Search Results (504)

Disparities in primary care access among Medicaid enrollees may be driven by differences in provider acceptance of Medicaid, yet the extent to which primary care provider (PCP) panels reflect the racial and ethnic diversity of local Medicaid populations is unknown. Objectives: To quantify the alignment between the racial/ethnic composition of PCP Medicaid panels and the underlying Medicaid population in their service areas. Methods: We conducted a cross-sectional analysis of 2019 Transformed Medicaid Statistical Information System Analytic Files from 44 states focusing on non-Hispanic White (NHW), non-Hispanic Black (NHB), and Hispanic enrollees. We calculated a panel representation ratio (PRR) for each PCP (physicians, nurse practitioners, and physician associates) as the proportion of a racial/ethnic group in their panel divided by that group’s proportion in the county Medicaid population. PRRs > 1 indicate overrepresentation; PRRs < 1, underrepresentation. Analyses were stratified by provider specialty, rurality, and Health Professional Shortage Area (HPSA) status. Results: The study sample included 372,320 PCPs from the following professions: nurse practitioners (NPs) and physician associates (PAs), along with physicians from the following specialties: family physicians (FPs), internal medicine physicians (IM), obstetrician gynecologists (ObGyn), and pediatricians (Peds). In the full sample, PRR was 1.28 for NHW enrollees, but less than one for NHB (0.98) and Hispanic (0.82) enrollees. Across provider specialties and professions, NHW enrollees were overrepresented in both rural and urban areas. In rural areas, NHB enrollees were overrepresented, but Hispanic enrollees remained underrepresented regardless of Health Professional Shortage Area (HPSA) status. In urban areas, both NHB and Hispanic enrollees were underrepresented in provider panels. Conclusions: Medicaid PCP panels do not reflect the racial/ethnic diversity of local Medicaid populations, particularly for NHB and Hispanic enrollees in urban settings. Efforts to improve equitable access to primary care must address these disparities in provider panel composition. Full article

Background and Objectives: A correct diagnosis of beta-hemolytic group A streptococcus (GAS)-pharyngitis allows the prevention of complications and unnecessary use of antibiotics. The aim of this study was to assess the management of pediatric GAS-pharyngitis in Romanian general practitioners (GPs)’ practice. Material and Methods: a cross-sectional study was conducted using a questionnaire distributed to Romanian GPs. Results: In total, 56 GPs completed the questionnaire, mostly females (83.9%, n = 47) from an urban area (60.7%, n = 34). They treated 5–10 (35.7%) or more than 10 (32.1%) cases of GAS monthly and considered white exudate on tonsils (92.9%, n = 52) to be the most suggestive clinical sign. Of the GPs, 25% (n = 14) used the Centor Criteria, 10.7% (n = 6) performed a rapid antigen detection test, and 42.9% (n = 24) requested throat culture for diagnosis. The younger GPs used the Centor Criteria significantly more often (p = 0.027) than the older ones. Most GPs (69.6%, n = 39) preferred targeted antibiotic therapy. Amoxicillin-clavulanate was the most commonly used antibiotic (55.4%, n = 31). Most GPs preferred oral antibiotics (89%, n = 50) for 10 days (55.4%, n = 31). Conclusions: Antibiotic treatment was initiated mostly based on clinical symptoms and in a short-course therapy. GPs stated that they prefer targeted antibiotic therapy, but they did not use proper diagnostic tools. Full article

