Search Results (298)

Urban tourism has evolved into a complex adaptive system, where unregulated expansion disrupts the ecological balance and intensifies resource stress. Understanding the dynamic evolution and resilience mechanisms of the tourism ecological health network (TEHN) is essential for supporting sustainable urban tourism as a coupled human–natural system. Using Shanghai as a case study, we applied the "vigor–organization–resilience–services" (VORS) framework to evaluate ecosystem health, which served as a constraint for constructing the TEHN, using the minimum cumulative resistance (MCR) model for the period from 2001 to 2023. A resilience framework integrating structural and functional dimensions was further developed to assess spatiotemporal evolution and guide targeted enhancement strategies. The results indicated that as ecosystem health degraded, particularly in peripheral areas, the urban TEHN in Shanghai shifted from a dispersed to a centralized structure, with limited connectivity in the periphery. The resilience of the TEHN continued to grow, with structural resilience remaining at a high level, while functional resilience still required enhancement. Specifically, the low integration and limited choice between the tourism network and the transportation system hindered tourists from selecting routes with higher ecosystem health indices. Enhancing functional resilience, while sustaining structural resilience, is essential for transforming the TEHN into a multi-centered, multi-level system that promotes efficient connectivity, ecological sustainability, and long-term adaptability. The results contribute to a systems-level understanding of tourism–ecology interactions and support the development of adaptive strategies for balancing network efficiency and environmental integrity. Full article

Background/Objectives: The demand for accessible and reliable digital health services has increased significantly in recent years, particularly in regions facing physician shortages. HomeDOCtor, a conversational AI platform developed in Slovenia, addresses this need with a nationally adapted architecture that combines retrieval-augmented generation (RAG) and a Redis-based vector database of curated medical guidelines. The objective of this study was to assess the performance and impact of HomeDOCtor in providing AI-powered healthcare assistance. Methods: HomeDOCtor is designed for human-centered communication and clinical relevance, supporting multilingual and multimedia citizen inputs while being available 24/7. It was tested using a set of 100 international clinical vignettes and 150 internal medicine exam questions from the University of Ljubljana to validate its clinical performance. Results: During its six-month nationwide deployment, HomeDOCtor received overwhelmingly positive user feedback with minimal criticism, and exceeded initial expectations, especially in light of widespread media narratives warning about the risks of AI. HomeDOCtor autonomously delivered localized, evidence-based guidance, including self-care instructions and referral suggestions, with average response times under three seconds. On international benchmarks, the system achieved ≥95% Top-1 diagnostic accuracy, comparable to leading medical AI platforms, and significantly outperformed stand-alone ChatGPT-4o in the national context (90.7% vs. 80.7%, p = 0.0135). Conclusions: Practically, HomeDOCtor eases the burden on healthcare professionals by providing citizens with 24/7 autonomous, personalized triage and self-care guidance for less complex medical issues, ensuring that these cases are self-managed efficiently. The system also identifies more serious cases that might otherwise be neglected, directing them to professionals for appropriate care. Theoretically, HomeDOCtor demonstrates that domain-specific, nationally adapted large language models can outperform general-purpose models. Methodologically, it offers a framework for integrating GDPR-compliant AI solutions in healthcare. These findings emphasize the value of localization in conversational AI and telemedicine solutions across diverse national contexts. Full article

Trauma-informed care (TIC) is an increasingly implemented approach in human services, but little research documents implementation within veterinary services. This study explored emotional experiences of veterinary clients and the perceived emotions/behaviors of their pets, studied experiences of TIC, and ascertained the extent to which experiences of TIC predicted client outcomes. Clients (N = 274) were surveyed about their experiences of veterinary care. Clients documented positive and negative emotional experiences, with negative emotions associated with more serious presenting issues. TIC was experienced during veterinary visits. Principal component analyses found that TIC fell into the following five factors: (1) transparent and client-centered communication; (2) client supports and strengths; (3) emotional safety and empowerment; (4) physical safety and comfort; (5) informed consent. Hierarchical regressions revealed that, after controlling for reason for the visit, client-reported emotions and pet emotions/behaviors, 53.9% and 56.3% of the variance in client satisfaction and client disappointment was accounted for by TIC practices, respectively. The results show that although the outcomes for pets receiving veterinary care might not always be positive, which can lead to negative emotional experiences for clients, these can be ameliorated and lead to positive client outcomes through utilizing TIC. Full article

