Search Results (6,518)

Context: It has been claimed that recently, in England, the places with the greatest amount of housing built were the places that least needed them. This is an accusation that has echoes in a number of countries around the globe. The lack of construction leads to greater unaffordability and a lower level of economic activity than could have been achieved if labour, particularly those with high human capital, was not so constrained as to where they could afford to live. The recent National Planning Policy Framework for England imposes mandatory targets on housing planning authorities. As such, the following question is raised: will the targets result in additional residential homes being located in places of greater need than the prevailing pattern? Research Questions: The paper sets out to consider the spatial mismatch between housing additions and national benefit in terms of unaffordability and productivity. Specifically, do the concentrations of high and/or low rates of the prevailing rates of additional dwellings and the target rates of adding dwellings correspond with the clusters of high and/or low unaffordability and productivity? A further question considered is: does the spatial distribution of additional dwellings match the clusters of population growth? Method: The values of the variables are transformed at the first stage into Anselin’s LISA categories. LISA maps can reveal unusually high spatial concentrations of values, or clusters. The second stage entails comparing sets of the transformed data for agreement of the classifications. An agreement coefficient is provided by Fleiss’s kappa. Data: The data used is of additional dwellings, the total number of dwellings, population estimates, gross value added per hour worked (productivity data), and house price–earnings ratios. The period of study covers the eight years prior to 2020 and the two years after, omitting 2020 itself due to the unusual impact on economic activity. All the data is at local authority district level. Findings: The hot and cold spots of additional dwellings do not correspond those of house price–earnings ratios or productivity. However, population growth hot spots show moderate agreement with those of where additional dwellings are concentrated. This is in line with findings from elsewhere, suggesting that population follows housing supply. Concentrations of districts with relatively high targets per unit of existing stocks are found correspond (agree strongly) with clusters of house price–earnings ratios. Links between productivity and housing are much weaker. Conclusions: The strong link between targets and affordability suggests that if the targets are met, the claim that the places that build the most housing are the places that least need them can be challenged. That said, house-price–earnings ratios present a view of unaffordability that will favour greater building in the countryside rather than cities outside of London, which runs against concentrating new housing in urban areas consistent with fostering clusters/agglomerations implicit in the new modern industrial strategy. Full article

Despite global initiatives to combat Illegal, Unreported, and Unregulated (IUU) fishing, such activities continue unabated. As a response, states are encouraged to join the Food and Agriculture Organization of the United Nations Port State Measures Agreement (PSMA) as a countermeasure. Despite these efforts, it is suspected that many IUU fishing activities involve non-party or unknown vessels that evade international sanctions. This study aims to propose technical and institutional improvement measures in light of these challenges. First, using available IUU vessel lists, we conducted independent-sample comparisons and paired-sample comparisons to analyze the characteristics of IUU vessels. As key solutions, we propose the formation of a global collaborative body to facilitate an integrated information chain, the implementation of advanced technologies for systematic operations, strategies to encourage PSMA accession by non-parties, market investigations, and enhanced national inspection and organizational capabilities. Furthermore, this study seeks to strengthen global deterrence of IUU fishing activities by proposing a phased international cooperation framework to enhance the feasibility of integrating the PSMA, Global Record (GR), Global Information Exchange System (GIES), and Regional Fisheries Management Organization (RFMO) systems. These strategies are expected to contribute positively to the transparent governance, sustainable management of fishery resources, and safety officers and vessels. Full article

Background: Tetralogy of Fallot is a congenital heart defect that requires early surgical correction. However, in developing countries, many patients undergo delayed treatment due to limited healthcare resources. This study aims to identify risk factors for postoperative complications in humanitarian patients undergoing late Tetralogy of Fallot repair, defined as surgery performed after 12 months of age. Methods: A retrospective analysis was conducted on 115 humanitarian paediatric patients with a median age of 1444 days (approximately 4 years) who underwent complete Tetralogy of Fallot correction. In this humanitarian programme, patients from developing nations underwent surgical repair at our tertiary referral centre in a high-resource country. Postoperative complications were monitored within the first 30 days after surgery. Two multivariable logistic regression models were used to analyse pre/perioperative (Model 1) and postoperative (Model 2) risk factors for complications. Results: Complications occurred in 24.3% of patients. No deaths were recorded. In Model 1, smaller pulmonary valve annulus (OR = 0.066; p < 0.01) and the use of right ventricle to pulmonary artery conduit (OR = 13.252; p < 0.01) were significantly associated with a higher risk of complications. In Model 2, prolonged invasive ventilation time (OR = 1.068; p < 0.01) and extended hospitalisation time (OR = 1.093; p = 0.04) were significantly associated with complications. Conclusions: Late surgical correction of Tetralogy of Fallot in humanitarian paediatric patients can be performed with low mortality but carries a significant risk of postoperative complications. The predictive models provide useful tools for proactive clinical monitoring, personalised management, and optimisation of hospital resources. Full article

