Search Results (1,058)

Rapid urbanization, uncoordinated land-use growth, and insufficient integration of public transport have led to severe traffic congestion and declining mobility in Peshawar, Pakistan, even after the implementation of a Bus Rapid Transit (BRT) system. The core research problem addressed in this study is the mismatch between growing travel demand and the limited capacity, coverage, and operational efficiency of the existing urban transport network. This research aims to evaluate the current performance of Peshawar’s transport system and to identify integrated, evidence-based strategies to alleviate congestion and enhance urban mobility. Specifically, the objectives are to assess roadway level of service on major corridors, examine public transport user satisfaction with the BRT system, and propose targeted infrastructure and operational improvements. A mixed-methods approach was employed, combining traffic volume and level-of-service (LOS) analysis, public transport user surveys, and field observations at critical intersections. The findings indicate that several key arterial roads operate at LOS E–F during peak hours, and future traffic projections indicate widespread capacity failures under existing road geometries. Survey results reveal significant dissatisfaction with the BRT system, particularly due to limited spatial coverage, inadequate feeder routes, overcrowding, and excessive travel times. Based on these results, the study proposes integrated interventions, including road widening and auxiliary lanes, geometric and signalized junction improvements, expansion of BRT feeder services, development of new arterial and ring roads, and enhanced pedestrian and parking infrastructure. This study links quantitative traffic performance measures with user-perceived service deficiencies. It provides practical, data-driven guidance for policymakers and planners to support a more efficient, accessible, and sustainable urban transport system in Peshawar. Full article

Background/Objectives: Cervical radiculopathy is a frequent cause of pain, often leading to disability, reduced quality of life, and significant healthcare utilization. Cervical epidural steroid injections are widely used, though safety concerns have been reported. Ultrasound-guided cervical retrolaminar block (RLCB) is a potential alternative. The purpose of this study was to evaluate the long-term clinical trajectory after ultrasound-guided cervical retrolaminar block, including pain outcomes, patient-reported improvement, and the rate of subsequent cervical spine surgery. Methods: This is a retrospective cohort analysis that was conducted at the Pain and Spine Surgery units in a single center. : We included 121 patients with cervical radiculopathy treated between January 2020 and September 2022 (mean age 49.4 ± 11.1 years; 51.2% male). All patients underwent RLCB. s: Primary outcome measures were subsequent cervical decompressive surgery and composite pain response (≥2-point absolute and ≥50% relative NRS reduction). Secondary outcome measures included recurrence, analgesic use, global rating of change (GRC), satisfaction, willingness to repeat, and safety. Baseline data was extracted from records; structured follow-up interviews were conducted at two years. Results: At two years, 9.1% required surgery, and 57.9% achieved composite pain response; 74.4% reported ≥2-point NRS reduction. GRC scores showed improvement (mean 5.0 ± 3.4), with 37% reporting “very much better.” Satisfaction was high, with 70.2% willing to repeat. Pain recurred in 71.1% but persisted in 28.9%. No major complications occurred; minor events were reported in 6.6%. Outcomes were less favorable in patients with pre-injection pain duration ≥1 year. p. Conclusions: In this retrospective cohort, cervical RLCB was associated with sustained patient-reported improvement, high satisfaction, and a 9.1% observed subsequent surgery rate at two years. These findings are hypothesis-generating and require confirmation in prospective controlled studies. Full article

