Search Results (26,848)

Background: The COVID-19 pandemic has had lasting psychological consequences, with primary care playing a key role in identifying emotional distress. Objective: Our objective was to characterize levels of depression, anxiety, and stress in a primary care population in the post-pandemic context and to examine their associations with sociodemographic and COVID-19-related variables. Methods: A cross-sectional study was conducted among 260 adult users of a Family Health Unit. Participants completed a sociodemographic questionnaire and the Depression, Anxiety, and Stress Scale (DASS-21). Group differences were assessed using Mann–Whitney U and Kruskal–Wallis tests, and multivariable generalized linear models (negative binomial regression for symptom scores and logistic regression for perceived impact) were used to identify factors independently associated with each outcome. Results: Most participants fell within normal symptom ranges (66.9% depression; 65.0% anxiety; 74.6% stress), although approximately one-third presented at least moderate levels of depressive or anxiety symptoms. In unadjusted analyses, women, older adults and professionally inactive individuals had significantly higher levels of psychological distress. Self-reported COVID-19 infection history was not associated with DASS-21 scores. In contrast, participants reporting a negative psychological impact from the pandemic and poorer self-rated mental health had significantly higher depression, anxiety, and stress scores. Conclusions: In this primary care sample, self-reported psychological impact from the pandemic and self-rated mental health were more strongly associated with psychological distress than self-reported COVID-19 infection history. Multivariable analyses identified independent associations between psychotropic medication use, self-rated health, and DASS-21 scores and the outcomes examined. These findings indicate associations between these variables within the cross-sectional sample; however, their temporal or causal relationships cannot be established. Full article

The use phase of the pavement life cycle assessment (LCA) contributes significantly to both economic and environmental burdens. However, its role is often overlooked when making decisions for pavement construction, maintenance, and rehabilitation. Pavement roughness is among the key factors influencing these burdens, and understanding its effect is crucial. This paper presents comprehensive insights into the impact of pavement roughness on road user costs and carbon emissions, while also highlighting associated challenges. The literature review clearly defines pavement roughness and distinguishes it from surface texture, a common source of confusion. Additionally, it outlines the impact of pavement roughness on climate change, energy use, user cost, and carbon emissions. Reported impacts include a 15 to 20% increase in fuel consumption under high-roughness conditions and user cost increases from $84 to $629 per vehicle annually as the International Roughness Index (IRI) rises from 1.58 to 3.95 m/km (100 to 250 inches/mile), with optimized rehabilitation triggers capable of cutting CO₂eq emissions by up to 44%. Moreover, this review shows that vehicle electrification directly mitigates roughness-related impacts, with the transition to EVs capable of lowering roughness-induced emissions, with studies reporting reductions of 25% and 54% under different conditions. As a whole, it can be stated that the impact of pavement roughness is inevitably affected by pavement type, vehicle type and speed, vehicle tire condition, traffic load, and environmental factors. Although vehicle electrification offers potential for combating the consequences associated with pavement roughness, it introduces new challenges, including the high initial costs, limited charging ports, battery capacity, heavy load on the grid, and safety concerns. Overall, the current review improves the understanding of pavement roughness as a critical factor in sustainable transportation systems, consequently supporting the decision-making that reduces the effects of climate change and promotes sustainability. Full article

Satellite-enabled content delivery networks (S-CDNs) are needed to improve content access for wide-area, remote, and highly dynamic users, for whom relying only on terrestrial CDN infrastructure is often insufficient. However, in conventional CDN systems, request acceptance and origin fetching are not tightly coupled. In satellite–ground environments with high latency, dynamic connectivity, and limited observability of requester state, low-cost and fully protocol-compliant requests may still trigger disproportionate backend work. This paper attributes the problem to open-loop request admission and studies two protocol-compliant paths. The range path is an instance of a known CDN cost asymmetry. The second path, called “Disconnection-induced amplification after request submission,” builds on known connection-decoupling behavior. Its attack realization is a protocol-compliant requester-side stop inspired by satellite coverage motion. The stop emulates the observable effect of a user leaving the service area after task triggering. The experiment evaluates this emulation. Experiments on an in-orbit prototype and a matched terrestrial configuration, together with supplementary analysis, show substantial back-to-origin amplification along both paths: the smallest byte-range request on uncached objects reaches a peak amplification of about 15,000, while the disconnection-induced path causes persistent satellite-side bandwidth occupation, a lower benign completion ratio, and higher downlink overhead. These findings indicate that cache misses in S-CDNs are not only performance events but also security-relevant points of backend commitment. Full article