This paper reviews the variability of passenger service time (PST) at the platform–train interface (PTI), a critical performance indicator in metro systems shaped by the infrastructure design, affecting passenger behavior and accessibility. Despite its operational importance, PST remains underexplored in relation to crowd management strategies. This review synthesizes findings from empirical and experimental research to clarify the main factors influencing PST and their implications for platform-level interventions. Key contributors to PST variability include door width, gap dimensions, crowd density, and user characteristics such as mobility impairments. Design elements—such as platform edge doors, yellow safety lines, and vertical handrails—affect flow efficiency and spatial dynamics during boarding and alighting. Advanced tracking and simulation tools (e.g., PeTrack and YOLO-based systems) are identified as essential for evaluating pedestrian behavior and supporting Level of Service (LOS) analysis. To complement traditional LOS metrics, the paper introduces Level of Interaction (LOI) and a multidimensional LOS framework that captures spatial conflicts and user interaction zones. Control strategies such as platform signage, seating arrangements, and visual cues are also reviewed, with experimental evidence showing that targeted design interventions can reduce PST by up to 35%. The review highlights a persistent gap between academic knowledge and practical implementation. It calls for greater integration of empirical evidence into policy, infrastructure standards, and operational contracts. Ultimately, it advocates for human-centered, data-informed approaches to PTI planning that enhance efficiency, inclusivity, and resilience in high-demand transit environments. Full article

Forests in the Eastern and Midwestern U.S. have been profoundly affected by human use over the last 150 years, with few old growth forests remaining. Such mature forests may harbor distinct communities and high biodiversity, particularly detritivores and their associated food webs. These communities, however, have been surveyed only rarely in comparisons of diversity and community composition between old and young forests. Here, we compare the mycophilous beetle communities of young and old deciduous forest stands in Southwestern Ohio (U.S.A.). We assess how the abundance and diversity of beetles associated with fungal sporocarps varies with forest age, downed woody debris, and invasive honeysuckle density. We surveyed fungus-associated beetles with baited traps at eight wooded parklands centered around Dayton, Ohio, conducting sampling three times over a growing season. In contrast to expectation, we found no clear effect of forest age on mycophilous beetle communities, but infestation by invasive honeysuckle (Lonicera maackii) negatively affected beetle abundance and diversity. Beetle abundance, richness, and community composition also strongly varied across seasonal sampling periods. Our surveys of mycophilous beetles in a Midwestern U.S. forest represent an initial step toward understanding how these communities are shaped by forest age and invasive species. Such information is crucial in managing forests to preserve biodiversity and ecosystem services. Full article

Logs supplied in Papua New Guinea and Indonesia are predominantly sourced from fast-growing tree species of plantation forests. The timber primarily consists of sapwood, which is highly susceptible to biodeterioration. At a training center, CCA (chromated copper arsenate) is still used for wood preservation, while in the wood industry, ACQ (alkaline copper quaternary) is commonly applied to enhance the service life of timber. In the future, polystyrene impregnation or other non-biocidal treatments could potentially serve this purpose. This study aimed to determine the discoloration and resistance of polystyrene-impregnated and CCA-preserved woods. Wood samples, Anisoptera thurifera and Octomeles sumatrana from Papua New Guinea, and Anthocephalus cadamba and Falcataria moluccana from Indonesia, were used. The wood samples were treated with polystyrene impregnation, CCA preservation, or left untreated, then exposed at the PNG Forest Research Institute site for four months. After treatment, the color change in polystyrene-impregnated wood was minor, whereas CCA-preserved wood exhibited a noticeably different color compared to untreated wood. The average polymer loading for polystyrene-impregnated wood reached 147%, while the average CCA retention was 8.4 kg/m³. Densities of untreated-, polystyrene-, and CCA-wood were 0.42, 0.64, and 0.45 g/cm³, respectively, and moisture contents were 15.8%, 9.4%, and 13.4%, respectively. CCA preservation proved highly effective in preventing termite attacks; however, CCA is hazardous to living organisms, including humans. Polystyrene impregnation also significantly improved wood resistance to subterranean termites, as indicated by lower weight loss and a higher protection level compared to untreated wood. Additionally, polystyrene treatment is nonhazardous and safe for living organisms, making it a promising option for enhancing wood resistance to termite attacks in the future as an alternative to the biocides currently in use. Full article

