Search Results (1,137)

The perianal skin is a unique “skin–gut” boundary that serves as a critical hotspot for the exchange and evolution of antibiotic resistance genes (ARGs). However, its role in the dissemination of antimicrobial resistance (AMR) has often been underestimated. To characterize the resistance patterns in the perianal skin environment of patients with perianal diseases and to investigate the drivers of AMR in this niche, a total of 51 bacterial isolates were selected from a historical strain bank containing isolates originally collected from patients with perianal diseases. All the isolates originated from the skin site and were subjected to antimicrobial susceptibility testing, whole-genome sequencing, and co-occurrence network analysis. The analysis revealed a highly structured resistance pattern, dominated by two distinct modules: one representing a classic Staphylococcal resistance platform centered around mecA and the bla operon, and a broad-spectrum multidrug resistance module in Gram-negative bacteria centered around tet(A) and predominantly carried by IncFIB and other IncF family plasmids. Further analysis pinpointed IncFIB-type plasmids as potent vehicles driving the efficient dissemination of the latter resistance module. Moreover, numerous unexplained resistance phenotypes were observed in a subset of isolates, indicating the potential presence of emerging and uncharacterized AMR threats. These findings establish the perianal skin as a complex reservoir of multidrug resistance genes and a hub for mobile genetic element exchange, highlighting the necessity of enhanced surveillance and targeted interventions in this clinically important ecological niche. Full article

(1) Background: This article aims to understand the forms and elements through which the inhabitants of the city of Medellin have configured their subjectivity in the context of the application of neoliberal policies in the last two decades. In this way, we can approach the frameworks of understanding that constitute a fundamental part of the individuation processes in which the incorporation of their subjectivities is evidenced in neoliberal contexts that, in the historical process, have been converging with authoritarian, antidemocratic and neoconservative elements. (2) Method: A qualitative approach with a hermeneutic-interpretative paradigm was used. In-depth semi-structured interviews were conducted with 41 inhabitants of Medellín who were politically identified with right-wing or center-right positions. Data analysis included thematic coding to identify patterns of thought and points of view. (3) Results: Participants associate success with individual effort and see state intervention as an obstacle to development. They reject redistributive policies, arguing that they generate dependency. In addition, they justify authoritarian models of government in the name of security and progress, from a moral superiority, which is related to a negative and stigmatizing perception of progressive sectors and a negative view of the social rule of law and public policies with social sense. (4) Conclusions: The naturalization of merit as a guiding principle, the perception of themselves as morally superior based on religious values that grant a subjective place of certainty and goodness; the criminalization of expressions of political leftism, mobilizations and redistributive reforms and support for policies that establish authoritarianism and perpetuate exclusion and structural inequalities, closes roads to a participatory democracy that enables social and economic transformations. Full article

During the transition of culture-featured district planning from static conservation to innovation-driven models, existing research remains constrained by mechanistic paradigms, reducing districts to functional containers and neglecting human perceptual interactions and meaning-production mechanisms. This study explores and quantifies the generative mechanisms of spatial communicability and cultural dissemination efficacy within human-centered frameworks. Grounded in humanistic urbanism, we analyze Harbin Central Street as a case study integrating historical heritage with contemporary vitality, developing a tripartite communicability assessment framework comprising perceptual experience, infrastructure utility, and behavioral dynamics. Machine learning-based threshold analysis reveals that spatial encoding elements govern communicability through significant nonlinear mechanisms. The conclusion shows synergies between street view-quantified greenery visibility and pedestrian accessibility establish critical human-centered design thresholds. Spatial data analysis integrating physiologically sensed emotional experiences and topologically analyzed spatial morphology resolves metric fragmentation while examining spatial encoding’s impact on interaction efficacy. This research provides data-driven decision support for sustainable urban renewal and enhanced cultural dissemination, advancing heritage sustainability. Full article

