001) and skills (adjusted mean difference = 1.87, 95% CI 1.56–2.18, p < 0.001). Conclusions: The results indicate that the STEADI program produces significant short-term improvements in knowledge, skills, and behavioral intentions related to fall prevention. The findings emphasize the importance of integrating prevention programs into community settings and activating the role of families in supporting preventive practices. Full article

Background/Objectives: Shift work is a form of circadian dysregulation, which has been associated with adverse reproductive health outcomes. However, the association between circadian dysregulation and ovarian reserve remains uncertain. The present study examines whether shift work is associated with lower AMH levels in women seeking fertility treatment. Methods: This retrospective cohort study includes female patients aged 20–39 years presenting between February 2023 and June 2024. Patients were excluded if they had only one ovary, a current cancer diagnosis, or past chemotherapy use. Demographic and medical data were obtained from the electronic medical record. AMH levels were compared between daytime workers and shift workers. Results: A total of 1135 patients met inclusion criteria. The median age was 35 years (IQR 32–37). Of these, 89% (n = 1014) reported daytime work, and 11% (n = 121) reported shift work, comprising 102 working rotating shifts, seven working night shifts, and 12 working evening shifts. Daytime-only workers had a median AMH of 17.20 pmol/L (9.1–30.0). Combined shift workers had a median AMH of 17.10 pmol/L (8.1–31.0). There was no statistically significant difference in AMH levels between daytime workers and shift workers (p = 0.935). Although not significant, the odds of having low AMH levels (<7 pmol/L) were 25% higher among shift workers compared to daytime workers (OR 1.246, p = 0.345). Conclusions: In this cohort, AMH levels did not significantly differ between daytime and shift workers, offering reassurance to individuals required to engage in shift work. Future research should include larger cohorts and incorporate more comprehensive measures of circadian disruption. Full article

Background/Objectives: Eating disorders (EDs) are among the most severe psychiatric conditions affecting young people, with increasing prevalence in the post-pandemic period. This study assessed the prevalence of ED risk and dysfunctional eating behaviors among Italian university students, a population poorly characterized with respect to ED risk, and examined associations with key socio-demographic and anthropometric variables. Methods: A cross-sectional online screening study was conducted between August 2023 and February 2026 with 401 Italian university students (306 women and 95 men). Participants completed the validated Italian versions of the Eating Attitudes Test-26 (EAT-26) and the Eating Disorder Examination Questionnaire 6.0 (EDE-Q 6.0), alongside self-reported anthropometric data. Multiple linear regression analyses were performed to identify predictors of ED risk scores. Results: A total of 37.9% of participants had BMI outside the normal range (19.7% underweight; 18.2% overweight or obese). EAT-26 scores exceeded the clinical cut-off in 28.4% of participants (women: 35.6%; men: 5.3%). EDE-Q 6.0 global scores exceeded the clinical cut-off in 21.0% (women: 25.8%; men: 5.3%). Only 45.4% showed no anthropometric or questionnaire-based screening risk indicators (i.e., scores above the clinical cut-off on the EAT-26 or EDE-Q 6.0). BMI was negatively associated with EAT-26 scores in the total sample and in women, while a positive association between BMI and EDE-Q 6.0 scores was observed in men. Conclusions: A substantial proportion of Italian university students, particularly women, presented screening-based indicators of ED risk. The combined use of anthropometric and questionnaire-based screening tools provides a more comprehensive risk assessment than either measure alone, highlighting the need for multidimensional screening programs. Full article

Background: In patients with traumatic brain injury (TBI), proteins are considered the main source of energy. Previous studies have suggested that an increase in the urea-to-creatinine ratio (UCR) indicates the onset of protein catabolism. Therefore, we aimed to investigate the associations of the UCR with the functional independence measure (FIM). Methods: This single-center retrospective study included 291 patients aged 17–87 years who underwent inpatient rehabilitation within the first 6 months post-TBI. Their demographic, clinical, neuroradiological, and laboratory data (eGFR, urea, creatinine, UCR) were collected. Spearman’s correlation and hierarchical multivariate regression analyses adjusted for clinical covariates were performed. Results: The strongest significant positive correlation was found between the Glasgow Coma Scale (GCS) and FIM at admission (ρ = 0.488, p < 0.001) and between GCS and FIM at discharge (ρ = 0.340, p < 0.001). A significant negative correlation was found between the discharge UCR and FIM at discharge (ρ = −0.262, p < 0.003), as well as with the change in FIM (ρ = −0.207, p < 0.02). Patients with UCRs ≥ 80 had a significantly lower discharge FIM compared to patients with UCRs < 80 (median 27 vs. 40; p = 0.02). The significant independent predictors of discharge FIM were the nutritional route (NGT/PEG), level of consciousness, and FIM at admission. The UCR did not remain independently associated with the discharge FIM (ΔR² = 0.004, Cohen’s f² = 0.014). Conclusions: Although UCR is associated with functional outcomes measured by FIM in TBI patients, it is not an independent predictor of these outcomes but rather a biomarker of catabolic burden. Full article