Search Results (91)

Introduction: Tuberculosis (TB) predominantly affects older adults in Japan, and prolonged hospitalization remains a challenge. This study evaluated both clinical and social factors influencing hospitalization duration. Methods: We retrospectively analyzed 203 patients with smear-positive pulmonary TB admitted to NHO Wakayama Hospital (2017–2022). Stepwise multiple regression was used to identify factors associated with hospitalization duration. Results: Key factors included time to smear negativity, duration from isolation release to discharge, independence in daily life, and discharge destination. Prolonged stays were often due to social issues, such as difficulties in arranging transfers to long-term care homes or family acceptance. Conclusions: While Japan is developing new discharge criteria based on clinical indicators, our findings highlight the significant impact of non-clinical, social factors on hospitalization duration. Addressing these factors is essential for effective discharge planning. Full article

Dairy wastewater is highly polluting and requires treatment before being discharged into receiving surface waters or destined for reuse. This study aimed to evaluate the performance of a wastewater treatment plant (WWTP) at a dairy facility, which includes the following treatment stages: screening, grease trap, and an upflow anaerobic filter (UAF). Monitoring data from a WWTP at a dairy situated in the southern region of Minas Gerais, Brazil, were assessed based on pollutant removal efficiency in accordance with Brazilian environmental regulations. The results showed that the WWTP achieved average removal efficiencies of 96.2% for COD and 97.1% for BOD₅. The BOD₅/COD ratio of raw and treated wastewater averaged 0.46 and 0.30, respectively, indicating preferential removal of the biodegradable organic fraction. The treated wastewater complied with legal standards for pH, settleable solids, and total suspended solids. However, at least one sample did not meet regulatory limits for discharge into water bodies regarding surfactants and oils & greases. Strong linear correlations (R²~0.8) between COD and BOD₅ data were observed for both raw and treated wastewater. While the treated wastewater was not suitable for use in the facility’s wood-fired boiler, it may be reused for agricultural irrigation. Full article

Background/Objectives: The increasing emphasis on early mobilization in intensive care units (ICUs) has underscored the need for quick, simple, and reliable tools to assess patients’ mobilization levels. The ICU Mobility Scale (IMS) was developed to address this need and has been translated into a Japanese version. This study aimed to evaluate the construct and predictive validity of the Japanese version of the IMS in critically ill patients. Methods: This was a secondary analysis of the EMPICS study, which included patients who stayed in ICUs for at least 48 h. The Japanese version of the IMS and physical function were assessed at ICU discharge. At hospital discharge, outcomes such as walking ability, discharge destination, activities of daily living (ADL) dependency, ICU-acquired weakness, and physical impairment were evaluated. At 90-day follow-up, the presence of post-intensive care syndrome (PICS) was assessed using quality of life scores, and mortality data were collected. Construct and predictive validity were analyzed using Spearman’s rank correlation coefficients, the Mann–Whitney U test, and logistic regression analysis. Results: A total of 193 patients (mean age 68.2 years; 65.8% male) were included. The mean IMS score at ICU discharge was 5.6. The IMS score at ICU discharge showed significant correlations with the Barthel Index (ρ = 0.55, p = 0.001), Medical Research Council sum score (ρ = 0.45, p < 0.001), and grip strength (ρ = 0.44, p < 0.001), but not with body weight or sex. Logistic regression analyses demonstrated that a higher IMS score at ICU discharge was significantly associated with better physical outcomes at hospital discharge, a lower incidence of PICS, and reduced 90-day mortality. Conclusions: The Japanese version of the IMS demonstrated both construct and predictive validity in ICU patients. It is a useful tool for assessing daily mobilization levels in critical care settings. The findings may not be generalizable to all ICU patients due to the strict eligibility criteria. Full article

