Search Results (724)

To ensure stability and transparency in the European logistics sector, in May 2017, the European Commission presented several proposals to change the regulation of the market—in particular, market access, driving and rest periods, and business trips. In the development of this package, several unfavourable decisions were made that go against Lithuanian transport companies, which will have a significant impact on the companies’ finances, as the frequent return of trucks will lead to additional fuel costs and is also in contradiction with the concept of green logistics. Thus, it is essential to study the Mobility Package’s pros and cons and compare researchers’ views. Accordingly, the subject of this article is the impact of the Mobility Package on Lithuanian logistics companies. This article employs various methods, including an analysis of the scientific literature and legislation, statistical data analysis, PEST analysis, and qualitative research based on expert interviews. The results allow us to identify that the content of the Mobility Package is driven by the goal of ensuring equivalent working conditions throughout the EU, which in this case is the most important object of the legal changes. Also, based on the results obtained, it can be stated that Lithuanian logistics companies that want to remain in the market have several solutions they can employ to achieve that goal, and to support their efforts, a competitiveness improvement model for Lithuanian logistics companies has been developed. Full article

Background: Gold mining is a critical part of the industry of Central Asia, contributing significantly to regional economic growth. However, gold production management faces numerous challenges, including adopting innovative technologies such as AI, using improved logistical equipment, resolving supply chain inefficiencies and disruptions, and incorporating modernized waste management and advancements in gold bar processing technologies. This study explores how advanced technologies and improved logistical processes can enhance efficiency and sustainability. Method: This paper examines gold production processes in Kyrgyzstan, a gold-producing country in Central Asia. The case study approach combines qualitative interviews with industry stakeholders and a system dynamics (SD) simulation model to compare current operations with a technology-based scenario. Results: The simulation model shows improved outcomes when innovative technologies are applied to ore processing, waste refinement, and gold bar production. The results also indicate an approximate twenty-five percent reduction in transport time, a thirty percent decrease in equipment downtime, a thirty percent reduction in emissions, and a fifteen percent increase in gold extraction when using artificial intelligence, smart logistics, and regional smelting. Conclusions: The study concludes with recommendations to modernize equipment, localize processing, and invest in digital logistics to support sustainable mining and improve operational performance in Kyrgyzstan’s gold sector. Full article

This study develops a domain-adaptive multimodal RAG (Retrieval-Augmented Generation) system to improve the accuracy and efficiency of technical question answering based on large-scale structured manuals. Using Hyundai Staria maintenance documents as a case study, we extracted text and images from PDF manuals and constructed QA, RAG, and Multi-Turn datasets to reflect realistic troubleshooting scenarios. To overcome limitations of baseline RAG models, we proposed an enhanced architecture that incorporates sentence-level similarity annotations and parameter-efficient fine-tuning via LoRA (Low-Rank Adaptation) using the bLLossom-8B language model and BAAI-bge-m3 embedding model. Experimental results show that the proposed system achieved improvements of 3.0%p in BERTScore, 3.0%p in cosine similarity, and 18.0%p in ROUGE-L compared to existing RAG systems, with notable gains in image-guided response accuracy. A qualitative evaluation by 20 domain experts yielded an average satisfaction score of 4.4 out of 5. This study presents a practical and extensible AI framework for multimodal document understanding, with broad applicability across automotive, industrial, and defense-related technical documentation. Full article

Background: Etiologic diagnosis in suspected viral meningitis is not always achievable, yet it can play a significant role in patient management. Our study aimed to do a comprehensive analysis of current practices regarding etiologic diagnosis in these cases and compare patients with and without known etiologic diagnosis in order to visualize if and how having an etiological diagnosis can impact patient management and/or outcome. Methods and results: We conducted a convergent mixed-methods study. Quantitative data was obtained from 118 patients hospitalized during a one-year period. There were 40.7% (n = 48) cases with unknown etiology. The length of hospitalization was longer in the group with unknown etiology vs. known etiology (12.6 days vs. 9.8 days p = 0.01). Thematic analysis was used for the qualitative approach in order to evaluate physicians’ overall perceptions regarding this subject. Conclusions: Our mixed-methods study shows that while clinicians consider etiologic diagnosis very important, it remains a diagnostic challenge even in modern times. Continued efforts are needed to optimize diagnostic strategies and address existing gaps in the etiologic workup of viral meningitis. There may be overlooked pathogens that have cost-efficient testing methods, like TBEV, that can be introduced in a testing protocol and may enhance patient management and reduce unnecessary hospital stays. Full article

