Search Results (364)

This study presents an approach based on machine learning (ML) techniques to analyze the relationship between emergency room (ER) admissions for cardiorespiratory diseases (CRDs) and environmental factors. The aim of this study is the development and verification of an interpretable machine learning framework applied to environmental and health data to assess the relationship between environmental factors and daily emergency room admissions for cardiorespiratory diseases. The model’s predictive accuracy was evaluated by comparing simulated values with observed historical data, thereby identifying the most influential environmental variables and critical exposure thresholds. This approach supports public health surveillance and healthcare resource management optimization. The health and environmental data, collected through meteorological sensors and air quality monitoring stations, cover eleven years (2013–2023), including meteorological conditions and atmospheric pollutants. Four ML models were compared, with XGBoost showing the best predictive performance (R² = 0.901; MAE = 0.047). A 10-fold cross-validation was applied to improve reliability. Global model interpretability was assessed using SHAP, which highlighted that high levels of carbon monoxide and relative humidity, low atmospheric pressure, and mild temperatures are associated with an increase in CRD cases. The local analysis was further refined using LIME, whose application—followed by experimental verification—allowed for the identification of the critical thresholds beyond which a significant increase in the risk of hospital admission (above the 95th percentile) was observed: CO > 0.84 mg/m³, P_atm ≤ 1006.81 hPa, Tavg ≤ 17.19 °C, and RH > 70.33%. The findings emphasize the potential of interpretable ML models as tools for both epidemiological analysis and prevention support, offering a valuable framework for integrating environmental surveillance with healthcare planning. 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

This study evaluates the risk-adjusted performance of Hospitality REITs using multi-factor asset pricing models and downside risk measures with the aim of assessing their diversification potential and crisis sensitivity. Unlike prior studies that examine REITs in aggregate, this study isolates Hospitality REITs to explore their unique cyclical and macroeconomic sensitivities. This study looks at the risk-adjusted performance of Hospitality Real Estate Investment Trusts (REITs) in relation to more general REIT indexes and the S&P 500 Index. The study reveals that monthly returns of Hospitality REITs increasingly move in tandem with the stock markets during financial crises, which reduces their historical function as portfolio diversifiers. Investing in Hospitality REITs exposes one to the hospitality sector; however, these investments carry notable risks and provide little protection, particularly during economic upheavals. Furthermore, the study reveals that Hospitality REITs underperform on a risk-adjusted basis relative to benchmark indexes. The monthly returns of REITs show significant volatility during the post-COVID-19 era, which causes return-to-risk ratios to be below those of benchmark indexes. Estimates from multi-factor models indicate negative alpha values across conditional models, indicating that macroeconomic variables cause unremunerated risks. This industry shows great sensitivity to market beta and size and value determinants. Hospitality REITs’ susceptibility comes from their showing the most possibility for exceptional losses across asset classes under Value at Risk (VaR) and Conditional Value at Risk (CvaR) downside risk assessments. The findings have implications for investors and portfolio managers, suggesting that Hospitality REITs may not offer consistent diversification benefits during downturns but can serve a tactical role in procyclical investment strategies. Full article

Discourses on breastfeeding extend beyond simple scientific evidence, framed within a dialogue between diverse sociocultural perspectives throughout history. Building on this premise, this article aims to explore, from the perspective of the sociology of deviance, the maternal experiences of women who choose not to breastfeed or cease breastfeeding within the hospital setting. To this end, this qualitative and phenomenological study was conducted, using semi-structured interviews with mothers in the municipality of Lorca who had decided not to breastfeed or had discontinued breastfeeding as a data collection tool. The results indicate that breastfeeding is influenced by the repercussions of delivery room routines and a challenging learning process where complications often arise, contradicting the prevailing innatist discourse of maternal instinct. Within this framework, mothers feel pressured by professionals to breastfeed, and their identities are undermined by symbolic stigma when they express their decision not to breastfeed. We conclude that it is essential to propose clinical approaches and support models that genuinely consider the sociocultural, historical, and experiential factors influencing breastfeeding, moving beyond an exclusive focus on its biological or nutritional aspects. Full article