This study presents the first comprehensive investigation establishing the relationship between color consistency and luminous efficacy of radiation (LER) in phosphor-converted light-emitting diodes (LEDs), introducing novel selection criteria for energy-efficient applications. A systematic analysis of LED sources with nominal correlated color temperature (CCT) values of 3000 K and 4000 K across color-rendering index (CRI Ra) thresholds (≥60 and ≥80) was conducted, evaluating spectral power distributions (SPD) and chromaticities relative to 3-step, 5-step color-consistency circles, and 7-step American National Standards Institute (ANSI) quadrangles. Novel findings reveal a previously uncharacterized strong positive correlation between color consistency and luminous efficacy across all analyzed LED sources. LEDs with chromaticities within 3-step color-consistency circles consistently demonstrated superior LER values compared to 5-step boundaries, while sources outside established circles showed significantly inferior energy performance despite meeting nominal CCT requirements. The research establishes that tighter color-consistency tolerances directly correlate with enhanced luminous efficacy, revealing an intrinsic relationship between color quality and energy performance. These breakthrough findings introduce a paradigm shift in LED selection methodology, providing lighting professionals with evidence-based criteria that simultaneously optimize color consistency and energy efficiency, enabling more sustainable lighting solutions through integrated quality–performance assessment. Full article

Objective: We aimed to quantify multiple sclerosis (MS)-related work productivity and to illustrate the longitudinal trends for relapses, disease progression, and utilization of health care resources in a nationally representative cohort of working North Americans living with MS. Background: The North American Registry for Care and Research in Multiple Sclerosis (NARCRMS) is a multicentered physician-reported registry which prospectively collects clinical information including imaging data over a long period of time from people with MS from sites across the U.S. and Canada. The Health Economics Outcomes Research (HEOR) Advisory Group has also incorporated Health-Related Productivity and Health Resource Utilization questionnaires, which collect information about health care economics of people with MS and its effects on daily life. Design/Methods: This is a prospective observational study utilizing data from NARCRMS. Socio-demographic, clinical, and health economic outcome data were collected through previously validated and structured questionnaires. Logistic regression was used to calculate the relative odds of symptom impact, with a generalized logit link for number of relapses. Cox proportional hazards regression was used to calculate hazard ratios for time to first relapse. Results: Six hundred and eighty-two (682) people with MS were enrolled in NARCRMS and had completed the HEOR questionnaires at the time of the analysis. Among the participants, 61% were employed full-time and 11% were employed part time. Fatigue was the leading symptom reported to impact both work and household chores. Among the employed participants, 13% reported having missed work with a median of 6.8 (IQR: 3.0–9.0) missed hours due to MS symptoms (absenteeism), while 35% reported MS having impacted their work output (presenteeism). The odds of higher disease severity (EDSS 2.0–6.5 vs. 0.0–1.5) were 2.29 (95% CI = 1.08, 4.88; p = 0.011) times higher for participants who identified reduction of work output. Fatigue was the most identified symptom attributed to work output reduction. Among all participants, 33% reported having missed planned household work with a median of 3.0 (IQR: 2.0–5.0) hours. The odds of higher disease severity were 2.49 (95% CI = 1.37, 4.53; p = 0.006) times higher for participants who identified reduction in household work output, and 1.70 (CI = 1.27, 2.49; p = 0.006) times higher for those whose fatigue affected housework output as compared to other symptoms. Conclusions: A preliminary review of the first 682 patients showed that people with MS had reduced work and housework productivity even at an early disease state. Multiple sclerosis (MS) can significantly impair individuals’ ability to function fully at work and at home, with fatigue overwhelmingly identified as the primary contributing factor. The economic value of finding an effective treatment for MS-related fatigue is substantial, underscoring the importance of these findings for policy development, priority setting, and the strategic allocation of healthcare resources for this chronic and disabling condition. Full article

