Search Results (559)

Assessing a city’s level of smartness according to global indices is a relatively new area of investigation. It is useful in encouraging a rethinking of urban digital strategies, although the different approaches to global smart city rankings have been subject to criticism. This paper highlights the methodological features of constructing the Smart City Index (SCI) from the IMD (International Institute for Management Development) based on residents’ assessments, their satisfaction with electronic services, and their perception of the priority of urban infrastructure areas. The Central European cities of the Visegrad region (Prague/Czech Republic, Budapest/Hungary, Bratislava/Slovakia, Warsaw and Krakow/Poland) were chosen as the basis for an in-depth analysis. The architectonics, i.e., the internal system of constructing and calculating city rankings by SCI, is analyzed. A comparative analysis of the technology indicators (e-services) in five cities of the Visegrad region, presented in the SCI, showed the smart features of each city. The progressive and regressive trends in the dynamics of smartness in the cities in the Visegrad region were identified in five urban spheres indicated in the Index: Government, Activity, Health and Safety, Mobility, and Opportunities. This also made it possible to identify certain methodological gaps in the SCI in establishing interdependencies between the data on the residents’ perception of the priority of areas of life in a particular city and the residents’ level of satisfaction with electronic services. In particular, the structural indicators “Affordable housing” and “Green spaces” are not supported by e-services. This research aims to bridge this methodological gap by proposing a model for evaluating the e-service according to the degree of coverage of different spheres of life in the city. The application of the project, as well as cross-sectoral and systemic approaches, made it possible to develop basic models for assessing the value of e-services. These models can be implemented by municipalities to assess and monitor e-services, as well as to select IT projects and elaborate strategies for smart sustainable city development. Full article

Water resources are strategic resources that support regional economic social development and maintain the health and stability of ecosystems. This study revealed the evolution of the coordinated development of China’s water resources–economic society–ecological environment system based on the coordination degree mode. The research was conducted by integrating machine learning with traditional mathematical methods; by setting up the status quo development scenario, water resources priority scenario, economic society priority scenario, ecological environment priority scenario and balanced development scenario; and by using the Holt exponential smoothing–feedforward neural network prediction model, the coordinated development trends under different scenarios were predicted. The results showed that, analyzed from the perspective of the coordinated evolution type of the dual systems, the dominant development system during the study period gradually transformed from water resources–economic society to water resources–ecological environment. For the coordinated development of the complex system, the coordination degree showed “stepped leap—resilient fluctuation (from 0.7242 to 0.8238)”, and “better in the southeast than in the northwest, with significant advantages in the coast”. The most significant increase in the coordination degrees were observed in the balanced development scenario and economic society priority scenarios, where it increased by an average of around 5%, confirming the effective contribution of stable economic and social development to the level of coordination. This study provides theoretical support and practical guidance for regional water resources management. Full article

Heavy metal pollution of lake sediments is one of the prominent ecological and environmental problems worldwide, and it is of great significance to conduct research on heavy metal pollution in lake sediments to protect the ecological environment, safeguard human health, and promote sustainable development. As an integral part of Dongting Lake, Datong Lake holds a crucial ecological position. More than 10 years ago, due to a series of factors, including excessive fertilizer application and fishing, the water quality of Datong Lake declined, resulting in varying degrees of contamination by Cd, Mn, and other heavy metals in the sediments. After 2017, Datong Lake began to establish a mechanism for protecting and managing the lake, and its ecological and environmental problems have been significantly improved. To clarify the current situation of heavy metal contamination in the sediments of Datong Lake, 15 sediment samples were collected from the lake, and the contents of soil heavy metals Cd, As, Pb, Cr, Cu, Mn, Ni, and Zn were determined. A Monte Carlo simulation was introduced to carry out the ecological and human health risk evaluation of the sediments in the study area to overcome the problem of low reliability of the results of ecological and human health risk evaluation due to the randomness and incompleteness of the environmental data as well as the differences in the human body parameters. The results and conclusions show that (1) the average values of Cd, Pb, Cr, Cu, Mn, Ni, and Zn contents in the sediments of Datong Lake are higher than the background values of soil elements in the sediments of Dongting Lake, and the average values of As contents of heavy metals are lower than the background values of the soil, and the heavy metal contamination in the sediments in the study area is dominated by slight contamination, and the possibility of point-source contamination is slight. (2) The results of both the Geo-accumulation index and Enrichment factor evaluation showed that the degree of heavy metal contamination of sediments was Ni > Cu > Cr > Mn > Cd > Pb > Zn > As. (3) The average value of the single ecological risk index of heavy metal elements, in descending order, was as follows: Cd > As > Pb > Cu > Ni > Cr > Zn > Mn; all the heavy metal elements were at the level of light pollution, and the average value of the comprehensive ecological risk index was 32.83, which is a slight ecological risk level. (4) Both non-carcinogenic and carcinogenic risks for all populations in the study area remain low following heavy metal exposure via ingestion and dermal pathways. Ecological and health risk assessments identified As and Cd as exhibiting significantly higher sensitivity than other heavy metals. Consequently, continuous monitoring and source-tracking of these elements are recommended to safeguard long-term ecological integrity and public health in the region. Full article

