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Search Results (1,259)

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Keywords = universal mobility

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23 pages, 2168 KB  
Article
Course-Oriented Knowledge Service-Based AI Teaching Assistant System for Higher Education Sustainable Development Demand
by Ling Wang, Tingkai Wang, Tie Hua Zhou and Zehuan Liu
Sustainability 2026, 18(2), 807; https://doi.org/10.3390/su18020807 (registering DOI) - 13 Jan 2026
Abstract
With the advancement of artificial intelligence and educational informatization, there is a growing demand for intelligent teaching assistance systems in universities. Focusing on the university “Algorithms” course in the computer science department, this study develops a multi-terminal collaborative knowledge service system, Course-Oriented Knowledge [...] Read more.
With the advancement of artificial intelligence and educational informatization, there is a growing demand for intelligent teaching assistance systems in universities. Focusing on the university “Algorithms” course in the computer science department, this study develops a multi-terminal collaborative knowledge service system, Course-Oriented Knowledge Service–Based AI Teaching Assistant System (CKS-AITAS), which consists of a PC terminal and a mobile terminal, where the PC terminal integrates functions including knowledge graph, semantic retrieval, intelligent question-answering, and knowledge recommendation. While the mobile terminal enables classroom check-in and teaching interaction, thus forming a closed-loop platform for teaching organization, resource acquisition, and knowledge inquiry. For the document retrieval module, paragraph-level semantic modeling of textbook content is conducted using Word2Vec, combined with approximate nearest neighbor indexing, and this module achieves an MRR@10 of 0.641 and an average query time of 0.128 s, balancing accuracy and efficiency; the intelligent question-answering module, based on a self-built course FAQ dataset, is trained via the BERT model to enable question matching and answer retrieval, achieving an accuracy rate of 86.3% and an average response time of 0.31 s. Overall, CKS-AITAS meets the core teaching needs of the course, provides an AI-empowered solution for university teaching, and boasts promising application prospects in facilitating education sustainability. Full article
(This article belongs to the Special Issue Sustainable Digital Education: Innovations in Teaching and Learning)
21 pages, 2308 KB  
Article
Time Efficiency Gains from Bike-Metro Integration: Improving Accessibility and Urban Mobility in Quito
by Nicoletta González-Cancelas, Javier Vaca-Cabrero, Alberto Camarero-Orive and Mariela Macías-Párraga
Future Transp. 2026, 6(1), 16; https://doi.org/10.3390/futuretransp6010016 - 13 Jan 2026
Abstract
This study analyzes the potential impact of integrating bicycles with the Quito Metro transport system to address connectivity barriers and improve urban mobility. Based on data from surveys carried out on students of the Central University, it was identified that a significant percentage [...] Read more.
This study analyzes the potential impact of integrating bicycles with the Quito Metro transport system to address connectivity barriers and improve urban mobility. Based on data from surveys carried out on students of the Central University, it was identified that a significant percentage of users face difficulties in accessing metro stations due to the lack of direct connections with other transport systems. In addition, the time savings by complementing access to the metro with bicycles were evaluated, suggesting that stations such as Quitumbe and Morán Valverde could particularly benefit from this strategy. Recommendations include the implementation of cycling infrastructure, awareness campaigns and integrated fare policies to maximise adoption of the system Full article
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43 pages, 10782 KB  
Article
Nested Learning in Higher Education: Integrating Generative AI, Neuroimaging, and Multimodal Deep Learning for a Sustainable and Innovative Ecosystem
by Rubén Juárez, Antonio Hernández-Fernández, Claudia Barros Camargo and David Molero
Sustainability 2026, 18(2), 656; https://doi.org/10.3390/su18020656 - 8 Jan 2026
Viewed by 156
Abstract
Industry 5.0 challenges higher education to adopt human-centred and sustainable uses of artificial intelligence, yet many current deployments still treat generative AI as a stand-alone tool, neurophysiological sensing as largely laboratory-bound, and governance as an external add-on rather than a design constraint. This [...] Read more.