As climate change intensified water scarcity in Southern Europe, tourism-dependent regions such as Portugal’s Algarve faced growing pressure to adapt their water management systems. This study investigated how hotel groups in the Algarve have adopted and communicated water reuse technologies—specifically desalination and greywater recycling—under environmental, institutional, and reputational constraints. A comparative qualitative case study was conducted involving three hotel groups—Vila Vita Parc, Pestana Group, and Vila Galé—selected through purposive sampling based on organizational capacity and technology adoption stage. The analysis was supported by a supplementary mini-case from Mallorca, Spain. Publicly accessible documents, including sustainability reports, media coverage, and policy frameworks, were thematically coded using organizational environmental behavior theory and the OECD Principles on Water Governance. The results demonstrated that (1) higher organizational capacity was associated with greater maturity in water reuse implementation; (2) communication transparency increased alongside technological advancement; and (3) early-stage adopters encountered stronger financial, regulatory, and operational barriers. These findings culminated in the development of the Maturity–Communication–Governance (MCG) Framework, which elucidates how internal resources, stakeholder signaling, and institutional alignment influence sustainable infrastructure uptake. This research offered policy recommendations to scale water reuse in tourism through financial incentives, regulatory simplification, and public–private partnerships. The study contributed to the literature on sustainable tourism and decentralized climate adaptation, aligning with UN Sustainable Development Goals 6.4, 12.6, and 13. Full article

Governance challenges, success factors, and stakeholder dynamics are central to the implementation of Positive Energy District (PED) Labs, which aim to develop energy-positive and sustainable urban areas. In this paper, a qualitative analysis combining expert surveys, participatory workshops with practitioners from the COST Action PED-EU-NET network, and comparative case studies across Europe identifies key barriers, drivers, and stakeholder roles throughout the implementation process. Findings reveal that fragmented regulations, social inertia, and limited financial mechanisms are the main barriers to PED Lab development, while climate change mitigation goals, strong local networks, and supportive policy frameworks are critical drivers. The analysis maps stakeholder engagement across six development phases, showing how leadership shifts between governments, industry, planners, and local communities. PED Labs require intangible assets such as inclusive governance frameworks, education, and trust-building in the early phases, while tangible infrastructures become more relevant in later stages. The conclusions emphasize that robust, inclusive governance is not merely supportive but a key driver of PED Lab success. Adaptive planning, participatory decision-making, and digital coordination tools are essential for overcoming systemic barriers. Scaling PED Labs effectively requires regulatory harmonization and the integration of social and technological innovation to accelerate the transition toward energy-positive, climate-resilient cities. Full article

This exploratory case study examines the alignment between GIS-based displacement models and lived experiences of residents in Salt Lake City, addressing the benefits and limitations of spatial tools in capturing urban displacement complexities. By comparing the Urban Displacement Project’s Estimated Displacement Risk (EDR) model with qualitative interviews from diverse neighborhoods, the research highlights discrepancies between predictive outputs and community narratives. The findings reveal that while GIS models effectively identify displacement hotspots, they often underestimate risks in areas with high homeownership or recent development. Conversely, resident interviews provide valuable insights into emerging displacement pressures that GIS may overlook. This study underscores the importance of integrating spatial analysis with community engagement to produce more equitable land-use planning strategies. The study contributes to urban governance and sustainable development by advocating for policies that prioritize the voices of vulnerable populations, fostering more resilient and inclusive cities. Full article