Diabetes is associated with an increased risk of tuberculosis (TB), but whether the class of glucose-lowering therapy is associated with TB outcomes remains uncertain. We conducted a retrospective observational cohort study to examine the association between glucagon-like peptide-1 receptor agonist (GLP-1 RA) use versus dipeptidyl peptidase-4 inhibitor (DPP-4i) use and the risk of TB and mortality. We used de-identified records from the TriNetX Global Collaborative Network. Adults with diabetes who had a qualifying record for either a GLP-1 RA or a DPP-4i between 2016 and 2024 were eligible. Cohort entry was defined as the first qualifying drug-class record during this period. Patients with prior-year use of the comparator drug class, a history of TB, or death before cohort entry were excluded. Propensity score matching was performed at a 1:1 ratio. Outcomes assessed during days 1–365 included TB (ICD-10-CM A15–A19), the platform-defined death outcome, and a composite outcome of gastrointestinal and hepatobiliary diagnoses. After matching, 466,903 patients remained in each group. GLP-1 RA exposure was associated with fewer recorded TB events, deaths, and gastrointestinal/hepatobiliary events than DPP-4i exposure during the first year after cohort entry. TB was recorded in 155 GLP-1 RA users and 320 DPP-4i users (HR, 0.472; 95% CI, 0.390–0.572). The corresponding numbers for the platform-defined death outcome were 7575 and 14,572 (HR, 0.505; 95% CI, 0.492–0.520), and those for gastrointestinal/hepatobiliary diagnoses were 15,914 and 20,559 (HR, 0.750; 95% CI, 0.735–0.766). The analysis restricted to patients with type 2 diabetes (ICD-10-CM E11) yielded a similar association for TB. Residual imbalance in body mass index (BMI) and residual confounding, including confounding by indication, limit a causal interpretation. Full article

Carpal tunnel syndrome (CTS) is a common condition caused by increased carpal tunnel pressure and compression of the median nerve. Wrist–hand orthosis is widely used as a nonsurgical treatment to maintain the wrist in a near-neutral position and reduce pressure within the carpal tunnel. However, conventional orthosis often suffers from poor comfort, inadequate ventilation, localized pressure, and low patient compliance. This study aimed to design and evaluate a customized, multi-material 3D-printed wrist-to-finger orthosis that incorporated individual finger supports, perforated regions, and a volar clearance zone intended to avoid direct shell contact over the carpal tunnel region. A customized proof-of-concept orthosis was designed using a dual-material structure consisting of a rigid polylactic acid (PLA) outer shell and a flexible thermoplastic polyurethane (TPU) inner liner. The TPU liner was incorporated at skin contact regions to improve comfort, while the PLA shell provided structural support. Perforated lattice patterns were integrated to enhance ventilation and reduce weight, and a dedicated clearance zone was created on the volar side of the wrist to minimize direct pressure on the carpal tunnel area. Finite element analysis (FEA) was conducted under three loading conditions to evaluate stress distribution and deformation. The design refinement reduced the calculated mass from 258.27 to 205.36 g, corresponding to a 20.5% reduction. The maximum sampled von Mises stresses on the final PLA shell were 1.04 MPa on the upper surface and 0.99 MPa on the lower surface. Flexural testing demonstrated that the orthosis possessed adequate stiffness and maintained structural integrity under applied loads. The developed customized proof-of-concept orthosis demonstrates the feasibility of combining multi-material fused filament fabrication (FFF), personalized design, and FEA to produce a lightweight, breathable, comfortable, and mechanically reliable device for CTS management. The incorporation of a TPU liner and a carpal tunnel clearance zone has the potential to improve user comfort while maintaining the mechanical support required for effective treatment. Full article

