Search Results (35)

Facilities with high energy demands, such as swimming pools, face escalating costs in electricity and heating, exacerbated by economic instability and fluctuating energy prices. These facilities are often overdesigned to meet extreme peak demands, resulting in higher than necessary energy usage. Therefore, to reduce costs, diversification of heat sources and tailoring their efficiency to meet real-time needs is required. This study analyzes a swimming pool complex in Poland with a sports pool, a recreational pool, an outdoor pool, and a spa bath, comparing the initial design assumptions for the use of heat and electricity with actual consumption data. By incorporating a mix of energy sources, including cogeneration (combined heat and power), gas boilers, district heating, heat pumps, and photovoltaic panels, the system can flexibly adjust to market energy prices. An automated monitoring system continuously monitors energy use, identifies deviations, and helps pinpoint errors, allowing more precise and economical energy management. Detailed reports generated from meter readings enable comparisons with previous usage periods and guide future planning. A balance of energy production with consumption, adjustment of production to match demand, and configuration of equipment operation with defined parameters all contribute to an effective and cost-effective approach to facility energy management. Full article

Using a 3D microscope imaging technique that we pioneered for alpha-track imaging of Solid-State Nuclear Track Detectors (SSNTDs), here, we present results from imaging of neutron-induced recoil proton tracks formed by exposing CR39-based detectors to an ²⁴¹Am(Be) neutron source. Detectors were arranged at zero, thirty, and sixty degrees to the source to assess any variation in the tracks according to source orientation. An Olympus (Olympus Corporation Japan) LEXT laser scanning confocal microscope was used to image the SSNTDs. Depth and cross-sectional size measurements were made on nine tracks, with a median (range) of 3.07 μm in depth (min 0.98 μm to max 8.34 μm), width in plan view of 7.49 μm (min 4.00 μm to 14.89 μm max), and breadth in plan view of 8.41 μm (min 4.17 μm to max 11.80 μm). In this study, we have shown our confocal microscopy approach can successfully image the 3D surface of neutron-induced tracks in SSNTDs; the imaging method thus enables the measurement of track cross-sectional dimensions and depth, as well as the identification of angled tracks. Full article

The aim of the study is to carry out a technical assessment of a Hungarian baths complex, which is a major tourist center with approximately 180,000 visitors per year. The bath complex had been partially closed. Following the partial closure of the spa, a comprehensive survey was carried out, identifying four main problem areas: operational difficulties with the thermal and cold-water wells, outdated water treatment technology, structural damage to the swimming pool and general mechanical deficiencies. Based on these investigations, recommendations were made for a safe and sustainable reopening of the spa, such as the reactivation of the geothermal system, the installation of modern filtration and dosing systems, and the application of energy-efficient and intelligent technologies. Based on the recommendations, the safe, economical, and sustainable reopening of the spa can be achieved, while also providing guidance for the modernization of other spa complexes. A separate section presents detailed development proposals, such as restarting the geothermal system, applying modern water treatment technologies and intelligent control systems, renovating the pool structure, and modernizing the mechanical and electrical systems. These proposals contribute to the modernization of the spa infrastructure and can also provide guidance for solving technical problems in other similar facilities. Full article

Magnetic Resonance Imaging (MRI) services in high-complexity hospitals often suffer from operational inefficiencies, including suboptimal MRI machine utilization, prolonged patient waiting times, and inequitable service delivery across clinical priority levels. Addressing these challenges requires intelligent scheduling strategies capable of dynamically managing patient waitlists based on clinical urgency while optimizing resource allocation. In this study, we propose a novel framework that integrates a digital twin (DT) of the MRI operational environment with a reinforcement learning (RL) agent trained via Deep Q-Networks (DQN). The digital twin simulates realistic hospital dynamics using parameters extracted from a MRI publicly available dataset, modeling patient arrivals, examination durations, MRI machine reliability, and clinical priority stratifications. Our strategy learns policies that maximize MRI machine utilization, minimize average waiting times, and ensure fairness by prioritizing urgent cases in the patient waitlist. Our approach outperforms traditional baselines, achieving a 14.5% increase in MRI machine utilization, a 44.8% reduction in average patient waiting time, and substantial improvements in priority-weighted fairness compared to First-Come-First-Served (FCFS) and static priority heuristics. Our strategy is designed to support hospital deployment, offering scalability, adaptability to dynamic operational conditions, and seamless integration with existing healthcare information systems. By advancing the use of digital twins and reinforcement learning in healthcare operations, our work provides a promising pathway toward optimizing MRI services, improving patient satisfaction, and enhancing clinical outcomes in complex hospital environments. Full article