This study examines the role of public–private partnerships in promoting the sustainable development of travel destinations through a comparative analysis of two emblematic heritage-based hospitality projects: Dar Tantora in Al Ula, Saudi Arabia, and Sextantio Le Grotte della Civita in Matera, Italy. These case studies were analysed through both architectural–urban and economic–legal perspectives to highlight how public–private partnership models can support heritage conservation, community engagement, and responsible tourism development. A mixed-methods approach was employed, combining quantitative indicators—such as projected profitability, tourist volume, and employment—with qualitative insights from interviews with key stakeholders. The analysis reveals that while both models prioritise cultural authenticity and adaptive reuse, they differ significantly in funding structures, legal frameworks, and governance dynamics. Dar Tantora exemplifies a top-down, publicly funded model integrated into Saudi Arabia’s Vision 2030 strategy, whereas Sextantio reflects a bottom-up, private initiative rooted in social enterprise. The findings offer insights into how different public–private partnership configurations can foster sustainable tourism development, depending on local context, institutional frameworks, and strategic goals. The study contributes to the broader discourse on regenerative tourism, architectural conservation, and policy-driven heritage reuse. Full article

Objectives: The aim of this study was to assess the association of diabetes mellitus and its medications with overall response (ORR) and mortality or cancer-specific survival (CSS) in patients with metastatic urothelial cancer receiving enfortumab vedotin monotherapy. Methods: This multicentre retrospective cohort study was designed according to the guidelines for the synthesis of qualitative research (ENTREQ). Eligible patients were adults (≥18) years treated with enfortumab vedotin monotherapy for metastatic urothelial cancer between June 2024 and January 2025. A total of 125 patients were reported across 11 centres. Results: The cohort included 93 males (74.4%) and 32 females (25.6%), with a mean age of 68.3 years (SD 9.3). The primary tumour site was the bladder in 109 (87.2%) cases and the upper tract (UTUC) in 16 (12.8%) cases. Interestingly, medication with metformin was significantly associated with cancer-specific mortality (37.9% versus 77.8%; p = 0.019), while patients with insulin-dependent diabetes mellitus had a significantly better CSS (Log Rank = 0.004). Upon comparing only patients who already had diabetes mellitus and then received anti-diabetic medication, there was a significant association between patients with diabetes mellitus receiving metformin and a worse 3-month ORR (80.0% versus 55.6%; p = 0.039). Regarding the subpopulation of UTUC, cancer-specific mortality was significantly associated with metformin medication (p = 0.033). Conclusions: Despite recent reports that metformin has protective effects in urothelial cancer, our findings suggest that metformin use may be linked to worse responses and survival outcomes in patients treated with enfortumab vedotin monotherapy. Further research, particularly translational research into the underlying diabetic and pharmacologic pathways, is warranted. Full article

This study examines how international mega-events have adapted to post-pandemic conditions, with a focus on sustainability, resilience, and the integration of public health. Employing a qualitative comparative case study design, the analysis spans events such as the Olympic Games, FIFA World Cup, Lollapalooza, and NASCAR’s Chicago Street Race. Drawing on numerous secondary sources, the study explores shifts in infrastructure planning, socio-cultural engagement, marketing strategies, and environmental practices. The findings reveal a pivot toward modular infrastructure, hybrid formats, and community-centered governance. The research contributes to event management theory by highlighting emergent adaptive strategies and offering a framework for more resilient, inclusive, and sustainable mega-event planning. Full article

Circular economy (CE) is a recently introduced concept by the EU and several national governments that aims to reduce the total resources extracted from the environment and limit waste generated by human activities to achieve human well-being and sustainability. This review aims to bring awareness of heritage sites’ role and significance in reducing carbon footprints as a strategy for applying CE and promoting sustainable urban development. This study adopts a qualitative content analysis methodology, selecting academic literature, international case studies, and policy documents based on their relevance to CE principles and heritage conservation. The approach examines the emergence and dissemination of these concepts through published literature, including professional standards and guidelines for valuing and managing heritage sites. Key themes include adaptive re-use strategies, preventive conservation, and policy integration. A comparative reflection on international case studies was conducted to highlight trends, regional variations, and challenges. This review concludes by identifying research gaps and proposing future directions, reinforcing the value of heritage sites as pivotal assets in advancing CE frameworks. This structured synthesis provides a theoretical and practical contribution to integrating circular economy strategies in heritage conservation. Full article