The continued migration of physicians from independent practice to affiliation with larger entities has garnered significant scrutiny. These affiliation models include hospitals and health systems, payers and corporate entities, and management services organizations, which may or may not be private equity (PE)-backed. Data on the impact of different physician affiliation models on cost of care is limited. We examined the relationship between provider affiliation model, site of care (SOC), and cost of care for certain high-volume procedures in procedure-intensive specialties for both Medicare and commercial insurance. We found that hospital-affiliated physicians are least likely—and PE-affiliated physicians are most likely—to provide care in lower-cost settings. For both Medicare and commercial insurance, SOC contributes meaningfully to procedure unit price, which is consistently greater in hospital-based settings. These findings suggest that the physician affiliation model and associated SOC cost differentials contribute materially to healthcare expenditures. As the Medicare cost differentials are set by statute and regulations, strategies such as site-neutral payments are needed to mitigate the monetary impact of historical and future physician practice migration. Full article

This study examines the complex process of Islam’s localization in Sudan, focusing on how hospitality, Sufi dhikr, and Mawlid celebrations integrate with Islamic practices. Drawing on three years of qualitative fieldwork, it demonstrates how Sudan’s geography, ethnic diversity, and historical heritage enable the blending of core religious principles with local customs. Sufi brotherhoods—particularly Qādiriyya, Tījāniyya, Shādhiliyya, and Khatmiyya—play a pivotal role in local culture by incorporating traditional musical, choreographic, and narrative art forms into their rituals, resulting in highly dynamic worship and social interaction. In Sudan, hospitality emerges as a near-sovereign social norm, reflecting the Islamic ethics of charity and mutual assistance while remaining deeply intertwined with local traditions. Islam’s adaptability toward local customs is further illustrated by the vibrant drumming, chanting, and dancing that enhance large-scale Mawlid al-Nabi celebrations, uniting Muslims under a religious identity that goes beyond dogmatic definitions. Beyond their spiritual meanings, these Sufi practices and networks also serve as tools for social cohesion, often functioning as support systems in regions with minimal state presence. They help prevent disputes and foster unity, demonstrating the positive impact of a flexible Islam—one that draws on both scripture and local traditions—on peacebuilding in Sudan. While highlighting the country’s social realities, this study offers insights into how Islam can function as a transformative force within society. Full article

The implementation of Digital Twins (DTs) in hospitality facilities represents a significant opportunity to optimize front-end services, enhancing guest experience and operational efficiency. This paper proposes an ontology-driven approach for DTs in hotel reception areas, focusing on integrating IoT devices, real-time data processing, and service optimization. By modeling interactions between guests, receptionists, and hotel management systems, DTs enhance resource allocation, predictive maintenance, and customer satisfaction. Simulations and historical data analysis enable forecasting demand fluctuations and optimizing check-in/check-out processes. This research provides a structured framework for DT applications in hospitality, validated through scenario-based simulations, showing significant improvements in check-in time and guest satisfaction. Validation was conducted through scenario-based simulations reflecting real-world operational challenges, such as guest surges, room assignment, and staff workload balancing. Metrics including check-in time, guest satisfaction index, task completion rates, and prediction accuracy were used to evaluate performance. Simulations were grounded in historical hotel data and modeled typical peak-period dynamics to ensure realism. Results demonstrated a 25–35% reduction in check-in time, a 20% improvement in staff efficiency, and significant enhancements in guest satisfaction, underscoring the practical value of the proposed framework in real hospitality settings. Full article