As quantum computing has progressed toward fault-tolerant implementations, quantum error correction (QEC) for quantum hardware and software has become a dominant concern. While conventional QEC measurements, such as qubit overhead, code distance, and error thresholds, quantify physical resource costs, they do not capture the software-level functionality introduced by error detection, correction, and fault-tolerant gate protocols. This study investigated the QEC contribution to the functional size of quantum software and demonstrated that this contribution can be systematically measured using the COSMIC Functional Size Measurement method. A gate-level sizing approach, known as Gates’ Occurrences, was used to quantify functional user requirements (FUR) associated with QEC processes, including logical encoding, syndrome extraction, and recovery operations. A prototype measurement tool, implemented in Qiskit (Version 0.7.2), enables the automated calculation of COSMIC Function Points (CFP) from annotated circuit representations. Case studies involving Bell state preparation, Grover’s search algorithm, and 15-to-1 magic state distillation revealed that QEC-related functionality can account for 70–85% of the total functional size, even under simplified encoding assumptions. The results underscore the importance of QEC for the functional size of quantum software. These findings offer a reproducible foundation for functional sizing and future fault-tolerant quantum applications. Full article

Finite element analysis is essential for ship structural design because it enables accurate assessment of structural strength, fatigue, and vibration performance. However, mesh generation for large-scale hull structures remains challenging due to the trade-off between computational efficiency and local mesh resolution. This study proposes a semi-automatic hybrid coarse–fine mesh generation framework based on precise geometric models for local refinement. Users mark critical regions during geometric modeling; the framework then processes them automatically through a rule-driven strategy incorporating Common Structural Rules (CSR) requirements, while coarse meshes are retained in non-critical areas. A subdivision approach combining trisection with proportional and non-proportional transition patterns is developed to achieve smooth element-size variation between different mesh regions. For complex structural features, including stiffener-frame cut-outs and openings, an enhanced cross-field method is introduced to generate high-quality quadrilateral meshes while preserving geometric characteristics. A boundary simplification strategy is further developed to avoid mesh degradation near complex boundaries. Validation using representative transverse and bottom-side tank sections of a very large crude carrier (VLCC) with a deadweight tonnage (DWT) of 300,000 tonnes demonstrates the applicability of the proposed framework to local mesh refinement. The final refinement zones meet the specified mesh-density and geometric-quality criteria, whereas some transition-zone elements fall outside the adopted quality limits. Validation addresses local refinement results and geometric mesh quality rather than structural response. The proposed framework supports semi-automatic local mesh refinement of large-scale hull structures. Full article

Generative artificial intelligence services combine functional performance with humanlike interaction, yet it remains unclear whether perceived humanlikeness contributes directly to post-use satisfaction or is associated primarily with more proximal performance and relational appraisals. Drawing on the stimulus–organism–response framework, anthropomorphism theory and the Computers Are Social Actors perspective, the Expectation-Confirmation Model, and consumer–brand relationship research, this study examines perceived AI anthropomorphism (PAIA), confirmation, brand trust, satisfaction, continuance intention, and brand loyalty. Survey data were obtained from 555 ChatGPT users in Türkiye and analyzed using PLS-SEM. PAIA was strongly associated with confirmation (β = 0.624) and brand trust (β = 0.578), whereas its direct association with satisfaction was small (β = 0.081). Confirmation and brand trust were positively associated with satisfaction (β = 0.581 and β = 0.306), satisfaction was strongly associated with continuance intention (β = 0.705), and brand trust, satisfaction, and continuance intention were each positively associated with brand loyalty. Exploratory factor analysis, HTMT diagnostics, and confirmatory comparisons of alternative measurement structures showed substantial overlap between confirmation and satisfaction. The six-construct model fit better than the more parsimonious alternatives examined, but conclusions that depend on separating these two constructs are treated as tentative. Overall, PAIA was strongly associated with post-use and relational appraisals, but whether its association with satisfaction runs mainly through confirmation could not be established with confidence. Because the design is cross-sectional, the findings are interpreted as associations rather than causal effects. Full article