Background/Objectives: Work-related musculoskeletal disorders (WMSDs) and occupational stress substantially affect workforce health and productivity. This systematic review aimed to synthesize evidence regarding the effectiveness of the Pilates method as a biopsychosocial intervention for employees, examining its impact on physical, psychological, and occupational outcomes. Methods: A systematic search was conducted across major electronic databases and search engines (PubMed, Scopus, Web of Science, PEDro, and Google Scholar) following PRISMA 2020 guidelines. The review protocol was prospectively registered in PROSPERO (CRD420261390771). Eligible studies included randomized controlled trials, quasi-experimental, and observational designs involving employees participating in Pilates programs. Outcomes were categorized into three domains: physical health, mental well-being, and occupational performance. Results: Twenty-three studies (n = 1179 participants) met the inclusion criteria. The evidence indicates that Pilates may reduce pain intensity and disability in workers with chronic low back or neck pain, with moderate certainty based on randomized controlled trials. Improvements in psychological outcomes, including anxiety and job-related stress, were also reported, although the certainty of evidence was lower. Occupational benefits included enhanced job satisfaction and, in limited cases, favorable cost-utility findings. Conclusions: Pilates appears to be a feasible multidimensional intervention for workplace health, with potential benefits across physical and psychosocial domains. Further high-quality trials are needed to clarify long-term effects, economic impact, and optimal implementation strategies within occupational settings. Full article

Background/Objectives: Major Depressive Disorder (MDD) is a leading cause of disability, yet physical therapy (PT) is underrepresented in hospital-based psychiatric care. While exercise is a known adjunctive treatment, specific evidence on functional, task-oriented interventions in acute settings remains scarce. This study explored changes in quality of life, depressive symptoms, pain, and self-efficacy in patients with MDD following a specialized hospital-based PT program focused on functional movement and autonomy. Methods: We conducted a prospective pre–post case series in the Short-Stay Psychiatric Unit of the Royo Villanova University Hospital (Zaragoza, Spain). We recruited seven adult patients with MDD via convenience sampling. The intervention consisted of a group-based PT program (two 45 min sessions/week during the hospital stay) utilizing task-oriented functional exercises targeting progressive strength, balance, and motor control designed to enhance self-efficacy through activities of daily living (ADLs), combined with health education. Outcomes included the EQ-5D-3L (quality of life), MADRS (depression), NRS (pain), GSE (self-efficacy), and GCPC-UN-ESU (satisfaction). Results: All seven participants (100%) exhibited a positive upward trend in self-perceived health status via the EQ-VAS (mean increase of 35 points). Six cases (85.7%) showed preliminary positive trends in the anxiety/depression dimension of the EQ-5D-3L, with the mean Single Index Value increasing from 0.310 to 0.683. Reductions in depressive symptom severity were observed in six participants, with several transitioning toward moderate or mild levels. Additionally, four patients reported descriptive reductions in pain intensity and showed favorable shifts in self-efficacy scores. Six participants expressed high satisfaction with the intervention. Conclusions: Integrating a hospital-based functional PT program with standard care may offer preliminary benefits for quality of life and reduce depressive symptoms in MDD patients. These findings suggest that task-oriented PT presents a feasible complementary approach for acute psychiatric admissions, although larger controlled trials are needed to confirm these exploratory results. Full article

Introduction: Currently, there is an ongoing debate regarding the benefits of kinematic alignment (KA) versus mechanical alignment (MA) in total knee arthroplasty (TKA). Robotic-assisted TKA has been shown to improve implant positioning and precision of the KA technique, enabling successful kinematic alignment. However, its impact on early postoperative and functional outcomes remains unclear. This study aims to examine how imageless, table-mounted, robotic-assisted KA-TKA compares with conventional MA-TKA. Methods: Registry data of all primary TKAs using ATTUNE™ cruciate-retaining implants (January 2021–December 2024) performed by a single, experienced surgeon in a high-volume arthroplasty center were retrospectively reviewed. A total of 64 patients who underwent robotic-assisted KA-TKA were compared to 39 patients who underwent conventional MA-TKA. The mean age was 70.3 ± 7.71 and 69.3 ± 9.47 in the KA-TKA group and the MA-TKA group, respectively, while the male proportion was 32.8% and 30.7%, respectively. Early postoperative outcomes (static/dynamic pain score, ambulation distance, length of stay) and 6-month functional outcomes (range of motion, Knee Society Score, Oxford Knee Score, SF-36, patient expectation/satisfaction scores) were analyzed. Delta changes in outcome scores and proportion of patients attaining a minimum clinically important difference (MCID) were studied. Results: Robotic-assisted KA-TKA displayed benefits in the majority of the early postoperative outcomes, with significant improvements in ambulation distance (23.3 vs. 14.7 m, p = 0.002) compared to conventional MA-TKA. Both groups showed significant improvements in the majority of the functional outcomes at 6 months. Robotic-assisted KA-TKA also shows significant improvements in selected mental health aspects of SF-36, namely vitality (p = 0.001), mental health (p = 0.048), mental component summary (MCS) (p = 0.004), and a larger proportion attaining SF-36 vitality MCID (p = 0.045). Following false discovery rate correction for multiple comparisons, postoperative ambulation distance, SF-36 vitality, and MCS remained statistically significant between groups. No significant differences in KSS, OKS, and satisfaction/expectation fulfillment were noted. Conclusions: Robotic-assisted KA-TKA demonstrated early rehabilitation and select mental health-related quality of life improvements compared to conventional MA-TKA. Further studies are needed to examine its long-term clinical outcomes. Full article