This research aims to investigate the Italian architectural heritage in Brazil through the analysis of the ‘Santa Casa de Misericórdia’ hospital in São Carlos, in the state of São Paulo. As part of the KNOW.IT national project, the work aims to recover and digitally enhance Italian heritage abroad from the 19th and 20th centuries. The buildings analysed were either designed or built by Italian architects who emigrated to South America or constructed using materials and techniques typical of Italian architecture of those years. The hospital, designed by the Italian architect Samuele Malfatti in 1891, was chosen for its historical value and its role in the urban context of the city of São Carlos, which, moreover, continues to perform its function even today. The study aims to create a digital archive with 3D models and two-dimensional graphical drawings. The methodology includes historical analysis, photogrammetric survey, and digital modelling using Agisoft Metashape and 3DF Zephyr software. A total of 636 images were processed, with the maximum resolution achieved in the models being 3526 × 2097 pixels. The results highlight the influence of Italian architecture on late 19th-century São Carlos and promote its virtual accessibility and wide-ranging knowledge. Full article

Background and Objectives. Umbilical hernia is particularly common among patients with liver cirrhosis, affecting about 20% of this group, compared to 3–8.5% in healthy individuals. This increased prevalence is mainly due to weakened abdominal fascia, elevated intra-abdominal pressure, and malnutrition. The rapid progression of umbilical hernias often leads to complications such as skin necrosis, perforation, and strangulation. Historically, patients with liver cirrhosis and complicated umbilical hernia have faced high morbidity and mortality rates. However, recent advancements in perioperative management, especially in controlling ascites, have improved outcomes in elective treatments. Despite these advancements, managing patients with decompensated liver cirrhosis and complicated umbilical hernia in emergency settings remain a significant surgical challenge. Materials and Methods: We conducted a retrospective review of patients treated for complicated umbilical hernia at the University Medical Centre Ljubljana from 2015 to 2024, using prospectively collected data. This analysis involved implementing hernioplasty combined with incisional negative pressure wound therapy (iNPWT) as part of the surgical protocol. The primary endpoint of our study was the rate of local complications, while the secondary endpoints included the rate of systemic complications and 90-day mortality. Results: We treated 28 consecutive patients with complicated umbilical hernia and liver cirrhosis. Local wound complications were observed in three (10.7%) patients. Systemic complications developed in 10 patients (35.7%). The median duration of hospitalization was 8 days (range: 5–29), and no readmissions were recorded within the 30-day period. Two (7.1%) patients died within 90 days. Conclusions: Our experience indicates that iNPWT, when combined with surgical repair, can be safely utilized, yielding outcomes comparable to elective hernia repairs, even in emergency contexts. Further randomized controlled trials are necessary to validate these findings and optimize treatment protocols. Full article

Lower gastrointestinal bleeding (LGIB) is a frequent and potentially life-threatening clinical condition. Over the past two decades, several prognostic scoring systems have been developed to stratify risk and guide the management of patients with LGIB. This comprehensive review aims to summarize and compare the current evidence on the utility, accuracy, and limitations of key LGIB scoring systems, including the Glasgow-Blatchford Score (GBS), AIMS65, ABC score, Oakland score, SALGIB, CHAMPS, and Rockall score. We conducted a structured literature review of studies evaluating these scores in adult patients with LGIB. For each scoring system, we analyzed its origin, components, intended use, and predictive performance regarding clinical outcomes such as severe bleeding, transfusion requirement, in-hospital mortality, rebleeding, and safe discharge. Comparative analyses of diagnostic accuracy were extracted where available. Our findings indicate that while no single score offers comprehensive predictive accuracy across all outcomes, certain tools are particularly effective for specific endpoints. The Oakland and GBS scores are useful for identifying patients at low risk who may be managed safely as outpatients. The ABC and CHAMPS scores demonstrate superior performance in predicting mortality, especially in elderly or comorbid populations. SALGIB, a newer score developed in Vietnam, shows promising performance for early triage but requires further validation. The Rockall score, although historically valuable in upper GI bleeding, offers limited applicability in LGIB due to its reliance on post-endoscopic findings. In conclusion, multiple prognostic tools are now available to support early decision-making in LGIB. Their optimal use requires understanding their strengths, limitations, and appropriate clinical contexts. Integrating these scores into routine practice, along with clinical judgment, can enhance patient outcomes and resource allocation. Full article