Placenta accreta spectrum (PAS) refers to a group of abnormal placental attachments in which the placenta adheres too deeply to the uterine wall, with varying degrees of invasion classified as accreta, increta, or percreta. Increased rates of uterine surgeries, advanced maternal age, and cesarean deliveries have all contributed to an increase in the incidence of PAS. Complications associated with PAS can lead to severe intrapartum or postpartum hemorrhage, hysterectomy, and significant maternal morbidity, making early diagnosis and management crucial for improving outcomes. Understanding the epidemiology and risk factors of PAS is crucial for developing early detection protocols and preventive strategies. Localized data, particularly from Bahrain, can inform targeted care approaches and optimize resource allocation, ultimately leading to improved clinical guidelines, enhanced patient education, and better healthcare outcomes for affected women. There are growing concerns about the impact of PAS on maternal health and healthcare resources in Bahrain, similar to trends observed in other regions. To improve patient education and management strategies, it is essential to comprehend the regional patterns, characteristics, and outcomes associated with PAS. However, the absence of comprehensive data specific to Bahrain hinders effective clinical decision-making and policy development. Addressing this gap is imperative for advancing maternal healthcare in the region. Full article

Background: Obesity is a major global public health issue with no fully satisfactory solutions. Most nutritional interventions rely on caloric restriction, with varying degrees of success. Very low-calorie ketogenic diets (VLCKD) have demonstrated rapid and sustained weight loss by inducing ketone bodies through lipolysis, reducing appetite, and preserving lean mass while maintaining metabolic health. Methods: A prospective clinical study analyzed sociodemographic, anthropometric, and adherence data from 7775 patients undergoing a multidisciplinary nutritional single-arm intervention based on a commercial weight-loss program. This method, using protein preparations with a specific balanced nutritional profile, aimed to identify key predictors of weight-loss success and classify population phenotypes with shared baseline characteristics and weight-loss patterns to optimize treatment personalization. Results: Statistical and machine learning analyses revealed that male gender (−9.2 kg vs. −5.9 kg) and higher initial body weight (−8.9 kg vs. −4.0 kg) strongly predict greater weight loss on a VLCKD, while age has a lesser impact. Two distinct population clusters emerged, differing in age, sex, follow-up duration, and medical visits, demonstrating unique weight-loss success patterns. These clusters help define individualized strategies for optimizing outcomes. Conclusions: These findings translationally support associations with the efficacy of a multidisciplinary VLCK weight-loss program and highlight predictors of success. Recognizing variables such as sex, age, and initial weight enhances the potential for a precision-based approach in obesity management, enabling more tailored and effective treatments for diverse patient profiles and prescribe weight loss personalized recommendations. Full article