Background: Breast cancer is a major health concern in Poland, with significant incidence and mortality rates despite national screening programs. This retrospective study aimed to evaluate critical aspects of breast cancer management, focusing on waiting times, treatment coordination, cancer characteristics, diagnostic testing, and staging. Methods: We retrospectively analyzed 587 medical records of breast cancer patients (585 female, 2 male) collected between March 2023 and June 2024 through a data donation model. Data included tumor characteristics (histological type, grade, stage, biological subtype, receptor status, Ki-67), diagnostic and genetic tests, and timelines of key events in the diagnostic and therapeutic pathways. Results: Although referral to first oncology consult (18 days) and MDT referral/admission to treatment (10 days) met NFZ guidelines, diagnosis to surgery (94 days) and diagnosis to drug treatment (109 days) were significantly delayed. No records showed oncology coordinator assignment or educational material provision. Clinically, invasive carcinoma NST (77%) and early-stage (IA/IIA, 61%) were prevalent, with Luminal B (HER2-negative) being the most common biological subtype. BRCA1/2 testing was common, but Oncotype DX was not. For 314 HR+ HER2- patients, stage IA (44%) was most common, with no BRCA1/2 mutations found. Conclusion: Breast cancer care in the Łódź voivodeship falls short of national guidelines due to long waiting times and poor care coordination, a problem worsened by incomplete data. Improving record-keeping and speeding up diagnostic and treatment pathways are crucial for better breast cancer management in Poland. While patient data donation can help analyze real clinical pathways, data completeness, and consistency remain challenges. Full article

Free-living amoebae (FLAs) are widely present in the environment and may be pathogenic for animals and humans. Studies on the prevalence of FLAs in European soils are few in number. This study aimed to molecularly identify the species and genotypes of FLAs occurring in soil from Southern Poland. Forty soil samples were collected in June 2024 in the Babiogórski National Park. Amoebae cultures and a thermal-tolerance test were conducted, and all strains grew at 37 °C. Five PCR protocols were applied for the amplification of FLA SSU rRNA fragments. The following FLAs, including potentially pathogenic ones, were detected: Acanthamoeba T4 and T13 genotypes in 79.1% of positive samples, Naegleria gruberi and Naegleria galeacystis in 25%, Vermamoeba vermiformis in 12.5%, and Paravahlkampfia sp. and Ptolemeba bulliensis in 8.3%. Species and genotype identification were determined by sequence comparison and phylogenetic analysis. This study reports, for the first time, the isolation of N. galeacystis from soil and N. gruberi and V. vermiformis from soil collected in Europe. The used primer sets have different usefulness for Naegleria species identification and their phylogenetic analysis. The primers applied in this study may not reveal the full diversity of amoebae in soil; therefore, it is necessary to design new primers for this purpose. Full article

Objective: Investigate patient characteristics, treatments used, treatment response, and factors associated with outcomes when managing SE in a pediatric population admitted to the emergency department (ED). Methods: This retrospective observational study included pediatric patients (age ≤ 18 years) with SE admitted to the ED at King Khalid University Hospital between 2015 and 2023. SE and refractory SE (RSE) were diagnosed according to the American Epilepsy Society (AES) definitions. The data included demographics, home medications, treatment sequences, medication dosing, and clinical outcomes. To assess appropriateness, the administered doses were compared with the AES standards for pediatric patients. Results: The study included 487 episodes of SE. The mean patient age was 6.1 ± 4.1 years, and most patients were males (57.3%) with a history of epilepsy (74.1%). Benzodiazepines (BDZs) were administered first in 83.0% of cases, with a 10.9% success rate, whereas anti-seizure medications (ASMs) were administered first in 17.0% of cases, with a 66.3% success rate (p < 0.0001). Surprisingly, medications administered at appropriate doses during the first round were significantly less effective compared to those that were underdosed (18.2% vs. 28.4%; p = 0.0222), mainly because of poor response to BDZs. Younger patients and those who received BDZs on their first medication round had higher hospital admission rates. Conclusions: ASMs were more effective than BDZs in managing pediatric patients with SE, regardless of the dosing precision. These findings point toward the adoption of personalized treatment strategies and may warrant early initiation of ASMs. National multicenter studies are needed to define a standardized pediatric SE protocol. Full article

