Search Results (797)

Background: Periprosthetic joint infections (PJI) represent a serious complication following joint arthroplasty and require, in addition to surgical intervention, a targeted antibiotic therapy. The aim of this study was to compare microbiological recommendations for the antibiotic treatment of fictitious PJI patients generated by an artificial intelligence (AI) system with those of an interdisciplinary team (IT) consisting of microbiologists and orthopedic surgeons. The differences between the recommendations suggested by AI and the IT were analyzed with regard to the suggested agents and duration of antibiotic therapy. Methods: Based on meta-analyses, a cohort of 100 fictitious patients with acute early- and acute late-onset PJI was created, reflecting the typical demographic data, comorbidities and pathogen profiles of such a population. This information was input into the AI system ChatGPT (OpenAI, GPT-5 “Thinking mode” accessed via ChatGPT Plus, San Francisco, CA, USA) to generate corresponding recommendations. The objective was to use these profiles to obtain recommendations for definitive antibiotic therapy, including daily dosage, intravenous and oral treatment durations. Simultaneously, the same fictitious patient data were reviewed by the IT to produce their own recommendations. Results: The results revealed both concordances and discrepancies in the selection of antibiotics. Notably, in cases involving multidrug-resistant organisms and more complex clinical scenarios, the AI-generated recommendations were incongruent with those of the IT, with estimated percentage agreement ranging from 0–33%. In straightforward clinical scenarios with monomicrobial infections, AI reached an estimated percentage agreement of up to 57% (95%-CI [0.47–0.67]). Furthermore, AI consistently recommended 12 weeks of therapy duration vs. six weeks usually recommended by the IT. Conclusions: The study provides important insights into the potential and limitations of AI-assisted decision-making models in orthopedic infection treatments. Consultation of AI is universally accessible at all times of day, which may offer a significant advantage in the future for the treatment of PJI. This kind of application will be of particular interest for institutions without in-house microbiology services. However, from our perspective, the current level of incongruence between the AI-generated recommendations and those of an experienced interdisciplinary team remains too high for this approach to be clinically implemented at this time. Furthermore, AI lacks transparency regarding the sources it uses to inform about its decision-making and therapeutic recommendations, currently carries no legal weight and clinical implementation is severely hindered by restrictive privacy laws regarding health care data. Full article

This study aimed to identify and evaluate the risk factors associated with Giardia spp. infection among generally hospitalized patients with various conditions specific to infectious diseases in Western Romania. A total of 312 patients, ranging in age from 2 months to 90 years and originating from both urban and rural settings, were included in the analysis. Fecal specimens were collected and analyzed using the Rapid-VIDITEST Crypto Giardia antigen test, a qualitative chromatographic assay for the detection of Giardia spp. Infection-related risk factors were assessed through a standardized questionnaire completed by adult patients or by the guardians of pediatric patients. The overall prevalence of Giardia spp. infection was 4.8%. Of the risk factors analyzed, only age demonstrated a statistically significant association with infection status (p < 0.05). Notably, the highest prevalence (12.5%) was recorded in the <1-year age group (2–11 months), with a marked decrease in prevalence observed among patients aged ≥60 years. Other evaluated risk factors—including area of residence, gender, contact with animals, pet ownership, hand hygiene after animal contact, type of housing (house or apartment), fruit washing practices, use of potable water, use of public transportation, international travel, and visits to playgrounds or swimming pools—did not show a statistically significant association with Giardia spp. infection among the study participants. The lack of statistical significance for several expected factors may be related to limited statistical power resulting from the low number of positive cases. These findings contribute to the current understanding of Giardia spp. transmission dynamics and may inform future research efforts aimed at elucidating relevant risk factors. Furthermore, the results may support the development of targeted public health interventions (focusing on infants and their caregivers) and prevention strategies. Full article

