Search Results (354)

Dynamic ventilation has proven effective in enhancing indoor thermal comfort. However, previous studies often expose participants to inconsistent thermal environments, potentially compromising the accuracy of subjective evaluations. To address this limitation, this study implemented dynamic ventilation with fluctuating air velocity in an accurately controlled environmental chamber. Objective measurements of indoor air velocity and air temperature distribution are conducted, and subjective thermal sensation votes are collected under thermally consistent environments among participants. During the experiment, all participants experience similar dynamic thermal environments. The results show that participants experience thermal comfort under dynamic ventilation. Dynamic ventilation enhances convective heat transfer between the human body and the surrounding air and stimulates cutaneous cold receptors. The pronounced cooling effect of dynamic airflow contributes to a reduction in skin temperature on the head, chest, upper arm, forearm, hand, and thigh, with a temperature drop ranging from 1.3% to 2.8%. In addition, dynamic ventilation significantly reduces draft risk, with the proportion of participants reporting a dissatisfied sensation decreasing from 10% to 0%. This study demonstrates the advantages of dynamic ventilation in improving thermal comfort and minimizing draft risk under controlled and uniform environmental conditions for all participants. Full article

Background: A negative lifestyle has been reported to be associated with poor quality of life (QoL). However, there is limited information regarding the relationship between satisfaction with life (SWL) and lifestyle factors in university students. Objective: The aim of the present study was to determine the association between lifestyle parameters, quality of life (i.e., physical, psychological, social, and environmental dimensions), and categories of satisfaction with life (i.e., extremely satisfied, satisfied, slightly satisfied, dissatisfied, extremely dissatisfied) in Chilean university students. Methods: This cross-sectional study included a total of 212 university students (128 females and 83 males), aged between 18 and 28 years. Physical activity (PA), screen time (ST), dietary habits, sleep quality, QoL, and SWL were assessed using validated questionnaires. Results: SWL presented inverse association with unhealthy diet (β = −0.18, 95%CI; −0.28 to −0.09, p < 0.001), sleep < 6 h (β = −0.21, 95%CI; −0.31 to −0.11, <0.001), ST > 4 h (β = −0.10, 95%CI; −0.18 to −0.01, 0.015) and non-PA (β = −0.10, 95%CI; −0.19 to −0.01, p = 0.027). Regarding the association between lifestyle parameters and QoL, unhealthy diet was inversely associated with the physical (β; 0.18, 95%CI; −0.27 to −0.09, <0.001), psychological (β = −0.18, 95%CI; −0.27 to 0.09, p < 0.001), and environmental (β = −0.14, 95%CI; −0.23 to −0.06, 0.001) dimensions, and overall QoL score (β = −0.06, 95%CI; −0.09 to −0.03, p < 0.001). Sleep duration < 6 h showed inverse associations with the physical (β = −0.21, 95%Ci; −0.30 to −0.11, <0.001), psychological (β = −0.20, 95%CI; −0.30 to −0.10, <0.001), social (β = −0.30, 95%CI; −0.47 to −0.14, p < 0.001), and environmental (β = −0.13, 95CI; −0.21 to −0.04, p = 0.004) dimensions, and overall QoL score (β = −0.07, 95%CI; −0.10 to −0.04, p < 0.001). Non-PA was associated with physical dimensions (β = −0.09, 95%CI; −0.17 to −0.01, p = 0.019). Non-PA reported association with physical (β = −0.16, 95%CI; −0.25 to −0.07, p < 0.001), psychological (β = −0.20, 95%CI; −0.30 to −0.10, p < 0.001), social (β = −0.25, 95%CI; −0.41 to −0.09, p = 0.002), and environmental (β = −0.11, 95%CI; −0.19 to −0.02, p = 0.010) dimensions, and QoL overall score (β = −0.06, 95%CI; −0.09 to −0.03, p < 0.001). Conclusions: Poor diet, inadequate sleep, excessive ST, and non-PA are all associated with negative impacts on SWL and QoL in Chilean university students. Full article