Background/Objectives: Veterans differ in sociodemographic composition and experience higher frequencies of disability than non-Veterans of the same age. Yet the epidemiology of the long-term care needs of Veterans, specifically activities of daily living (ADLs) and instrumental activities of daily living (IADLs), remains an important gap in the literature. The objectives of this study were to (1) characterize Veterans across levels of hierarchy of ADL and IADL support needs; (2) compare Veterans across the degree of need for help, from those who can still “self-manage” to those with an “unmet need”; and (3) identify the types and prevalence of ADL and IADL need combination patterns. Methods: This study used cross-sectional data from the 2021 administration of the HERO CARE survey. We included Veterans ages 65+ in our analyses (N = 7424). We calculated the overall weighted descriptive statistics across a hierarchy of ADL and IADL problems and the degree of need for help. One-way ANOVA for continuous variables and Rao–Scott chi-square tests for categorical variables were conducted to examine associations between groups, followed by post hoc pairwise comparisons, as appropriate. Results: Veteran respondents mean age was 82.3 (SD: 8.2 years), and most were male, non-Hispanic White, and married. In weighted analyses, more Veterans with both ADL and IADL problems compared to only ADL problems reported food insecurity, missed appointments, low health literacy, and depression. Among Veterans with ADL or IADL problems, 32.3% reported an unmet need for help. Almost a quarter of Veterans with ADL problems reported difficulties performing all eight ADLs (23.9%), and over a quarter of Veterans with IADL problems reported difficulties performing all seven IADLs (31.3%). Conclusions: Our findings show that Veterans are demographically and clinically different based on their hierarchy of impairment and degree of need for help. Identifying the patterns and prevalence of ADL and IADL needs among Veterans provides valuable information to align the Veterans Affairs (VA) programs and services with Veterans’ needs. Full article

Background: European health systems are shifting toward more proactive, person-centered models, thereby highlighting the need to strengthen nurses’ clinical leadership in primary care. Nurse demand management (NDM) has emerged as an innovative practice which allows nurses to autonomously and comprehensively respond to a population’s health needs. However, knowledge on its implementation varies widely, often being intuitive, partly due to the absence of standardized evaluation tools. The xGID instrument aims to measure the degree of NDM adoption in primary care teams (PCTs), activating collective intelligence mechanisms to foster shared diagnosis, organizational reflection, and the generation of targeted recommendations. Methods: We designed and implemented xGID in 47 PCTs in Catalonia, involving 1474 healthcare professionals. Data were collected through structured surveys assessing key dimensions of NDM adoption, including professional autonomy, teamwork, continuity, and accessibility. Results: Overall adoption of NDM was high, with a mean score of 7.6 out of 10. Notable differences emerged between professional groups and practice areas. Nurses tended to be more critical of teamwork, longitudinal care, and accessibility, reflecting the central yet high-pressure role they play in NDM. High-scoring dimensions included professional autonomy and the capacity to act across multiple domains, whereas weaker areas pointed to systemic organizational challenges. Conclusions: The preliminary findings indicate that a standardized tool for NDM evaluation is a cornerstone for identifying contextual barriers and guiding the transformation of care models. Its participatory and strategic approach offers novel pathways to embed data-driven decision-making into daily clinical practice, consolidating NDM as a key pillar of future primary care. Full article

Firework-related injuries remain a serious public health issue in Germany, especially during New Year’s Eve. While many injuries are minor, the misuse of illegal or homemade fireworks can cause severe trauma resembling military combat injuries and can heavily burden emergency services. Notably, injury rates declined during the COVID-19 firework bans, underscoring the impact of preventive measures. We report two cases of young males with severe injuries from illicit fireworks. The first is a case of a 16-year-old that detonated an illegal Polish firework ball bomb, sustaining 9% total body surface area (TBSA) burns (second- to third-degree), hand fractures, compartment syndrome of the hand, and soft-tissue trauma. He underwent multiple surgeries, including fasciotomy, osteosynthesis, and skin grafting. The other case presented is a 19-year-old man who was injured by a homemade device made of bundled firecrackers, suffering deep facial and bilateral hand burns. He required prolonged ventilation, surgical debridement, and treatment with Kerecis^® fish skin and Epicite^® dressings. Both required intensive ICU care, interdisciplinary management, and lengthy rehabilitation. Total hospital costs amounted to €58,459.52 and €94,230.23, respectively, as calculated according to the standardized German DRG. These cases illustrate the devastating impact of illegal fireworks. The devastating consequences of explosive trauma are often difficult to treat and may lead to long-term functional and psychological impairments. Prevention through public education, stricter regulations, and preparedness is essential. Pandemic-era injury reductions support sustained policy efforts. Full article