Smart living is strongly promoted to enhance the quality of life via the application of innovative solutions, and this is driven by domain specialists and policymakers, including designers, urban planners, computer engineers, and property developers. Nonetheless, the actual user, whose views ought to be considered during the design and development of smart living systems, has received little attention. Thus, this study aims to identify and examine the critical smart functions to achieve smart living in smart buildings based on occupants’ perceptions. The aim is achieved using a sequential quantitative research method involving a literature review and 221 valid survey data gathered from a case of a smart student residence in Hong Kong. The method is further integrated with descriptive statistics, the Kruskal–Walli’s test, and the criticality test. The results were validated via a post-survey with related experts. Twenty-six critical smart functions for smart living were revealed, with the top three including the ability to protect personal data and information privacy, provide real-time safety and security, and the ability to be responsive to users’ needs. A need was discovered to consider the context of buildings during the design of smart living systems, and the recommendation is for professionals to understand the kind of digital technology to be integrated into a building by strongly considering the context of the building and how smart living will be achieved within it based on users’ perceptions. The study provides valuable insights into the occupants’ perceptions of critical smart features/functions for policymakers and practitioners to consider in the construction of smart living systems, specifically students’ smart buildings. This study contributes to knowledge by identifying the critical smart functions to achieve smart living based on occupants’ perceptions of smart living by considering the specific context of a smart student building facility constructed in Hong Kong. Full article

Previous reviews have examined specific facets of Geographic Information Systems (GIS) in transportation planning, such as transit-focused applications and open source geospatial tools. However, this study offers the first systematic, PRISMA-guided longitudinal evaluation of GIS integration in transportation planning, spanning thematic domains, data models, methodologies, and outcomes from 2004 to 2024. This study addresses this gap through a longitudinal analysis of GIS-based transportation research from 2004 to 2024, adhering to PRISMA guidelines. By conducting a mixed-methods analysis of 241 peer-reviewed articles, this study delineates major trends, such as increased emphasis on sustainability, equity, stakeholder involvement, and the incorporation of advanced technologies. Prominent domains include land use–transportation coordination, accessibility, artificial intelligence, real-time monitoring, and policy evaluation. Expanded data sources, such as real-time sensor feeds and 3D models, alongside sophisticated modeling techniques, enable evidence-based, multifaceted decision-making. However, challenges like data limitations, ethical concerns, and the need for specialized expertise persist, particularly in developing regions. Future geospatial innovations should prioritize the responsible adoption of emerging technologies, inclusive capacity building, and environmental justice to foster equitable and efficient transportation systems. This review highlights GIS’s evolution from a supplementary tool to a cornerstone of data-driven, sustainable urban mobility planning, offering insights for researchers, practitioners, and policymakers to advance transportation strategies that align with equity and sustainability goals. Full article

Information and communication technologies (ICTs) are becoming increasingly important for sustainable rural development through the smart village concept. This study aims to model ICT’s potential for public services management in European rural areas. It identifies ICT applications across rural service domains, analyzes how these technologies address specific rural challenges, and evaluates their benefits, implementation barriers, and future prospects for sustainable rural development. A qualitative content analysis method was applied using purposive sampling to analyze 79 peer-reviewed articles from EBSCO and Elsevier databases (2000–2024). A deductive approach employed predefined categories to systematically classify ICT applications across rural public service domains, with data coded according to technology scope, problems addressed, and implementation challenges. The analysis identified 15 ICT application domains (agriculture, healthcare, education, governance, energy, transport, etc.) and 42 key technology categories (Internet of Things, artificial intelligence, blockchain, cloud computing, digital platforms, mobile applications, etc.). These technologies address four fundamental rural challenges: limited service accessibility, inefficient resource management, demographic pressures, and social exclusion. This study provides the first comprehensive systematic categorization of ICT applications in smart villages, establishing a theoretical framework connecting technology deployment with sustainable development dimensions. Findings demonstrate that successful ICT implementation requires integrated urban–rural cooperation, community-centered approaches, and balanced attention to economic, social, and environmental sustainability. The research identifies persistent challenges, including inadequate infrastructure, limited digital competencies, and high implementation costs, providing actionable insights for policymakers and practitioners developing ICT-enabled rural development strategies. Full article