Lower limb motor dysfunction caused by stroke severely impacts patients’ quality of life. Existing rehabilitation products tend to prioritize technology over emotional considerations, leading to poor compliance—a critical issue that urgently needs to be addressed in product design. This study explores human-centered design for home-use rehabilitation devices by integrating the Three-Level Theory of Emotional Design (ED), the Analytic Hierarchy Process (AHP), and the Needs–Function–Behavior–Structure (NFBS) model. The study employed AHP to quantify user needs and identify core requirements. It utilized the NFBS model and Jaccard similarity clustering to construct a systematic mapping pathway from needs to structure, categorizing 44 structural components into six major modules. Based on this framework, an iterative optimization strategy encompassing functional configuration, structural optimization, and emotional interaction was proposed and implemented through two rounds of design practice. Through two rounds of iterative design, the expert-rated overall satisfaction score increased from 0.883 to 0.928, with satisfaction scores at the instinctive, behavioral, and reflective levels reaching 0.949, 0.931, and 0.892, respectively. The study demonstrates that the proposed ED-AHP-NFBS integrated model effectively bridges the gap between technical rationality and humanistic care, providing an actionable framework for the human-centered design of home rehabilitation devices. Full article

Background: The White Esthetic Score (WES) is a standardized clinician-reported index that assesses the esthetic quality of a single-tooth restoration by comparison with a natural reference tooth, typically the contralateral tooth. It evaluates five domains: tooth form, crown outline/volume, color (hue/value), surface texture, and translucency/characterization. Each domain is scored from 0 to 2 (major discrepancy, minor discrepancy, no discrepancy), yielding a total score of 0–10; higher scores indicate a closer match. Although developed for single-tooth implant restorations, WES has also been applied to natural teeth and tooth-supported restorations. Methods: This comprehensive review summarizes case-report evidence applying WES to tooth-supported restorations, outlining the concept, scoring method, documentation requirements, and available data on reliability and interpretation. A case illustration is also presented in which a patient received eight anterior veneers; outcomes were assessed using all WES parameters. Results: Published reports support WES as a practical qualitative tool to assess esthetic outcomes in tooth-supported restorations. In the presented case, the veneers achieved a WES of 9, reflecting marked improvement in tooth form, crown outline/volume, color, surface texture, and translucency/characterization. Conclusions: The comprehensive review indicates WES is feasible for routine clinical use in practice, but agreement varies by parameter and improves with standardized photography and examiner calibration; some components show lower inter-rater agreement than simpler soft-tissue indices. Because correlations between WES and patient satisfaction are inconsistent, WES should be complemented with patient-reported outcome measures. Common thresholds consider WES ≥ 6 acceptable. Clinical use for crowns and veneers should emphasize case selection, standardized records, and combined clinician- and patient-centered outcome reporting. Full article