Background: There are very few reviews on how children’s food allergy is managed across various educational settings, and none have considered psychological support in addition to child safety. This scoping review aimed to understand interventions to manage food allergy, addressing children’s safety and psychological support in childcare centres, preschools, and schools. Methods: Following the JBI methodology for scoping reviews and applying the PCC (population, concept, and context) mnemonic, a search was conducted via Medline (Ovid), Embase (Ovid), CINAHL (EBSCOhost), ERIC (ProQuest), PsychInfo (EBSCOhost), Scopus, and ProQuest Dissertations and Theses (ProQuest). Furthermore, two supplementary searches were conducted: first, backward citation tracking of all publications included in this review; and second, a search of seven peak allergy organisation websites, including Allergy & Anaphylaxis Australia and the World Allergy Organization. Findings: Eighteen publications were included from 6812 records retrieved from the databases. Most publications were from the United States of America (61%), representing food allergy management mainly in schools (39%), followed by preschools (22%), childcare centres (17%), and mixed settings (11%). All the interventions focused on child physical safety, largely neglecting psychosocial support for children or their families, and only four publications reported the use of control groups to test intervention benefits (22%). Furthermore, safety-focused interventions were centred on building educator or staff knowledge of food allergy and their skills, confidence, and self-efficacy to manage it (72%); these were found to be highly effective. Most interventions were aimed at adults, and none considered children. Interpretation: The findings suggest a need for more research on food allergy management involving child-focused, developmentally appropriate approaches, especially in childcare and preschool settings. There is also a need for research on psychological support, particularly that which involves control groups and encompasses different nations. Full article

Purpose: This study aimed to develop and validate a new machine learning (ML)-based screening tool for a two-step prediction of the need for and type of nutritional therapy (enteral, parenteral, or combined) using Nutrition Risk Screening 2002 (NRS-2002) and other demographic parameters from the Optimal Nutrition Care for All (ONCA) national cohort data. Methods: This multicenter retrospective cohort study included 191,028 patients, with data on age, gender, body mass index (BMI), NRS-2002 score, presence of cancer, and hospital unit type. In the first step, classification models estimated whether patients required nutritional therapy, while the second step predicted the type of therapy. The dataset was divided into 60% training, 20% validation, and 20% test sets. Random Forest (RF), Artificial Neural Network (ANN), deep learning (DL), Elastic Net (EN), and Naive Bayes (NB) algorithms were used for classification. Performance was evaluated using AUC, accuracy, balanced accuracy, MCC, sensitivity, specificity, PPV, NPV, and F₁-score. Results: Of the patients, 54.6% were male, 9.2% had cancer, and 49.9% were hospitalized in internal medicine units. According to NRS-2002, 11.6% were at risk of malnutrition (≥3 points). The DL algorithm performed best in both classification steps. The top three variables for determining the need for nutritional therapy were severe illness, reduced dietary intake in the last week, and mild impaired nutritional status (AUC = 0.933). For determining the type of nutritional therapy, the most important variables were severe illness, severely impaired nutritional status, and ICU admission (AUC = 0.741). Adding gender, cancer status, and ward type to NRS-2002 improved AUC by 0.6% and 3.27% for steps 1 and 2, respectively. Conclusions: Incorporating gender, cancer status, and ward type into the widely used and validated NRS-2002 led to the development of a new scale that accurately classifies nutritional therapy type. This ML-enhanced model has the potential to be integrated into clinical workflows as a decision support system to guide nutritional therapy, although further external validation with larger multinational cohorts is needed. Full article