Background: Telemonitoring aimed at detecting subclinical heart failure and facilitating medication up-titration offers a promising approach to reducing heart failure hospitalizations. Our team has recently developed a non-invasive metric called “respiratory stability time (RST)”, which quantifies respiratory instability, a surrogate marker of subclinical worsening heart failure. A decrease in RST below 20 s predicts the onset of worsening heart failure within 28 days. However, the clinical utility of RST-guided management in reducing mortality and heart failure hospitalizations remains uncertain. Methods: The Innovative Tele-Monitoring Environment To Halt Ongoing Deterioration of Heart Failure-III (ITMETHOD-HF-III) is a non-blinded, interventional, multicenter, single-arm study. Eighty heart failure patients with a history of at least two prior hospitalizations for heart failure will be enrolled. After validating the robustness of RST measurements, participants will be monitored for 1.5 years through daily RST measurements. Mandatory up-titration of heart failure medications will be started if RST values decrease below 20 s for two consecutive days or decrease progressively below 30 s over 10–90 days from RST values above 45 s maintained for over 1 month, irrespective of the presence of heart failure signs/symptoms. Medication adjustment will continue until RST exceeds 30 s. The study will compare a composite endpoint of heart failure hospitalization and cardiac death between the present RST-guided group and a historical control group from the ITMETHOD-HF-II trial, in which management was based on patients’ symptoms. Results: We anticipate that the precent ITMETHOD-HF-III study will demonstrate that mandatory, RST-guided heart failure management significantly reduces the incidence of the primary composite endpoint—heart failure hospitalization and cardiac death—compared with symptom-guided standard care in the historical control group (ITMETHOD-HF-II). Conclusions: The ITMETHOD-HF-III study aims to demonstrate the clinical efficacy of RST-guided management in reducing heart failure hospitalization rates and cardiac mortality by enabling early detection of subclinical heart failure and facilitating timely medication adjustments, irrespective of heart failure signs/symptoms. If successful, RST-guided management could establish a new standard for telemonitoring heart failure patients in outpatient settings. Full article

Background and Objectives: Pelvic organ prolapse (POP) is a prevalent condition that negatively impacts women’s quality of life. Uterine-preserving procedures are increasingly demanded by patients with uterine prolapse, particularly when associated with true cervical elongation. The Manchester procedure, historically used for uterine preservation, has regained interest due to its effectiveness and low morbidity. This study aims to evaluate the anatomical and functional outcomes of the Manchester procedure in women with uterine prolapse due to cervical elongation, assessing patient satisfaction and associated clinical factors. Materials and Methods: We conducted a retrospective, observational, single-center study at the Regional University Hospital of Málaga, Spain, including patients undergoing the Manchester procedure between January 2017 and December 2022. Inclusion criteria required a diagnosis of uterine prolapse due to clinically confirmed true cervical elongation. Surgical details, complications, and postoperative outcomes were recorded. Patient satisfaction was assessed using a Likert scale during follow-up visits. Results: A total of 38 patients were included, with a mean age of 48.7 years. All presented with symptomatic uterine prolapse and elongated cervix (>5 cm). The anatomical success rate was 97%, with only one case of symptomatic recurrence. The most common early postoperative complication was urinary tract infection (10.5%). The average follow-up duration was 18.6 months. A high level of satisfaction was recorded: 94.8% of patients were either “very satisfied” (73.7%) or “satisfied” (21.1%), and only 5.3% reported dissatisfaction. Multicompartmental repair (anterior and/or posterior colporrhaphy) improved satisfaction outcomes. Conclusions: The Manchester procedure is a safe, effective uterine-sparing surgical option for patients with cervical elongation-related uterine prolapse. It demonstrates a high anatomical success rate and low morbidity, with excellent patient satisfaction. Comprehensive preoperative assessment and addressing modifiable risk factors such as obesity and smoking are key to optimizing results. Further prospective studies are needed to assess long-term durability and quality-of-life outcomes. Full article