Objectives: The increasing use of fetal MRI has increased the diagnosis of posterior fossa malformations, yet the long-term neurodevelopmental outcomes of affected fetuses remain unclear. This study aims to examine the long-term neurodevelopmental outcomes of fetuses with structural posterior fossa malformation diagnosed on fetal MRI. Methods: A historical cohort study was conducted at a single tertiary referral center, including fetuses diagnosed with structural posterior fossa malformations and apparently healthy fetuses who underwent fetal brain MRI between 2011 and 2019. Maternal, pregnancy, and newborn characteristics were compared between groups, alongside long-term neurodevelopmental outcomes using the Vineland Adaptive Behavior Scales II (VABS-II) questionnaire. This included an extensive assessment of malformation types, additional structural, genetic, or neurodevelopmental anomalies, and outcomes. Results: A total of 126 fetuses met the inclusion criteria, of which 70 were apparently healthy fetuses, and 56 had structural posterior fossa malformations. Among the latter, 18 pregnancies were terminated, 4 resulted in neonatal death, and 11 were lost to follow-up. No significant differences were found in the overall neurodevelopmental outcomes between fetuses with structural posterior fossa malformation (93.4 ± 19.0) and apparently healthy fetuses (99.8 ± 13.8). Motor skills scores were lower among fetuses with structural posterior fossa malformations (87.7 ± 16.5 vs. 99.3 ± 17.2, p = 0.01) but remained within the normal range. Conclusion: Fetuses with structural posterior fossa malformations may exhibit normal long-term neurodevelopmental outcomes if no additional anomalies are detected during thorough prenatal screening that includes proper sonographic, biochemical and genetic screening, as well as fetal MRI. Further research with larger cohorts and longer-term assessments is recommended to validate these findings and support clinical decision-making. Full article

Background: Cardiac implantable electronic device (CIED) infections necessitate extraction and subsequent pacing interventions. Conventional methods after removing the infected CIED system involve temporary or semi-permanent pacing followed by delayed permanent pacemaker (PPM) implantation. Leadless pacemakers (LPs) may offer an alternative, allowing immediate PPM implantation without increasing infection risks. Our objective is to evaluate the safety and cost-effectiveness of LP implantation during the same procedure of CIED extraction, compared to conventional two-stage approaches. Methods: Pacemaker-dependent patients with systemic or pocket infection undergoing device extraction and LP implantation during the same procedure at Sheba Medical Center, Israel, were compared to a historical group of patients undergoing a semi-permanent (SP) pacemaker implantation during the procedure, followed by a permanent pacemaker implantation. Results: The cohort included 87 patients, 45 undergoing LP implantation and 42 SP implantation during the extraction procedure. The LP group demonstrated shorter intensive care unit stay (1 ± 3 days vs. 7 ± 12 days, p < 0.001) and overall hospital days (11 ± 24 days vs. 17 ± 17 days, p < 0.001). Rates of infection relapse and one-year mortality were comparable between groups. Economic analysis revealed comparable total costs, despite the higher initial expense of LPs. Conclusions: LP implantation during CIED extraction offers significant clinical and logistical advantages, including reduced hospital stays and streamlined treatment, with comparable safety and cost-effectiveness to conventional approaches. Full article

Amid ongoing societal development, tourists’ travel behavior patterns have been undergoing substantial transformations, and understanding their evolution has emerged as a key area of scholarly interest. Taking Beijing as a case study, this research aims to uncover the spatiotemporal evolution patterns of tourist flows and their underlying driving mechanisms. Based on digital footprint relational data, a dual-perspective analytical framework—“tourist perception–tourist flow network”—is constructed. By integrating the center-of-gravity model, social network analysis, and regression models, the study systematically examines the dynamic spatial structure of tourist flows in Beijing from 2012 to 2024. The findings reveal that in the post-pandemic period, Beijing tourists place greater emphasis on the cultural connotation and experiential aspects of destinations. The gravitational center of tourist flows remains relatively stable, with core historical and cultural blocks retaining strong appeal, though a slight shift has occurred due to policy influences and emerging attractions. The evolution of the spatial network structure reveals that tourism flows have become more dispersed, while the influence of core scenic spots continues to intensify. Government policy orientation, tourism information retrieval, and the agglomeration of tourism resources significantly promote the structure of tourist flows, whereas the general level of tourism resources exerts no notable influence. These findings offer theoretical insights and practical guidance for the sustainable development and regional coordination of tourism in Beijing, and provide a valuable reference for the spatial restructuring of urban tourism in the post-COVID-19 era. Full article