Industry 5.0 challenges higher education to adopt human-centred and sustainable uses of artificial intelligence, yet many current deployments still treat generative AI as a stand-alone tool, neurophysiological sensing as largely laboratory-bound, and governance as an external add-on rather than a design constraint. This article introduces Nested Learning as a neuro-adaptive ecosystem design in which generative-AI agents, IoT infrastructures and multimodal deep learning orchestrate instructional support while preserving student agency and a “pedagogy of hope”. We report an exploratory two-phase mixed-methods study as an initial empirical illustration. First, a neuro-experimental calibration with 18 undergraduate students used mobile EEG while they interacted with ChatGPT in problem-solving tasks structured as challenge–support–reflection micro-cycles. Second, a field implementation at a university in Madrid involved 380 participants (300 students and 80 lecturers), embedding the Nested Learning ecosystem into regular courses. Data sources included EEG (P300) signals, interaction logs, self-report measures of engagement, self-regulated learning and cognitive safety (with strong internal consistency; α/ω0.82), and open-ended responses capturing emotional experience and ethical concerns. In Phase 1, P300 dynamics aligned with key instructional micro-events, providing feasibility evidence that low-cost neuro-adaptive pipelines can be sensitive to pedagogical flow in ecologically relevant tasks. In Phase 2, participants reported high levels of perceived nested support and cognitive safety, and observed associations between perceived Nested Learning, perceived neuro-adaptive adjustments, engagement and self-regulation were moderate to strong (r=0.410.63, p<0.001). Qualitative data converged on themes of clarity, adaptive support and non-punitive error culture, alongside recurring concerns about privacy and cognitive sovereignty. We argue that, under robust ethical, data-protection and sustainability-by-design constraints, Nested Learning can strengthen academic resilience, learner autonomy and human-centred uses of AI in higher education. Full article
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25 pages, 2143 KB  
Article
University Commuters’ Travel Behavior and Route Switching Under Travel Information: Evidence from GPS and Self-Reported Data
by Maria Karatsoli and Eftihia Nathanail
Future Transp. 2026, 6(1), 14; https://doi.org/10.3390/futuretransp6010014 - 8 Jan 2026
Viewed by 88
Abstract
In medium-sized cities, daily travel often follows routine patterns, which may lead to suboptimal route choices. This study examines such trips and evaluates them to assess the influence of travel information. The research is motivated by the growing importance of sustainable urban mobility [...] Read more.
In medium-sized cities, daily travel often follows routine patterns, which may lead to suboptimal route choices. This study examines such trips and evaluates them to assess the influence of travel information. The research is motivated by the growing importance of sustainable urban mobility and the need to address traffic congestion, environmental concerns, and inefficient transportation choices in the city of Volos, Greece. To achieve that, a survey of two phases was performed. First, self-reported and GPS data of an examined group of 96 participants from the University of Thessaly, Volos, Greece, were collected. The data were used to evaluate the daily trips in terms of travel time, cost, and environmental friendliness. Second, a stated preference survey was designed, targeting motorized vehicle users of the examined group. The survey investigated the extent to which shared information on social media can be used to recommend a different route than the usual one or convince them to shift to a sustainable way of transportation. The analysis shows that travelers are more inclined to accept the recommended route after receiving travel information; however, this effect does not translate into choosing a sustainable mode of transport. We also found that women are more likely to change routes than men. Full article
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19 pages, 262 KB  
Article
Integrating Ukrainian Students in Romanian Higher Education: Qualitative Insights from the EIUS Erasmus+ Project
by Maria Alina Caratas and Tanase Tasente
Educ. Sci. 2026, 16(1), 91; https://doi.org/10.3390/educsci16010091 - 8 Jan 2026
Viewed by 164
Abstract
Russia’s 2022 invasion precipitated one of Europe’s largest episodes of forced academic mobility, compelling universities to shift from emergency access to durable inclusion. This article investigates how Ukrainian students are integrated into Romanian higher education through a qualitative case study at Ovidius University [...] Read more.