Categorization of enterprises by size provides a fundamental understanding of the composition of the business environment. Small, medium-sized, and large enterprises play a significant role in the national economy through the execution of specific business activities. In their pursuit of enhancing the efficiency of individual business processes and mitigating the risks associated with these activities, enterprises may implement various ISO standards, including quality management, environmental management, occupational health and safety (OSH), or corporate social responsibility (CSR) systems. The sources published to date do not clearly explain the mutual relationship that arises when implementing multiple ISO standards that prioritize different activities within a single enterprise. This gap is particularly evident in the context of small enterprises, which often do not have the obligation or capacity to implement ISO standards. This study addresses this research gap by identifying the relationship between implemented ISO standards, priority activities in the risk management process, and the person responsible for these activities. The objective of this article is to examine the relationship of dependency between specific ISO standards and the priority activity in risk management. Furthermore, the study seeks to determine whether the degree of implementation of ISO standards influences the selection of the person responsible for risk management. Additionally, it examines whether dependence exists between the priority activity in risk management and the specific person responsible for risk management. The authors provide statistical hypothesis testing based on data from a nationwide survey conducted across all enterprise size categories. The results obtained from this study confirm the presence of a dependency between the degree of ISO standards implementation and the priority activity in risk management across all enterprise size categories. However, a statistically significant dependency between the degree of implementation of ISO standards and the person responsible for risk management was not confirmed in large companies. The dependency between the selection of the person responsible for risk management and the priority activity in risk management was confirmed only in small enterprises. Full article

Perineal injuries are a common complication of vaginal delivery, affecting 75–85% of women. This review examines current knowledge on risk factors, classification, treatment, and quality of life impacts. Risk factors are divided into maternal, foetal, and labour-related categories. Treatment depends on injury severity. First-degree tears can be managed conservatively, with skin glue or suturing—preferably with synthetic absorbable sutures to reduce pain and infection risk. Second-degree tears and episiotomies respond best to continuous non-locking sutures, improving healing, and minimizing postpartum pain. Severe third- and fourth-degree tears require specialised surgical techniques, such as the overlay method for anal sphincter repair, which improves faecal continence. Proper preoperative care, including antibiotics and anaesthesia, enhances outcomes. Episiotomy is controversial; selective use based on clinical indications is recommended over routine practice. Research shows no significant long-term benefits compared to spontaneous tears, and links episiotomy to psychological distress and negative body image. Preventative strategies, like perineal massage and warm compresses during labour, may reduce the risk of severe trauma, particularly in first-time mothers. Perineal trauma can have lasting physical and psychological effects, impacting sexual function, continence, and mental health. Proper diagnosis, treatment, and postpartum care are essential. Future studies should aim to standardise care protocols and explore long-term outcomes to enhance patient quality of life. Full article

Background and Clinical Significance: Scimitar Syndrome is a rare congenital cardiopulmonary anomaly characterized by partial anomalous pulmonary venous return, often requiring early surgical correction. It may coexist with other congenital or acquired cardiovascular anomalies, including valvular diseases such as mitral regurgitation. When surgical correction of Scimitar Syndrome is combined with mitral valve annuloplasty, the proximity to the atrioventricular node may potentially predispose patients to late-onset conduction disturbances, although causality remains speculative. Case Presentation: We describe the case of a 53-year-old male who developed paroxysmal atrial fibrillation, atrial flutter, and intermittent second-degree AV block decades after undergoing surgical correction of Scimitar Syndrome with concomitant mitral annuloplasty. Multimodal echocardiographic evaluation revealed preserved left atrial volume, normal intra-atrial conduction time, mildly reduced strain, and maintained atrial synchrony. The patient was treated with direct oral anticoagulants and beta-blockers and underwent the implantation of a ventricular leadless pacemaker. Conclusions: This case highlights the supportive role of atrial function imaging in assessing atrial health and informing rhythm management and procedural choices in surgically corrected congenital heart disease. Full article