The management of adult spinal deformity (ASD) has evolved dramatically over the past century, transitioning from external bracing and in situ fusion to complex, technology-driven surgical interventions. This review traces the historical development of spinal deformity correction and highlights contemporary enabling technologies that are redefining the surgical landscape. Advances in stereoradiographic imaging now allow for precise, low-dose three-dimensional assessment of spinopelvic parameters and segmental bone density, facilitating individualized surgical planning. Robotic assistance and intraoperative navigation improve the accuracy and safety of instrumentation, while patient-specific rods and interbody implants enhance biomechanical conformity and alignment precision. Machine learning and predictive modeling tools have emerged as valuable adjuncts for risk stratification, surgical planning, and outcome forecasting. Minimally invasive deformity correction strategies, including anterior column realignment and circumferential minimally invasive surgery (cMIS), have demonstrated equivalent clinical and radiographic outcomes to traditional open surgery with reduced perioperative morbidity in select patients. Despite these advancements, complications such as proximal junctional kyphosis and failure remain prevalent. Adjunctive strategies—including ligamentous tethering, modified proximal fixation, and vertebral cement augmentation—offer promising preventive potential. Collectively, these innovations signal a paradigm shift toward precision spine surgery, characterized by data-informed decision-making, individualized construct design, and improved patient-centered outcomes in spinal deformity care. Full article

Wireless sensor networks (WSNs) are used for data acquisition and transmission in unmanned surface vessels (USVs). However, the openness of wireless networks makes USVs highly susceptible to false data injection (FDI) attacks during data transmission, which affects the sensors’ ability to receive real data and leads to decision-making errors in the control center. In this paper, a novel dynamic data encryption method is proposed whereby data are encrypted prior to transmission and the key is dynamically updated using historical system data, with a view to increasing the difficulty for attackers to crack the ciphertext. At the same time, a dynamic relationship is established among ciphertext, key, and auxiliary encrypted ciphertext, and an attack detection scheme based on dynamic encryption is designed to realize instant detection and localization of FDI attacks. Further, an $H_{\infty }$ fusion filter is designed to filter external interference noise, and the real information is estimated or restored by the weighted fusion algorithm. Ultimately, the validity of the proposed scheme is confirmed through simulation experiments. Full article

In this paper, we argue that what is sometimes at fault for the poor attendance and lack of engagement in schools observed from historically marginalized families is a missed opportunity to increase understanding or cultural relevance on the part of schools. In this paper, we use the construct of “counter stories” which has the potential to change the script on the instrumentalist demands of quantity versus quality in parent engagement. By providing examples of what we consider “quality” engagement techniques via the staff’s interpretation of their roles within one demographically rich early learning center, the strategies used to engage parents are documented. Counter-stories of practice show family-centrism as interpreted by school leaders. By describing one community context and its practices of building relationships with newcomer families, relationally driven parent engagement techniques are revealed. The authors highlight how inquiry-based methods surpass the generic approaches described in policy. When parent engagement “arises” from within parents’ motivations and informs authentic knowing (by teachers and school leaders), community systems are elevated. Professionals’ decisions about children and community groups that are informed by families’ knowledge are consequently meaningful and authentic. Full article

