Search Results (339)

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

The transmission of infectious diseases via the use of public restrooms has been previously documented. The goal of this study was to compare bacterial contamination in public vs. household restrooms and, using quantitative microbial risk assessment (QMRA), to assess the probability of infection from fomite contact with selected high-touch sites within the restrooms. Fomite surfaces in four public and four household restrooms were sampled over a period of two months. The public restrooms were in an office building occupied by 80 individuals and were considered moderate usage. The toilet seat, toilet flush handle, countertops, and floor were sampled for heterotrophic, coliform, and Escherichia coli bacteria. The highest numbers of heterotrophic bacteria and coliforms were detected on the countertops, followed by the floor. The greatest numbers of E. coli were recovered from the countertops in the household restroom, but the greatest numbers in the public restroom were recovered from the toilet flush handle. Numbers of heterotrophic bacteria and coliforms were 10 to 100 times greater in household restrooms than in public restrooms. The QMRA suggested that the greatest risk of acquiring a norovirus infection involved the touching of the countertops in household restrooms and the toilet flush handles in public restrooms. Full article

Constipation affects around 30% of children and in 95% of cases is functional (FC), a consequence of alterations in digestive tract peristalsis, modulated by the immune and nervous systems, bile acid metabolism, and the gut microbiota. The aim of this review was to assess the role of gut microbiota and the use of probiotics in children with constipation. The current treatment involves education, toilet training, and oral laxatives, effective in only 50% of patients. In chronic FC, the composition of the microbiota is altered, with increased abundance of Bacteroidetes, Enterobacteriaceae, and Firmicutes and decreases in Prevotella, Bifidobacteria, Faecalibacterium prausnitzii, and Clostridium leptum. Probiotics replenish lacking beneficial resident bacteria, downregulate mucosal inflammation, or produce short-chain fatty acids (SCFAs). Probiotics like Bifidobacterium breve and Bifidobacterium longum increase the defecation frequency and decrease the episodes of both fecal incontinence and abdominal pain. Bifidobacterium animalis subsp. lactis XLTG11 improves the gut microbiota by upregulating SCFA genes and downregulating those related to methane metabolism. Lactobacilli produce organic acids that stimulate bowel peristalsis and augment fecal bolus moisture. The heterogeneity of the current studies involving pediatric subjects thus far hinders the use of probiotics as a standard in the management of children with constipation. Full article

Urban public toilets are essential for improving urban and rural living environments. Traditional evaluations have relied on statistical indicators such as total numbers and network coverage, but have overlooked population demand, limiting their ability to reflect actual service levels and optimize spatial allocation. This study assesses the public toilet service capacity according to spatial accessibility and offers insights into layout optimization. The main urban area of Kunming was considered as the case study. First, the Gaussian two-step floating catchment area (G2SFCA) method was used to calculate public toilet accessibility. The service level of public toilets at the community scale was assessed based on the calculation results. Finally, recommendations for the optimization of the spatial layout of public toilet provision are proposed based on the evaluation findings. Results indicate that (1) 57 communities lacked access to public toilets within a 5 min walk, while only two lacked access within 20 min; all communities had access within 30 min; (2) increasing stalls in old public toilets by 50% would meet the policy requirements for most residents; (3) transportation accessibility has a significant impact on residents’ convenience in accessing public toilets. Areas with lower transportation connectivity tend to have poorer toilet accessibility. The construction of new public toilets near road networks can effectively enhance overall restroom convenience for residents in the study area. By integrating public toilet accessibility with resident restroom demand, this study proposes targeted strategies for optimizing the spatial layout of urban public toilets, offering valuable insights and feasible solutions for improving the scientific and rational allocation of urban public resources. Full article

Water scarcity is a critical issue exacerbated by climate change, urbanization, and population growth, particularly in regions with insufficient water infrastructure. Rainwater harvesting (RWH) systems offer a sustainable solution to mitigate water shortages by collecting and storing rainwater for non-potable uses. This study focuses on the design, efficiency, and reliability of RWH systems in residential environments, with an emphasis on optimizing the sizing of storage volumes and collection areas. Using a behavioural simulation model, we generate nomograms that facilitate the design of RWH systems by analyzing the interactions among storage capacity, collection area, rainfall patterns, and water demand. Specifically, this paper evaluates the effectiveness of RWH systems through efficiency and reliability metrics such as water savings, mains reliance, overflow discharge, and system reliability. The proposed procedure integrates stochastic rainfall and water demand data, including a detailed analysis of toilet usage, in order to simulate the performance of RWH systems across different time scales. Case studies in Italy and Denmark are used to assess the influence of climatic differences on system performance. The findings provide a comprehensive methodology for RWH system design, and offer valuable insights into improving a sustainable water management strategy. Full article

