Search Results (1,643)

The city, like a piece of architecture, is a structure in space, but one of gigantic scale, something perceived only over a long period. A space is termed a place when it acquires an identity. The entirety of urban personality, urban communication, urban conduct, and urban design constitute the urban identity. This research delves into divided urban identities and examines how urban and architectural design influence the fragmentation of the cityscape. It explores the connection between urban environments’ physical attributes and the divide of social, cultural, and political identities within cities. This study uses a multidisciplinary method to acquire thorough knowledge by combining architectural studies, urban planning theories, and social-cultural perspectives. The case study of reference is the city of Matera, in southern Italy, which has a unique history of a slow shaping of its urban and productive landscape throughout centuries due to heavy environmental constraints and resource availability and which has suffered forced evacuation and major discontinuities in the past century. Here, the opposing traits of the historical Sassi district and the new town are examined, focusing on their resulting separated urban identities. The study also looks at how divided cities may be reconciled and integrated, emphasizing the relevance of a holistic urban approach for the framing of complex issues. The research proposes methods and best practices for developing inclusive urban settings that promote cohesion and shared identities through the analysis of successful cases of urban regeneration, adaptive reuse of spaces, and participatory design processes. The findings of this research contribute to both academic and practical knowledge by deepening the understanding of the relationship between urban design, architecture, and divided urban identities. It emphasizes the value of comprehensive approaches to urban planning that take into account the social, cultural, and historical settings of cities to foster inclusivity, rapprochement, and the development of common urban identities. Full article

Polycystic ovary syndrome is a presvalent endocrine disorder affecting women globally, characterized by hormonal imbalance, metabolic disturbances, and reproductive dysfunction. Diagnosis relies on clinical evaluation, medical history assessment, physical examination, and laboratory tests, with the Rotterdam criteria being widely used. The pathophysiology of PCOS involves genetic predisposition, environmental factors, and lifestyle influences, with hormonal dysregulation, particularly elevated androgens, insulin resistance, and chronic inflammation, playing a pivotal role. These mechanisms not only contribute to reproductive and metabolic disturbances but also to the various cutaneous manifestations, such as acne, hirsutism, and alopecia. This review aims to analyze the role of androgens in the dermatological manifestations in patients with polycystic ovary syndrome, providing insights into underlying mechanisms and guiding the development of effective therapeutic strategies. By synthesizing available evidence, this review aims to deepen understanding of related dermatological manifestations and improve outcomes for affected individuals. Full article

Urban memory involves the re-creation of a city’s physical, historical, social, and cultural elements in the memories of its inhabitants. However, urban transformation and commercial tourism-oriented projects may threaten the continuity of this memory. This study aims to provide an understanding of the relationship between urban memory and spatial experience while exploring how urban memory elements convey meanings to daily users and local inhabitants of a touristic settlement. The research focuses on Misi Village in Bursa, Turkey, a settlement with a 2000-year history known for its traditional architecture and natural beauty. Over the past two decades, local authorities have pursued extensive restoration projects to rebrand Misi Village as an Art and Tourism Village. The research employs the oral history method, focusing on two user groups: tourists and locals. The findings reveal that while tourists appreciate Misi Village for its natural beauty and recreational activities, they lack a deeper understanding of its history and the transformation of its identity. Instead, they mostly focus on commerce-oriented spatial experiences. In contrast, local residents emphasize daily life and traditional practices as they strive to sustain their livelihoods. By highlighting this difference, strategic planning is proposed to preserve Misi Village’s unique urban memory and promote sustainable, culturally centered tourism. Full article

Background: Infective endocarditis is a life-threatening disease with diverse clinical presentations, making diagnosis challenging and requiring a range of complementary tests. The level of suspicion, based on clinical judgment, guides decisions regarding the initiation of empirical treatment and the selection of appropriate diagnostic tools. This study aimed to develop and validate the EndoPredict-Dx score for early prediction of infective endocarditis diagnosis. Methods: Patients admitted to a specialized cardiovascular hospital emergency department with suspected infective endocarditis between January 2011 and January 2020 were included. The primary outcome was left-sided infective endocarditis according to the Duke criteria. Logistic regression was used to derive the scoring system, with internal validation performed through bootstrapping. Candidate variables were obtained from the admission medical history, physical examination, and laboratory parameters. Results: Of the 805 individuals with suspected infective endocarditis (median age 56 years (40–73); 58.6% men), 530 confirmed the diagnosis based on the Duke criteria. The EndoPredict-Dx assigned points for male sex, previous endocarditis, petechiae, heart murmur, suspected embolism, symptoms lasting 14 or more days at the time of admission, hemoglobin level ≤ 12 g/dL, leukocyte level ≥ 10 × 10⁹/L, C-reactive protein level ≥ 20 mg/L, and urine red blood cells ≥ 20,000 cells/mL. Patients were divided into three risk groups. The AUROC was 0.78 (95% CI 0.75–0.81) for the derivation cohort and 0.77 for the internal validation. Conclusions: The EndoPredict-Dx score accurately predicted the likelihood of infective endocarditis using clinical and laboratory data collected at admission. Full article