Historic commercial districts sustain urban memory and public life, yet variations in their spatial conditions and user experiences present challenges for renewal. However, existing studies often examine accessibility, spatial vitality, and user perceptions separately, with limited quantitative integration of objective and subjective evidence. Taking Dehua Pedestrian Commercial Street in Zhengzhou, China, as a case study, this study investigates spatial variations and the relationships among these three dimensions within an integrated analytical framework. A multi-source approach combines space syntax analysis, POI kernel density analysis, street-view image semantic segmentation, and social media sentiment analysis to characterize spatial structure, functional activity, and user experience. The results reveal distinct spatial variations within the district, including uneven public service provision, limited accessibility in peripheral areas, and low greenery coverage. Pearson correlation analysis indicates positive associations among the three dimensions, with the strongest association between accessibility and spatial vitality (r = 0.65). User evaluations are generally positive, although concerns remain regarding greening, traffic congestion, and spatial openness. Overall, these findings demonstrate the interrelationships among accessibility, spatial vitality, and user perceptions and highlight the value of integrating objective and subjective evidence to identify spatial shortcomings and inform targeted renewal strategies for historic commercial districts. Full article

A street-constrained distribution-network synthesis framework is evaluated using open geographic data, physical medium-voltage (MV) outage consequences, and benchmark electrical checks. A synthetic radial case study in Queens, New York, compares minimum-hop Dijkstra, minimum-spanning-tree connection, distance-weighted Dijkstra, Steiner approximation, conventional OpenStreetMap (OSM) routing, and Adaptive Risk OSM on shared road support for nested population representations of 20–100%. Rather than treating every low-voltage (LV) service segment as an independent contingency, it recomputes primary resilience indicators for aggregated physical MV assets. At full representation and 20 m road mesh, the selected Adaptive Risk OSM solution ($\alpha =4$) has an MV length of 3.2717 km, CVaR${}_{95}$ of 50.42%, critical-asset share of 13.04%, interruption exposure of 0.3014 user-km/user, and targeted-removal robustness AUC of 0.2386. The six-method comparison shows that minimum-hop Dijkstra achieves the lowest CVaR${}_{95}$, critical-asset share, and interruption exposure; conventional OSM routing achieves the shortest MV route; and distance-weighted Dijkstra achieves the highest targeted-removal AUC. The proposed method therefore represents a risk-aware compromise rather than a universally dominant routing strategy. Benchmark three-phase balanced calculations reveal route-dependent voltage, conductor utilization, and loss differences; transformer utilization, by contrast, is governed by the common customer allocation and reaches 108.55% at threefold full-population demand, the only violating loading condition among the 150 convergent electrical cases. The findings are confined to the defined synthetic radial case and benchmark medium-voltage checks; low-voltage electrical performance is outside the validation scope. Full article

