Search Results (4,234)

This study establishes a structured framework to identify and evaluate risk factors that may hinder the achievement of sustainable development goals in green buildings and sustainable infrastructure projects. Fifty-six risk factors are identified and categorized into four risk groups, including stakeholder and management, financial and economic, technological and resource, and process and regulatory risks. The risk factors are evaluated across four risk indices related to probability of occurrence, manageability, impact on building performance, and project cost. Further, the severity of risks based on combining the four indices’ effects is quantified using a new Green Risk Index (GRI), while the relationships among all risk indices are determined. The strongest positive correlation is observed between the probability and the impact on cost, whereas a negative relationship is found between the probability and manageability. The analysis demonstrates that a risk factor related to the lack of knowledge about energy-saving procedures and environmental concerns during the design phase is the most critical, as it has the highest severity based on the GRI. “Non-compliance with environmental standards in project design” is also identified as a critical risk factor due to its high effect on building performance. Additionally, the risk factor associated with unstable funds from investors shows the highest effect on manageability. Process and regulatory is identified as the most critical risk group, encompassing the maximum number of key risk factors, and has the highest average weight related to the GRI. These findings reveal crucial vulnerabilities and underline the importance of targeted strategies to strengthen the use of nature-based solution frameworks for mitigating the risk effects in green buildings and sustainable infrastructures. Full article

Cyber-sexual crimes have become a growing concern in the digital age, as rapid technological progress continues to create new forms of violence and victimization. These offenses affect society unevenly, striking more intensely among minors, women, and other vulnerable groups. Their prevalence is shaped by structural inequalities, educational, economic, and technological, that condition both exposure to digital risks and the capacity for protection. Although international research has connected these disparities with digital victimization, evidence from Spain remains limited. The aim was to analyze the regional distribution of cyber-sexual crimes in Spain between 2011 and 2022 and to explore how education, income, and digital access relate to their incidence. To this end, official data from the Spanish Statistical Crime Portal (PEC) were combined with structural indicators provided by the Spanish National Institute of Statistics. The analysis encompassed reported cases of sexual abuse, sexual harassment, corruption of minors, online grooming, exhibitionism, pornography, and sexual provocation, using standardized incidence rates per 100,000 inhabitants. Statistical methods included ANOVA with post hoc comparisons, correlation analyses, and K-means clustering to identify territorial patterns. Results revealed a sustained national increase in cyber-sexual crimes, with grooming and sexual harassment showing the most pronounced growth. The Balearic Islands (mean 4.9), Canary Islands (4.0), and Andalusia (3.9) registered the highest incidence rates, well above the national average (3.0). Educational disadvantages and low income were linked to sexual abuse and corruption of minors, whereas greater digital connectivity, expressed through higher mobile phone use, broadband access, and computer ownership, was strongly associated with grooming and other technology-facilitated offenses. Cluster analysis identified three distinct territorial profiles: high-incidence regions (Balearic and Canary Islands, Andalusia), intermediate (Murcia, Madrid, Navarre, Valencian Community), and low-incidence (Galicia, Catalonia, Castile and León, among others). In conclusion, the findings demonstrate that cyber-sexual crimes in Spain are unevenly distributed and closely linked to persistent structural vulnerabilities that shape digital exposure. These results underscore the need for territorially sensitive prevention strategies that reduce educational and economic inequalities, foster sexual and digital literacy, and promote safer online environments. Without addressing these underlying structural dimensions, public policies risk overlooking the conditions that sustain regional disparities and limit adequate protection against technology-driven sexual crimes. Full article