This article outlines the development of an inter-scale analytical tool designed to evaluate urban, intermediate, and domestic spaces from a gender perspective. Framed within feminist urbanism and ecofeminist theory, the study addresses the need to foster inclusive and equitable environments by incorporating gender-sensitive criteria into spatial planning processes. The methodology employed consists of a six-stage process: (1) a review of the existing literature; (2) the definition of scales of approach; (3) the formulation of indicators; (4) the establishment of evaluation criteria; (5) the design of data collection instruments; and (6) the refinement of the tool through field testing. The tool uses both qualitative and quantitative indicators across three spatial scales—neighbourhood, inter-block, and housing—organised into dimensions such as safety, accessibility, diversity, vitality, and representativeness. The evaluation process employs direct observation, graphic analysis, interviews, and participatory focus groups to provide a nuanced and multidimensional understanding of the built environment. The results confirm that both urban and domestic spaces have historically been designed from an androcentric perspective. They also highlight the potential of using gender-based evaluations to identify spatial inequalities and guide transformative interventions. The tool is replicable, adaptable, and scalable, and can therefore offer a robust framework for future research and public policy-making aimed at fostering gender equity in urban contexts. Full article

Post-disaster temporary housing units (PDTHUs) are crucial to the rebuilding process after disasters; however, current designs fall short in several areas, including user comfort, contextual relevance, and long-term flexibility. This situation suggests that design weaknesses emerge through interactions among multiple factors, requiring an analytic approach that goes beyond isolated evaluation. This study aims to (1) identify the main design issues in PDTHUs, (2) explore the relationships among these issues, and (3) prioritize interventions by grouping causes for decision makers. First, eleven primary design problems were identified through a systematic literature review. Next, a matrix-based questionnaire was developed and administered to five experts with experience in post-disaster projects. In the third stage, expert opinions were analyzed using the DEMATEL (Decision-Making Trial and Evaluation Laboratory) method. As a result, the design problems were classified into “cause” and “effect” groups, and a cause-and-effect diagram was created. The findings indicate that the lack of contextual and cultural integration in design (4.485); the absence of pre-disaster planning and prototyping (3.964); and low thermal, acoustic, and ergonomic comfort (3.385) are the most influential issues because they belong to “cause groups” with high Pi values. This study provides a guiding framework for practitioners and policymakers to allocate resources efficiently, plan strategically, and develop context-sensitive designs. Full article

Reducing energy demand and carbon emissions in residential buildings requires more than technological upgrades; it demands a nuanced understanding of occupant behaviour. Residential energy use is shaped by both physical design and human actions, yet behavioural factors remain underexplored, contributing to the energy performance gap. This study addresses this issue by developing and validating a behavioural framework grounded in the Theory of Planned Behaviour (TPB) to examine how attitudes, social norms, perceived control, and environmental awareness influence energy-related decisions. Data were collected through an online survey of 310 households in metropolitan Sydney and analysed using Stata v17 software employing principal component analysis and regression modelling. Results reveal that environmental awareness is the most significant predictor of pro-environmental intention, which strongly correlates with actual behavioural outcomes. While attitudes and perceived control were generally positive, subjective norms and awareness remained moderate, limiting behavioural change. The proposed framework demonstrates strong validity and reliability, offering a practical tool for policymakers, designers, and educators to integrate behavioural insights into sustainable building strategies. By prioritising awareness campaigns and normative interventions, stakeholders can complement technical retrofits with behavioural measures, accelerating progress towards low-carbon housing and benefiting both households and the broader community. Full article