Background and Objectives: Lung cancer represents one of the principal causes of cancer-associated mortality worldwide. Despite the numerous novel therapeutic agents, surgical resection remains, in many cases, the mainstay treatment. A growing body of evidence indicates that the anesthetic technique of choice contributes to perioperative immunosuppression, thus having an impact on cancer recurrence and prognosis. The aim of this systematic review is to provide a thorough summary of the current literature regarding the modulation of the immune response induced by the various anesthetic techniques that are used in lung cancer surgery, with a particular emphasis on cellular immunity. Materials and Methods: PubMed, Scopus, and the Cochrane databases were systematically searched from November 2023 up to March 2024 to identify randomized controlled trials (RCTs) that met the eligibility criteria. Results: A total of seven RCTs were included. Four of the RCTs compared the administration of general anesthesia alone versus general anesthesia combined with epidural anesthesia. The subsequent meta-analysis showed that the combination of general and epidural anesthesia exerted a positive impact on the cell counts of the CD3+ cells (SMD −0.42, 95% Cl −0.70 to −0.13 24 h postoperatively and SMD −0.86 95% Cl −1.48 to −0.23 72 h postoperatively), the CD4+ cells (SMD −0.41 95% Cl −0.69 to −0.12 at the end of surgery and SMD −0.56 95% Cl −0.85 to −0.27 72 h later), and the CD4+/CD8+ ratio (SMD −0.31 95% Cl −0.59 to −0.02 immediately after surgery, SMD −0.50 95% Cl −0.86 to −0.14 24 h postoperatively, and SMD −0.60 95% Cl −0.89 to −0.31 72 h later). The pooled results regarding CD8+ and NK cell counts were inconclusive. The remaining three studies compared volatile-based anesthesia with total intravenous anesthesia (TIVA). Due to disparities between these studies, qualitative analysis was inconclusive, whereas quantitative analysis was not feasible. Conclusions: The supplementation of general anesthesia with epidural anesthesia favorably impacts CD3+ and CD4+ cell counts, as well as the CD4+/CD8+ ratio. The present results and the effects of anesthetic technique on other immune cells must be consolidated with further high-quality studies. Full article

Increasing frequency and severity of urban flooding, driven by climate change and urban population growth, present major challenges. Traditional flood control infrastructure alone cannot fully prevent flood damage, highlighting the need for a comprehensive and multi-dimensional disaster management approach. This study proposes the Flood Risk Index for Building (FRIB)—a building-level assessment framework that integrates vulnerability, hazard, and exposure. FRIB assigns customized risk levels to individual buildings and evaluates the effectiveness of a multi-dimensional method. Compared to traditional indicators like flood depth, FRIB more accurately identifies high-risk areas by incorporating diverse risk factors. It also enables efficient resource allocation by excluding low-risk buildings, focusing efforts on high-risk zones. For example, in a case where 5124 buildings were targeted based on 1 m flood depth, applying FRIB excluded 24 buildings with “low” risk and up to 530 with “high” risk, reducing unnecessary interventions. Moreover, quantitative metrics like entropy and variance showed that as FRIB levels rise, flood depth distributions become more balanced—demonstrating that depth alone does not determine risk. In conclusion, while qualitative labels such as “very low” to “very high” aid intuitive understanding, FRIB’s quantitative, multi-dimensional approach enhances precision in urban flood management. Future research may expand FRIB’s application to varied regions, supporting tailored flood response strategies. Full article