Urban sustainability is closely linked to walkability, as it impacts social interaction, public health, and economic development. In megacities like Riyadh, where automobiles dominate mobility, the development of pedestrian infrastructure remains inadequate. An online survey was conducted through public sampling to evaluate walking conditions in central Riyadh’s commercial districts. The 302 participants evaluated 49 critical walkability indicators to determine their significance and satisfaction with the current conditions. Gap analysis and a displeasure measurement framework identified pedestrian challenges. Participants acknowledged the importance of walkability aspects but expressed strong dissatisfaction with existing conditions. Key barriers to pedestrian comfort included inadequate facilities, environmental discomfort, weak safety measures, and cultural driving preferences. The study highlighted crucial walkability issues requiring improvement, such as public toilets, shaded pathways, air quality, and pedestrian-friendly infrastructure. The findings emphasize the need for targeted policy interventions in Riyadh’s commercial districts to enhance pedestrian accessibility and comfort, to promote urban sustainability through improved walkability. This study offers a methodological advancement by combining Relative Importance Index, gap analysis, and a novel disgruntlement measurement framework to assess walkability. The use of 49 Delphi-derived indicators contextualized within a GCC megacity adds a unique perspective to urban sustainability research. The findings inform both local policy and global urban studies by demonstrating how culturally and climatically adaptive walkability metrics can guide equitable, data-driven interventions. Full article

Vernacular architecture is a complex and living heritage type, and the study of the evolution laws of its spatial form is of great value to the conservation of architectural heritage diversity. Taking vernacular architecture in the Yunnan–Tibet area as the research object, based on the theory of spatial syntax, 30 building samples were subjected to global and local calculations of MD, I_RRA, and NACH values, while the common characteristics among the samples were obtained by using Kendall’s W test, and the individual characteristics among the samples were obtained by using differentiation analysis. The results show that: (a) vernacular architecture in the Yunnan–Tibet area exhibits characteristics of multi-cluster branched centrality and spatial hierarchical layout; (b) these architectures possess four categories of inheritance factors: the privacy of granary spaces, the centrality of corridor spaces, the passability of breeding areas, and the independence of scripture hall spaces; (c) these architectures possess three categories of differentiation factors: the functional evolution of traditional spaces, the spatial reconstruction of breeding areas, and the “Toilet Revolution” driven by multiple forces. This study elucidates the regulatory role of cultural continuity in shaping the spatial forms of vernacular architecture, providing new evidence for analyzing the formation mechanisms of vernacular architecture in the Yunnan–Tibet area. Full article

Background: Client satisfaction with HIV service delivery reflects the ability of healthcare providers to effectively deliver care and treatment that meets the requirements and expectations of clients, and is associated with improved health outcomes, including increased retention in care and HIV viral suppression. The aim of the study was to conduct a client satisfaction study among PLHIV attending a large HIV clinic in Trinidad to identify the gaps in service delivery and factors associated with reduced HIV viral suppression. Methods: This cross-sectional study was conducted over the period April 2023–March 2024 among 362 clients attending the HIV clinic. A structured, pre-tested questionnaire collected demographic data and factors that affected client clinic experiences, including wait time, communication with staff, confidentiality, physical amenities and HIV viral suppression. Multivariable logistic regression was used to assess the likelihood of reporting satisfaction based on key independent variables. Results: Among participants, 219 (60.5%) were females, 202 (55.8%) were aged 30–49 years and 337 (93.1%) were virally suppressed. Participants reported satisfaction with overall care (95.3%), confidentiality (95.9%) and interactions with doctors (96.1%), nurses (98.6%) and other staff. Dissatisfaction was reported with facility-related, elements including the outdoor/tented waiting area (46.1%), the toilet/washrooms (37.0%) and the clinic wait time (31.8%). Participants were less likely to be satisfied with the amount of medication received if they had unsuppressed viral loads (p = 0.035), were aged 20–29 years old (p = 0.048) or had a tertiary education (p = 0.008). Conclusions: The study showed that 93.1% of the study participants were virally suppressed, and there was a general level of satisfaction with the overall care at the clinic, confidentiality and healthcare workers’ service delivery; however, gaps involving the physical facilities, wait times and medication services should be prioritized. Full article