Online reviews of home medical devices are noisy, heterogeneous, and uneven in information density, which makes it hard to turn the voice of the customer into engineering design decisions. This study proposes and validates a review-mining framework that couples rule-based data governance with a locally deployed large language model (LLM) and complex-network analysis. Taking home oxygen concentrators as the case, we collected 25,893 raw review entries from JD.com, Taobao, and Tmall. Because overlapping collection windows made 80.4% of these rows redundant (5084 unique review texts), a four-stage pipeline combining regular-expression cleaning, domain-relevance filtering, low-value review removal, and exact-plus-prefix deduplication refined them into a 2238-review corpus (44.0% of the unique review texts). A locally hosted Qwen3-8B model then performed aspect-level extraction within nine predefined design aspects, yielding 6068 structured aspect–topic–confidence records from 2214 reviews (98.9% parsing success), and scored sentiment for 6052 unique review–aspect pairs on a [−1, 1] scale. From these records, we built a topic co-occurrence network (202 nodes and 1895 edges after low-frequency filtering) and ranked design requirements with a Composite Centrality Index (CCI; weights 0.4/0.4/0.2 over min–max-normalized degree, betweenness, and closeness). Simple Operation (CCI = 1.000) and Low Noise (0.981) dominate user preference, followed by Solid Build Quality (0.611) and Oxygen Concentration (0.574); sentiment is strongly polarized on acoustic experience (Low Noise +0.755 vs. Excessive Noise −0.560). Five checks support these findings: an LDA baseline produced substantially coarser, partly brand-dominated topics; the CCI ranking is stable under five alternative weightings (Spearman’s ρ ≥ 0.978) and across 16 combinations of network-construction thresholds; bootstrap resampling (B = 1000) places the top two topics within ranks 1–2 with 95% confidence; the leading themes replicate in a JD.com-only subnetwork; and manual validation of a stratified 450-pair sample (two blinded annotators, adjudicated gold standard) gave 87.6% aspect accuracy and 94.4% sentiment-polarity accuracy. The framework converts unstructured reviews into a quantified, traceable design-priority list for oxygen concentrator development; we interpret the resulting associations as descriptive evidence for prioritization, not as causal effects. Full article

Health-literacy challenges are associated with greater risk and adverse outcomes of long-term conditions such as diabetes mellitus AND contribute to persistent health inequalities. In response, increasing attention has been given to Organisational Health Literacy (OHL), which addresses how healthcare organisations can make health information and services more accessible and easier to navigate for users (def: people receiving care, treatment, education or health-related support from the organisation) with diverse health-literacy needs. Despite the increased focus on the organisational perspective, most previous interventions have focused on individual health literacy. Thus, there is limited systematic evidence on organisational interventions designed to improve OHL and which mechanisms and contextual factors support and facilitate change. The aim of this paper is to describe the protocol for the implementation and evaluation of an OHL intervention (OHL-Act) across primary care and hospital settings caring for individuals with long-term conditions. The primary objective for the future project will be to evaluate whether the implementation of OHL-Act is associated with improvements in OHL across diverse healthcare organisations providing care and support for people living with long-term conditions. The OHL-Act comprises three workshops designed to strengthen OHL through facilitated reflections among staff and managers, a structured self-assessment of the organisation and identification and prioritisation of improvement ideas in a local action plan. The OHL-Act will be implemented in 8–10 Danish outpatient clinics and municipal units providing care and preventive services for people living with long-term conditions such as diabetes. A mixed-methods evaluation (2026–2029) will use the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework combined with the Practical, Robust Implementation and Sustainability Model (PRISM) to examine implementation processes, mechanisms of change and contextual factors. Data will be collected from surveys, organisational self-assessments, and implementation logs, as well as qualitative interview data. The study will generate insights into the implementation and effectiveness of the OHL-Act across healthcare settings and thereby give a deeper understanding of how OHL can be embedded in routine care and provide evidence of the development of more health-literacy-responsive and equitable healthcare systems. Full article

Rapid modernization and commercialization have weakened the cultural symbolism and social functions of many urban public spaces, yet the mechanisms through which public art contributes to the formation of the spirit of place remain insufficiently theorized and empirically tested. Drawing on Bourdieu’s field theory, this study conceptualizes public art as a cultural-capital intervention situated within a structured field of relations among artists, public authorities, and everyday users, and develops a mediation model linking the physical interactive attributes of public art, perceived spatial interaction, and the perceived formation of the spirit of place. An on-site questionnaire survey at 18 public-art sites in Ningbo, China, yielded 323 valid responses. Pearson correlation analysis, structural equation modeling (SEM), and bootstrap mediation tests were employed. The results show that physical interactive attributes significantly and positively affect perceived spatial interaction, which in turn significantly enhances the perceived formation of the spirit of place (p < 0.01). Perceived spatial interaction partially mediates this relationship (indirect effect = 0.183), accounting for 44.3% of the total effect; thus, all three hypotheses are supported. Emotional and cognitive interaction are particularly salient, whereas opportunities for embodied psychological interaction and immersive experience remain comparatively limited. Read through the lens of field theory, these findings indicate that public art converts cultural capital into place meanings only when its physical configuration and spatial setting afford sustained interaction, thereby reproducing the field relations through which habitus and shared place dispositions are formed. These findings indicate that public art contributes to place experience not only through visual or symbolic representation, but also through the interaction opportunities afforded by its physical configuration and spatial setting. The study therefore offers evidence-based implications for human-centered public-space design, socially sustainable urban regeneration, and the improvement of urban human settlements. Full article