Introduction: The organization of mental health care is undergoing a transformation from an institutionalized model to a community-centered model. Due to the critical specialist workforce shortage, insufficient funding, and the large number of children in crisis, its implementation presents a challenge. The aim of this study is to analyze the current situation regarding access to system-based care under contracts with the National Health Fund in various provinces in Poland. Materials and Methods: Based on an analysis of data, resources available to patients were assessed—specifically, information was obtained from the National Health Fund website entitled “NFZ Treatment Waiting Times.” From this, the waiting times for appointments in child and adolescent mental health care facilities, the availability of mental health care facilities under contracts with the National Health Fund in Poland, legal acts, and data from the Central Statistical Office were extracted. Then, an analysis of the current accessibility to child and adolescent mental health services was conducted. The inclusion criteria for data sources were as follows: accessibility—the data had to be openly available to researchers without restrictions; credibility—the data had to be verified by individual health care facilities; usefulness—the data had to accurately reflect the actual availability of services and the needs within the child and adolescent psychiatric care system. Results: There are significant differences and deviations from the average number of facilities and waiting times when comparing the 16 provinces. Notably, some of the analyzed facilities are already operating within the framework of Child and Adolescent Mental Health Centers, where the mean waiting period for inpatient care is 105 days, the mean waiting period for day-care units is 61 days, and the mean waiting period for outpatient clinics is 257 days. The number of facilities is increasing under the reform, with new level I reference centers being opened, which ensures prevention and early support is provided by a pedagogue, psychologist, and non-medical staff, providing enhanced accessibility to care without the need for a visit to a child and adolescent psychiatrist, of whom there are only 579 for the entire child population in Poland. This metric primarily refers to first-time appointments in public institutions, with notable disparities between urban and rural areas. Conclusions: The development of the reform offers hope for quicker access to mental health support for children and adolescents. With the consistent implementation of the reform and further support from non-governmental organizations, there is a high chance of building an effective community-based model with a short waiting time for help and reducing ineffective hospitalizations, among other things, in terms of costs. Full article

While technologies like renewable energy and low-carbon transportation are known to mitigate carbon emissions from urban expansion, achieving carbon neutrality during this process remains a critical unresolved challenge. This issue is particularly pressing for developing countries striving to balance urbanization with carbon reduction. Taking Qionglai City as a case study, this study simulated the territorial spatial functional patterns (TSFPs) and carbon emission distribution for 2025 and 2030. Based on the key drivers of carbon emissions from urban expansion identified through the Geographical and Temporal Weighted Regression (GTWR) model, carbon-neutral pathways were designed for two scenarios: urban expansion scenarios under historical evolution patterns (Scenario I) and urban expansion scenarios optimized under carbon neutrality targets (Scenario II). The results indicate that (1) urban space is projected to expand from 6094.73 hm² in 2020 to 6249.77 hm² in 2025 and 6385.75 hm² in 2030; (2) total carbon emissions are forecasted to reach 1.25 × 10⁶ t (metric tons) and 1.40 × 10⁶ t in 2025 and 2030, respectively, exhibiting a spatial pattern of “high in the central-eastern regions, low in the west”; (3) GDP, Net Primary Productivity (NPP), and the number of fuel vehicles are the dominant drivers of carbon emissions from urban expansion; and (4) a four-pronged strategy, optimizing urban green space vegetation types, replacing fuel vehicles with new energy vehicles, controlling carbon emissions per GDP, and purchasing carbon credits, proves effective. Scenario II presents the optimal pathway: carbon neutrality in the expansion zone can be achieved by 2025 using the first three measures (e.g., optimizing 66.73 hm² of green space, replacing 800 fuel vehicles, and maintaining emissions at 0.21 t/10⁴ CNY per GDP). By 2030, carbon neutrality can be achieved by implementing all four measures (e.g., optimizing 67.57 hm² of green space, replacing 1470 fuel vehicles, and achieving 0.15 t/10⁴ CNY per GDP). This study provides a methodological basis for local governments to promote low-carbon urban development and offers practical insights for developing nations to reconcile urban expansion with carbon neutrality goals. Full article