The CORUS-XUAM project defined three two-way U-space corridors linking Frankfurt Airport’s Terminal 2 on the city outskirts with the city-center Trade Fair. These corridors avoid the approach cones of the northern and central runways and bypass hospital no-fly zones and large buildings. In our previous studies, we first used fast-time simulations to evaluate the U-space routing and its operating concept, based on historical air traffic data. Included were arriving and departing airplanes as well as police, and medical helicopters throughout the city. The focus was on the limitations of the airspace, avoiding conflicts with other airspace users and between the airtaxis using a different corridor or delaying the departure, as well as determining the throughput potential of such a corridor system. Building on our previous studies, this study incorporates higher-fidelity traffic simulation data and an updated demand analysis for the airtaxi shuttle service. Our new sizing analysis reveals that ground operations typically, not airspace capacity, constitute the primary bottleneck. Full article

Introduction: Chromosomal study via karyotype is one of the historical gold-standard procedures used to provide a clearer view of chromosomal trisomy abnormalities. It has been used to correlate several phenotypic manifestations that require immediate medical intervention. However, the laboratory procedure persisted with various drawbacks. The recent machine learning model shed light on prediction capabilities in the medical field. In this study, we aimed to use a support vector machine model for predicting postnatal chromosomal trisomy cases. Methods: A dataset of 946 neonatal records from the Royal Hospital, Muscat, Oman, covering the period from 2013 to 2023, has been used in this model. The model is based on features such as thyroxine hormone levels and thyroid-stimulating hormone levels. With different R packages, we used a support vector machine model with leave-one-out cross-validation and ten iterations to test three kernel functions: linear, radial, and polynomial. Results: Among the obtained kernel performances, the linear kernel has optimal classification performance. The training accuracy was 81%, and the testing accuracy was 82%. Sensitivity ranged from 97 to 98%, and specificity ranged from 79 to 80%. The area under the curve in relation to the training dataset came to 0.89, and it came to 0.90 for the test dataset. We deployed the trained models in a website tool called ChromoCheck. Conclusions: Our study is an example of how machine learning can be instrumental in augmenting conventional methods of cytogenetics diagnosis and decision-making in a clinical setup. Full article

The use of ileum for ureteral reconstruction was first described in 1906. Since then, its utilization has evolved considerably. Early in the history of ileal ureters, urologists were limited by a lack of familiarity with bowel harvesting and handling. The popularization of ileal conduits for urinary diversions, however, allowed urologists to familiarize themselves with the use of ileum and paved the way for broader applications. With the emergence of laparoscopy and, later, robotic-assisted surgery, the application of ileal ureteral replacement expanded the capabilities of reconstructive urologists. This article describes the historical development of surgical techniques for ileal ureter replacement and the integration of new technologies aiding in improved outcomes, and anticipates potential future directions. In contemporary practice, robotic-assisted ileal ureteral replacement is used in cases of extensive ureteral obstruction or damage. Advantages of the robotic platform include reduced blood loss, shorter recovery time and hospital length of stay, and superior operative ergonomics. Although robotic ileal ureter replacement is a complex and challenging surgery with notable complications, studies have demonstrated the efficacy and safety of this technique in patients with an otherwise end-stage ureter. In addition, the robotic approach has provided urologists the ability to conduct complex reconstructive surgeries including bilateral ureteral replacement in conjunction with bladder augmentation or a urinary diversion. Long-term studies and continued innovation are necessary to further improve the surgical techniques, outcomes, and scope of ileal ureter reconstruction. Full article