Efficient and accurate data entry is essential for ensuring high-quality clinical registries; however, conventional electronic data-capture (EDC) interfaces impose a substantial workload on healthcare professionals. This study compared a wizard-style graphical user interface (WS-GUI) with an exploratory–selective graphical user interface (ES-GUI) for registry data-entry tasks. Twenty physical and occupational therapists completed standardized simulated registry data-entry tasks using both interfaces in a randomized, within-participant crossover design. Data-entry time, input accuracy, and perceived workload were evaluated using task completion time, error counts, and the National Aeronautics and Space Administration Task Load Index (NASA-TLX), respectively. The evaluated WS-GUI implementation was associated with shorter data-entry times, fewer errors, and lower perceived workload than the evaluated ES-GUI implementation. The largest workload differences were observed for mental demand, physical demand, and effort. Because the interfaces also differed in navigation and input methods, these findings are specific to the tested implementations, participant group, and short simulated tasks and do not establish the general superiority of wizard-style interfaces. Full article

Across Europe, cities are redefining the function of streets in city centers, transforming them from spaces primarily serving car traffic into vibrant, liveable public spaces. These transformations reflect a broader shift toward sustainable urban development, aimed at fostering local communities, enhancing walkability, and reducing the environmental impact of transport. Gdynia’s Starowiejska Street—one of the key service-oriented streets in the port city center—underwent a redesign in 2023 that prioritized pedestrians, local services, and social interaction. This article examines customers’ transport preferences when visiting retail and service establishments along Starowiejska Street, analyzing differences by business type and the perceived role of parking availability. The study draws on a field survey conducted in May 2025 among 588 users of the street, complemented by inferential testing, binary logistic regression, correspondence analysis, and k-means cluster analysis, providing both descriptive and multivariate evidence on customer mobility patterns in a shared street environment. The results confirm that the street functions primarily as a local, pedestrian- and public transport-oriented destination, with walking (46.6%) and public transport (28.2%) dominating access modes. Statistically significant associations between travel mode, visit frequency, and business type were established through chi-square testing. Cluster analysis identified three distinct customer mobility profiles—Local Regulars, Occasional Visitors, and Car-Oriented Visitors—reflecting differentiated accessibility needs across the street’s commercial mix. Because the survey was conducted on a single day in 2025, two years after the redesign and without a pre-redesign baseline or a comparison street, the study describes the current, post-redesign accessibility pattern rather than demonstrating a change caused by the redesign. Within this scope, the case of Starowiejska Street illustrates how the organization of access to local services and public space is associated with everyday mobility choices in a way that appears compatible with environmental and economic sustainability goals. The redesign also illustrates, descriptively, how a more inclusive, pedestrian-oriented built environment can broaden accessibility for diverse user groups—including older residents, caregivers, and people with mobility limitations—whose needs are central to universal design thinking. The study contributes to the growing body of research on sustainable urban mobility by providing empirical evidence on the relationship between accessibility, street design, and local commerce in a single European port-city case. The research was supported by Gdynia Maritime University and conducted within the framework of the EU Horizon project SPINE—Smart Public Transport Initiative for Climate-Neutral Cities in Europe—situating the findings within a broader European context of mobility transition. Full article