Background: Variability and low volume yield in breast aesthetic outcomes utilizing fat grafting promoted a search for surgical technique improvement. Aim: Using evidence-based information to optimize a surgical technique for aesthetic breast augmentation using stem cell-enriched fat grafting. Methods: Retrospective study of consecutive women (n = 118) from 2008 to 2025 requesting breast fat grafting using centrifugation–filtration fat processing combined with platelet-rich plasma and autologous adipose-derived stem cell-enriched fat. Results: Most surgical indications were for primary breast augmentation (65.8%), followed by fat grafting after implant removal (13.6%), during or after mammoplasty (13.6%), or simultaneously with implant exchange (12.7%). The mean volume per breast of purified, enriched fat grafted was 192 to 206 cc. Each patient had fat grafted into the subcutaneous plane with some patients having additional fat placed submuscularly in those without a dual plane or submuscularly placed implant, or where an implant capsule was absent. Most patients were either very satisfied or satisfied (95.8%), with 4.2% dissatisfied. Those dissatisfied were mainly those with insufficient breast volume and one with a suspected atypical mycobacteria infection. There was a 11.9% complication rate, with seroma formation at the harvested site the most common at 5.1% (n = 6). Palpable fibrotic areas were second in frequency at 3.4% (n = 4), but with no instances of breast oil cyst formation. The average number of fat grafting sessions per indication was only one, with 6.8% requesting a second staged fat grafting procedure. The revision procedures were only in patients with a sole augmentation indication, except for one mastopexy patient with severe breast size asymmetry. An estimated 75–85% grafted volume take was confirmed by a previous diagnostic ultrasound measurement study. Conclusions: Breast fat grafting incorporating learned knowledge of optimal harvesting, processing, storing, enrichment, and administration techniques yielded superior consistent breast enhancement aesthetic outcomes with a high patient and surgeon satisfaction rate through increased adipocyte survival, while minimizing complications including a low incidence of fibrotic areas and no oil cyst formation. Full article

Approximately 15% of total knee arthroplasty (TKA) patients remain dissatisfied after surgery, with joint line obliquity (JLO) potentially affecting patient outcomes. This study investigated whether JLO restoration influenced lower extremity frontal plane joint moments during stair negotiation by TKA patients. Thirty unrestored and twenty-two restored JLO patients participated in this study and were asked to perform five trials on each limb for stair negotiation while three-dimensional kinematics and ground reaction forces were recorded. Frontal plane moments at the ankle, knee and hip were calculated using Visual 3D. The restoration of JLO did not alter frontal plane joint moments during stair negotiation. Both groups showed symmetrical moment profiles, indicating no significant biomechanical differences between the restored and unrestored JLO groups. Restoring JLO did not affect frontal plane joint moments during stair negotiation, suggesting it may not contribute to patient satisfaction disparities post-TKA. Further research should explore other factors, such as surgical technique and implant design, that might influence recovery. Full article

Background: Medical education is considered one of the most academically and emotionally demanding training programs. Throughout their education, medical students are exposed to various factors that can lead to psychological distress, depression, and anxiety. The aim of this longitudinal study was to examine the changes in psychological distress, depression, anxiety levels and internet addiction among medical students throughout their six-year education and to identify the contributing factors. Methods: The study cohort consisted of 282 students who enrolled in the medical faculty in the 2017–2018 academic year. A questionnaire including sociodemographic characteristics, the General Health Questionnaire-12 (GHQ-12), Beck Depression Inventory (BDI), State–Trait Anxiety Inventory (STAI), and Young Internet Addiction Test (IAT) was administered to the students during the first week of their education. The same questionnaire was readministered at the end of the third and sixth years. Friedman’s variance analysis was used to compare measurement data across the three time points, while Cochran’s Q Test was employed for categorical variables. Results: The median scores of the GHQ-12, BDI, S-Anxiety, and IAT significantly increased from the first to the sixth year (p < 0.05). The prevalence of depressive symptoms, S-Anxiety, and risky internet use significantly increased from the first to the final year, particularly between the third and sixth years. According to logistic regression analysis based on sixth-year data, students whose fathers were university graduates, who had been diagnosed with COVID-19, and who were dissatisfied with their social lives were found to be at increased risk for psychological distress and depression. Students with high parental expectations were found to be at risk of depression and S-anxiety. Those dissatisfied with their occupational choice were at risk for both psychological distress and S-anxiety. Conclusions: It was found that the mental health of medical students deteriorated during their education, especially during the clinical years. Given that these students will be responsible for protecting and improving public health in the future, it is essential to prioritize their own mental well-being. Interventions aimed at preserving the mental health of medical students should be planned. Full article