Background: Gestational diabetes mellitus (GDM) is defined by an insufficient insulin response to counteract the insulin resistance (IR) that arises from the physiological adaptations associated with pregnancy. However, the pathophysiology of IR is complex and unclear, as it encompasses elements such as epigenetics, environmental factors, modifiable lifestyle factors, and psychosocial factors. Aim: The objective of this study was to evaluate the influence of GDM and other maternal factors on IR markers in comparison to mothers with normal glucose tolerance during pregnancy in the first week postpartum. Material and Methods: The study population comprised 70 participants, including mothers with gestational diabetes who were treated with a diet and physical activity (GDM G1), with insulin (GDM G2), and a control group of healthy mothers without gestational diabetes (non-GDM). A series of statistical techniques were employed to facilitate the comparison of data between the study groups, with the objective of identifying potential associations with maternal factors. A taxonomic analysis was conducted using the following factors: classification by study group, a history of hypothyroidism in the maternal medical interview, and maternal gestational weight gain, which were identified as the best-fitting predictors. Results: The analysis resulted in the identification of four clusters of patients. Comparison of the insulin resistance markers between mothers assigned to the abovementioned clusters showed differences in the incidence of excessive weight loss and in the results of glucose screening tests during pregnancy. Also, differences concerning fasting glucose levels in the first and second/third trimesters of pregnancy and glucose levels at 1 h post-OGTT were found. For the clusters, the results of the HOMA-IR and the QUICKI did not show any differences in the first week after delivery (p > 0.05). HbA1c results varied significantly. Conclusions: Degree of glucose metabolism disorders, hypothyroidism, and weight gain in pregnancy influence maternal insulin resistance markers in the first week postpartum. Additionally, gestational weight fluctuation has a significant influence on the outcome of pregnancy, particularly with regard to fetal growth and, consequently, the infant’s birth weight and adipose tissue accumulation. Full article

Rather than simply claiming the “unorthodox” or “pluralistic” mindset of an early modern Muslim thinker, this intellectual micro-history aims to show the complexity of Shāh Walī Allāh’s (d. 1762) thought-world. This article follows him to Mecca and Medina for the Hajj pilgrimage. While pilgrimage is traditionally included in the fundaments of Islamic practice, it is also important to realize that the majority of Muslims have not historically participated in this pilgrimage. Due to the physical limitations of travelling as the Muslim community rapidly expanded in the 7th century onwards, we have nearly a thousand years until the 18th century where only a select few Muslims, usually wealthy enough to make the arduous journey, participated in the yearly practice. This created a complex culture of pilgrims in the Holy Cities with the cities functioning as informal circles of scholarship. Shāh Walī Allāh Dihlawī engages in this knowledge production process while carrying out the mandatory rituals associated with the Hajj pilgrimage. Thus, this article shows that the complex interplay of Walī Allāh with Meccan and Medinan scholars is a highly dynamic process with unexpected outcomes as specific sacred geography interacts with the conceptual (and genealogical) categories that scholarly pilgrims bring with them to this intellectual encounter. In doing so, we catch a glimpse of the 18th century through a very particular set of Indian Sufi eyes. Full article

Background/Objective: Eating behaviors (EB) correlate with weight loss after bariatric surgery (BS). Therefore, the investigation of EB could guide interventions to prevent insufficient weight outcomes. Method: A prospective cohort of 85 patients undergoing Roux-en-Y Gastric Bypass (RYGB; 84.7% female, mean age 44.7 ± 9.3 years) was included. Six months after undergoing RYGB, EB patterns, including cognitive restraint (CR), uncontrolled (UE), and emotional eating (EE), were assessed using the Three-Factor Eating Questionnaire R21 (TFEQ-R21). History, physical examination, and anthropometric assessments were collected pre- and 12 months postoperative. Patients were divided based on the percentage of excess weight loss (%EWL < 80% or ≥80%) and EB patterns were correlated with weight outcomes at 12 months. Results: The %EWL ≥ 80% group demonstrated significantly higher scores in CR and EE compared to %EWL < 80% (p < 0.001 and p = 0.01, respectively). UE scores were similar between groups (p = 0.41). At 12 months postoperative, the %EWL ≥ 80% group had negative correlations between CR and BMI and positive correlations between CR and EWL (rho = −0.33 and rho = 0.29; p = 0.04). Multiple logistic regression considering %EWL ≥ 80% as the aim outcome revealed that CR had a significant influence (OR = 1.037; p = 0.058), while age (OR = 0.962; p = 0.145), sex (OR = 2.984; p = 0.135), UE (OR = 0.995; p = 0.736), and EE (OR = 1.017; p = 0.296) did not. Conclusions: EBs influence outcomes after BS, and a model using TFEQ-R21 predicted them. CR six months post-surgery was the strongest predictor of higher EWL at 12 months. Further research is needed to understand the relationship between restrictive EB and BS outcomes, possibly identifying strategies to prevent disordered EB in patients with higher scores. Full article