Background. Peripartum cardiomyopathy (PPCM) is a rare but potentially life-threatening condition typically presenting as heart failure with reduced ejection fraction in the last month of pregnancy or in the first five months following delivery in women without other known causes of heart failure. PPCM incidence and prevalence are highly variable in different populations and geographical areas. The etiology of PPCM is likely multifactorial, with genetic predisposition, autoimmune conditions, nutritional deficiencies, hormonal and metabolic changes, myocardial inflammation, enhanced oxidative stress, vascular dysfunction, and angiogenic imbalance all listed as possible contributing factors. Objectives. The complexity and multifactorial nature of PPCM can be explored by large-scale “omics” investigations, and their integration has the potential to identify key drivers and pathways that have the largest contribution to the disease. The scarcity of relevant knowledge and experience with most rare diseases raises the unique need for cooperation and networking. Methods and results. In the context of PPCM, we hypothesize that the creation of prospective patient registries could represent an answer to this criticality. Therefore, we created a multicenter national registry of PPCM in different geographical areas in Italy. Conclusions. We expect that the integration of clinical, imaging and omics-based data might provide novel insights into PPCM pathophysiology and allow in the future early detection, risk assessment, and patient-specific therapeutic interventions, thereby offering new perspectives in precision medicine. Full article

Background: Non-variceal upper gastrointestinal bleeding (NVUGIB) remains a critical medical–surgical emergency associated with significant morbidity, mortality, and healthcare burden worldwide. Despite advances in diagnostic and therapeutic modalities, NVUGIB continues to pose complex clinical challenges, particularly in resource-limited settings. Methods: This retrospective observational study analyzed 364 consecutive adult patients diagnosed with NVUGIB and hospitalized at the First Surgical Clinic of the County Emergency Clinical Hospital Craiova between January 2009 and December 2014. Inclusion criteria required a confirmed diagnosis based on clinical presentation, laboratory findings, and upper gastrointestinal endoscopy (UGIE). Demographic variables, etiology, comorbidities, drug-induced triggers, laboratory parameters, onset-to-admission and onset-to-surgery intervals, endoscopic findings, therapeutic interventions (medical, endoscopic, surgical), rebleeding rates, and mortality were recorded and analyzed. Results were descriptively compared with historical data from the national and international literature. Due to the retrospective and aggregate nature of the data, survival analysis (Kaplan–Meier) was not applicable. Results: Peptic ulcers, erosive gastritis, Mallory–Weiss syndrome, and gastric neoplasms were the predominant etiologies. NSAID use, oral anticoagulation, and alcohol consumption emerged as major risk factors. Endoscopic hemostasis was achieved in the majority of cases; surgical intervention was required in 11.5% of patients, mainly for refractory or recurrent bleeding. The overall mortality rate was 10.9%, consistent with historical benchmarks. Comparative analysis revealed trends in etiology and management reflecting evolving clinical practice standards. Conclusions: NVUGIB remains a significant clinical challenge with persistent mortality and rebleeding risks. This cohort highlights the need for timely diagnosis, risk stratification, and an evidence-based therapeutic strategy integrating modern endoscopic and surgical options. An updated diagnostic and management algorithm is proposed to guide practical decision-making and optimize outcomes in similar tertiary care settings. Full article

Despite local and national road authorities striving to provide motorists with a durable and safe infrastructure environment, one in six UK roads are currently classed as being in poor condition. In terms of safety, Department for Transport statistics report high numbers of road incidents; 29,711 killed or seriously injured in 2023, representing little change compared to 2022. As such, reported in this paper is research aimed at developing artificial geopolymer cement mortar-based aggregate as a cost/environmentally attractive alternative to calcined bauxite for high friction surfacing applications. Work was undertaken in two distinct phases. In the first, the performance of alkali silicate-based geopolymers comprising a range of industrial wastes as binder materials was assessed using modified versions of standardized polished stone value and micro-Deval tests. In phase two, selected mixes were assessed for resistance to simulated wear by exposing test specimens to 20,000-wheel passes on an accelerated road test machine. Performance was further investigated using a dynamic friction test method developed by the Indiana Department of Transportation. Despite commercially sourced calcined bauxite aggregates exhibiting the highest performance levels, the findings from this preliminary research were generally positive, with acceptable levels of performance noted for manufactured geopolymer-based aggregates. For instance, in accordance with recommended levels of performance prescribed in BBA/HAPPAS standards, this included attainment of polished stone values higher than 65 and, following accelerated road testing, average texture depths greater than 1.1 mm. It is recognized that further research is needed to investigate geopolymer binder systems and blends of aggregate types, as well as artificial aggregate manufacturing procedures. Full article