Marine mammals have been successfully maintained under human care; however, the media, public, and professionals within the field frequently voice welfare concerns. This study systematically surveyed peer-reviewed (PR) literature from 1948 to 2024 (n = 1308) and included an opportunistic sample of non-peer-reviewed (NPR) literature from the past 40 years (n = 756) to evaluate research efforts associated with species housed in zoos and aquariums. The current study updates and extends previous efforts to assess research categories. The findings indicate that the volume of research published mirrors the species abundance in human care. Across taxa, PR papers concentrate on science that enhances the understanding of biological functions (Acoustics, Biology, Breeding, Behaviour, Health) but is not necessarily tailored to improve management or optimal care. In contrast, a substantial portion of the NPR literature focuses on daily handling and management, highlighting Environment and Management and Enrichment-related activities. While welfare-related research has increased in both PR and NPR literature, this review underscores the need for additional welfare-related empirical studies to further enhance animal care and wellbeing. We encourage those involved in the practical care of such taxa to empirically evaluate these interventions and disseminate their findings in the PR literature. Full article

Urban parks are essential components of sustainable cities, providing vital health, social, and environmental benefits. Using weekly smartphone-based visitation data for 182 parks in Las Vegas from 2019 to 2022, this study quantifies how the COVID-19 pandemic altered park use and identifies the socio-economic, environmental, and infrastructural determinants of these changes. Park visitation in Las Vegas showed a marked early pandemic decline followed by uneven recovery, with socially vulnerable neighborhoods lagging behind. Ordinary Least Squares (OLS) and Random Forest (RF) models were used to capture both linear and nonlinear relationships. The RF model explained 81% of the variance in standardized visitation (R² = 0.81, RMSE = 0.0415), substantially outperforming the OLS benchmark (R² = 0.24, RMSE = 0.0656). Domain-specific RF models show that socio-economic variables alone achieve an R² of 0.88, compared with about 0.70 for housing, environmental/health, and lighting variables, while demographic variables explain only 0.39, indicating that social vulnerability is the dominant driver of visitation inequalities. Phase-specific analyses further reveal that RF performance increases from R² = 0.84 before the pandemic to R² = 0.87 after it, as park visitation becomes more strongly coupled with socio-economic and health-related burdens. After COVID-19, poverty, uninsured rates, and asthma prevalence emerge as the most influential predictors, while the relative importance of demographic composition and environmental exposure diminishes. These findings demonstrate that pandemic-era inequalities in park visitation are driven primarily by reinforced socio-economic and health vulnerabilities, underscoring the need for targeted, equity-oriented green-infrastructure interventions in disadvantaged neighborhoods. Full article

The United Kingdom’s (UK) retrofit revolution is at a crossroads and the efficacy of retrofit interventions is not solely a function of insulation thickness. To truly slash emissions and lift households out of fuel poverty, we must solve the persistent problem of thermal bridging (TB), i.e., the hidden flaws that cause heat to escape, dampness to form, and well-intentioned retrofits to fail. This review moves beyond basic principles to spotlight the emerging tools and transformative strategies to make a difference. We explore the role of advanced modelling techniques, including finite element analysis (FEA), in pinpointing thermal and moisture-related risks, and how emerging materials like vacuum-insulated panels (VIPs) offer high-performance solutions in tight spaces. Crucially, we demonstrate how an integrated fabric-first approach, guided by standards like PAS 2035, is essential to manage moisture, ensure durability, and deliver the comfortable, low-energy homes the UK desperately needs. Therefore, achieving net-zero targets is critically dependent on the systematic upgrade of the building envelope, with the mitigation of TB representing a fundamental prerequisite. The EnerPHit approach applies a rigorous fabric-first methodology to eliminate TB and significantly reduce the building’s overall heat demand. This reduction enables the use of a compact heating system that can be efficiently powered by renewable energy sources, such as solar photovoltaic (PV). Moreover, this review employs a systematic literature synthesis to critically evaluate the integration of TB mitigation within the PAS 2035 framework, identifying key technical interdependencies and research gaps in whole-house retrofit methodology. This article provides a comprehensive review of established FEA modelling methodologies, rather than presenting results from original simulations. Full article