Background: Sport-related concussion (SRC) is a recognised public health concern, with combat sport athletes particularly vulnerable due to frequent head impacts. In Taekwondo, concussion incidence is comparable to other contact sports, yet underreporting and misconceptions may hinder safe management. Understanding knowledge, attitudes, and behaviours in this cohort is critical for athlete safety. Methods: This cross-sectional online survey was distributed to Australian Taekwondo athletes (AKA). Participants completed demographic, concussion history, and the Rosenbaum Concussion Knowledge and Attitudes Survey. Knowledge (CKI) and attitudes (CAI) indices were derived. Group differences were analysed using non-parametric tests, with associations between knowledge, attitudes, and reporting behaviours explored via correlation and logistic regression. Results: Athletes (n = 98) demonstrated good knowledge (mean CKI 19.8/25) and positive attitudes (mean CAI 61.6/75), though misconceptions remained. While 92% indicated they would seek medical attention, 21% reported returning to play the same day as a suspected concussion, and over 20% admitted to concealing symptoms. Higher CAI scores, but not CKI, were associated with safer reporting intentions. Conclusions: AKA showed strong knowledge and attitudes towards concussion; however, risky behaviours persisted. Attitudes, rather than knowledge, were more predictive of reporting behaviours, underscoring the need for interventions that strengthen positive attitudes and cultural support for symptom disclosure. Full article

Background: Surgical management of trauma in the maxillofacial complex can result in iatrogenic nerve injuries, particularly involving the infraorbital, inferior alveolar, and mental nerves. Paresthesia is a common postoperative complication, often attributed to the anatomical positioning of these nerve structures, making them vulnerable to injury. Among current therapeutic options for nerve injuries, low-level laser therapy (LLLT) has shown promising results in published studies. Objectives: This prospective observational study evaluated the effects of LLLT on nerve recovery following maxillofacial trauma surgery. Methods: A total of 21 participants, with a median age of 35 years and no gender-based selection criteria, were enrolled. Cases included zygomaticomaxillary complex and mandibular osteosynthesis; analyses were within-subject across time. Postoperative laser therapy was administered to both groups using the DUO MMO device (MMOptics, São Carlos, Brazil), delivering infrared light along the pathways of the inferior alveolar, infraorbital, and mental nerves. Nerve function was assessed regularly using a Visual Analog Scale (VAS) and the Brush Stroke Direction (BSD) test to evaluate sensory recovery. Results: Compared with baseline (15 days post-op, pre-LLLT), VAS scores showed significant reductions at sessions 7 and 10, and BSD responses increased over time. Conclusion: After multiplicity control, only the session 10 comparison remained significant. These observational findings support the feasibility of multi-session LLLT after maxillofacial trauma; controlled trials are warranted to determine efficacy. Full article

Background/Objectives: Unpaid medical expenses incurred by foreign nationals represent a growing concern for healthcare systems amid increasing international mobility. Japan, which lacks mandatory public insurance coverage for non-resident visitors, faces particular vulnerability in terms of uncompensated hospital care. This study aims to identify factors contributing to unpaid medical charges among uninsured, non-resident foreign patients hospitalized at a tertiary care facility in Tokyo. Methods: This retrospective observational analysis was conducted using medical and administrative data from patients admitted between January 2023 and February 2025. Patients who received elective medical tourism care were excluded. Data on demographics, length of hospital stay, care intensity, payment status, and third-party financial assistance were analyzed. Logistic regression models were applied to assess predictors of nonpayment. Results: Among 153 eligible cases, 9 patients (5.9%) had outstanding hospital bills upon discharge. Compared with those with completed payments, the unpaid group experienced longer admissions, more intensive care utilization, and higher total charges. Notably, the absence of third-party financial support (primarily travel insurance) was significantly associated with unpaid charges. Multivariate analysis identified this factor as the main independent predictor (adjusted odds ratio [OR]: 0.12; 95% confidence interval [CI]: 0.02–0.915; p = 0.040). Total amount of billing was also statistically significant (adjusted odds ratio [OR]: 1.01; 95% confidence interval [CI]: 1.00–1.01; p = 0.039). Conclusions: These findings highlight the importance of private insurance in mitigating financial risk in hospitals. Implementing policy measures to promote or require insurance enrollment, along with streamlined reimbursement systems, may contribute to sustainable care delivery for international patients. Full article