Russia’s 2022 invasion precipitated one of Europe’s largest episodes of forced academic mobility, compelling universities to shift from emergency access to durable inclusion. This article investigates how Ukrainian students are integrated into Romanian higher education through a qualitative case study at Ovidius University of Constanta, undertaken within the Erasmus+ EIUS project. We analysed a participatory focus-group workshop (“Building Bridges,” May 2024) involving 72 participants (15 Ukrainian students, 31 Romanian students, 26 academic staff). Transcripts were coded via reflexive thematic analysis and interpreted through a SWOT lens to connect lived experience with institutional strategy. Findings indicate that integration generates tangible pedagogical and social value—diversity enriches coursework, empathy strengthens peer collaboration, and exposure to multilingual classrooms catalyses instructional innovation. Yet systemic fragilities persist: language anxiety (“translation silence”), fragmented support pathways, and limited access to counselling shift emotional labour onto faculty and peers. Opportunities cluster around Erasmus+ infrastructures, bilingual materials, and co-created projects that transform access into participation; threats include latent prejudice, social isolation, compassion fatigue, and policy discontinuity as crisis attention wanes. We advance the concept of institutionalised solidarity—a multi-level inclusion model that couples emotional infrastructures (mentoring, trauma-informed pedagogy, counselling) with organizational infrastructures (integration offices, linguistic scaffolding, adaptive assessment). The study contributes an empirically grounded framework for moving from humanitarian reaction to sustainable academic inclusion and offers actionable guidance for European universities seeking resilience under protracted disruption. Full article
(This article belongs to the Section Higher Education)
15 pages, 13247 KB  
Article
Volatile Profiling and Variety Discrimination of Leather Using GC-IMS Coupled with Chemometric Analysis
by Lingxia Wang, Siying Li, Xuejun Zhou, Yang Lu, Xiaoqing Wang and Zhenbo Wei
Sensors 2026, 26(2), 382; https://doi.org/10.3390/s26020382 - 7 Jan 2026
Viewed by 89
Abstract
Volatile fingerprint analysis using Gas Chromatography–Ion Mobility Spectrometry (GC-IMS) was applied to differentiate cowhide (22 samples), sheepskin (6 samples), and pigskin (6 samples). A total of 126 signal peaks were detected from the whole GC-IMS dataset, with 96 volatile compounds identified. Principal Component [...] Read more.
Volatile fingerprint analysis using Gas Chromatography–Ion Mobility Spectrometry (GC-IMS) was applied to differentiate cowhide (22 samples), sheepskin (6 samples), and pigskin (6 samples). A total of 126 signal peaks were detected from the whole GC-IMS dataset, with 96 volatile compounds identified. Principal Component Analysis (PCA) revealed distinct clustering: cowhide exhibited unique volatile profiles, separating itself clearly from sheepskin and pigskin, which showed significant similarity. This was confirmed by Hierarchical clustering, K-means clustering (optimal k = 2), and Partial Least Squares Discriminant Analysis (PLS-DA) (R2 = 0.9836, Q2 = 0.9040). Cowhide was characterized by exclusive compounds (2-Hexanone, alpha-Thujene, Butyl acetate, 3-Methyl-2-butanol, 2-Heptanone, Hexyl methyl ether-monomer, Diethyl disulfide). Sheepskin and pigskin shared exclusive compounds (2-Methyl propanol, Isobutyl acetate, 2-Pentyl