This study examines how aquarium visitors’ perceived restorative environmental attributes influence leisure life satisfaction, positive emotional experience, and visit intention. Drawing on Attention Restoration Theory, aquariums are conceptualized not merely as indoor exhibition facilities but as restorative indoor blue space leisure settings. Using survey data from 452 Korean adults who had visited major aquariums within the previous 12 months, this study employed structural equation modeling and multi-group analysis. The results show that being away, fascination, and compatibility positively affected leisure life satisfaction, while fascination and compatibility significantly enhanced positive emotional experience. Both leisure life satisfaction and positive emotional experience were found to increase visit intention. Multi-group analysis revealed a significant difference only in the relationship between compatibility and positive emotional experience. Specifically, compatibility had a stronger effect on positive emotional experience among repeat visitors. In this study, Attention Restoration Theory is extended to aquarium-based indoor blue space settings, and restorative environmental perceptions are shown to influence and shape visitor responses through both cognitive and affective pathways. Although the outcome variable primarily captures visitors’ intention to revisit and recommend aquariums rather than direct pro-environmental behavior, the findings offer implications for sustainable marine leisure by showing how restorative and emotionally meaningful aquarium experiences can support conservation-oriented communication and longer-term visitor engagement. Practically, the findings suggest that aquarium managers should move beyond short-term price-oriented strategies and design restorative experiences that enhance fascination and compatibility, thereby strengthening emotionally meaningful and longer-term visitor engagement in sustainability-relevant leisure contexts. Full article

Introduction: The ethics of dental care in children are complex and involve the dentist’s approach, the child’s perception, and the parents’ attitudes. Aim: This study aims to analyse children’s experiences, parents’ perceptions, and the dentist’s approach to dental pain in relation to ethical principles, communication, and informed consent. Methodology: This cross-sectional study included 116 paediatric patients, using a semi-structured questionnaire. We assessed demographic data, children’s overall experiences and pain during dental visits, parent–dentist communication, and parents’ ethical approaches to pain management in paediatric patients. Results: The majority of children were informed by their parents about the dental visit (97.4%) and the reason for the visit (94.8%). Communication between the dentist and child during the procedure was the main factor that helped reduce fear (61.2%). Most children reported no pain (45.8%) or only minimal pain (51.8%), with needle puncture being the most commonly reported source of dental pain. Overall, parents demonstrated positive ethical attitudes towards paediatric dental care, high satisfaction with dental services (96.6%), and strong support for the development of legal and written guidelines for pain management in children. Discussion: The ethical framework for children’s pain management in our dental services is well established, resulting in a high level of satisfaction with the care provided and strong trust in dental professionals. Conclusions: This study provides a basis for the promotion of ethical standards for dental procedures in pain management in paediatric patients, and other measures to reduce anxiety and fear should be part of future strategies. Full article

Breast cancer accounts for nearly one in four cancer diagnoses amongst women, with 36–50% of patients electing to undergo post-mastectomy breast reconstruction. Though immediate reconstruction has risen in popularity due to higher patient satisfaction scores, factors such as individual patient anatomy, patient preference, and adjuvant oncologic treatments may preclude this option for some patients. In such circumstances, a delayed approach to reconstruction offers a promising alternative, often offering comparable aesthetic results with lower rates of major complications. Autologous, implant-based, and hybrid reconstructive techniques may all be applied in a delayed setting at a time point clinically distinct from oncologic resection, with each technique carrying unique advantages and risks that must be evaluated in the context of patient-specific factors. By providing an overview of common complications associated with various delayed breast reconstruction modalities, this review seeks to synthesize the current approaches to prevention, management, and treatment of reconstructive obstacles and outcomes to foster shared decision-making, individualized surgical planning, and optimal reconstructive results. Full article