Job satisfaction in sub-Saharan Africa is crucial as it directly impacts employee productivity, retention, and overall economic growth, fostering a motivated workforce that drives regional development. In sub–Saharan Africa, poor remuneration, limited professional development opportunities, and inadequate working conditions impact satisfaction. This study examined job-satisfaction predictors among health workers in primary healthcare settings across eight countries: Ethiopia, Kenya, Malawi, Senegal, South Sudan, Tanzania, Uganda, and Zambia. A cross-sectional study surveyed 1711 health workers, assessing five dimensions: employer–2employee relationships, remuneration and recognition, professional development, physical work environment, and supportive supervision. The study was conducted from October 2023 to March 2024. The job-satisfaction assessment tool was adopted from a validated tool originally developed for use in low-income healthcare settings. The tool was reviewed by staff from all the country offices to ensure contextual relevance and organization alignment. The responses were measured on a five-point Likert scale: 0: Not applicable, 1: Very dissatisfied, 2: Dissatisfied, 3: Neutral, 4: Satisfied, and 5: Very satisfied. The analysis employed descriptive and multivariable regression methods. Job satisfaction varied significantly by country. Satisfaction with the employer–employee relationship was highest in Zambia (80%) and lowest in Tanzania (16%). Remuneration satisfaction was highest in Senegal (63%) and Zambia (49%), while it was very low in Malawi (9.8%) and Ethiopia (2.3%). Overall, 44% of respondents were satisfied with their professional development, with Uganda leading (62%) and Ethiopia having the lowest satisfaction level (29%). Satisfaction with the physical environment was at 27%, with Uganda at 40% and Kenya at 12%. Satisfaction with supervisory support stood at 62%, with Zambia at 73% and Ethiopia at 30%. Key predictors of job satisfaction included a strong employer–employee relationships (OR = 2.20, p < 0.001), fair remuneration (OR = 1.59, p = 0.002), conducive work environments (OR = 1.71, p < 0.001), and supervisory support (OR = 3.58, p < 0.001. Improving the job satisfaction, retention, and performance of health workers in sub-Saharan Africa requires targeted interventions in employer–employee relationships, fair compensation, supportive supervision, and working conditions. Strategies must be tailored to each country’s unique challenges, as one-size-fits-all solutions may not be effective. Policymakers should prioritize these factors to build a motivated, resilient workforce, with ongoing research and monitoring essential to ensure sustained progress and improved healthcare delivery. Full article