acetate, 3-Penten-2-one, 2,5-Dimethylfuran). Orthogonal PLS-DA (OPLS-DA) further differentiated sheepskin (Ethyl isobutanoate-dimer, Pentyl acetate-dimer, 3-Methyl-2-butanol, 2-Pentanone, 2-Methylbutanol-dimer, 3-Methyl-1-butanol, 2,5-Dimethylfuran, Propan-2-ol, Ethanol-dimer, and alpha-Thujene) and pigskin (Butan-2-one, Pentanal-dimer, 1-Pentanal-monomer, Ethyl vinyl ether, Z-2-Heptene, and Butyronitrile), identifying alpha-Thujene, 3-Methyl-2-butanol, and 2,5-Dimethylfuran as universal discriminatory markers. GC-IMS coupled with chemometric analysis provides a robust approach for leather authentication. Full article
(This article belongs to the Section Chemical Sensors)
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26 pages, 1294 KB  
Article
Health Benefits of Cycling as a Form of Active Travel: A Pilot Empirical Study
by Mehrnaz Zargarzadeh, Anabela Salgueiro Narciso Ribeiro, Amândio Manuel Cupido Santos and Rafael Nogueira Rodrigues
Int. J. Environ. Res. Public Health 2026, 23(1), 79; https://doi.org/10.3390/ijerph23010079 - 6 Jan 2026
Viewed by 194
Abstract
Integrating physical activity into daily routines through walking and cycling supports health while promoting sustainable mobility. This assumption aligns with SDGs 3, 5 and 11. This study assessed the feasibility and health impacts of cycling within a university setting. As part of the [...] Read more.
Integrating physical activity into daily routines through walking and cycling supports health while promoting sustainable mobility. This assumption aligns with SDGs 3, 5 and 11. This study assessed the feasibility and health impacts of cycling within a university setting. As part of the UCicletas program at Coimbra University, sixteen participants (8 males, 8 females) used conventional or pedal-assist bicycles for eight weeks. Descriptive analyses, t-tests, and Spearman correlations were applied to anthropometric and cardiorespiratory measurements collected before and after the intervention. Weekly cycling distance was obtained through self-reported odometer values. After eight weeks, notable health improvements were observed. Body fat decreased by 1.8% overall, with a significant reduction in females (p < 0.05). VO2max increased by 13.79% in males (p = 0.02) and 12.21% in females (p = 0.03). The Ruffier Index decreased by 18.87% in males (p < 0.05) and 14.73% in females (p = 0.03). Gender differences were evident in correlations: male BMI showed a strong negative association with respiratory recovery (ρ = −0.867, p = 0.005), whereas the female association was weak (ρ = 0.371). Correlations between cycling distance and health outcomes were weak and non-significant. Overall, the findings confirm that modest daily cycling improves health outcomes. Full article
(This article belongs to the Section Exercise and Health-Related Quality of Life)
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15 pages, 1566 KB  
Article
Digital Leisure as a Resource for Environmental Education and Environmental Conservation
by Macarena Esteban Ibañez, Luis Vicente Amador Muñoz and Francisco Mateos Claros
Sustainability 2026, 18(2), 564; https://doi.org/10.3390/su18020564 - 6 Jan 2026
Viewed by 146
Abstract
This study examines patterns of Information and Communication Technology (ICT) use during leisure time among non-university students in the Autonomous Community of Andalusia (Spain) and explores their potential to inform environmental education initiatives. Two research questions guided the study: (1) Which devices and [...] Read more.