Agroecological transitions in collective urban gardens in Toulouse region were studied through the prism of global health (2011–2022). The specific meaning of “global health” in the context of urban gardens concerns the health of gardeners (well-being and physical health), plants, soil, and animals, as well as the interactions between humans and non-humans, which are crucial for gardeners. A sociotechnical research project was developed on four different collective gardening sites, consisting of the following: 1. surveys issued to 100 garden stakeholders to highlight issues and practices, participation in meetings with the social centers in charge of events, and focus groups; 2. participative agronomic and environmental measurements and field observations, including soil quality analyses; and 3. analysis of the available documentary corpus. In order to produce the results, these three research methods (surveys, agronomy, document analysis) were combined through a transdisciplinary approach, in that both the field experimentation outcomes and retrieved scientific publications and technical documents informed the discussions with gardeners. Consideration of the four different sites enabled the exploration of various contextual factors—such as soil or air quality—affecting the production of vegetables. A rise in the concerns of gardeners about the impacts of their activities on global health was observed, including aspects such as creating and enjoying landscapes, taking care of the soil and biodiversity, developing social connections through the transmission of practices, and regular outside physical activity and healthier eating. The increased consideration for global health issues by all stakeholders promotes the implementation of agroecological practices in gardens to improve biodiversity and adherence to circular economy principles. Four concepts emerged from the interviews: health, production of vegetables, living soil, and social interactions. Notably, nuances between the studied sites were observed, according to their history, environment, and organization. These collective gardens can thus be considered as accessible laboratories for social and agroecological experimentation, being areas that can strongly contribute to urban ecosystem services. Full article

Tourism offers many economic benefits but can have long-lasting ecological effects when improperly managed. Tourism can cause overwhelming pressure on wastewater treatment systems, as in Belize, where some of the over 400 small islands (cayes) that were once temporary sites for fishermen have become popular tourist destinations. An overabundance of nitrogen, in part as a result of incomplete wastewater treatment, threatens human health and ecosystem services. The tourism industry is a complex and dynamic industry with many sectors and stakeholders with conflicting goals. In this study, a systems thinking approach was adopted to study the dynamic interactions between stakeholders and the environment at Laughing Bird Caye National Park in Belize. The project centered on nutrient discharges from the caye’s onsite wastewater treatment system. An archetype analysis approach was applied to frame potential solutions to nutrient pollution and understand potential behaviors over time. “Out of control” and “Underachievement” were identified as system archetypes; “Shifting the Burden” and ‘‘Limits to Success’’ were used to model specific cases. Based on these results, upgrading of the wastewater treatment system should be performed concurrently with investments in the user experience of the toilets, education on the vulnerability of the treatment system and ecosystem, and controls on the number of daily tourists. Full article

Background and Objectives: Breast reconstruction following mastectomy improves quality of life and psychosocial outcomes, yet it is not consistently performed despite multiple federal mandates. Current data shows decreased reconstruction in minority races, those with a low socioeconomic status, and those holding public health insurance. Many barriers remain misunderstood or unstudied. This study examines barriers to post-mastectomy breast reconstruction to promote a supportive clinical climate by addressing multifactorial obstacles to equitable access to care. Materials and Methods: The California Cancer Registry Data Surveillance, Epidemiology, and End Results (SEER) database and California Health and Human Services Agency Cancer Surgeries Database (2013–2021 and 2000–2021, respectively) were used in this retrospective observational study on mastectomy with immediate breast reconstruction (IBR), delayed breast reconstruction (DBR), or mastectomy only (MO) rates. Data were collected on age, sex, race, insurance type, hospital type, socioeconomic status, and residence. Pearson’s chi-square analysis was performed. Results: We found that 168,494 mastectomy and reconstruction surgeries were performed (82.36% MO, 7% IBR, 10.6% DBR). The 40–49 age group received significantly less MO (38.1%) compared to the 70–74 age group (94.8%, (p = <0.001). Significantly more reconstruction was carried out in patients with private, HMO, or PPO insurance (IBR 75.86%, DBR 75.32%, p = <0.001). Almost all breast surgeries were in urban areas as opposed to rural/isolated rural areas (96.02% vs. 1.55%, p = <0.001). There was no significant difference between races. Of all surgeries, 7.46% were completed in a cancer center with significantly higher rates of IBR. LA County, San Luis Obispo/Ventura County, and Northern CA had significantly more MO than other regions (p = <0.001). Conclusions: Reconstruction rates after mastectomy are low, with only 17.64% of patients undergoing reconstruction. Nationally, 70.5% of patients received MO, with 29.6% undergoing reconstruction. Significant factors positively contributing to reconstruction were private insurance, high SES, cancer center care, and urban residency. Identified barriers include public health insurance enrollment, rural or non-urban residence, older age, low SES, and non-white race/ethnicity, indicating potential monetary influences on care. Full article