Safety and security are major priorities in modern society. Especially for vulnerable groups of individuals, such as the elderly and patients with disabilities, providing a safe environment and adequate alerting for debilitating events and situations can be critical. Wearable devices can be effective but require frequent maintenance and can be obstructive or stigmatizing. Video monitoring by trained operators solves those issues but requires human resources, time and attention and may present certain privacy issues. We propose optical flow-based automated approaches for a multitude of situation awareness and event alerting challenges. The core of our method is an algorithm providing the reconstruction of global movement parameters from video sequences. This way, the computationally most intensive task is performed once and the output is dispatched to a variety of modules dedicated to detecting adverse events such as convulsive seizures, falls, apnea and signs of possible post-seizure arrests. The software modules can operate separately or in parallel as required. Our results show that the optical flow-based detectors provide robust performance and are suitable for real-time alerting systems. In addition, the optical flow reconstruction is applicable to real-time tracking and stabilizing video sequences. The proposed system is already functional and undergoes field trials for cases of epileptic patients. Full article

Introduction: The COVID-19 pandemic posed additional challenges for this vulnerable population, such as Sjögren’s disease (SjD), underscoring the need for effective and safe vaccination strategies. Objective: To evaluate the immunogenicity and safety of COVID-19 vaccines in patients with SjD. Methods: This prospective, observational, longitudinal study included SjD patients from the SAFER cohort. Immunogenicity was assessed via anti-spike IgG (IgG-S) titers using chemiluminescence reported as geometric mean titers (GMT) and fold increase in GMT (FI-GMT). Disease activity was evaluated using the ESSDAI score. Adverse events and COVID-19 infections were also monitored. Assessments were conducted at four time points: pre-first dose (T1), pre-second dose (T2), pre-booster (T3), and four weeks post-booster (T4). Primary vaccination involved ChAdOx1 nCoV-19 or inactivated vaccine (CoronaVac), and boosters were either homologous (ChAdOx1 nCoV-19) or heterologous (BNT162b2). Results: Among 51 participants (mean age 46 years; 90% female), 41% had comorbidities and 27% (n = 14/51) were highly immunosuppressed. Among those 73% (n = 37/51) under low immunosuppression, n = 8/51 (13%) were not using any medication. At baseline, 11% (n = 4/35) showed moderate/high disease activity, which decreased to 6.5% (n = 2/31) at T4. Primary vaccination was ChAdOx1 in 94% (n = 48/51) and CoronaVac in 6% (n = 3/51); 73% (n = 37/51) received heterologous and 27% (n = 14/51) homologous boosters. COVID-19 infection post-booster occurred in 20% (n = 10/51). Seroconversion rates reached nearly 100% across all medication subgroups except for biologic users, who showed delayed but stable seroconversion by T4. IgG-S titers increased progressively through T4. Primary immunization induced an ascending GMT in both vaccine types. At T4, the GMT was significantly higher in the BNT162b2 group (2148.03 [1452.05–3155.84]; p < 0.001; 95% CI) than in the ChAdOx1 group (324.29 [107.92–974.48]; p < 0.001; 95% CI); the fold-increase in immune response was six times greater with BNT162b2 (5.98 [2.97–12.03]; p = 0.001; 95% CI). Seroconversion was 100% in the heterologous group versus 83% in the homologous group (p > 0.01). Those with prior infection showed significantly higher titers, particularly at T2 and T3 (p < 0.001 for T1–T3). Adverse events were mild and not statistically significant. Multivariate regression confirmed BNT162b2 as an independent factor for higher antibody titers. Conclusion: COVID-19 vaccination in patients with SjD was safe and induced high anti-spike antibody titers and seropositivity. Heterologous boosting, particularly with BNT162b2, demonstrated superior immunogenicity. No association was found between vaccination and SjD disease flares or worsening activity. Full article