The hydrological response of a watershed is strongly influenced by the spatiotemporal dynamics of rainfall. Rainfall events of similar magnitude can produce markedly different flood processes due to variations in the spatiotemporal patterns of rainfall, posing significant challenges for flood forecasting under complex rainfall scenarios. Traditional methods typically rely on high-resolution or synthetic rainfall data to characterize the scale, direction and velocity of rainstorms, in order to analyze their impact on the flood process. These studies have shown that storms traveling along the main river channel tend to exert the greatest impact on flood processes. Therefore, tracking the movement of the rainfall center along the flow direction, especially when only rain gauge data are available, can reduce model complexity while maintaining forecast accuracy and improving model applicability. This study proposes a machine learning-based time-variable instantaneous unit hydrograph that integrates rainfall spatiotemporal dynamics using quantitative spatial indicators. To overcome limitations of traditional variable unit hydrograph methods, a pre-training and fine-tuning strategy is employed to link the unit hydrograph S-curve with rainfall spatial distribution. First, synthetic pre-training data were used to enable the machine learning model to learn the shape of the S-curve and its general pattern of variation with rainfall spatial distribution. Then, real flood data were employed to learn the actual runoff routing characteristics of the study area. The improved model allows the unit hydrograph to adapt dynamically to rainfall evolution during the flood event, effectively capturing hydrological responses under varying spatiotemporal patterns. The case study shows that the improved model exhibits superior performance across all runoff routing metrics under spatiotemporal rainfall variability. The improved model increased the simulation qualified rate for historical flood events, with significant rainfall center movement during the event from 63% to 90%. This study deepens the understanding of how rainfall dynamics influence watershed response and enhances hourly-scale flood forecasting, providing support for disaster early warning with strong theoretical and practical significance. Full article

Africa’s rapid urbanization often exceeds the capacity of governments to provide essential services and infrastructure, exacerbating structural inequalities and exposing vulnerable populations to serious health risks. This paper examines the case of Douala, Cameroon, to demonstrate that health inequities in African cities are not simply the result of urban growth but are shaped by spatial inequities, historical legacies, and systemic exclusion. Disadvantaged neighborhoods are particularly impacted, becoming epicenters of health crises. Using a mixed-methods approach combining spatial analysis, household surveys and interviews, the study identifies three key findings: (1) Healthcare services in Douala are unevenly distributed and dominated by private providers, which limits access for low-income residents. (2) Inadequate infrastructure and environmental risks in informal settlements lead to a higher disease burden and an overflow of demand into better-equipped districts, which overwhelms public health centers across the city. (3) This structural mismatch fuels widespread reliance on informal and unregulated care practices. This study positions Douala as a microcosm of broader public health challenges in rapidly urbanizing African cities. It highlights the need for integrated urban planning and health system reforms that address spatial inequalities, strengthen public health infrastructure, and prioritize equity—key principles for achieving the third Sustainable Development Goal (ensuring good health and well-being for all residents) in sub-Saharan Africa. Full article

Historical buildings are exposed to an increased risk of fire. The direct influence comes from the buildings’ structural design and the fire protection level. The fundamental principle for reducing the loss of heritage value in historical buildings due to fire is fire protection, as part of crisis management. This article focuses on selected castle buildings from Slovakia. Three castle buildings were selected based on their location in the country. All of them are currently used for museum purposes. Using an analytical form, we assessed fire hazards and fire safety measures in two parts, calculated the fire risk index, and proposed solutions. Qualitative research, which is more suitable for the issue at hand, was used to evaluate the selected objects. The main methods used in the research focused on visual assessment of the current condition of the objects and analysis of fire documentation and its comparison with currently valid legal regulations. Based on the results, we can conclude that Kežmarok Castle (part of the historical city center) has a small fire risk (fire risk index = 13 points). Trenčín Castle (situated on a rock above the city) and Stará Ľubovňa Castle (situated on a limestone hill outside the city, surrounded by forest) have an increased risk of fire (fire risk index = 50–63). Significant risk sources identified included surrounding forest areas, technical failures related to outdated electrical installations, open flames during cultural events, the concentration of highly flammable materials, and complex evacuation routes for both people and museum collections. Full article