Online hotel reviews provide a major source of information for understanding guest satisfaction, yet rating prediction remains difficult because review text is often short, highly skewed toward positive scores, and affected by inconsistent or repetitive content. This study presents a framework designed to prevent information leakage in hotel rating prediction. The empirical analysis uses 26,675 Booking.com reviews covering 819 hotels. After minimal cleaning, 26,384 reviews are retained and split chronologically before any vectorizer fitting, reliability scoring, or model training. The protocol ensures that the test set is never filtered and that no rating-derived reliability signal is used to construct training features. The study evaluates TF-IDF Ridge baselines, recurrent neural models, and transformer architectures including DistilBERT, BERT, RoBERTa, MobileBERT, and TinyBERT. Evaluation is performed on the same unfiltered chronological test set using MAE, RMSE, $R^2$, rounded rating accuracy, accuracy within one rating point, low score recall, rating group errors, and confusion matrices. DistilBERT achieves the strongest overall performance, with MAE = 0.4370, RMSE = 0.6979, and $R^2=0.8217$, while BiLSTM models show stronger sensitivity to low rating reviews. Additional analyses include language composition auditing, unseen hotel generalization, reliability threshold sensitivity, and forecasting of future hotel rating dynamics across 7-, 30-, 60-, and 90-day horizons. The results show that reliable hotel rating prediction requires both expressive language models and careful evaluation protocols that separate review reliability analysis from filtering based on the target rating. Full article

Chronic kidney disease (CKD) is a rising public health concern in low- and middle-income countries (LMICs), with urban populations disproportionately affected. In Bangladesh, particularly in Dhaka, dialysis services have become essential for CKD management. This study investigates the determinants of revisit intention among adult attendants of dialysis patients in Dhaka, using partial least squares structural equation modeling. A cross-sectional survey was conducted across four major dialysis centers totaling 399 valid responses. A purposive sampling technique was employed to ensure the inclusion of respondents with relevant experience and engagement in dialysis service utilization. Among respondents, over half were male, 43% had primary to higher secondary education, and one-third reported household incomes between BDT 40,001 and 60,000. The largest age group was 45–49 years (32.3%), and nearly 60% selected the facility due to nearness. Reliability and validity metrics met recommended thresholds, and multivariate normality was not assumed (Mardia’s test, p < 0.05). The structural model revealed significant direct effects of cost (β = 0.167, p = 0.003), Perceived trust in healthcare providers (β = 0.252, p < 0.001), and Perceived patient satisfaction (β = 0.422, p < 0.001) on Perceived revisit intention. Dialysis Delivery Service and word of mouth influenced revisit behavior indirectly through Perceived patient satisfaction. All mediation paths were statistically significant and classified as complementary. To improve patient retention, the policymaker should prioritize affordability, perceived trust in healthcare providers, and overall service quality, which together enhance perceived patients’ satisfaction and revisit intention. Full article

Background/Objectives: Deep inferior epigastric perforator (DIEP) flap reconstruction represents the gold standard for autologous breast reconstruction, while profunda artery perforator (PAP) flap reconstruction has developed as a reliable alternative, particularly in patients with low body mass index or inadequate abdominal tissue. Even though several comparative studies have evaluated surgical and patient-reported outcomes between PAP and DIEP flaps, evidence regarding reconstructive timing, oncologic safety, and interactions with adjuvant therapies remains scarce, especially for PAP reconstruction. Methods: A narrative review of the literature was conducted using PubMed. Studies assessing PAP and DIEP flap breast reconstruction were included, with particular focus on surgical outcomes, patient-reported outcomes, reconstructive timing (immediate or delayed reconstruction), oncologic safety, recurrence, and the effects of radiotherapy and chemotherapy. Comparative studies, cohort studies, systematic reviews, and meta-analyses were synthesized through a narrative review. Results: Twenty studies were included. Comparative evidence showed similar flap survival rates and overall patient satisfaction between the two methods, with flap success rates approaching 98–100%. PAP reconstruction was associated with increased donor-site wound complications and, in some studies, increased fat necrosis rates, while long-term patient-reported and aesthetic outcomes remained equivalent between techniques. In contrast to the relatively limited PAP literature, DIEP reconstruction has been widely studied in terms of reconstructive timing and oncologic safety. Current evidence indicates that immediate DIEP reconstruction does not increase the risk of flap loss, major complications, or recurrence in comparison with delayed reconstruction and might optimize early postoperative recovery and patient-reported outcomes. Nevertheless, none of the identified studies directly compared PAP and DIEP reconstruction with respect to immediate versus delayed timing, exposure to radiotherapy or chemotherapy, or long-term oncologic outcomes. Conclusions: PAP flap appears to represent a reliable alternative to DIEP flap reconstruction. However, major gaps in the literature persist involving PAP reconstruction in oncologic and timing-related settings. Future prospective multicenter studies that directly compare PAP and DIEP flaps according to reconstructive timing, exposure to adjuvant therapy, recurrence, and patient-reported outcomes are warranted to establish evidence-based reconstructive strategies for oncologic breast reconstruction. Full article