People who use crack cocaine (PWUCC) constitute a key population due to vulnerability and marginalization, especially in a socio-ecologically diverse, relatively isolated region with limited public health infrastructure. This study aimed to perform a genetic characterization of circulating HCV among PWUCC in the municipality of Bragança, situated on the Brazilian Amazon coast, identifying viral genotypes, subtypes, resistance-associated substitutions (RAS)—naturally occurring mutations in the viral genome that can reduce the efficacy of direct-acting antiviral (DAA) agents—and predictions of phenotypic resistance. Methods: Between 2016 and 2018, biological samples and epidemiological data were obtained from 165 PWUCC. Viral detection was performed using RT-PCR, while genotyping, subtyping, and RAS profiling were conducted through nucleotide sequencing and fragment analysis. Results: In 165 PWUCC, 22 (13.3%) tested positive for HCV RNA. Most of them had not had access to public health services (91.5%), and more than half (57.0%) reported living in unstable housing conditions. HCV subtypes 1a (27.3%), 1b (40.9%), and 3a (31.8%) were detected. Evidence of resistance associated with DAAs, such as daclatasvir and dasabuvir, was detected in five PWUCC with HCV (22.7%). Conclusions: The high prevalence of HCV infection, predominantly subtype 1b, and significant levels of resistance are very concerning. This demonstrates the urgent need for targeted public health interventions to expand access to testing, treatment, and effective antiviral therapy in this vulnerable population of the Brazilian Amazon. Full article

The end-of-life phase of a building, which includes demolition and waste disposal, represents a crucial aspect of sustainable construction. In Europe, construction and demolition (C&D) waste accounts for approximately 40% of the total waste generated in the EU, making its management a global challenge. The EU Construction & Demolition Waste Management Protocol (2024) emphasizes the importance of evaluating, before proceeding with the demolition of a building, whether renovation could be a more efficient solution, considering economic, environmental, and technical aspects. From an economic perspective, demolition costs vary depending on several factors, including project size, structural complexity, techniques employed (conventional or non-conventional), materials to be removed, and local regulations. In addition to the direct costs of the intervention, it is essential to consider indirect impacts, such as the management of construction and demolition (C&D) waste, the removal of hazardous substances, and potential environmental damage to be mitigated. This study analyzes a case located in Italy, in the municipality of Caivano (Metropolitan City of Naples, in Campania region), concerning a building that required energy efficiency improvements and seismic upgrades. The decision to demolish and rebuild proved to be economically more advantageous than renovation, while also allowing a 35% increase in volume, enabling the creation of a greater number of housing units. Through the analysis of this real case study, the aim is to highlight how investments in demolition, if properly planned, designed, assessed, and managed, can effectively contribute to building redevelopment, supporting the transition towards a sustainable construction model in line with the principles of the circular economy. Full article

Over the last 40 years, the Kingdom of Saudi Arabia (KSA) has experienced economic growth that has driven urbanization and infrastructure improvements. However, this has also led to high resource use and poor planning, exacerbating climate challenges and underscoring the need for international cooperation. Given the substantial energy use associated with buildings, sustainable global building standards have been developed. Saudi Vision 2030 encourages sustainable practices in energy, housing, and water by adopting green building standards to guide environmentally friendly initiatives. This study provides an overview of the current status of green building rating systems in KSA and examines the principal obstacles faced during their implementation. Utilizing importance-performance analysis (IPA), the study identifies and evaluates strategies to advance green building ratings, drawing upon survey data from diverse stakeholders. Major barriers include low awareness across the public and private sectors and technical challenges such as a shortage of qualified professionals, limited information, and unreliable resources. The strategies proposed aim to establish clear standards for sustainable construction and promote targeted awareness campaigns with industry leaders and government, highlighting the long-term environmental and financial advantages of green buildings. Identifying these barriers and evaluating interventions will help to advance green building rating systems and sustainability in KSA and worldwide. Full article