This article presents a methodological framework for elective surgery scheduling based on the integration of patient-specific Digital Twins (DTs) and reinforcement learning (RL). The proposed approach aims to support the future development of an intelligent e-health platform for dynamic, data-driven prioritization of surgical patients. We generate prioritization scores by modeling clinical, economic, behavioral, and social variables in real time and optimize access through a reinforcement learning engine designed to maximize long-term system performance. The methodology is designed as a modular, transparent, and interoperable digital decision-support architecture aligned with the goals of organizational transformation and equitable healthcare delivery. To validate its potential, we simulate realistic surgical scheduling scenarios using synthetic patient data. Results demonstrate substantial improvements compared withto traditional strategies, including a 55.1% reduction in average wait time, a 41.9% decrease in clinical risk at surgery, a 16.1% increase in OR utilization, and a significant increase in the prioritization of socially vulnerable patients. These findings highlight the value of the proposed framework as a foundation for future smart healthcare platforms that support transparent, adaptive, and ethically aligned decision-making in surgical scheduling. Full article

Objectives: Spondyloarthritis (SpA) is a chronic inflammatory arthritis that mainly affects the sacroiliac joints and spine. Despite effective biological treatments, persistent pain is common in SpA patients, potentially due to central sensitization (CS), a condition of heightened central nervous system responsiveness. The purpose of this study was to investigate the link between disease activity and CS in SpA patients on biological therapy. Patients and Methods: One hundred and twenty SpA patients with at least six months of treatment with biological agents were included in this cross-sectional study. Patients’ demographic, clinical, and functional information were collected. The assessment of CS was conducted using the Central Sensitization Inventory (CSI), whereas disease activity and quality of life were evaluated using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Ankylosing Spondylitis Disease Activity Score (ASDAS)-C-reactive protein (CRP), and Ankylosing Spondylitis Quality of Life (ASQoL). Statistical analyses included correlation assessments and logistic regression to identify predictors of CS. Results: CS (CSI ≥ 40) was present in 40.8% of patients. Disease activity was significantly higher and quality of life was lower in patients with CS. BASDAI and ASQoL scores were strongly correlated with CS (r = 0.774 and r = 0.839, respectively). Logistic regression identified ASQoL and BASDAI scores as independent predictors of CS. ROC curve analysis demonstrated that ASQoL had the highest discriminative ability for predicting CS (AUC = 0.97). Conclusions: CS is significantly associated with higher disease activity and poorer quality of life in SpA patients receiving biological therapy. Incorporating CS assessment into routine clinical practice may enhance our understanding and management of persistent symptoms in SpA, improving patient outcomes. Full article