Background: The purpose of this study was to clinically characterize neutrally satisfied patients and compare outcomes between satisfied, dissatisfied, and neutral patients. Methods: This was a secondary analysis from data collected in a multicenter longitudinal cohort study comprising total knee arthroplasty (TKA) patients using a digital care management platform. The Knee Society Score (KSS) satisfaction survey was administered at post-operative 90 days, and dissatisfaction was defined as a composite score of less than 20, satisfied as a score equal to or greater than 30, and neutral as a score of 20 up to 29. Patient-reported outcome measures (PROMs) were assessed pre-operatively and at post-operative one, three, six, and twelve months. Results: Approximately 58% of patients were satisfied (n = 1486), 29.4% neutral (n = 747), and 12.2% dissatisfied (n = 311). Neutral and dissatisfied patients were younger and more likely to be female and had lower pre-operative KSS scores compared to satisfied patients, though statistical differences were found between all groups. Pre-operative pain was significantly less in satisfied compared to neutral or dissatisfied patients. Changes in the pre-operative Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS JR) displayed significant differences between all groups at all time points, with greater improvements in satisfied versus neutral patients and neutral versus dissatisfied patients. Similarly, satisfied patients experienced significantly greater improvements in pain and KSS scores at post-operative three months, and neutral patients improved more than dissatisfied patients. Conclusions: Neutral patients present with distinctively different clinical outcomes compared to satisfied or dissatisfied patients and should be classified separately as neutral. Full article

In this work, the indoor thermal environment and indoor air quality of rural houses in Northern China were investigated in detail. The current heating situation in rural areas, the causes of indoor air pollution, and the indoor ventilation habits of residents were analyzed. The indoor thermal environment and indoor air quality were improved by upgrading the thermal insulation of the rural housing envelope and installing indoor ventilation systems with heat recovery, leading to an average indoor temperature increase of 6 °C. The Predicted Mean Vote reached approximately 1.0, so the human body heat sensation was more moderate. The air age was greatly reduced, and the indoor air quality was significantly improved. The Predicted Percentage of Dissatisfied dramatically decreased to 15%. Thus, when focusing on heat source renovation in rural areas, priority should be given to improving the energy efficiency of buildings, especially the building envelope insulation performance. Ventilation and air exchange systems with heat recovery are inexpensive and effective, and they are suitable for rural dwellings where the temperatures are not as high as they should be but where the indoor air quality is poor and ventilation is urgently needed. Full article

Background: Although percutaneous laser disc decompression (PLDD) has been proposed as an alternative to conventional surgery for lumbar disc herniation (LDH), we specifically propose it for patients with contained herniations where standard surgical intervention is not the first option. This study evaluates PLDD compared to conservative therapy as an early treatment alternative. Methods: This retrospective observational study compared PLDD to conservative treatment in adult patients with contained LDH. All patients underwent 3 months of standard conservative therapy. Those who remained dissatisfied according to the Visual Analog Scale (VAS) and/or Macnab criteria were then treated with PLDD. We analyzed outcomes from both treatment phases using the Wilcoxon signed-rank test and the Mann–Whitney U test. Results: 121 patients underwent outpatient evaluation for LDH and received an average of 90 days of conservative therapy. Of these 103 patients, dissatisfied with the outcomes of conservative treatment, subsequently underwent PLDD. Following conservative treatment, the average VAS score reduction was 4.1%. Six months after PLDD, the VAS scores demonstrated a significant reduction, with an average decrease of 30% (p < 0.0001). In terms of functional outcomes assessed by the Macnab criteria, 39.8% of patients treated with PLDD achieved ‘Excellent’ or ‘Good’ outcomes, compared to only 11.4% after conservative treatment. Conclusions: PLDD appears to be a viable alternative to conservative therapy for this subgroup of patients with contained LDH. It may be beneficial to propose PLDD early in the therapeutic regimen to accelerate short term clinical improvement. Further studies are required to evaluate the long term efficacy of this treatment approach. Full article

The present paper aims to analyze consumers’ attitudes to domestic leisure tourism, considering essential factors that affect consumer travel choices and experiences. The focus is on the attitudes to the main advantages and disadvantages of domestic leisure tourism in Bulgaria. The research is based on the outcomes of a nationally representative survey among 1003 respondents aged over 18. The results are interpreted using the Fishbein multi-attribute model. The results reveal that the customers’ attitudes toward the advantages of the Bulgarian winter (ski) and summer (sea) domestic leisure tourism are relatively higher compared to the midpoint of the interval and to their highest point. Although the score for summer domestic leisure tourism is slightly lower than that of winter tourism, Bulgarian consumers appear to be more dissatisfied with the advantages of summer (sea) domestic leisure tourism. The dissatisfaction is not only greater compared to the midpoint of the scale but also in comparison to the disadvantages associated with winter domestic leisure tourism. Overall, Bulgarian consumers are more attracted to the positive aspects of domestic winter leisure tourism and more concerned about the negative aspects of summer tourism. Full article