This study examines patterns of Information and Communication Technology (ICT) use during leisure time among non-university students in the Autonomous Community of Andalusia (Spain) and explores their potential to inform environmental education initiatives. Two research questions guided the study: (1) Which devices and usage times characterize students’ digital leisure according to gender and educational level? (2) How can these patterns inform the design of contextualized environmental education actions? A cross-sectional quantitative study was conducted using a survey administered to 1251 students enrolled in Primary Education, Compulsory Secondary Education, Upper Secondary Education (Baccalaureate), and Vocational Training in the cities of Seville, Malaga, Cádiz, and Granada. The questionnaire, consisting of 49 items, assessed the use of television, tablets, mobile phones, computers, and video games during leisure time. Data were analysed using descriptive statistics, inferential analysis (ANOVA), and multivariate analysis (MANOVA). The results highlight the central role of the mobile phone as the dominant device across all educational stages, as well as significant age-related differences in the use of television, tablets, and video games. Gender differences were found only in the time devoted to video gaming. The main contribution of this study lies in providing updated empirical evidence on youth digital leisure within a specific geographical context, identifying opportunities to integrate digital resources into environmental education initiatives that are sensitive to educational stage and gender and aligned with sustainability goals. The use of ICTs is proposed to create interactive educational experiences that prepare students to address ecosocial challenges, promote sustainable development, and foster a stronger connection with the natural environment. Full article
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17 pages, 2583 KB  
Article
Transportation and Access to Rural Healthcare in Mt Elias, uMshwathi Municipality
by Babra Duri and Blessing Takawira
Soc. Sci. 2026, 15(1), 26; https://doi.org/10.3390/socsci15010026 - 5 Jan 2026
Viewed by 314
Abstract
Access to healthcare is a crucial factor in achieving health equity. In rural South Africa, geographical isolation and inadequate transportation systems continue to hinder access to healthcare services, despite the existence of progressive national health policies. This study examines the impact of transportation [...] Read more.
Access to healthcare is a crucial factor in achieving health equity. In rural South Africa, geographical isolation and inadequate transportation systems continue to hinder access to healthcare services, despite the existence of progressive national health policies. This study examines the impact of transportation on healthcare access in Mt Elias, uMshwathi Municipality, KwaZulu-Natal. Using a qualitative, exploratory design, semi-structured interviews were conducted with 52 community members. The data were analyzed thematically using ATLAS.ti. The findings reveal several structural barriers, including high transportation costs, long distances to clinics, unreliable ambulance services, poorly maintained roads, and unsafe travel conditions. In Mt. Elias, even when mobile clinics are available, their infrequent visits and fixed locations prevent access for individuals who are sick or those with a disability or living in widely scattered homesteads. Access to healthcare in rural communities is fundamentally shaped by transportation. To achieve universal health coverage, it is essential to improve rural road infrastructure, expand mobile clinic services, subsidize transportation costs, and integrate transportation planning into healthcare policies. Addressing these transportation barriers is not only a matter of service delivery but also of equity, justice, and human rights. Full article
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16 pages, 441 KB  
Article
Effectiveness of a Mobile-Based Self-Regulation Training on Youths’ Affect
by Anouk Aleva, Annemiek Karreman, Loes H. C. Janssen, Anouk Vroegindeweij, Marcel A. G. van Aken, Christel J. Hessels and Odilia M. Laceulle
Healthcare 2026, 14(1), 133; https://doi.org/10.3390/healthcare14010133 - 5 Jan 2026
Viewed by 290
Abstract
Background: The rising prevalence and enduring impact of mental health problems in youth have intensified the call for population-level prevention. Low positive and high negative affect in childhood are vulnerability factors for mental health problems in adolescence. Supporting youth in managing affect during [...] Read more.