Transverse fetal head position during labor is associated with increased rates of operative deliveries and cesarean sections. Traditional assessment methods rely on digital examination, which can be inaccurate in cases of prolonged labor. Intrapartum ultrasound offers improved diagnostic capabilities, but standardized interpretation frameworks are needed. This study aimed to evaluate the significance of appropriate assessment and management of transverse fetal head position during labor, with particular emphasis on the correlation between geometric parameters and delivery outcomes. Additionally, the investigation analyzed the potential role of Artificial Intelligence Dystocia Algorithm (AIDA) as an innovative decision support system in standardizing diagnostic approaches and optimizing clinical decision-making in cases of fetal malposition. This investigation was conducted as a focused secondary analysis of data originally collected for the development and validation of the Artificial Intelligence Dystocia Algorithm (AIDA). The study examined 66 cases of transverse fetal head position from a cohort of 135 nulliparous women with prolonged second-stage labor across three Italian hospitals. Cases were stratified by Midline Angle (MLA) measurements into classic transverse (≥75°), near-transverse (70–74°), and transitional (60–69°) positions. Four geometric parameters (Angle of Progression, Head–Symphysis Distance, Midline Angle, and Asynclitism Degree) were evaluated using the AIDA classification system. The predictive capabilities of three machine learning algorithms (Support Vector Machine, Random Forest, and Multilayer Perceptron) were assessed, and delivery outcomes were analyzed. The AIDA system successfully categorized labor dystocia into five distinct classes, with strong predictive value for delivery outcomes. A clear gradient of cesarean delivery risk was observed across the spectrum of transverse positions (100%, 93.1%, and 85.7% for near-transverse, classic transverse, and transitional positions, respectively). All cases classified as AIDA Class 4 required cesarean delivery regardless of the specific MLA value. Machine learning algorithms demonstrated high predictive accuracy, with Random Forest achieving 95.5% overall accuracy across the study cohort. The presence of concurrent asynclitism with transverse position was associated with particularly high rates of cesarean delivery. Among the seven cases that achieved vaginal delivery despite transverse positioning, none belonged to the classic transverse positions group, and five (71.4%) exhibited at least one parameter classified as favorable. The integration of artificial intelligence through AIDA as a decision support system, combined with intrapartum ultrasound, offered a promising approach for objective assessment and management of transverse fetal head position. The AIDA classification system’s integration of multiple geometric parameters, with particular emphasis on precise Midline Angle (MLA) measurement in degrees, provided superior predictive capability for delivery outcomes compared to qualitative position assessment alone. This multidimensional approach enabled more personalized and evidence-based management of malpositions during labor, potentially reducing unnecessary interventions while identifying cases where expectant management might be futile. Further prospective studies are needed to validate the predictive capability of this decision support system and its impact on clinical decision-making in real-time labor management. Full article

Urban blue–green space (UBGS) plays a critical role in mitigating the urban heat island (UHI) effect and reducing land surface temperatures (LSTs). However, existing research has not sufficiently explored the optimization of UBGS spatial configurations or their interactions with urban morphology. This study takes New York City as a case and systematically investigates small-scale urban cooling strategies by integrating multiple factors, including adjustments to the blue–green ratio, spatial layouts, vegetation composition, building density, building height, and layout typologies. We utilize multi-source geographic data, including LiDAR derived land cover, OpenStreetMap data, and building footprint data, together with LST data retrieved from Landsat imagery, to develop a prediction model based on generative adversarial networks (GANs). This model can rapidly generate visual LST predictions under various configuration scenarios. This study employs a combination of qualitative and quantitative metrics to evaluate the performance of different model stages, selecting the most accurate model as the final experimental framework. Furthermore, the experimental design strictly controls the study area and pixel allocation, combining manual and automated methods to ensure the comparability of different ratio configurations. The main findings indicate that a blue–green ratio of 3:7 maximizes cooling efficiency; a shrub-to-tree coverage ratio of 2:8 performs best, with tree-dominated configurations outperforming shrub-dominated ones; concentrated linear layouts achieve up to a 10.01% cooling effect; and taller buildings exhibit significantly stronger UBGS cooling performance, with super-tall areas achieving cooling effects approximately 31 percentage points higher than low-rise areas. Courtyard layouts enhance airflow and synergistic cooling effects, whereas compact designs limit the cooling potential of UBGS. This study proposes an innovative application of GANs to address a key research gap in the quantitative optimization of UBGS configurations and provides a methodological reference for sustainable microclimate planning at the neighborhood scale. Full article