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

Awareness of design when planning public urban spaces assumes particular importance through its mission to meet the diverse needs of the different segments within the community. The elderly is considered one of the pivotal segments, with their influence on strengthening social cohesion, fortifying values, and upholding traditions. On the other hand, such a segment demands special physical, behavioral, and mental requirements that would entail specific consideration in the design process of public common spaces. The study aimed to identify and evaluate the most relevant and important indicators pertaining to the most effective design of an age-friendly public space, with community parks taken as a particular case. The study relies on a mixed approach, combining desk research, expert views, the Delphi technique, and the Analytical Hierarchy Process to achieve that purpose. It resulted in a group of sourced, filtered, and evaluated indicators classified into Physical, Experiential, and Social/Emotional categories, which were evaluated by a mixed representative group of academics, practitioners, governmental officials, and end users, being the elderly or their caretakers. Focus was placed on the central park in the Dahiyat Al-Hussein suburb in Amman, Jordan, which was utilized as a contextual case through which a refined design framework was extracted. This framework serves as a potential base that can be expanded and adapted to create a more generalizable model. Full article

This paper presents a large-scale empirical study aimed at identifying the optimal local deep learning model and data volume for deploying intrusion detection systems (IDS) on resource-constrained IoT devices using federated learning (FL). While previous studies on FL-based IDS for IoT have primarily focused on maximizing accuracy, they often overlook the computational limitations of IoT hardware and the feasibility of local model deployment. In this work, three deep learning architectures—a deep neural network (DNN), a convolutional neural network (CNN), and a hybrid CNN+BiLSTM—are trained using the CICIoT2023 dataset within a federated learning environment simulating up to 150 IoT devices. The study evaluates how detection accuracy, convergence speed, and inference costs (latency and model size) vary across different local data scales and model complexities. Results demonstrate that CNN achieves the best trade-off between detection performance and computational efficiency, reaching ~98% accuracy with low latency and a compact model footprint. The more complex CNN+BiLSTM architecture yields slightly higher accuracy (~99%) at a significantly greater computational cost. Deployment tests on Raspberry Pi 5 devices confirm that all three models can be effectively implemented on real-world IoT edge hardware. These findings offer practical guidance for researchers and practitioners in selecting scalable and lightweight IDS models suitable for real-world federated IoT deployments, supporting secure and efficient anomaly detection in urban IoT networks. Full article

Automated parcel lockers (APLs) are transforming urban last-mile delivery by reducing failed distributions, decoupling delivery from recipient availability, optimizing carrier routes, reducing carbon foot-print and mitigating traffic congestion. The paper investigates the optimal design of APLs systems under stochastic demand and operational constraints, formulating the problem as a resource allocation optimization with service-level guarantees. We proposed a data-driven discrete-event simulation (DES) model implemented in ARENA to (i) determine optimal locker configurations that ensure customer satisfaction under stochastic parcel arrivals and dwell times, (ii) examine utilization patterns and spatial allocation to enhance system operational efficiency, and (iii) characterize inventory dynamics of undelivered parcels and evaluate system resilience. The results show that the configuration of locker types significantly influences the system’s ability to maintain high customers service levels. While flexibility in locker allocation helps manage excess demand in some configurations, it may also create resource competition among parcel types. The heterogeneity of locker utilization gradients underscores that optimal APLs configurations must balance locker units with their size-dependent functional interdependencies. The Dickey–Fuller GLS test further validates that postponed parcels exhibit stationary inventory dynamics, ensuring scalability for logistics operators. As a theoretical contribution, the paper demonstrates how DES combined with time-series econometrics can address APLs capacity planning in city logistics. For practitioners, the study provides a decision-support framework for locker sizing, emphasizing cost–service trade-offs. Full article