Background: The rising prevalence and enduring impact of mental health problems in youth have intensified the call for population-level prevention. Low positive and high negative affect in childhood are vulnerability factors for mental health problems in adolescence. Supporting youth in managing affect during early adolescence may foster mental health preventively. Self-regulation training has shown promise in this regard. Moreover, its parallels with Behavioral Activation (BA) align with the recommendation to adapt evidence-based clinical interventions into scalable, accessible formats for prevention. Methods: This study examined whether a 12-day mobile-based self-regulation training, consistent with BA principles and delivered in an innovative digital format, could increase positive and decrease negative affect in a sample of 156 youths (Mage = 10.0). Results: No significant group differences emerged in affect change over time, and neither baseline levels of self-control nor emotion regulation strategies moderated the effects. Conclusions: The findings suggest that low-intensity mobile-based interventions may be insufficient to produce meaningful affect change in youth. The potential need to shift from universal prevention strategies to more selective approaches targeting at-risk youth is discussed. Full article
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28 pages, 1056 KB  
Article
Resilience or Mirage? Deconstructing the Economic Recovery and Labor Market Structural Lag in Macao’s Tourism Sector
by Jingwen Cai, Chunning Wang, Haoqian Hu, Wai In Ho, Ka Ip Chan and Yifen Yin
Tour. Hosp. 2026, 7(1), 10; https://doi.org/10.3390/tourhosp7010010 - 2 Jan 2026
Viewed by 206
Abstract
This study investigates the deep-seated impacts of the COVID-19 pandemic on Macao, a mono-economy extremely dependent on the single factor of “tourism mobility”. We investigate a counter-intuitive phenomenon observed during the 2020–2022 shock: the Herfindahl–Hirschman Index (HHI) declined significantly, suggesting “apparent diversification”. Using [...] Read more.
This study investigates the deep-seated impacts of the COVID-19 pandemic on Macao, a mono-economy extremely dependent on the single factor of “tourism mobility”. We investigate a counter-intuitive phenomenon observed during the 2020–2022 shock: the Herfindahl–Hirschman Index (HHI) declined significantly, suggesting “apparent diversification”. Using counterfactual simulations and a Two-Way Fixed Effects (TWFE) model, we quantitatively deconstruct this “resilience illusion”. The results confirm that the decline in the HHI was driven entirely by the “denominator effect” triggered by the collapse of the dominant industry’s (gaming) GVA; if the impact of this recession is excluded, the Counterfactual HHI was even higher than pre-pandemic levels, indicating that the structure did not undergo substantive optimization. Furthermore, inferential statistical tests confirmed the existence of significant “structural lag” in the labor market. This study further reveals a dual divergence mechanism based on “skill specificity”: in sectors with high skill universality (e.g., transport and catering), a structural shift toward “workforce casualization” occurred, manifested by a significant decline in the full-time ratio; conversely, in sectors with strong skill specificity (e.g., gaming and hospitality), firms tended toward “labor hoarding”. This study exposes the macro-indicator trap faced by tourism mono-economies under extreme shocks and provides new micro-evidence for understanding the heterogeneous scars in the service labor market. Full article
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24 pages, 1234 KB  
Article
Reimagining Proximity: Operationalising the X-Minute City and Urban Regeneration in Amsterdam and Milan
by Fulvia Pinto and Mina Akhavan
Land 2026, 15(1), 71; https://doi.org/10.3390/land15010071 - 30 Dec 2025
Viewed by 255
Abstract
The study explores the concept of the X-Minute City, an evolution of the 15-min city paradigm, as an operational tool for sustainable urban regeneration in Europe. Starting from the goal of ensuring daily accessibility to key services within 5–20 min on foot or [...] Read more.