The growing proportion of older adults in the population necessitates improved methods for assessing functional recovery. Objective, continuous monitoring using wearable sensors offers a promising alternative to traditional, often subjective assessments. This study aimed to investigate the utility of inertial measurement unit (IMU)-based data, combined with deep learning, to predict postoperative mobility, activities of daily living, and discharge destination in older adults following surgery. Data from the SURGE-Ahead project was analyzed, involving 39 patients (mean age 79.05 years) wearing lumbar IMU sensors for up to five postoperative days. Deep learning models (TabPFN) were applied and validated using leave-one-out cross-validation to predict the Charité Mobility Index (CHARMI), the Barthel Index, and discharge destination. The TabPFN model achieved R² values of 0.65 and 0.70 for predicting CHARMI and Barthel Index scores, respectively, with moderate to strong agreement with human assessments (weighted kappa ≥ 0.80). Discharge destination was predicted with an accuracy of 82%. The z-channel IMU data and parameters related to walking bouts were most predictive of outcomes. IMU-based data, combined with deep learning, demonstrates potential for automated functional assessment and discharge decision support in older adults following surgery. Full article

The increasing integration of intermittent renewable energy sources necessitates effective energy storage solutions, with battery energy storage systems (BESSs) emerging as promising candidates for energy arbitrage operations. This study conducted a comprehensive comparative analysis of 29 European electricity markets to identify optimal locations for utility-scale BESS-enabled energy arbitrage ventures. Using hourly wholesale electricity price data spanning January 2015 to December 2023, we employed statistical analysis techniques, 3D surface plots, and developed a novel energy arbitrage feasibility (EAF) score-based ranking system that integrates electricity market volatility metrics with regulatory and economic variables including gross domestic product per capita, index of economic freedom, and electricity supply-origin risk (ESOR). Five investor preference scenarios were analyzed: risk-averse, ESOR-sensitive, economy-sensitive, volatility-sensitive, and equally weighted approaches. Results demonstrated that Estonia ranked highest in three scenarios, achieving the maximum absolute EAF score of 0.558197 in the volatility-sensitive scenario, while Luxembourg led in the ESOR and economy-sensitive scenarios. Estonia’s market characteristics support single daily charge–discharge cycles, whereas Luxembourg enables dual cycles, offering different operational strategies. The EAF scoring methodology provides a standardized framework for cross-country investment decision-making in energy arbitrage ventures. These findings indicate that market selection significantly impacts the BESS arbitrage profitability, with Estonia and Luxembourg representing the most favorable investment destinations. Full article

Background/Objectives: Predicting comprehensive patient characteristics is essential for optimal individualized rehabilitation plans for acute stroke patients. However, current models primarily predict single outcomes. This study aimed to assess the applicability of latent class analysis (LCA) in rehabilitation practice by identifying comprehensive characteristics and associated predictors in acute stroke patients. Methods: We conducted a retrospective observational study using the Japan Association of Rehabilitation Database, including 10,270 stroke patients admitted to 37 acute-care hospitals between January 2005 and March 2016. Patients were classified using LCA based on outcomes at discharge, including Functional Independence Measure (FIM), National Institutes of Health Stroke Scale (NIHSS) subscales for upper-extremity function, length of hospitalization, and discharge destination. Predictor variables at admission included age, FIM scores, NIHSS subscales for upper-extremity function, stroke type, and daily rehabilitation volume. Results: 6881 patients were classified into nine distinct classes (class size: 4–29%). Class 1, representing the mildest cases, was noted for independent ambulation and good upper limb function. Class 2 comprised those with the most severe clinical outcome. Other classes exhibited a gradient of severity, commonly encountered in clinical practice. For instance, Class 7 included right-sided paralysis with preserved motor activities of daily living (ADLs) and modified dependence in cognitive functions, such as communication. All predictors at admission were significantly associated with class membership at discharge (p < 0.001). Conclusions: LCA effectively identified unique clinical subgroups among acute stroke patients and demonstrated that key admission variables could predict class membership. This approach offers a promising insight into targeted, personalized rehabilitation practice for acute stroke patients. Full article