Understanding the contribution of macroinvertebrate diversity indices to community stability in urban rivers is critical for developing more effective strategies to manage and conserve the ecological health of urban rivers and to maintain sustainable regional economic and social development. However, knowledge regarding the relationship between environmental factors, multidimensional biodiversity, and community stability in urban rivers remains limited. In this study, we investigated the relationships among macroinvertebrate multidimensional diversity, secondary productivity-to-biomass ratio (SP/B), and average variation degree (AVD) in a typical urban river—the North Canal River basin in Beijing—to identify which biodiversity metric best indicates community stability. Macroinvertebrates were extensively sampled from September to October 2020 in the North Canal River basin (BYH), a typical urban river in Beijing. We comparatively analyzed the spatial variation in different types of diversity—species diversity (SD), functional diversity (FD), and phylogenetic diversity (PD)—as well as SP/B and AVD between the upstream and midstream–downstream reaches of the river under varying degrees of urbanization and human disturbance. Partial Least Squares Structural Equation Modeling (PLS-SEM) was used to assess the relationships among multidimensional diversity, SP/B, and AVD. The results showed that upstream environmental factors and diversity indices together explained 52.9% and 52.0% of the variance in SP/B and AVD, respectively, while midstream–downstream factors explained 65.9% and 84.2%, respectively. These findings suggest that both SP/B and AVD are suitable indicators for examining the relationships between macroinvertebrate community stability, diversity indices, and environmental factors in the BYH. In the upstream region, total phosphorus (TP), FD, and PD were more indicative of SP/B in the central urban area, while SD and PD were more indicative of AVD. In contrast, in the midstream–downstream suburban areas, dissolved oxygen (DO), SD, and PD were more indicative of SP/B, while FD and PD were more indicative of AVD. These findings demonstrate that PD is a stronger indicator of both SP/B and AVD under varying anthropogenic disturbances and environmental conditions. The PLS-SEM results also indicated differences in the specific effects of FD and SD on community stability across the upstream and midstream–downstream sections, as well as differences in the direct effects of environmental factors such as TP and DO. These results suggest that PD is more sensitive than FD and SD in detecting the impacts of anthropogenic disturbances and environmental fluctuations on macroinvertebrate community stability in urban rivers. Our study provides evidence that PD outperforms FD and SD in predicting macroinvertebrate community stability in urban river ecosystems and that the combined use of SP/B and AVD better reveals the complex interactions between biodiversity and environmental factors influencing community stability. This combination can thus enhance our understanding of how biodiversity affects macroinvertebrate community stability in urban rivers. Full article

Liver fluke infections, especially those induced by Opisthorchis viverrini, pose considerable health and economic difficulties in aquaculture, particularly in Southeast Asia. Traditional approaches for parasite elimination, including chemical treatments and freezing, exhibit constraints regarding efficacy, environmental sustainability, and practicality. This research investigates an improved dielectric heating system utilizing a 2.45 GHz horn antenna for the selective thermal targeting of parasite-associated regions in Cirrhinus microlepis (small-scale mud carp). The dielectric characteristics of fish tissues, encompassing scales, skin, and muscle, were analyzed utilizing an open-ended coaxial probe technique. Simulation and experimental evaluations were performed to improve energy absorption, heating uniformity, and a particular absorption rate to enable precise thermal localization while preserving the integrity of fish tissue. The findings demonstrate that dielectric heating can specifically elevate the temperature of fish scales, where parasites predominantly inhabit, to levels beyond 70 degrees Celsius, while reducing thermal impact on the underlying muscle tissue. The application of a salt coating on fish scales markedly increased their dielectric loss, exceeding that of muscle tissue, thus enhancing selective heating efficiency and supporting targeted thermal treatment. The ideal distance from the antenna to the sample was established as ranging from 6 to 9 cm, ensuring a balance between energy efficiency and homogeneous heating. This work illustrates the efficacy of dielectric heating as a novel and non-chemical approach for thermal management of parasite-prone tissues in aquaculture, providing a sustainable and viable substitute for traditional treatments. Full article