The study explores the concept of the X-Minute City, an evolution of the 15-min city paradigm, as an operational tool for sustainable urban regeneration in Europe. Starting from the goal of ensuring daily accessibility to key services within 5–20 min on foot or by bicycle, the research analyses how this proximity model can respond to contemporary environmental, social, and infrastructural challenges. Through a comparative approach between Amsterdam and Milan, chosen for their regulatory and cultural differences, the study combines documentary analysis, urban policy evaluation, and the construction of a grid of multidimensional indicators relating to proximity, sustainable mobility, spatial reuse, and social inclusion. In conceptual terms, the X-Minute City is understood here as a flexible and governance-oriented extension of the 15-min city, in which proximity is treated as an adaptive temporal band (5–20 min) and as an infrastructure of multilevel urban governance rather than a fixed and universal design rule. The findings highlight that in the Netherlands, the model is supported by a coherent and integrated regulatory framework, while in Italy, innovative local experiments and bottom-up participatory practices prevail. The analysis demonstrates that integrating the X-Minute City with multilevel governance tools and inclusive policies can foster more equitable, resilient, and sustainable cities. Finally, the research proposes an adaptable and replicable framework, capable of transforming the X-Minute City from a theoretical vision to an operational infrastructure for 21st-century European urban planning. The limitations of this predominantly qualitative, document-based approach are discussed, together with future directions for integrating spatial accessibility modelling and participatory methods. Full article
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18 pages, 2589 KB  
Article
Global Genomic Landscapes of Lactiplantibacillus plantarum: Universal GABA Biosynthetic Capacity with Strain-Level Functional Diversity
by Monwadee Wonglapsuwan, Thitima Ninrat, Nattarika Chaichana, Thitaporn Dechathai, Sirikan Suwannasin, Kamonnut Singkhamanan, Rattanaruji Pomwised and Komwit Surachat
Life 2026, 16(1), 47; https://doi.org/10.3390/life16010047 - 27 Dec 2025
Viewed by 271
Abstract
Lactiplantibacillus plantarum is widely used in fermented foods and as a probiotic, yet the genomic basis underlying its γ-aminobutyric acid (GABA) production capacity and strain-level functional diversity remains incompletely resolved. We analyzed 1240 publicly available genomes to map species-wide genome architecture, the distribution [...] Read more.
Lactiplantibacillus plantarum is widely used in fermented foods and as a probiotic, yet the genomic basis underlying its γ-aminobutyric acid (GABA) production capacity and strain-level functional diversity remains incompletely resolved. We analyzed 1240 publicly available genomes to map species-wide genome architecture, the distribution of GABA-related genes, and accessory drivers of phenotypes. Pangenome analysis identified 45,201 gene families, including 622 strict core genes (1.38%) and 444 soft-core genes (2.36%). The accessory genome dominated (3138 shell and 40,997 cloud genes; 97.64%), indicating a strongly open pangenome. In contrast, the GABA (gad) operon was universally conserved: gadB (glutamate decarboxylase) and gadC (glutamate/GABA antiporter) were present in all genomes regardless of isolates source. Accessory-genome clustering revealed ecological and geographic structure without loss of the operon, suggesting that phenotypes variability relevant to fermentation and probiotic performance is primarily shaped by accessory modules. Accessory features included carbohydrate uptake and processing islands, bacteriocins and immunity systems, stress- and membrane-associated functions, and plasmid-encoded traits. Analysis of complete genomes confirmed substantial variation in plasmid load (median = 2; range = 0–17), highlighting the role of mobile elements in niche-specific adaptation. Carbohydrate-Active Enzymes database (CAZy) and biosynthetic gene cluster (BGC) profiling revealed a conserved enzymatic and metabolic backbone complemented by rare lineage-specific functions. Collectively, these results position L. plantarum as a genetically stable GABA producer with extensive accessory-encoded flexibility and provide a framework for rational strain selection. Full article
(This article belongs to the Section Microbiology)
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14 pages, 355 KB  
Review
Is There a Body Mass Index Threshold for Patients Undergoing Primary Total Knee Replacement—A Literature Review
by Muhammad Kamran, Mahmoud Abumarzouq and Anant Mahapatra
J. Clin. Med. 2026, 15(1), 103; https://doi.org/10.3390/jcm15010103 - 23 Dec 2025
Viewed by 262
Abstract
Background: Osteoarthritis (OA) is a prevalent degenerative joint disease and a major cause of disability in the aging population. Total knee arthroplasty (TKA) is a common intervention for advanced OA, yet postoperative outcomes may vary, particularly among individuals with obesity. Elevated body mass [...] Read more.