Background/Objectives: In recent years, the discharge of antibiotics into rivers and irrigation canals has increased. However, few studies have addressed the impact of these compounds on agricultural fields that use such water to meet crop demands. Methods: In this study, the transport of two types of gentamicin (pure gentamicin and gentamicin sulfate) was modeled at concentrations of 150 and 300 μL/L, respectively, in a soil with more than 60 years of agricultural use. Infiltration tests under constant head conditions and gentamicin transport experiments were conducted in acrylic columns measuring 14 cm in length and 12.7 cm in diameter. The scaling parameters for the Richards equation were obtained from experimental data, while those for the advection–dispersion equation were estimated using inverse methods through a nonlinear optimization algorithm. In addition, a fractal-based model for saturated hydraulic conductivity was employed. Results: It was found that the dispersivity of gentamicin sulfate is 3.1 times higher than that of pure gentamicin. Based on the estimated parameters, two simulation scenarios were conducted: continuous application of gentamicin and soil flushing after antibiotic discharge. The results show that the transport velocity of gentamicin sulfate in the soil may have short-term consequences for the emergence of resistant microorganisms due to the destination of wastewater containing antibiotic residues. Conclusions: Finally, further research is needed to evaluate the impact of antibiotics on soil physical properties, as well as their effects on irrigated crops, animals that consume such water, and the soil microbiota. Full article

Introduction: Traumatic brain injury (TBI) is a leading cause of morbidity worldwide, with the Glasgow Coma Scale (GCS) serving as a tool to measure injury severity. This study aimed to investigate the relationship between GCS admission scores and various socio-demographic, clinical, injury-related, and hospital-related variables in patients with TBI across two tertiary care centers in Eastern Europe, a region that remains underrepresented in the literature. Methods: A retrospective observational study was conducted using data from 119 TBI patients admitted between March 2020 and June 2023 at Cluj County Emergency Hospital (Romania) and Saint Vincent Hospital (Poland). GCS scores were analyzed as both categorical and continuous variables. Statistical analyses included Wilcoxon and Kruskal–Wallis tests for group comparisons and Spearman correlations for continuous variables. Results: Most patients included suffered a mild TBI (GCS score between 13 and 15). There were significant associations between GCS scores and post-traumatic amnesia (p < 0.05), discharge status (p < 0.01), discharge destination (p < 0.01), and education level (p < 0.01). GCS scores at admission were linked to survival, absence of post-traumatic amnesia, higher education levels, and home discharge. No significant differences observed across sex, residence, employment status, injury type, cause, or mechanism of injury. A weak but significant negative correlation was observed between GCS and length of hospital stay (rho = −0.229, p > 0.05), while age showed a non-significant correlation. Conclusions: The GCS score at admission is significantly associated with various clinical and socio-demographic outcomes in TBI patients, supporting the utility of the GCS score as a prognostic tool. The predominance of mild cases and the absence of radiological data, such as cerebral contusions or epidural or subdural hematomas, limit the generalizability of the findings. Further studies with larger samples and comprehensive imaging data are necessary to validate these findings. Full article

Background: While Asia contributes 44.3% of traumatic brain injuries (TBI) worldwide, data regarding Asian TBI inpatient rehabilitation length of stay (RLOS) is scarce. A retrospective cohort study was conducted to determine correlates of inpatient RLOS (days) and prolonged RLOS >30 days (PRLOS > 30). (2) Methods: Data extraction of discharged inpatient records was performed from 2018 to 2024. Dependent variables included RLOS (days) and PRLOS > 30. Independent variables included demographic characteristics, TBI severity (emergency-room Glasgow Coma Scale-GCS), admission/discharge Functional Independence Measure (FIM), intra-rehabilitation complications, post-traumatic amnesia (PTA) duration, and discharge placement. (3) Results: Altogether, 289 data sets were analysed, median (IQR) age, 64 (28) years, 78.9% (228/289) males, and 79.6% (230/289) Chinese. Median (IQR) RLOS was 28 (21) days, with PRLOS >30 at 39.8% (115/289); RLOS of 44 (19.5) days. PRLOS > 30 was significantly associated with PTA duration >28 days (OR 4.01, 95% CI 1.90–8.45, p < 0.001), admission FIM ≤ 40/126 (OR 4.71, 95% CI 2.32–9.59, p < 0.001), delayed neurosurgical complications (OR 4.74, 95% CI 1.28–17.6, p = 0.02) and discharge to non-home destination (OR 2.75. 95% CI 1.12–6.76, p = 0.03). (4) Conclusion: PRLOS >30 was significantly associated with longer PTA > 4 weeks, lower admission FIM score, delayed neurosurgical complications, and discharge to a nursing home. Full article