Seawater is a long-standing remedy against a number of skin or rheumatic conditions since ancient times, now popular in many countries, where spa, thalassotherapy and seawater pools have considerably boomed. Exposure to seawater and sunlight is an essential component of thalassotherapy, defined by any controlled interaction with marine environments and their natural elements, even in the absence of skin applications of algae, sands or muds. Seawater pools therefore offer the opportunity of thalassotherapy to patients unable to go the beach or during the winter months. The evidence from various studies seems to converge on combined exposure to solar radiation and seawater as a more effective approach than irradiation alone or bathing in freshwater followed by irradiation to reduce symptoms of inflammatory skin diseases or rheumatic conditions. An unwanted consequence of chlorine-based treatment of seawater is the formation of disinfection-by-products (DBPs) due to reactions of disinfectants with organic matter of anthropogenic origin released by bathers. Whilst chlorination of freshwater predominantly generates chlorinated DBPs, the prevailing species produced by chlorination of seawater pools are brominated DBPs, reportedly more genotoxic. However, despite greater toxicity of brominated DBPs, there is evidence that DBPs concentration in freshwater pools is significantly higher (probably due to the larger number of users) compared to seawater pools. Containing the number of bathers could therefore reduce the risk of exposure to DBPs in both types of pool. The outdoor location of pools can further contribute to reducing the risk of genotoxicity thanks to volatilization, airborne dispersion and photodegradation of some DBPs. Full article

Borsec is one of the most important mineral water spa resorts in Romania and is also an important mineral water bottling facility. There are several public springs with significant mineral content. The present paper focuses on mineral powder extraction by the drying of water samples collected from springs no. 3, 5, 6, 10, and 11. These springs have a continuous flow being available for everyone who wants to fill a bottle; meanwhile, the rest of the water is discarded into the river. Thus, the dissolved ions such as Ca²⁺, Mg²⁺, Na⁺, and Cl⁻ are wasted. This study aims to investigate the possibility of mineral content extraction as crystalline powder by drying. The dissolved ions’ reaction with carbonic acid generates carbonates which crystallize progressively with the water evaporation. Mineralogical investigation including X-ray diffraction (XRD) and polarized light optical microscopy (POM) reveal that calcite (rhombohedral and pseudo-hexagonal crystals of about 5–25 µm) is the dominant mineral followed by pseudo-dolomite (columnar crystals of about 5–20 µm), aragonite (rhombic and granular crystals of 2.5–15 µm), and natron (prismatic crystals of about 5–20 µm), in addition to small amounts of halite. Scanning electron microscopy (SEM) investigation combined with energy dispersive (EDS) elemental analysis indicates that traces of K are uniformly distributed in the calcite mass and some S traces for springs 3 and 11 are distributed predominantly into the pseudo-dolomite crystals. The crystalline germs precipitate from the supersaturated solution via homogeneous germination and progressively grow. The latest stage is characterized by the formation of a dendritic crust of calcite mixed with halite that embeds the individually grown crystals. The amount of the formed crystals strongly depends on the water’s total dissolved solids (TDS) and salinity: the springs with high TDS and salinity form a large number of crystals and spectacular dendritic crusts such as spring 10 followed by springs 6 and 5. Lower mineralization was observed in springs 3 and 5, which was related with the S traces. Also, it is evident that mineralization is seasonally dependent: the mineral amount was lower in November 2023 than for the samples collected in March 2024. The obtained mineral powder might be used for spa baths or for the electrolytic balance regulation in dietary supplements due to the high calcium and magnesium content. Full article

Objective: This study aimed to establish a correlation between fecal calprotectin levels (FC) and intestinal inflammation in patients with spondyloarthritis without inflammatory bowel disease. Methods: A total of 180 SpA patients were included in the study of them 20.6% required Digital chromoendoscopy (DCE). FC, C-reactive protein (CRP), HLA-B*27 and clinical indices were assessed. Results: Positive fecal calprotectin (PFC) and high fecal calprotectin (HFC) levels were observed in 27.0% and 16.0% of patients, respectively. HFC correlated with a Bath Ankylosing Spondylitis Functional Index (BASFI) score > 4.0 (p = 0.036) and a Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score > 4.0 (p = 0.047). Loss of vascular pattern in the ileum (LVPI) was observed in approximately 70.0% of patients (p = 0.005), which was associated with PFC and abdominal bloating (p = 0.020). LVPI was also linked to microscopic inflammation (p = 0.012) and PFC with abdominal pain (p = 0.007). HFC was significantly associated with alterations in the ileal mucosa (p = 0.009) and LVPI (p = 0.001). Additionally, HFC and diarrhea were associated with LVPI in 27.3% of patients (p = 0.037) and with erosions in the ileum (p = 0.031). Chronic ileal inflammation correlated with HFC (p = 0.015), ASDAS-CRP > 2.1 (p = 0.09), LVPI (p = 0.001), and villous atrophy (p = 0.014). Factorial analysis of mixed data (FAMD) identified significant associations between micro/macroscopic changes in chronic inflammation and HFC (CC = 0.837); increased levels of CRP and microscopic acute inflammation (CC = 0.792); and clinical activity scores of ASDAS-CRP and BASDAI (CC = 0.914). Conlusions: FC levels were significantly elevated in patients with SpA, particularly those with LVPI, suggesting their potential as a valuable biomarker for managing SpA when joint manifestations coincide with ileal villous atrophy. This indicates a shared immune pathway linked to chronic gut damage. Full article