Background: Osteoarthritis (OA) is a prevalent degenerative joint disease and a major cause of disability in the aging population. Total knee arthroplasty (TKA) is a common intervention for advanced OA, yet postoperative outcomes may vary, particularly among individuals with obesity. Elevated body mass index (BMI) is a recognized risk factor for the development and progression of OA and may influence perioperative and postoperative complication rates. Objective: This literature review evaluates whether a specific BMI threshold should guide eligibility for primary TKA, with particular emphasis on the impact of BMI on surgical risk, implant outcomes, and functional recovery. Methods: A systematic search was conducted across PubMed (MEDLINE), Cochrane Library, EMBASE, and Google Scholar to identify peer-reviewed studies from the past two decades examining the relationship between BMI and clinical outcomes following primary TKA. Findings: Higher BMI—especially ≥40 kg/m2—is consistently associated with increased perioperative and postoperative complications, including wound issues, infection, thromboembolic events, longer hospital stay, and higher revision risk. Despite these elevated risks, evidence demonstrates that obese and morbidly obese patients experience substantial improvements in pain, mobility, and function that are comparable in magnitude to those seen in non-obese individuals. The literature does not support a universally applicable BMI cutoff for determining surgical eligibility. Conclusions: BMI is an important modifier of surgical risk but should not be used as an absolute criterion for excluding patients from TKA. Instead, a personalized approach is recommended—one that considers BMI within the context of comorbidities, functional limitation, patient motivation, and opportunities for preoperative optimization. With appropriate patient selection and risk-mitigation strategies, TKA remains a clinically valuable and justified intervention across all BMI categories. Full article
(This article belongs to the Special Issue New Advances in Total Knee Arthroplasty)
13 pages, 1634 KB  
Article
Immediate Postoperative Biofeedback with an Insole Device in Unilateral TKA
by Daniel Pfeufer, Mike B. Anderson, Jeremy Gililland, Robert Hube, Christoph Linhart, Julius Brendler and Christopher E. Pelt
Surgeries 2026, 7(1), 2; https://doi.org/10.3390/surgeries7010002 - 23 Dec 2025
Viewed by 242
Abstract
Background: After unilateral total knee arthroplasty (TKA), patients place more weight on the nonsurgical limb than the surgical limb. The objective of this study was to determine the possibility of providing live biofeedback during early recovery of patients undergoing unilateral TKA and to [...] Read more.
Background: After unilateral total knee arthroplasty (TKA), patients place more weight on the nonsurgical limb than the surgical limb. The objective of this study was to determine the possibility of providing live biofeedback during early recovery of patients undergoing unilateral TKA and to determine the necessary sample size for future trials. Methods: Twenty patients with unilateral TKA were randomized into two groups: a feedback group and a control group. Inclusion criteria included no contralateral knee pain and aid-free walking before surgery. There were 8 patients in the feedback group and 10 in the control group. Compliance with the recommended training was 91%. The feedback group trained with an insole device for 15 min a day for 4 weeks, along with normal physiotherapy. The control group received normal physiotherapy only. Gait parameters were recorded on level ground at two and six weeks. The primary outcome was the percent loading rate. The secondary outcomes included gait speed, cadence, percent peak force, and pain. Results: Patients within the feedback group showed a small, non-significant trend toward a higher precent load rate at 6 weeks compared to the control group in level walking (p = 0.92). Conclusions: Our findings indicate that live biofeedback on a gait parameter, like percent load rate, can be provided by the mentioned system and may support immediate changes in gait parameters. The compliance of 91% with training and no reported adverse events indicates that the system was easy to use. Following TKA, there may be a potential exploratory use of mobile, real-time biofeedback to help address gait abnormalities and accelerate rehabilitation. This clinical trial was registered at clinicaltrials.gov (Identifier: NCT03673293) on 14 September 2018. This study was conducted in accordance with the Declaration of Helsinki and approved by the institutional review board of the University of Utah (IRB_00110935) on 10 September 2018. Full article
(This article belongs to the Special Issue Advances in Total Hip and Knee Arthroplasty)
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