Rising temperatures are one of the most severe consequences of climate change, and the built environment plays a significant role in exacerbating heat, particularly in urban areas. In densely populated cities with hot climates, buildings release heat generated from cooling their interiors, contributing to the urban heat island (UHI) effect. Global research actively seeks ways to reduce UHI and promote a more sustainable built environment. Leadership in Energy and Environmental Design (LEED) is among the most widely used sustainability assessment systems. Additionally, digital technologies, especially Building Information Modelling (BIM), are increasingly used to assess and improve energy performance in buildings. While there are frameworks that apply LEED and BIM separately to address UHI strategies, there are potential LEED–BIM integrations which need to be investigated. This study investigates how LEED and BIM can be integrated to support UHI mitigation efforts. A systematic literature review was conducted to examine existing integrations, analyzing trends by publication year, country, and building type. The study identified approximately thirty examples of LEED–BIM integrations supporting ten UHI mitigation strategies. However, it also highlighted underutilized BIM technologies and gaps in addressing certain strategies. The study proposes a framework to help practitioners and policymakers apply LEED–BIM integrations more efficiently, reducing the effort required to implement UHI mitigation strategies while enhancing their practicality and effectiveness. Full article

This study introduces Edible Streets as a distinct and scalable model of community-led urban food growing, specifically investigating the drivers and barriers to the initiative. Unlike traditional urban food-growing initiatives, Edible Streets explores the integration of edible plants into street verges and footpaths with direct community involvement of the people who live/work in a street. This study contributes new knowledge by evaluating Edible Streets through the COM-B model of behavioural change, through policy and governance in addition to behaviour change, and by developing practical frameworks to facilitate its implementation. Focusing on Oxford, the research engaged residents through 17 in-person interviews and 18 online surveys, alongside a stakeholder workshop with 21 policymakers, community leaders, and NGO representatives. Findings revealed strong motivation for Edible Streets, driven by values of sustainability, community resilience, and improved well-being. However, capability barriers, including knowledge gaps in gardening, land-use policies, and food preservation, as well as opportunity constraints related to land access, water availability, and environmental challenges, hindered participation. To address these, a How-to Guide was developed, and a pilot Edible Street project was launched. Future steps include establishing a licensing application model to facilitate urban food growing and conducting a Post-Use Evaluation and Impact Study. Nationally, this model could support Right to Grow policies, while globally, it aligns with climate resilience and food security goals. Locally grown food enhances biodiversity, reduces carbon footprints, and strengthens social cohesion. By tackling key barriers and scaling solutions, this study provides actionable insights for policymakers and practitioners to create resilient, equitable urban food systems. Full article

This study explores modernization strategies for existing district heating (DH) networks to enhance their efficiency and sustainability, focusing on achieving net-zero emissions in urban heating systems. Building upon a literature review and expert interviews, we developed a strategic decision-support framework that outlines distinct strategies for retrofitting district heating grids and includes a portfolio analysis. This framework serves as a tool to guide DH operators and stakeholders in selecting well-founded modernization pathways by considering technical, economic, and social dimensions. The review identifies several promising measures, such as reducing operational temperatures at substations, implementing optimized substations, integrating renewable and waste heat sources, implementing thermal energy storage (TES), deploying smart metering and monitoring infrastructure, and expanding networks while addressing public concerns. Additionally, the review highlights the importance of stakeholder engagement and policy support in successfully implementing these strategies. The developed strategic decision-support framework helps practitioners select a tailored modernization strategy aligned with the local context. Furthermore, the findings show the necessity of adopting a comprehensive approach that combines technical upgrades with robust stakeholder involvement and supportive policy measures to facilitate the transition to sustainable urban heating solutions. For example, the development of decision-support tools enables stakeholders to systematically evaluate and select grid modernization strategies, directly helping to reduce transmission losses and lower greenhouse gas (GHG) emissions contributing to climate goals and enhancing energy security. Indeed, as shown in the reviewed literature, retrofitting high-temperature district heating networks with low-temperature distribution and integrating renewables can lead to near-complete decarbonization of the supplied heat. Additionally, integrating advanced digital technologies, such as smart grid systems, can enhance grid efficiency and enable a greater share of variable renewable energy thus supporting national decarbonization targets. Further investigation could point to the most determining context factors for best choices to improve the sustainability and efficiency of existing DH systems. Full article