Gastrointestinal disorders, such as colorectal cancer (CRC), pose a substantial health burden worldwide, showing increased incidence rates across different age groups. Detecting and removing polyps promptly, recognized as CRC precursors, are crucial for prevention. While traditional colonoscopy works well, it is vulnerable to specialist errors. This study suggests an AI-based diminutive sessile polyp localization assistant utilizing the YOLO-V8 family. Comprehensive evaluations were conducted using a diverse dataset that was assembled from various available datasets to support our investigation. The final dataset contains images obtained using two imaging methods: white light endoscopy (WLE) and narrow-band imaging (NBI). The research demonstrated remarkable results, boasting a precision of 96.4%, recall of 93.89%, and F1-score of 94.46%. This success can be credited to a meticulously balanced combination of hyperparameters and the specific attributes of the comprehensive dataset designed for the colorectal polyp localization in colonoscopy images. Also, it was proved that the dataset selection was acceptable by analyzing the polyp sizes and their coordinates using a special matrix. This study brings forth significant insights for augmenting the detection of diminutive sessile colorectal polyps, thereby advancing technology-driven colorectal cancer diagnosis in offline scenarios. This is particularly beneficial for gastroenterologists analyzing endoscopy capsule images to detect gastrointestinal polyps. Full article

Reliable inflow forecasting represents a challenging and representative problem in long-horizon time series forecasting. Although long-term time series forecasting (LTSF) algorithms have shown strong performance in other domains, their applicability to hydrological inflow prediction has not yet been systematically assessed. Therefore, this study examined two LTSF linear models for inflow forecasting: NLinear and DLinear. LTSF models were trained with a 24 h input window and evaluated for 24 h lead times at eight major dams in South Korea. Long Short-Term Memory (LSTM) network and eXtreme Gradient Boosting (XGBoost) were employed as a conventional AI model. LSTM consistently achieved the highest coefficient of determination (R²) and the lowest normalized root mean square error, DLinear minimized normalized mean square error, and NLinear delivered superior hydrological consistency as measured by Kling–Gupta efficiency. XGBoost showed comparatively larger variability across sites. Spatial heterogeneity was evident; sites were grouped into high-performing, transition, and vulnerable groups. Peak-flow analysis revealed amplitude attenuation and phase lag at longer horizons. Full article

Background/Objectives: Elderly cancer patients in perioperative intensive care units represent a highly vulnerable population due to complex medical needs and physiological challenges. In these high-pressure settings, nurses play a crucial role as patient advocates to ensure well-being and person-centered care. However, there is limited understanding of how nurses operationalize this advocacy role for this specific patient group. This study aimed to explore the conditions and strategies guiding nurses in advocating for elderly cancer patients in perioperative ICU contexts. Methods: Using a Grounded Theory approach, six nurses with direct experience in caring for elderly cancer patients in an oncology institution were recruited. Data were collected via in-depth semi-structured interviews, participant observation, and field notes. Analysis followed the constant comparative method and was supported by MAXQDA software to systematically identify codes, dimensions, and categories, highlighting essential elements of nursing advocacy. Results: Advocacy emerged as a central nursing function, serving both practical and ethical imperatives. Conditions activating advocacy included patients’ complex vulnerability, threatening dignity, mitigated by the family’s anchoring role. Institutional barriers, such as professional devaluation and staffing shortages, often hindered advocacy, resulting in moments of “failure to advocate.” Strategies formed a dynamic process: beginning with in-depth knowledge, progressing through communication mediation, and culminating in direct action. Conclusions: This study contributes to the development of a data-driven theory that deepens the understanding of nursing advocacy in perioperative intensive care for elderly cancer patients, offering valuable implications for practice, education, and policy development, ultimately supporting optimized care delivery and improved patient outcomes. Full article