The process of coal measure gas accumulation is relatively complex, involving multiple physicochemical processes such as migration, adsorption, desorption, and seepage of multiphase fluids (e.g., methane and water) in coal measure strata. This process is constrained by multiple factors, including geological structure, reservoir physical properties, fluid pressure, and temperature. This study used Well Z-7 in the Qinshui Basin as the research object as well as numerical simulations to reveal the processes of methane generation, migration, accumulation, and dissipation in the geological history. The results indicate that the gas content of the reservoir was basically zero in the early stage (before 25 Ma), and the gas content peaks all appeared after the peak of hydrocarbon generation (after 208 Ma). During the peak gas generation stage, the gas content increased sharply in the early stages. In the later stage, because of the pressurization of the hydrocarbon generation, the caprock broke through and was lost, and the gas content decreased in a zigzag manner. The reservoirs in the middle and upper parts of the coal measure were easily charged, which was consistent with the upward trend of diffusion and dissipation and had a certain relationship with the cumulative breakout and seepage dissipation. The gas contents of coal, shale, and tight sandstone reservoirs were positively correlated with the mature hydrocarbon generation of organic matter in coal seams, with the differences between different reservoirs gradually narrowing over time. Full article

Exer-games are interactive experiences in which participants engage in physical exercises to achieve specific goals. Some of these games have a collaborative nature, wherein the actions and achievements of one participant produce immediate effects on the experiences of others. Music serves as a stimulus that can be integrated into these games to influence players’ emotions and, consequently, their actions. In this paper, a framework of music services designed to enhance collaborative exer-games is presented. These services provide the necessary functionality to generate personalized musical stimuli that regulate players’ affective states, induce changes in their physical performance, and improve the game experience. The solution requires to determine the emotions that each song may evoke in players. These emotions are considered when recommending the songs that are used as part of stimuli. Personalization seeds based on players’ listening histories are also integrated in the recommendations in order to foster the effects of those stimuli. Emotions and seeds are computed from the information available in Spotify data services, one of the most popular commercial music providers. Two small-scale experiments present promising preliminary results on how the players’ emotional responses match the affective information included in the musical elements of the solution. The added value of these affective services is that they are integrated into an ecosystem of Internet of Things (IoT) devices and cloud computing resources to support the development of a new generation of emotion-based exer-games. Full article

Background: The demand for body sculpting procedures after massive weight loss (MWL) has grown, with medial thighplasty (MT) emerging as an effective option. This study examines the impact of MT on quality of life (QoL), particularly focusing on body image and self-perception in individuals who have undergone MWL. Methods: This retrospective, single-center study included 21 patients who had post-bariatric MWL and subsequently underwent MT. QoL, with a focus on body image and self-perception, and was assessed through a custom-designed questionnaire administered before and after surgery. Inclusion criteria were a BMI < 35 and a history of bariatric surgery. Results: Twenty-one patients (20 female, 1 male) were included, with an average age of 50.3 years. The median weight loss was 58.4 kg. Post-operatively, the Physical Component Score (PCS-12) showed significant improvement, while the Mental Component Score (MCS-12) did not show a notable change. However, self-acceptance, body contact, sexuality, and self-esteem all significantly improved post-surgery, whereas vitality did not. Conclusions: Consistent with previous studies, MT yields positive outcomes regarding physical well-being. This study further highlights the procedure’s benefits for self-acceptance, body contact, sexuality, and self-esteem. Patients with expectations of improvements in vitality, or mental health concerns like depression or anxiety, should be carefully selected and may benefit from multidisciplinary care, including psychiatry or psychological support, to avoid dissatisfaction with post-surgical outcomes. Full article