As the cradle of Jiangnan culture, Suzhou is home to a dense concentration of historical architectural heritage that is currently facing existential threats from rapid urbanization. This study aims to develop a spatial heritage corridor network for conservation and sustainable utilization. Using kernel density estimation, this study identifies 15 kernel density groups, along with the Analytic Hierarchy Process (AHP), to pinpoint clusters of historical architectural heritage and assess the involved resistance factors. Current Effective Conductance (CEC) theory is further applied to model spatial flow relationships among heritage nodes, leading to the delineation of 27 heritage corridors and revealing a spatial structure characterized by one primary core, one secondary core, and multiple peripheral zones. Based on 15 source points, six cultural relics-themed routes are proposed—three land-based and three waterfront routes—connecting historical sites, towns, and ecological areas. The study further recommends a resource management strategy centered on departmental collaboration, digital integration, and community co-governance. By integrating historical architectural types, settlement forms, and ecological patterns, the research builds a multi-scale narrative and experience system that addresses fragmentation while improving coordination and sustainability. This framework delivers practical advice on heritage conservation and cultural tourism development in Suzhou and the broader Jiangnan region. Full article

Currently, exploring digital immersive experiences is a new trend in the innovation and development of cultural tourism. This study addresses the growing demand for digital immersion in cultural tourism by examining the integration of spatial narrative and digitally gamified architectural scenarios. This study synthesizes an optimized framework for narrative design in digitally gamified architectural scenarios, integrating spatial narrative theory and feedback-informed design. The proposed model comprises four key components: (1) developing spatial narrative design methods for such scenarios; (2) constructing a spatial language system for spatial narratives using linguistic principles to organize narrative expression; (3) building a preliminary digitally gamified scenario based on the “Wuhu Jiaoji Temple Renovation Project” after architectural and environmental enhancements; and (4) optimization through thermal feedback experiments—collecting visitor trajectory heatmaps, eye-tracking heatmaps, and oculometric data. The results show that the optimized design, validated in the original game Dreams of Jiaoji, effectively enhanced spatial narrative execution by refining both on-site and in-game architectural scenarios. Post-optimization visitor feedback confirmed the validity of the proposed optimization strategies and principles, providing theoretical and practical references for innovative digital cultural tourism models and architectural design advancements. In the context of site-specific architectural conservation, this approach achieves two key objectives: the generalized interpretation of architectural cultural resources and their visual representation through gamified interactions. This paradigm not only enhances public engagement through enabling a multidimensional understanding of historical building cultures but also accelerates the protective reuse of heritage sites, allowing heritage value to be maximized through contemporary reinterpretation. The interdisciplinary methodology promotes sustainable development in the digital transformation of cultural tourism, fostering user-centered experiences and contributing to rural revitalization. Ultimately, this study highlights the potential use of digitally gamified architectural scenarios as transformative tools for heritage preservation, cultural dissemination, and rural community revitalization. Full article

Background: As intelligent systems increasingly operate in high-risk environments, understanding how they perceive and respond to hazards is critical for ensuring safety. Methods: In this study, we conduct a comparative analysis of 60 real-world accident reports, 30 from process control systems (PCSs) and 30 from autonomous vehicles (AVs), to examine differences in risk triggers, perception paradigms, and interaction failures between humans and artificial intelligence (AI). Results: Our findings reveal that PCS risks are predominantly internal to the system and detectable through deterministic, rule-based mechanisms, whereas AVs’ risks are externally driven and managed via probabilistic, multi-modal sensor fusion. More importantly, despite these architectural differences, both domains exhibit recurring human–AI interaction failures, including over-reliance on automation, mode confusion, and delayed intervention. In the case of PCSs, these failures are historically tied to human–automation interaction; this article extrapolates these patterns to anticipate potential human–AI interaction challenges as AI adaptation increases. Conclusions: This study highlights the need for a hybrid risk perception framework and improved human-centered design to enhance situational awareness and responsiveness. While AI has not yet been implemented in PCS incident studies, this work interprets human–automation failures in these cases as indicative of potential challenges in human–AI interaction that may arise in future AI-integrated process systems. Implications extend to developing safer intelligent systems across industrial and transportation sectors. Full article