Tourism offers many economic benefits but can have long-lasting ecological effects when improperly managed. Tourism can cause overwhelming pressure on wastewater treatment systems, as in Belize, where some of the over 400 small islands (cayes) that were once temporary sites for fishermen have become popular tourist destinations. An overabundance of nitrogen, in part as a result of incomplete wastewater treatment, threatens human health and ecosystem services. The tourism industry is a complex and dynamic industry with many sectors and stakeholders with conflicting goals. In this study, a systems thinking approach was adopted to study the dynamic interactions between stakeholders and the environment at Laughing Bird Caye National Park in Belize. The project centered on nutrient discharges from the caye’s onsite wastewater treatment system. An archetype analysis approach was applied to frame potential solutions to nutrient pollution and understand potential behaviors over time. “Out of control” and “Underachievement” were identified as system archetypes; “Shifting the Burden” and ‘‘Limits to Success’’ were used to model specific cases. Based on these results, upgrading of the wastewater treatment system should be performed concurrently with investments in the user experience of the toilets, education on the vulnerability of the treatment system and ecosystem, and controls on the number of daily tourists. Full article

Objectives: This study aimed to describe the profile and identify the clinical and sociodemographic factors associated with emergency department (ED) use among patients aged ≥65 years. Methods: This was a retrospective cross-sectional study of patients aged ≥65 years who were seen in the emergency department of the Hospital de Mérida (Spain) in 2019, the year before the Coronavirus Disease 2019 (COVID-19) pandemic. Descriptive statistics were calculated for dependent variables such as hours of ED stay, total number of visits, reasons for discharge, and diagnostic specialty, disaggregated by gender, season, age group, day type (work or holiday), shift, and population area (rural or urban). Results: Significant differences in ED hours were found according to gender (p < 0.001), season (p = 0.024), age group (p < 0.001), attention shift (p < 0.001), and population area (p = 0.003). Discharge to home was the most common destination (63.5%), followed by hospital admission (25.7%). Admissions for gastrointestinal surgery and neurology were predominant in men, and admissions for internal medicine and trauma were predominant in women. Patients aged 65–79 years were admitted to internal medicine, and those over 80 years were admitted to cardiology. Among patients who presented to the hospital’s emergency department and required admission, 51.5% were men aged ≥ 75 years, rising to 53.3% among those aged 65 to 74 years. The clinical areas were related to cardiology (27.67%) and pneumology (20.63%). Conclusions: Demands for ED care in those over 65 years of age are associated with sociodemographic and clinical characteristics, which can be used to better plan and manage resources and improve user satisfaction. Full article

Introduction: The rise in youth sports participation has led to an increase in pediatric sports-related injuries in the United States, contributing to growing healthcare costs and exacerbating socioeconomic disparities. Insurance payor status is a critical factor influencing access to care, treatment delays, and health outcomes. This study examines the association between insurance payor status and outcomes in pediatric sports-related injuries. Methods: A systematic review of the Medline database was conducted. Included studies reported insurance payor status and pediatric sports orthopedic patient outcomes following surgery. Outcomes included time to be seen by a provider, treatment access, complication and revision rates, postoperative Emergency Department (ED)/Urgent Care utilization, readmission rates, hospital length of stay, pain, functional scores, discharge destinations, return to activity, and follow-up. Results: A total of 35 studies comprising 535,891 pediatric patients were included. Publicly insured or uninsured patients consistently experienced significant delays in accessing care, with average wait times for clinic visits, imaging, and surgery up to six times longer compared to privately insured patients. These delays were associated with worsened injury severity, higher rates of postoperative complications, and poorer functional outcomes. Publicly insured patients were less likely to receive advanced treatments such as bracing or physical therapy, further compounding disparities. Minority groups faced delays even when controlling for insurance status. Conclusions: Public and uninsured pediatric patients face systemic barriers to timely and equitable care, resulting in worse outcomes following sports-related injuries. Future research should explore targeted solutions to ensure equitable care for this vulnerable population. Full article