Across the Baltic Sea region, areas situated in climate-sensitive water zones are increasingly exposed to environmental and socio-economic challenges. Gdańsk, Poland, is a prominent example where the rising threat of climate-related hazards, particularly connected with flooding, coincides with growing demand for resilient and adaptive housing solutions. Located in the Vistula Delta, the city’s vulnerability is heightened by its low-lying terrain, polder-based land systems, and extensive waterfronts. These geographic conditions underscore the urgent need for flexible, climate-responsive design strategies that support long-term adaptation while safeguarding the urban fabric and the well-being of local communities. This study provides evidence-based guidance for adaptive housing solutions tailored to Gdańsk’s waterfronts. It draws on successful architectural and urban interventions across the Baltic Sea region, selected for their environmental, social, and cultural relevance, to inform development approaches that strengthen resilience and social cohesion. To achieve this, an exploratory case study methodology was employed, supported by desk research and qualitative content analysis of strategic planning documents, academic literature, and project reports. A structured five-step framework, comprising project identification, document selection, qualitative assessment, data extraction, and analysis, was applied to examine three adaptive housing projects: Hammarby Sjöstad (Stockholm), Kalasataman Huvilat (Helsinki), and Urban Rigger (Copenhagen). Findings indicate measurable differences across nine sustainability indicators (1–5 scale): Hammarby Sjöstad excels in environmental integration (5/5 in carbon reduction and renewable energy), Kalasataman Huvilat demonstrates strong modular and human-scaled adaptability (3–5/5 across social and housing flexibility), and Urban Rigger leads in climate adaptability and material efficiency (4–5/5). Key adaptive measures include flexible spatial design, integrated environmental management, and community engagement. The study concludes with practical recommendations for local planning guidelines. The guidelines developed through the Gdańsk case study show strong potential for broader application in cities facing similar challenges. Although rooted in Gdańsk’s specific conditions, the model’s principles are transferable and adaptable, making the framework relevant to water sensitivity, flexible housing, and inclusive, resilient urban strategies. It offers transversal value to both urban scholars and practitioners in planning, policy, and community development. Full article

Objectives: This cross-sectional observational and epidemiological study aimed to collect data on the oral health conditions of the prison population in Rio de Janeiro, Brazil. Methods: The Penitentiary Moniz Sodré, part of the Penitentiary Complex of Bangu, houses 1385 male inmates of different nationalities. They were divided into groups according to age: Group 1, prisoners aged 18 to 27 years; Group 2, from 28 to 37 years; Group 3, from 38 to 47 years; and Group 4, from 48 and older. A survey was performed, and the Decayed, Missing, Filled Teeth (DMFT) index was applied. A statistical analysis was conducted, considering a p-value of less than 0.05 as significant. Then, multiple linear regression was implemented to verify correlations among the studied parameters, to adjust for confounders, and to examine predictors of DMFT scores. Results: The average age was 26.95 ± 6.72 years, with 57.7% smokers (n = 720) and 7.7% (n = 96) former smokers. Lung diseases were also relatively common (20.9%). The most frequently reported oral issue was bleeding on probing (37.7%, n = 470), with 100% presenting visible dental plaque and 71.3% dental calculus. Oral hygiene habits showed moderate adherence, with 20.1% brushing their teeth at least once daily and 20.3% flossing; however, only 10.3% reported using fluoride mouthwash. The average DMFT score progressively increased across age groups: Group 1 (age: 18–27): 6.89; Group 2 (age: 28–37): 10.87; Group 3 (age: 38–47): 16; and Group 4 (age ≥ 48): 22.5 (p < 0.0001). Decayed (D) teeth scores showed a moderate increase: Group 1: 2.94 ± 2.74; Group 2: 3.38 ± 2.65; Group 3: 3.11 ± 2.56; Group 4: 3.75 ± 3.1 (p = 0.0029). Missing (M) teeth scores demonstrated a significant increase with age, from 2.74 (±2.84) in group 1 to 18.12 (±7.71) in group 4 (p < 0.0001), whereas Filled (F) teeth scores were highest in group 3 (mean 1.92 ± 4.13), followed by a decline in the oldest group (mean 0.62 ± 1.18) (p < 0.0001). These findings indicate a strong age-related increase in the total DMFT score, primarily driven by the number of missing teeth. Conclusions: High levels of caries and its sequelae exist, demonstrating a correlation with age, as well as a low level of previous periodontal treatment or intervention. As the treatments performed did not manage to reduce the incidence of caries and periodontal diseases, a high number of extractions were observed in patients in confinement. Full article