The application of livelihood resilience theory in mining-under village relocation areas, coupled with the assessment of the coupling coordination degree between farming household livelihood resilience and ecological livability, is crucial for advancing sustainable development in mining regions and revitalizing rural communities. To examine whether a synergistic enhancement effect exists between the livelihood resilience and ecological livability of relocated farming households, this study utilizes a dataset of 1027 survey responses from farming households in typical mining-under-relocated villages within the eastern plain mining region of China. A measurement index system for farming household livelihood resilience was developed, encompassing three dimensions: buffering capacity, self-organization capacity, and learning capacity. Simultaneously, an evaluation index system for farming household ecological livability was constructed, focusing on three key dimensions: green production, green living, and green ecology. Using these frameworks, the coupling coordination degree between farming household livelihood resilience and ecological livability, along with its influencing factors, was analyzed. The findings reveal the following: (1) The overall livelihood resilience of relocated farming households in mining-under villages is relatively low, with the ranking being buffering capacity > learning capability > self-organization ability. The central village aggregation model demonstrates significantly greater resilience compared to the mine-village integration model. (2) The ecological livability across different relocation models is generally high, and farming households in the town-dependent village construction model, the central village aggregation model, and the suburban community model exhibit significantly higher ecological livability levels compared to those in the mine-village integration model. (3) The coupling coordination degree between livelihood resilience and ecological livability varies across relocation modes, with most modes demonstrating moderate to high-quality coordination. (4) Leadership potential and the presence of water-flush toilets are the most significant factors influencing the coupling coordination degree between livelihood resilience and ecological livability. This study provides valuable insights into the interplay between livelihood resilience and ecological livability in relocated farming households, offering practical implications for sustainable development and rural revitalization in mining regions. Full article

Restrooms are associated with the transmission of bacterial and viral illnesses. Disinfecting contaminated surfaces is associated with reducing transmission risk. The goal of this study was to determine how cleaning/disinfecting frequency affects restroom pathogen contamination. The Phase 1 intervention included cleaning toilet surfaces (the toilet bowl, water, and rim) using 9.5% w/w hydrochloric acid. The Phase 2 intervention used fomite-specific products to clean/disinfect additional restroom surfaces, including the vanity countertop, sink faucet handle, toilet seat, flush handle, floor, and doorknob. A designated household member was responsible for cleaning/disinfecting surfaces at the beginning of each interval. Fomite sample collection was randomized, and samples were tested for heterotrophic, coliform, and Escherichia coli bacteria after specified intervals: 1, 2, 3, or 7 days. The greatest numbers of bacteria and largest reductions occurred on fomites after three days. A statistically significant difference was found for heterotrophic bacteria (p = 0.009), coliforms (p = 0.10), and E. coli (p = 0.13) with cleaning/disinfecting every three days. A quantitative microbial risk assessment (QMRA) estimated a >98% reduction in risk of infection by norovirus with an every-3-day cleaning/disinfection routine on the most heavily contaminated sites. Results indicate an optimal cleaning frequency of twice weekly for minimizing exposure to pathogens. Full article

Legionella pneumophila (L. pneumophila), the bacteria causing Legionnaires’ disease, a severe pneumonia with high morbidity and mortality globally. The underreporting of this disease is marked particularly in low-income African countries, where data on Legionellosis remains extremely limited. Gauteng, South Africa’s most densely populated province, faces challenges such as rapid urbanisation, limited access to sanitary facilities, and ageing infrastructure, which can compromise drinking water quality by increasing the presence of bacteria within the water distribution systems. Although research on Legionella in South Africa has been conducted, no research has compared its prevalence in urban and rural households in the country. This study examines the presence and distribution of L. pneumophila and amoeba-associated strains in water distribution systems in both urban (Hillbrow and Atteridgeville) and rural (Zandspruit and Melusi) areas in Gauteng province in South Africa. In total, 134 water samples were obtained from tap faucets and storage containers, and 260 biofilm samples were obtained from tap faucets, storage containers, and toilet bowls. Water samples were analysed for Escherichia coli (E. coli) using the IDEXX Colilert^® and for L. pneumophila using the IDEXX Legiolert^TM assay. Both water and biofilm samples were analysed for evidence of amoeba-associated Legionella using the amoeba enrichment technique. The Colilert assay detected total coliforms in 13% of the urban samples and 25% of the rural samples. The Legiolert^TM assay detected L. pneumophila in 52% of urban and 78% of rural samples. Amoeba-associated L. pneumophila was confirmed in 35% of urban samples and 25% in rural samples. The conventional PCR confirmed L. pneumophila in 81% of both urban and rural samples, while real-time PCR detected L. pneumophila in 97% of urban and 100% of rural samples. In total, 111 water and 19 biofilm samples tested positive for the presence of L. pneumophila across the four areas. These results revealed that L. pneumophila is prevalent in both urban and rural water systems in Gauteng. Full article