Background: Urinary tract infections (UTIs) are the most common infections after kidney transplantation and significantly affect patient outcomes. In these immunosuppressed patients, antibiotic resistance is of particular concern due to recurrent infections and limited treatment options. The aim of this study was to evaluate the distribution of microorganisms isolated from urine cultures of kidney transplant patients and to assess their antimicrobial susceptibility patterns. Methods: This retrospective study included all adult kidney transplant recipients with positive urine cultures during 2023–2024. Microorganisms were identified using matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS), and antimicrobial susceptibility testing was performed with the Phoenix System according to European Committee on Antimicrobial Susceptibility Testing (EUCAST) guidelines. Results: A total of 363 urine samples from 123 patients (85% female) were analyzed. E. coli (49%) and Klebsiella spp. (24%) were the predominant uropathogens. High resistance rates to ciprofloxacin and trimethoprim–sulfamethoxazole (TMP–SMX) were observed in both species, while carbapenem resistance remained low. Elevated resistance to multiple antibiotics was also detected among Pseudomonas aeruginosa and Acinetobacter spp., highlighting the importance of continued microbiological surveillance in this population. Conclusions: Gram-negative bacteria were the predominant pathogens causing UTIs in kidney transplant recipients. The high resistance rates to ciprofloxacin and TMP–SMX emphasize the need for local antimicrobial surveillance and individualized empirical therapy. Systematic and ongoing monitoring of resistance patterns is essential to optimize infection management in this vulnerable patient group. Full article

Bee declines are making headlines, yet awareness of native bees is limited, which may stem in part from poor taxonomic knowledge and under-representation in media and education. This study aimed to determine the Australian public’s taxonomic knowledge of native bees and identify the relative popularity of species. We explored this by asking “What is your favourite Australian bee species?” to members joining the Facebook group “The Buzz on Wild Bees”. Over nine months, 580 people responded, but only 400 provided an answer of their favourite Australian native bee species, with 419 answers in total (as some provided more than 1 answer). Of these answers, just 12.9% provided a name for a species, rather than a group, and only 7.6% provided a scientific name. The group that emerged as the favourite were the Amegilla (“blue banded” and “teddy bear” bees), followed by the Meliponini (“sugarbag” or “stingless” bees). Euryglossinae, Neopasiphaeinae, and Stenotritidae were absent from the answers. We discuss our results in light of the taxonomic literacy among the public, and hypothesise why certain taxa are more or less popular. Amegilla species could represent a good gateway into raising awareness among the general Australian public about native bees. The selection of region-specific, vulnerable species such as Xylocopa aerata may better serve as flagships. Greater public exposure and education of under-represented Australian native bee taxa is required. Full article

Background/Objectives: With global population aging, long-term care (LTC) facilities play an essential role in supporting older adults. However, residents are vulnerable to dignity loss in these institutional settings. Understanding dignity from the perspectives of residents, staff, and relatives is critical for informing person-centered care and policy. This review aimed to synthesize qualitative evidence on dignity in LTC facilities across multiple stakeholders. Methods: Following the PRISMA guidelines, we systematically searched six databases (PubMed, Scopus, Web of Science, Wan Fang, VIP, and CNKI) for qualitative studies published in 2010–2023. Eligible studies explored experiences of dignity among older LTC residents, staff, or relatives. Methodological quality was appraised using the Critical Appraisal Skills Programme (CASP) checklist. Data were analysed through thematic synthesis, and findings were compared across stakeholder groups. Results: A total of 1948 records were identified, of which 27 qualitative studies met the inclusion criteria. Two themes emerged from residents’ perspectives: institutionalization and resilience in preserving dignity. From staff perspectives, three themes were identified: understaffing and workload pressures, general approaches to dignity care, and person-centered care. Relatives’ accounts highlighted two themes: uneasiness regarding indignity and ethical expectations in a caring culture. Integrating these perspectives, we propose a triangular model in which residents, staff, and relatives collaboratively sustain dignity. Conclusions: Older adults’ dignity in LTC is shaped by complex interactions among institutional conditions, caregiving practices, and family involvement. Enhancing dignity requires adequate staffing, structural support for person-centered care, and greater involvement of relatives in decision-making. The proposed triangular model offers a framework for guiding interventions, staff training, and policy reforms aimed at safeguarding dignity in LTC facilities. Full article