This study addresses the critical issue of Food Waste (FW) across the 27 European Union (EU) member states by investigating its correlation with key socio-economic and environmental factors. Utilizing panel data regression with a fixed-effects model, this research controls for inherent country-specific characteristics to isolate the influence of variables, such as GDP per capita, educational attainment, environmental taxes, and economic burden on FW levels. The analysis reveals that FW is shaped by a complex interplay of factors, where economic affluence (GDP per capita) and financial stress (housing cost overburden) both exhibit a positive and statistically significant relationship with increased FW. Conversely, higher educational attainment, particularly at the bachelor’s and master’s degree levels, is strongly associated with reduced FW, emphasizing education’s role in promoting sustainable behavior. Environmental policy variables, including environmental taxes and circular material use, are negatively correlated with waste, suggesting effective indirect reduction. Notably, government support for agriculture demonstrates a positive association with FW, potentially indicating incentives for overproduction. These findings highlight the multidimensional nature of FW in the EU, necessitating comprehensive policy responses that integrate educational initiatives, economic levers, and sustainability-oriented reforms to promote resource-efficient consumption across the continent. By clarifying these relationships, this study contributes to the literature by providing one of the few examples of cross-country, EU-wide panel analyses that jointly consider economic, educational, and policy dimensions of FW. The findings offer practical implications for policymakers, emphasizing that FW reduction requires integrated strategies: strengthening environmental taxation and circularity initiatives, aligning agricultural subsidies with sustainability goals, and expanding educational programs that cultivate food-responsible behavior. Together, these insights support the design of more targeted and evidence-based interventions to reduce FW and promote resource-efficient consumption across the EU. Full article

Over recent decades, planners in the U.S. have increasingly adopted mixed-use projects to reduce automobile dependency and strengthen local community identity, although results remain inconsistent across cities. Urban health and fitness outcomes are shaped by complex interactions between the built environment, socioeconomic factors, and demographic characteristics. This study introduces a Health and Fitness Index (HFI) for 28,758 U.S. ZIP codes, derived from normalized measures of walkability, healthcare facility density, and carbon emissions, to assess spatial disparities in health-supportive environments. Using four modeling approaches—lasso regression, multiple linear regression, decision trees, and k-nearest neighbor classifiers—we evaluated the predictive importance of 15 urban and socioeconomic variables. Multiple linear regression produced the strongest generalization performance (R² = 0.60, RMSE = 0.04). Key positive predictors included occupied housing units, business density, land-use mix, household income, and racial diversity, while income inequality and population density were negatively associated with health outcomes. This study evaluates five statistical formulations (Metropolis Hybrid Models) that incorporate different combinations of walkability, land-use mix, environmental variables, and socioeconomic indicators to test whether relationships between urban form and socioeconomic conditions remain consistent under different variable combinations. In cross-sectional multivariate regression, although mixed-use development in high-density areas is strongly associated with healthcare facilities, these areas tend to serve younger and more racially diverse populations. Decision tree feature importance rankings and clustering profiles highlight structural inequalities across regions, suggesting that enhancing business diversity, land-use integration, and income equity could significantly improve health-supportive urban design. This research provides a data-driven framework for urban planners to identify underserved neighborhoods and develop targeted interventions that promote walkability, accessibility to health infrastructure, and sustainability. It contributes to the growing literature on urban health analytics, integrating machine learning, spatial clustering, and multidimensional urban indicators to advance equitable and resilient city planning. Full article