Background/Objectives: Globally, antibiotic contamination has become an emerging issue in agricultural lands. The presence of antibiotic residues in farmlands, especially through the application of manure fertilizers containing veterinary antibiotics, e.g., tetracycline (TC), can cause severe toxicity, which inhibits crop growth and performance, subsequently threatening human health via consumption of contaminated products. This study was conducted to evaluate the phytotoxicity of TC on Kimchi cabbage (Brassica campestris L.) during seed germination, seedling, and vegetative growth stages, along with its physiological responses and bioaccumulation under TC stress. Methods: The responses of cabbage plants to TC stress were assessed through a germination test and a pot experiment, conducted for three days and six weeks, respectively, under different doses of TC (0, 5, 10, 25, and 50 mg/L). Results: As a result of the germination test, higher TC doses (25 and 50 mg/L) tended to delay seed germination, but all treatments achieved a 100% germination percentage by Day 3 after sowing. Eight days after sowing, the length of shoots and roots of seedlings exhibited a TC dose-dependent decline, specifically under 50 mg TC/L, showing a considerable decrease of 24% and 77%, respectively, compared to control. Similar results were observed in the plants transitioning from the seedling to vegetative stages in the pot experiment. Four and six weeks after sowing, the 50 mg TC/L dose showed the strongest phytotoxicity in cabbage plants with physiological parameters, such as the maximum photosystem II quantum yield (F_v/F_m), pigment content (chlorophyll and carotenoid), biomass, and leaf number, significantly reduced by 26 to 60% compared to control. Interestingly, at lower TC doses (5 and 10 mg/L), a hormesis effect was observed in the phenotype and biomass of the plants. In addition, the degree of TC accumulation in the plants was highly dose-dependent at Week 4 and Week 6, but a temporal decline in TC accumulation was noted between these time points in all TC treatments. This phenomenon might affect the value of the bio-concentration factor (BCF) as an indicator of the plant’s tendency to uptake TC. That is, in Week 6, the dose-dependent reduction in BCF for TC in the plants was likely attributed to a dilution effect caused by plant biomass increase or a degradation mechanism within the plant. Conclusions: Overall, our findings suggest that tetracycline toxicity induces seed germination delay and influences seedling elongation and photosynthetic functions, ultimately impairing crop growth and performance. Also, the antibiotic dynamics related to accumulation and degradation in plants were identified. These results will not only suggest the toxicity threshold of TC for cabbage but also provide insights into effective soil management strategies for food production safety and agroecosystem sustainability in antibiotic-contaminated soils. Full article

Background: Sedentary behavior is a considerable health risk, which is related to a variety of chronic diseases and a lower quality of life. Breathlessness, or dyspnea, is a significant barrier to physical exercise, especially in sedentary populations. This study aimed to assess the relationship between activity-related dyspnea and physical activity levels in women with sedentary behavior, while also identifying demographic and health factors that influence this association. Methods: This study used a cross-sectional design conducted in Saudi Arabia, utilizing an electronic survey for data collection. The participants were Saudi females aged 20–50 years with sedentary behavior, who reported sitting for 6 h or more each day. A self-administered online questionnaire was used to collect data, which examined sociodemographic information, breathlessness (assessed via the Modified Medical Research Council (mMRC) breathlessness scale and the Dyspnea-12 (D-12) questionnaire), and physical activity levels using the Godin Leisure-Time Exercise Questionnaire (GLTEQ). Only healthy volunteers without chronic or respiratory problems were included. Results: Among 646 participants, 95.2% reported breathlessness, with Grade 2 (32.2%) being most common. Physical activity levels were low, with 37.36% insufficiently active. Significant differences in dyspnea scores were observed across activity levels (H(2) = 50.43, p < 0.0001), with more active individuals reporting less dyspnea. Ordinal logistic regression showed that higher mMRC scores were strongly associated with lower activity (OR = 0.19, 95% CI [0.16, 0.23], p < 0.001). Dyspnea-12 physical domain scores also correlated inversely with activity (OR = 0.93, 95% CI [0.90, 0.96], p < 0.001), while the emotional domain was not significant. Conclusions: The study revealed a significant association between higher breathlessness severity and lower physical activity levels among Saudi women with sedentary behavior. Dyspnea was prevalent, with 95.2% of participants experiencing some degree of breathlessness. Future longitudinal or interventional studies are required to determine the direction of this relationship and explore whether interventions targeting breathlessness management could support increased physical activity or if greater activity itself may help alleviate dyspnea. Full article