As physical capabilities decline with age, elderly individuals often require assistance from others when using the toilet. An auxiliary standing toilet chair can enhance convenience for the elderly, allowing them to use the toilet independently. Commercially available auxiliary standing toilet chairs and related patents share common issues, such as seat link rotation angles of less than 45° and a high driving force requirement. This study categorizes four-bar linkages into three design concepts and then carries out a kinematic design process based on the design requirements and constraints of the auxiliary standing toilet chair. Three feasible design examples were developed, followed by motion simulations and driving force analyses using INSPIRE 2019.2 software. In Design Example I, an actuator directly drives the seat link, rotating the seat to 48°. The required driving force for a 150 kg user is reduced from 6070 N to 2258 N, representing a 62.35% reduction in the required force. Full article

Purpose: Urinary incontinence (UI) significantly impacts the quality of life, necessitating a range of treatments, from behavioral changes to surgical interventions. Electromagnetic muscle stimulation (HIFEM™) therapy presents an innovative, non-invasive approach to strengthening pelvic floor muscles (PFMs). Subjects and Methods: This retrospective, non-interventional case series study explores the efficacy and safety of HIFEM™ treatment in parous women experiencing stress (SUI) and mixed urinary incontinence (MUI). Nineteen women (mean age 54 ± 16) underwent six HIFEM™ sessions, with symptom progression tracked using the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF), along with comfort and satisfaction questionnaires. Results: At baseline, the mean ICIQ-UI SF score was 7.9 ± 4.2 points. By the final questionnaire administration, the average score had dropped to 4.7 ± 3.5, reflecting a 50.6% reduction from baseline (p < 0.001). According to ICIQ-UI SF Item 6, 21% of subjects achieved complete continence. Additionally, the percentage of subjects experiencing urine leakage before reaching the toilet declined by 40% after the sixth treatment. Post treatment, the number of subjects who leaked urine while coughing or sneezing decreased by 50%. Conclusions: The treatment has shown high efficacy in lowering the ICIQ-SF scores across the study group, with a significant number of subjects regaining entire continence. Full article

The universalization of basic sanitation remains a challenge. For the development of sanitation infrastructure projects, it is essential to use water consumption data that accurately reflect reality, ensuring greater precision. This study aimed to determine the per capita contribution to fecal sewage (Cp) in six quilombola residences in Goiás (Brazil). The research was conducted in two phases: (a) a literature review on Cp in similar communities (CpL) and (b) the determination of Cp in six residences from different rural communities (CpP), varying in the number of inhabitants (8, 8, 5, 2, 1, and 1 persons in households R1 to R6, respectively). Flow measurements were obtained using a volumetric flowmeter (nominal flow rate of 1.5 m³/h) installed in the water pipeline supplying the toilet(s) of each household. A dearth of Cp data was observed in the literature, particularly for rural areas. Research on this topic remains in its infancy, as evidenced by the small number of publications (nine papers) published between 2006 and 2022, of which 44.4% reported on-site measurements. In the present study, the CpP ranged from 12.10 L/cap.day to 21.79 L/cap.day, with a mean of 16.22 L/cap.day (CV = 0.239). These calculated values lie within the lower (9.9 L/cap.day) and upper (51.5 L/cap.day) ranges reported in the literature. Generally, estimated data are higher than values calculated from flowrate measurements, highlighting the importance of direct measurements—which can also help reduce construction costs. Therefore, it is recommended that flowrate measurements and Cp calculations be expanded to residences with diverse demographic and geographic characteristics, also incorporating meteorological data, to obtain more accurate results. Full article

Saudi Arabia faces rising urban water demand, yet significant regional disparities in daily per capita consumption persist despite uniform national pricing and policies. This study aims to identify the drivers of these disparities across the kingdom’s 13 administrative regions. We analyzed data on water consumption, climate, socio-demographics, property characteristics, environmental awareness, and institutional factors using descriptive statistics and correlations. Results indicate notable consumption variations, with Riyadh and the Eastern Region exhibiting the highest levels, while Asir, Jazan, and Najran exhibit the lowest. Appliance ownership—particularly washing machines (r = 0.75) and Western-style toilets (r = 0.77)—along with access to public water services (r = 0.73), and higher incomes (r = 0.58), positively correlated with increased usage, whereas, younger populations (r = −0.76), reliance on water tanks (r = −0.71), and attitude towards water scarcity (r = −0.69) were associated with lower consumption. Conservation practices showed mixed effects on water use. Overall, regional disparities are primarily driven by property characteristics, environmental awareness, and socioeconomic factors rather than climatic influences. This suggests a need for regionally tailored water policies that complement national standards. Addressing these variations will enable policymakers to design targeted water management strategies that balance consumption needs with water availability. Full article