Urban regeneration, as a key strategy for promoting sustainable development of urban areas, requires innovative digital technologies to address increasingly complex urban challenges in its implementation. With the fast advancement of digital technologies such as artificial intelligence (AI), Internet of Things (IoT), and big data, these technologies have extensively penetrated various dimensions of urban regeneration, from planning and design to implementation and post-operation management, providing new possibilities for improving urban regeneration efficiency and quality. However, the existing literature lacks a systematic evaluation of technology application patterns across different project scales and phases, comprehensive analysis of stakeholder–technology interactions, and quantitative assessment of technology distribution throughout the urban regeneration lifecycle. This research gap limits the in-depth understanding of how digital technologies can better support urban regeneration practices. This study aims to identify and quantify digital technology application patterns across urban regeneration stages, scales, and stakeholder configurations through systematic analysis of 56 high-quality articles from the Scopus and Web of Science databases. Using a mixed-methods approach combining a systematic literature review, bibliometric analysis, and meta-analysis, we categorized seven major digital technology types and analyzed their distribution patterns. Key findings reveal distinct temporal patterns: GIS and BIM/CIM technologies dominate in the pre-urban regeneration (Pre-UR) stage (10% and 12% application proportions, respectively). GIS applications increase significantly to 14% in post-urban regeneration (Post-UR) stage, while AI technology remains underutilized across all phases (2% in Pre-UR, decreasing to 1% in Post-UR). Meta-analysis reveals scale-dependent technology adoption patterns, with different technologies showing varying effectiveness at building-level, district-level, and city-level implementations. Research challenges include stakeholder digital divides, scale-dependent adoption barriers, and phase-specific implementation gaps. This study constructs a multi-dimensional analytical framework for digital technology support in urban regeneration, providing quantitative evidence for optimizing technology selection strategies. The framework offers practical guidance for policymakers and practitioners in developing context-appropriate digital technology deployment strategies for urban regeneration projects. Full article

Improving community walkability can encourage older adults to walk, which is beneficial for enhancing their physical activity level (PAL) and keeping healthy. The first purpose of this study was to formulate an optimized community Walk Score measurement system from the perspective of Chinese seniors. It will be optimized from the aspects such as community service facility selection, weight determination, and distance decay function calculation. The second purpose was to verify its validity by exploring the correlation between Walk Score and subjective/objective community environment variables based on Spearman correlation analysis and the ANOVA method. The third purpose was to examine the relationship between Walk Score and Chinese seniors’ PAL and health outcomes by means of ordered/binary logistic regression. The results show the following: (1) Walk Scores are significantly correlated with partial objective environmental variables. (2) Walk Score was related to older adults’ physical activity level. (3) There was no significant relationship between Walk Score and two health outcomes. Walk Score can provide a supporting basis for urban renewal, older-community renovation, age-friendly community planning and design, and public health practitioners or policymakers. Full article

Urbanisation in the context of climate change and rapid population growth presents an urgent need for innovative and sustainable urban planning. This study introduces the Green Blueprint, an original, spatially grounded, and evidence-informed conceptual framework designed to systematically embed ecosystem services into the planning, governance, and design of resilient and equitable cities in the United Kingdom. Unlike existing research that typically treats Urban Green Infrastructure (UGI) as a discrete intervention or evaluates its benefits in isolation, the Green Blueprint integrates cross-sectoral governance, multifunctional land use, and participatory planning into a coherent, scalable model for urban resilience. Developed through a qualitative, interpretivist methodology and critical documentary analysis of secondary data including policy documents, academic literature, and case studies from London, Manchester, and Sheffield, this framework highlights how embedding ecosystem services such as carbon sequestration, stormwater management, biodiversity enhancement, and public health into the urban fabric can support long-term climate adaptation and social equity. Rather than serving as a review, this paper advances a novel theoretical contribution through empirical synthesis and thematic cross-case comparison. It further identifies enabling governance structures and implementation pathways to support policy innovation and practical application. This study contributes a transferable planning template for cities aiming to achieve systemic UGI integration, offering clear value for scholars, practitioners, and policymakers engaged in sustainable urban development in the Anthropocene. Full article