Clinical education, traditionally linked to university training in health care, has found a new declination at the Fondazione Policlinico Universitario Campus Bio-Medico (FPUCBM) through a free public service aimed at patients, family members, and caregivers. This innovative approach aims to improve health self-management, promote empowerment, and foster the active involvement of patients in their own care pathway. Based on high-quality and safety certified standards (by the Joint Commission International), FPUCBM has launched structured initiatives such as “education box” events to provide clear and accessible information, addressing patients’ educational and emotional needs. The “health education service” integrates several activities, including single-topic educational events, the creation of information materials (brochures and video tutorials), and collaboration with patient associations. Since its launch in 2023, the service has reached more than 400 participants in 22 events, covering topics such as chronic disease management and prevention and the proper use of home devices. In total, 95 information brochures and 9 video tutorials have been produced to expand the available resources. Benefits include improved health awareness, increased confidence in care pathways, and a positive impact on the hospital’s reputation. In conclusion, it represents a replicable model of person-centered health care that combines human care and educational support to promote more effective and informed disease management while improving the overall patient experience. Full article

The proliferation of digital platforms and interactive technologies has transformed the way service providers engage with their customers, particularly in emerging economies, where digital inclusion is an ongoing process. This study explores the relationship between omnichannel strategies and customer satisfaction, conceptualized here as a proxy for Quality of Experience (QoE), within a smart service station located in a digitally underserved region. Grounded in customer journey theory and the expectancy–disconfirmation paradigm, the study investigates how data integration, digital payment systems, and logistical flexibility—key components of intelligent e-service systems—influence user perceptions and satisfaction. Based on a correlational design with a non-probabilistic sample of 108 customers, the findings reveal a moderate association between overall omnichannel integration and satisfaction (ρ = 0.555, p < 0.01). However, a multiple regression analysis indicates that no individual dimension significantly predicts satisfaction (adjusted R² = 0.002). These results suggest that while users value system integration and interaction flexibility, no single technical feature drives satisfaction independently. The study contributes to the growing field of intelligent human-centric service systems by contextualizing QoE and digital inclusion within emerging markets and by emphasizing the importance of perceptual factors in ICT-enabled environments. Full article

The pressing ecological challenges of the twenty-first century underscore the need for biodiversity protection. The “One Health” approach, which integrates human, animal, and environmental health, has become increasingly vital. This study investigates the relationship between bird species richness, an important indicator of biodiversity, and both all-cause and cause-specific mortality rates in China. This nationwide county-level ecological study combined citizen science bird data from the China Bird Report Center, all-cause and cause-specific mortality rates of 2021 from the National Mortality Surveillance System, and county-level statistics of population characteristics, socio-economics, education, and healthcare services. We employed univariate and multivariate linear regressions to explore the association between bird diversity and mortality rates. Overall, data from 421 counties revealed a negative association between bird species richness and all-cause mortality rates, with a regression coefficient (95% confidence interval) of −0.197 (−0.376, −0.017). This study also found significant negative associations between bird species richness and cause-specific mortality rates for several diseases, such as cardiovascular diseases (including cerebrovascular and ischemic heart diseases) and cancers (including lung cancer). The effects of associations were similar between both genders. Our findings underscore the significance of biodiversity conservation for public health and highlight the importance of integrated environmental and health policies. Full article