The collection of papers in this Special Issue serves to extend the literature and evidence base for physical literacy (PL) research within child and youth populations. Currently, child and youth populations are increasingly sedentary, resulting in them spending less time engaging in daily physical activity (PA). Physical literacy serves as an attractive concept to help reframe and address physical inactivity and poor health and wellbeing, utilising a different and integrated approach to physical activity, health and wellbeing promotion. The studies presented in this Special Issue respond to previous calls in PL research for further empirical evidence, clarity around PL assessment, the utility of physical literacy with diverse populations including indigenous children and those with disabilities, the application of PL within early years, parental engagement and the role of physical education in the promotion of PL. These studies shed new light on the frontiers of PL research within child and youth populations. Full article

The aim of this paper, and more generally, our project “Impact from the ground” (a multi-stage ongoing project), is to reimagine education so that it transcends the walls and harsh constraints of a “universal one size fits all” education. To achieve this, we propose a framework that will inform the design of a participatory approach to co-create a learning hub (an informal lifelong learning opportunity) with and within the community. To weave this framework, we explore the current landscape of education, looking at the challenges that youth from rural settings face to complete their studies in urban universities, and the difficulties they experience when looking for jobs after having done so. We briefly explain our research project and contextualize it in Kinangop, a small region in the Nyandarua County in Kenya, where we explored the enablers and constraints people face to engage in social innovation. We proceed to imagine an alternative education that is local and organic, with different principles and theories weaved into a, kitambaa in Swahili that serves as the ground for an education intervention that is meaningful, binding, and bonding for the community members. In so doing, we aim to center matters of knowledge production as multi-epistemic conversations, situating those at the margins of epistemic divisions at the center of productive and creative debates. Full article

The strong genetic association between HLA-B*27 and spondyloarthritis (SpA) accounts for about 90% of the susceptibility to axial SpA (axSpA), and the presence of HLA-B*27 is helpful in classifying patients according to the Assessment of SpondyloArthritis International Society (ASAS) classification criteria. However, over the years, other HLA-B alleles have been associated with an increased risk of developing SpA; on this basis, the aim of our study was to describe the demographic, clinical, and radiological characteristics of a cohort of SpA patients who were negative for HLA-B*27. We identified 85 patients with a clinical diagnosis of SpA displaying HLA-B alleles other than HLA-B*27; HLA-B*51 emerged as the most prevalent allele (N = 33, 39%), regardless of the fulfilment of either the axial or the peripheral ASAS criteria. The second most prevalent allele in the full cohort (N = 16, 19%) and in the patients fulfilling either the axial or the peripheral criteria was HLA-B*35. The third most prevalent allele in the full cohort was HLA-B*18 (N = 12, 15%), which was also the second most prevalent allele in the patients fulfilling neither of the two sets of criteria. Overall, the clinical picture was similar across the subgroups fulfilling the different sets of ASAS criteria; however, the patients not fulfilling any ASAS criteria had a higher likelihood of having arthritis compared to the patients fulfilling the axial criteria, whereas the Bath Ankylosing Spondylitis Functional Index was significantly higher in those patients fulfilling the axial criteria compared to those who did not fulfill any criteria. Our results indicate that other HLA alleles, beyond HLA-B*27, could be useful in facilitating SpA diagnosis, particularly in patients with a clinical picture which is consistent with SpA but does not fulfill the ASAS classification criteria. Full article