Background: The objective of this investigation was to assess the oral health (OH) of Bosnia and Herzegovinian adolescents in relation to differences and socioeconomic status (SES). Methods: This cross-sectional study included 306 school children from high schools located in the Tuzla Canton (Bosnia and Herzegovina). The sample consisted of 183 females and 123 males between 15 and 18 years old (mean of 16.82 years old). The study was conducted between December 2019 and March 2020, via an Annex 8 questionnaire from the World Health Organization (WHO), which collected information on OH behaviours, self-perceptions of oral health and dietary factors responsible for the OH of each subject. SES was categorized using five variables (occupation, education, income, place of residence and number of family members). Cross-tabulations were evaluated according to sex and socioeconomic status (SES) via the chi-square test. Results: Over 40% of the participants consumed sweets, cakes and biscuits on daily basis, whereas 41.5% of the participants visited a dentist only in the case of pain. The consumption of sweets (p = 0.024) and cakes and biscuits (p = 0.011) on a daily basis was significantly greater in female adolescents than in male adolescents. Compared with male adolescents, female adolescents reported occasional toothaches more frequently (p = 0.001) and were more dissatisfied with their dental appearance (p = 0.008) but presented a greater frequency of flossing (p = 0.001) and toothbrushing (3–5 times a day) (p = 0.0001). There was no association between the different levels (below average, average, above average) of SES and factors affecting OH status of adolescents. Conclusions: The study revealed significant sex differences in several factors affecting OH status and revealed no relationship between SES and OH behaviours or between perceptions and risk factors affecting OH in 15–18-year-old adolescents. Data obtained from this study might help in the creation of new OH prevention programs aimed at improving the OH status of adolescents in Bosnia and Herzegovina. Full article

Local data about indoor thermal comfort are in short supply, which are always different from the predicted results produced by models shown in previous studies. Shopping malls that consume substantial energy need to save energy, provided that thermal comfort is maintained. Therefore, this research investigated indoor thermal comfort using field measurements and questionnaires in a typical shopping mall in Danyang, China, with a hot summer and cold winter climate in order to explore local demands and energy-saving potential. The findings are as follows: (1) The average air temperature ($T_a$) and operative temperature ($T_{op}$) are 26.7 °C and 26.4 °C, which implies a minor influence from radiation and other factors on $T_a$. Women are more sensitive to changes in outdoor temperature since clothing insulation ($I_{cl}$) varies by gender: 0.31 clo and 0.36 clo for male and female individuals, respectively. (2) The thermal neutral temperature (TNT) derived from the thermal sensation vote (TSV) is 25.26 °C, which is significantly higher than the 21.77 °C obtained from the predicted mean vote (PMV) model. (3) There is a wide range of acceptable temperatures for thermal comfort because the highest temperature was identified by the thermal comfort vote (TCV) at 27.55 °C, followed closely by 27.48 °C, 26.78 °C, and 25.32 °C, which were separately derived from the thermal acceptance vote (TAV), TSV, and predicted percentage of dissatisfied (PPD) people; these were based on an upper limit of the acceptable 80% range. (4) In total, 94.85% of respondents accepted the indoor air quality, although the median concentration of CO₂ was 772 ppm, and the neutral relative humidity level was 70.60%. Meanwhile, there is an important relationship between air quality satisfaction and operative temperature; thus, the temperature (26.93 °C) with peak satisfaction can enhance air quality perception and thermal comfort. (5) The energy savings that can be achieved are 25.77% and 9.12% at most based on acceptable thermal comfort compared with baseline energy consumption at 23 °C and 26 °C, respectively. Full article