The Saudi Green Initiative (SGI) represents a major national effort to enhance environmental sustainability and urban livability in Saudi Arabia. Despite its ambitious targets, limited empirical research has evaluated its spatial performance and social impacts. This study assesses the progress of SGI implementation in Riyadh by examining the spatial distribution, accessibility, and equity of urban green spaces (UGS), alongside residents’ perceptions of their quality. A mixed-methods approach was adopted, integrating Geographic Information Systems (GIS)-based spatial analysis with a structured survey of 180 residents. Spatial indicators were evaluated against the World Health Organization (WHO) benchmark of 9 m² per capita and the SGI target of 28 m² per capita. The results reveal that although total green space has increased between 2018 and 2024, its distribution remains uneven, with high-density neighborhoods consistently falling below recommended standards. Survey findings indicate high satisfaction with recreational and environmental benefits, but lower satisfaction with facilities and public engagement. The study highlights that increasing total green space alone does not ensure equitable access and emphasizes the need for population-sensitive planning strategies. These findings provide practical insights for improving the spatial equity and effectiveness of urban greening initiatives and contribute to broader sustainable urban development goals. Full article

Healthcare professionals must acquire and maintain both declarative knowledge and fine psychomotor skills across a wide range of clinical procedures. Human working memory is physiologically limited, and the high cognitive demands of clinical environments frequently contribute to medical errors and adverse events. Intra-individual performance variability—driven by fatigue, stress, and motivation—represents a further challenge that conventional medical safety education has not adequately addressed. According to the World Health Organization, patient harm ranks fourteenth in the global burden of disease, with approximately 10% of hospitalised patients in high-income countries experiencing harm within healthcare facilities. This study reports the design, theoretical rationale, and preliminary outcomes of an augmented reality (AR) glasses system for hands-free, self-directed medical procedural training, developed from a human factors and ergonomics (HFE) perspective. The system integrates a see-through head-mounted display (HMD; Epson Moverio BT-40S), bone-conduction earphones (Shokz OpenComm), and an industrial-grade voice recognition application (NEC Solution Innovators), achieving fully hands-free operation compatible with aseptic technique. Content design is grounded in cognitive load theory (CLT) and the cognitive theory of multimedia learning (CTML), extended by neuroscientific evidence on multisensory integration and memory consolidation. More than 40 procedure-specific modules have been developed in-house at Tokyo University of Technology, spanning airway management, vascular access, respiratory therapy, dialysis, and cardiac support. In a four-year longitudinal survey (virtual reality (VR) simulator; n = 286), major satisfaction items consistently exceeded the scale midpoint. In an AR endotracheal suctioning cohort (n = 38/22), procedural flow understanding was rated 3.95/5.0. A peer-reviewed randomised controlled trial (Clinical Simulation in Nursing, n = 36) demonstrated significantly superior skill improvement (p < 0.001) and learning motivation (p = 0.001) in the AR group versus textbook self-practice. Principal ergonomic limitations of current HMD hardware—excessive weight, narrow field of view, and absence of medical-grade certification—are documented, and AI-based real-time procedural assessment is identified as a priority for the next research phase. Full article