(1) Background: Physical literacy is increasing in popularity across the world as a concept central to the promotion of lifelong engagement in physical activity across a multitude of sectors. The education sector has embraced physical literacy as a concept worthy of focus. Physical literacy literature is bold in its claim that physical literacy should be the foundation of physical education. The objective of this paper was to understand the value of physical literacy as the goal of physical education through the lens of the capability approach; (2) Positioning: This research adopted a post-qualitative sensibility whereby knowledge is decentered, favoring the inseparability of ethics, ontology, and knowledge (ethico-onto-epistemology); (3) Discussion: Throughout the discussion, traditional humanist examples are extended to include post-humanism perspectives to offer a more holistic and ecological appreciation of the relationship between capabilities, physical literacy, and physical education, using the ten capabilities of life, bodily health, bodily integrity, senses, imagination and thought, emotions, practical reason, affiliation, other species, play, and control over one’s environment; (4) Conclusions: The paper concludes with the recommendation that the capabilities approach offers a valuable framework for the continued justification of physical-literacy-enriched physical education, which, when aligned, can help to shape the opportunities provided for children and young people in support of their holistic development and lifelong engagement in physical activity. Full article

Background: The systemic inflammation response index (SIRI) and systemic immune-inflammation index (SII) have been introduced as inflammatory markers and predictors of poor prognosis in cancer and cardiovascular diseases. An appropriate evaluation of disease activity in spondyloarthritis (SpA) might be challenging. The purpose of this study was to evaluate the usefulness of cellular immune inflammation markers and ultrasound (US) evaluation of entheses and joints in the assessment of disease activity in SpA patients. Methods: This cross-sectional study involved patients with SpA (62 axial SpA, 38 peripheral SpA, pSpA). The clinical data of both tender, swollen joint counts, erythrocyte sedimentation rate, C-reactive protein, white blood cell counts, and disease activity using Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Disease Activity Index for Psoriatic Arthritis (DAPSA), were recorded. The SIRI, SII, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR) were calculated. US examination was performed (22 small joints, Achilles tendon, and plantar aponeurosis for enthesitis). Results: The SII, SIRI, NLR, and PLR were higher, and LMR was lower in patients with high disease activity (BASDAI > 4). Higher SII was observed in pSpA patients with moderate/high disease activity (DAPSA > 14). The SIRI was correlated with clinical and laboratory parameters of disease activity. The SII was correlated with US parameters in pSpA. Higher SII and NLR values were found in patients with signs of activity compared with no activity in the US of peripheral joints. There were no associations with US changes in entheses. Conclusions: The results of this study point to the value of SIRI and SII as biomarkers of disease activity in patients with SpA. The SII was associated with synovitis in the US of the peripheral joints. Full article

Reducing energy costs in Europe is more challenging than before due to extreme price increases. The use of local renewable energy sources is one way to contribute to this effort. In the case of spa resorts, the use of heat from hot springs for therapeutic baths is an option. It is necessary to cool down this thermal mineral water to a temperature acceptable to the human body. However, due to the high mineral content of this water, heavy fouling can be a problem for conventional heat exchangers. The purpose of this study is to identify the suitable cooling technology in terms of required cooling capacity and waste heat recovery capability. The cooling technology was selected on the basis of a literature search. A pilot cooling unit consisting of vacuum cooler and plate heat exchanger was designed and tested in a real spa resort for six months. Both selected technologies have demonstrated the ability to cool thermal mineral water in long-term operation, as well as the possibility to utilize waste heat for domestic hot water heating. However, fouling problems occur in the plate heat exchanger. The vacuum cooler demonstrated greater operational robustness and resistance to encrustation. Full article