Background/Objectives: Adolescents’ screen time has increased alongside rising rates of depression and suicidal ideation and behavior. This study examined associations between excessive screen time and mental health among U.S. high school students, and explored whether social image factors (overweight perception, sports team participation, and academic performance) mitigate these associations. Methods: We analyzed data from the 2019 Youth Risk Behavior Surveillance System (YRBSS) (N = 13,677). Screen time was categorized as <2, 2–3, ≥4 h per day for television watching and digital device use (excluding school-related use). Multivariate logistic regression analyses estimated adjusted odds ratios (AORs) and 95% confidence intervals (CIs) for associations between screen time and mental health outcomes, adjusting for demographic and social image factors. Results: Overall, 31.7% of students reported using digital devices for ≥4 h per day, compared with 10.2% who watched television for ≥4 h per day. Using digital devices for ≥4 h per day was significantly associated with difficulty concentrating (AOR = 1.68), insufficient sleep (AOR = 1.43), feeling sad or hopeless (AOR = 1.86), and suicidal ideation (AOR = 1.69 for considering suicide; AOR = 1.77 for planning suicide) compared with using digital devices for <2 h per day, after adjusting for demographic and social image factors. Significant associations between television viewing and mental health outcomes appeared to be largely explained by social image factors. Female students and certain racial/ethnic groups were more likely to report mental health difficulties. Students with a positive social image reported lower odds of poor mental health outcomes and excessive screen time. Conclusions: Excessive digital device use is associated with poor mental health and suicidal ideation among high school students, with female students particularly vulnerable. Social image factors were also associated with screen time and mental health outcomes. Interventions that promote school engagement, sports team participation, and a positive social image may help mitigate the adverse effects of excessive screen time. Full article

Background: Men who have sex with men (MSM) are at high risk for anal human papillomavirus (HPV) infection, with HIV-positive MSM bearing the highest disease burden. Longitudinal data on anal HPV infection among HIV-negative and HIV-positive MSM are limited. We assessed and compared the prevalence, incidence, and clearance of anal HPV infection among HIV-negative and HIV-positive MSM in Xinjiang, China. Methods: Sexually active HIV-positive and HIV-negative MSM aged 18 years and older have been enrolled in an ongoing observational cohort study of HPV since 1 September 2016, in Xinjiang, China. Participants were followed up on every 6 months with anal HPV testing and questionnaires regarding sexual behaviors. We compared HPV prevalence, incidence, and clearance between HIV-positive and HIV-negative MSM. Prevalence ratios (PRs), incidence rate ratios (IRRs), and clearance rate ratios (CRRs) for HIV-negative and HIV-positive MSM were calculated. Results: A total of 1425 MSM, including 131 HIV-positive and 1294 HIV-negative individuals, with a median age of 29 years (interquartile range [IQR]: 24 to 36), were included in our analysis. Compared with HIV-negative MSM, HIV-positive MSM demonstrated significantly higher prevalence across both individual and grouped HPV genotypes. Specifically, the prevalence of grouped HPV genotypes (any, high-risk, low-risk, 9v, 4v, HPV16/18, and HPV 6/11) was consistently elevated in HIV-positive individuals. PRs for individual HPV types 31, 45, 34, 44, 53, and 81 were 2.47 (95% CI: 1.16–5.25), 2.47 (1.10–5.54), 4.94 (1.25–19.52), 3.29 (1.08–10.06), 2.02 (1.01–4.04), and 2.66 (1.18–6.01), respectively. Furthermore, the incidence of most individual HPV genotypes were higher, while the clearance rates were lower among HIV-positive MSM. Specifically, IRRs for HPV types 31, 33, 45, 55, and 66 were 2.12 (1.19–3.75), 2.19 (1.24–3.90), 2.32 (1.17–4.59), 3.02 (1.15–7.93), and 2.44 (1.18–5.05), respectively. CRRs for HPV types 51 and 58 were 0.33 (0.21–0.52) and 0.60 (0.45–0.79), respectively. Conclusions: HPV prevalence, incidence, and clearance of anal HPV exhibited heterogeneity between HIV-positive and HIV-negative MSM. HPV vaccination and condom promotion programs should be recommended for HIV-positive MSM to mitigate the burden of HPV infection in this vulnerable population. Full article