Background: Hospitalization for severe neuropsychiatric symptoms in Alzheimer’s disease (AD) presents challenges, often requiring environments that ensure safety while addressing therapeutic needs. Traditional closed wards, originally designed for psychiatric conditions like schizophrenia, may not fully address the unique needs of AD patients. This study evaluates the effectiveness of a Specialized Dementia Ward (SDW) tailored for AD patients compared to a General Ward (GW). Methods: A retrospective study compared 51 AD patients in an SDW (February 2018–January 2019) and 40 AD patients in a GW (December 2017–January 2018). Patients met NINCDS-ADRDA criteria, with a Clinical Dementia Rating (CDR) ≤ 2 and a Korean Mini-Mental State Examination (K-MMSE) ≤ 20. Clinical assessments at admission and four weeks included K-MMSE, Resident Assessment Instrument Minimum Data Set Version 2.0 (RAI-MDS), and Neuropsychiatric Inventory Questionnaire (NPI-Q). Psychotropic medication use, length of stay, and discharge destination were also analyzed. Results: No statistically significant differences emerged between SDW and GW groups regarding baseline demographics, cognitive function, ADL, or neuropsychiatric symptoms. At four weeks, both groups exhibited trends toward improved K-MMSE, RAI-MDS, and NPI-Q scores and reduced psychotropic usage, but these did not reach statistical significance. Although mean length of stay was shorter for SDW patients (3.2 vs. 4.9 months; p = 0.078), the difference was not significant. Notably, a significantly higher proportion of SDW patients were discharged home (58.8% vs. 37.5%; p = 0.049). Conclusions: Although clinical outcomes were comparable, the SDW demonstrated advantages in facilitating discharge to home, suggesting that tailored ward environments may better support AD patients. These findings underscore the importance of therapeutic environments in dementia care and highlight the need for further research on specialized dementia ward designs to improve outcomes and patient satisfaction. Full article

Coastal bathing waters are leading tourist destinations, mainly during holiday periods. Therefore, the quality of bathing waters is of key importance to tourists. In 2006, the European Union (EU) adopted the Bathing Water Directive (BWD). EU Member States are required to analyze the status of their bathing waters, the quality of which is determined by the presence or absence of microbial contaminants (Escherichia coli and enterococci). This study presents the quality of coastal bathing waters in Portugal and Poland during the 3-year period from 2020 to 2022. The difference in the bathing water quality of the two countries—excellent in Portugal versus worse in Poland—is caused by their contrasting management and sampling practices and differing geographical and environmental conditions (in Portugal, warm, open sea, and in Poland, a temperate, semi-enclosed sea that is almost surrounded by land and is exposed to urban wastewater discharge). Additionally, the results of a questionnaire showed that ecological awareness and responses are well developed in Portuguese and Polish students regardless of the different status of their bathing waters. To the best of the authors’ knowledge, this study is among the first to analyze the relationships between water pollution and students’ ecological awareness and opinions on tourism. The results provide valuable information that policymakers, tourist entities, and educational institutions can use to develop more efficient management strategies for the coastal bathing waters in both countries. Full article

Background: Heart transplantation and left ventricular assist device (LVAD) implementation are effective treatments for advanced heart failure (HF), although their use is limited by organ availability and the high incidence of adverse events. The efficacy of mitral transcatheter edge-to-edge repair (TEER) as a bridge to transplantation or as a destination therapy in advanced HF is still debated. Methods: A total of 63 patients with INTERMACS class 3 or 4 with contraindications for LVAD and severe functional mitral regurgitation (FMR) were evaluated for TEER implantation eligibility. The primary endpoint was a composite of death, urgent heart transplantation and LVAD implantation at 12 months. Results: A total of 36 patients underwent TEER, while 27 patients received optimal medical therapy (MT) alone. In the intervention group, 35 patients (97%) were discharged alive. In the MT group, two in-hospital deaths occurred, two patients underwent urgent heart transplantation, and three patients were discharged on inotropes. At the 12-month follow-up, the incidence of the primary endpoint occurring was lower in the TEER group (25% vs. 70%, HR 0.25, 95% CI 0.11–0.60, p < 0.01) and the tolerance to neurohormonal therapy was higher (53% vs. 30%, p = 0.03). Conclusions: In advanced HF patients with INTERMACS profile 3 or 4 and severe FMR, TEER on top of optimal MT was associated with a lower incidence of death, urgent heart transplantation or LVAD implantation at 12 months compared to optimal MT alone. Full article