Clinical documentation, particularly the hospital discharge report (HDR), is essential for ensuring continuity of care, yet its preparation is time-consuming and places a considerable clinical and administrative burden on healthcare professionals. Recent advancements in Generative Artificial Intelligence (GenAI) and the use of prompt engineering in large language models (LLMs) offer opportunities to automate parts of this process, improving efficiency and documentation quality while reducing administrative workload. This study aims to design a digital system based on LLMs capable of automatically generating HDRs using information from clinical course notes and emergency care reports. The system was developed through iterative cycles, integrating various instruction flows and evaluating five different LLMs combined with prompt engineering strategies and agent-based architectures. Throughout the development, more than 60 discharge reports were generated and assessed, leading to continuous system refinement. In the production phase, 40 pneumology discharge reports were produced, receiving positive feedback from physicians, with an average score of 2.9 out of 4, indicating the system’s usefulness, with only minor edits needed in most cases. The ongoing expansion of the system to additional services and its integration within a hospital electronic system highlights the potential of LLMs, when combined with effective prompt engineering and agent-based architectures, to generate high-quality medical content and provide meaningful support to healthcare professionals. Hospital discharge reports (HDRs) are pivotal for continuity of care but consume substantial clinician time. Generative AI systems based on large language models (LLMs) could streamline this process, provided they deliver accurate, multilingual, and workflow-compatible outputs. We pursued a three-stage, design-science approach. Proof-of-concept: five state-of-the-art LLMs were benchmarked with multi-agent prompting to produce sample HDRs and define the optimal agent structure. Prototype: 60 HDRs spanning six specialties were generated and compared with clinician originals using ROUGE with average scores compatible with specialized news summarizing models in Spanish and Catalan (lower scores). A qualitative audit of 27 HDR pairs showed recurrent divergences in medication dose (56%) and social context (52%). Pilot deployment: The AI-HDR service was embedded in the hospital’s electronic health record. In the pilot, 47 HDRs were autogenerated in real-world settings and reviewed by attending physicians. Missing information and factual errors were flagged in 53% and 47% of drafts, respectively, while written assessments diminished the importance of these errors. An LLM-driven, agent-orchestrated pipeline can safely draft real-world HDRs, cutting administrative overhead while achieving clinician-acceptable quality, not without errors that require human supervision. Future work should refine specialty-specific prompts to curb omissions, add temporal consistency checks to prevent outdated data propagation, and validate time savings and clinical impact in multi-center trials. Full article

(1) Background: The objective of this study was to verify a model proposed adapted to the case of teachers working in the field of early childhood education of children with functional diversity. The model analyses the relationship between the perceptions, use, and necessity of Information and Communication Technologies (ICTs) and the level of ICT training. (2) Methods: Snowball sampling was used to acquire a random sample of 254 in-service teachers working in early childhood education centers including children with functional diversity in Andalusia (Spain). A partial least squares–structural equation model was developed. (3) Results: A positive relationship between teachers’ perceptions of ICTs and their use was found, corroborating the findings of previous studies on pre-service teachers working with students with functional diversity. However, unlike previous studies, no significant relationship was found between ICT use and needs and the level of ICT training. The novelty of this study is that the participants are in-service teachers, the education context is early childhood, and the model includes age as a control variable, which had a negative impact in this case in Spain. (4) Conclusions: The importance of improving teacher training to optimize the use of ICTs is emphasized. The professionals interviewed highlighted the need for early assessments and increased material and human resources in public educational institutions. The urgency of administrative restructuring to expedite the delivery of financial aid and the recruitment of more specialized professionals is underscored. Full article

A humanoid robot has a similar form to humans, allowing it to be deployed directly into many existing infrastructures built for people, making it highly applicable to future industries or services. However, generating motion is challenging, and it is highly affected by disturbances due to its complex dynamic characteristics. This paper proposes a method to enable a biped robot to achieve stable motion in various environments. The capture point (CP) control is used to modify the zero moment point (ZMP) to stabilize the naturally divergent dynamics of the simplified linear inverted pendulum model (LIPM) and a model predictive control (MPC) framework is implemented to generate a center of mass (COM) trajectory that tracks the adjusted ZMP. To minimize angular momentum caused by disturbances and discrepancies between the actual robot and the dynamics model, arm motion is generated through a momentum controller. Various walking simulations were conducted to verify stable whole-body motion. Full article