This study aims to experimentally evaluate a personal comfort system based on a radiant panel (R-PCS) that can regulate the thermal environment of the sleep zone during summer, with a focus on improving both the thermal comfort and energy efficiency of this system. To investigate thermal comfort under the coupling effect of different covering conditions and operating parameters of the R-PCS, the changing pattern of thermal environment parameters in the berth area and human skin temperature are analyzed. Then, the Predicted Mean Vote (PMV) -Predicted Percent Dissatisfied (PPD) index is employed for assessing the thermal comfort of the human body and energy-saving efficiency of the system. The results show that this system can satisfy the thermal comfort requirements of the human body in the berth area. Meanwhile, the corresponding cooling energy consumption of the R-PCS is significantly lower than that of the traditional HVAC system, indicating that the developed system has significant energy-saving potential in building design. Full article

Background and Objectives: Total knee arthroplasty (TKA) is one of the most common medical procedures worldwide. However, 10 to 20% of patients are still dissatisfied despite implants and surgical technique advancements. Recently, several medial-stabilized TKAs have been developed in attempts to replicate the native kinematics of the knee. The aim of this scoping review on medial-stabilized TKA inserts—medial congruent (MC) and medial pivot (MP)—is to focus on their clinical outcomes and the role of the posterior cruciate ligament (PCL), aiming to systematically map the existing research and highlight current knowledge gaps. Materials and Methods: A search of the PubMed, Embase and Cochrane databases was performed to identify relevant studies on the kinematics and outcomes of medial pivot (MP) or medial congruent (MC) inserts. The following Mesh terms were used in combination with the Boolean operators “AND” and “OR”: “total knee arthroplasty”, “total knee replacement”, “medial pivot”, “medial congruence”, “outcomes” and “kinematic”. Original studies reporting on clinical outcomes assessed with validated patient-reported scales, surgical techniques and reoperation rates for any reason with a minimum follow-up of 18 months were included. Results: A total of 39 articles met the inclusion criteria, accounting for 6143 total knee replacements. The overall reoperation-free survivorship rate was 98.4% (6047 out of 6143 knees) at a weighted average follow-up of 6.3 years (range 1.5–15.2 years, SD 0.7). Both MP and MC inserts demonstrated good outcomes, with no differences between groups. Few studies evaluated the role of the PCL in MP and MC inserts, with no differences in terms of clinical outcomes between retaining and sacrificing the PCL. Conclusions: MS-TKA demonstrated good outcomes in the literature independently of the specific design (medial pivot or medial congruent). Different possible biases may be present when evaluating the outcomes of these inserts, including different types of alignment and soft tissue balancing philosophies. Full article

Researchers have increasingly focused on thermal comfort, examining both individuals’ thermal sensations and the percentage of people dissatisfied with the thermal environment. Most studies rely on the widely used PMV (Predicted Mean Vote) model and the PPD (Predicted Percentage of Dissatisfied) value derived from it, both defined by the ISO 7730:2005 standard. However, previous studies have shown that this standardized method only applies under steady-state conditions, which do not reflect the dynamic nature of everyday environments. As closed-loop control technologies gain prominence in building services, the need to evaluate thermal comfort under time-varying conditions has grown. The standard method does not account for the thermal inertia of the human body, which limits its applicability in such dynamic contexts. In this study, we develop a method to estimate instantaneous thermal sensation under non-stationary conditions by incorporating thermal inertia through signal processing techniques. This approach addresses a well-recognized limitation of the standard PMV–PPD model and provides a way to assess thermal comfort in real time. We collected experimental data using a thermal comfort measurement station, a thermal manikin, and human subjects in a controlled climate chamber. The proposed method enables real-time evaluation of thermal comfort in dynamic environments and offers a foundation for integration into HVAC control and comfort optimization systems. Full article