Background: Children with learning disability (LD) often experience a poor quality of life (QOL) compared to their peers without a known history of LD. Coping strategies are known to play a role in influencing their QOL. Objectives: This study aims to compare the QOL and coping strategies between children with and without LD. Additionally, it seeks to evaluate how coping strategies impact the QOL of children with LD in the Eastern Governorate of Saudi Arabia. Method: A representative sample of 6 to 18-year-old children with (n = 97) and without (n = 89) LD were recruited from different schools. The Short Form-12 (SF-12) health survey was used to assess both physical and mental health components, while the validated Coping Orientation to Problems Experienced Inventory (Brief-COPE) measured coping strategies. Data analysis included descriptive statistics (mean, standard deviation, percentage), independent t-tests, Spearman’s correlation, and binary logistic regression. Results: The results reveal that participants with LD show poor QOL in terms of role functioning, bodily pain, general health, vitality, social functioning, role emotion, and mental health in comparison to non-disabled children. Participants with LD show greater reliance on substance abuse and religious coping than non-disabled children. The results clearly indicate a fairly to moderately strong correlation between the physical component summary and all approaches to coping strategies except religious coping. Of all the approaches to coping methods, we observe a weak correlation among denial (r = −0.17, p < 0.05), substance abuse (r = −0.15, p < 0.05), and behavioral disengagement (r = −0.18, p < 0.05) with the mental component summary aspect of QOL. The results of logistic regression analysis indicate that grade (OR = 3.79; p = 0.01) is significantly related to LD. The physical component summary score is significantly associated with denial (β = −0.33, CI = −6.87–−2.19, p < 0.01), and substance abuse (β = −0.14, CI = −4.96–0.40, p < 0.05), while the mental component summary is significantly associated with active coping (β = −0.30, CI = −4.50–0.76, p < 0.01), behavioral disengagement (β = −0.20, CI = −4.48–0.30, p < 0.05), and humor coping strategy (β = 0.22, CI = 0.06–4.55, p < 0.05). Conclusion: These findings are relevant to researchers, psychologists, special educators, teachers, and clinicians, given the need to understand the coping variables to improve the QOL of these learning-disabled children. Full article

Chest pain in children and adolescents is a common reason for emergency department visits and referrals to pediatric cardiologists, often driven by parental concern about potential cardiac causes. However, the vast majority of pediatric chest pain cases are benign and non-cardiac in origin. This narrative review examines the etiology, evaluation, and management of pediatric chest pain, emphasizing the importance of a thorough clinical history and physical examination in distinguishing between benign and serious conditions. This review also explores the role of diagnostic tests such as electrocardiograms, chest radiography, and echocardiography, highlighting the need to balance the avoidance of unnecessary tests with the imperative to rule out life-threatening cardiac conditions. Despite the low prevalence of cardiac causes, the variability in diagnostic approaches underscores the need for standardized evaluation algorithms. These could streamline care, reduce unnecessary resource utilization, and minimize anxiety for both patients and their families. Future studies should focus on assessing the effectiveness of such algorithms in improving clinical outcomes and resource management. The findings underscore the importance of a careful, evidence-based approach to the management of pediatric chest pain. Full article

This review delves into the pivotal primordial stage of the universe, a period that holds the key to understanding its current state. To fully grasp this epoch, it is essential to consider three fundamental domains of physics: gravity, particle physics, and thermodynamics. The thermal history of the universe recreates the extreme high-energy conditions that are critical for exploring the unification of the fundamental forces, making it a natural laboratory for high-energy physics. This thermal history also offers valuable insights into how the laws of thermodynamics have governed the evolution of the universe’s constituents, shaping them into the forms we observe today. Focusing on the Standard Cosmological Model (SCM) and the Standard Model of Particles (SM), this paper provides an in-depth analysis of thermodynamics in the primordial universe. The structure of the study includes an introduction to the SCM and its strong ties to thermodynamic principles. It then explores equilibrium thermodynamics in the context of the expanding universe, followed by a detailed analysis of out-of-equilibrium phenomena that were pivotal in shaping key events during the early stages of the universe’s evolution. Full article

Background and Objectives: Osteoporosis is becoming more prevalent with the rise in the aging population, leading to the increased use of bisphosphonates for treatment. While these medications are effective in preventing osteoporotic fractures, long-term use has been associated with atypical insufficiency fractures, primarily in the femur. However, atypical fractures in other weight-bearing bones, such as the tibia, have rarely been reported. This study aims to present a case of an atypical insufficiency fracture of the tibia in an elderly female who has been on long-term bisphosphonate therapy and to review treatment outcomes within the context of the current literature. Patient concerns: A 76-year-old female presented with pain in the proximal right tibia, developing two months prior without trauma. She had been receiving long-term bisphosphonate therapy for osteoporosis, initially taking sodium risedronate orally for 4 years, followed by intravenous ibandronate for 10 years. Physical examination revealed localized tenderness, and radiographs showed cortical thickening and a horizontal fracture line in the proximal right tibia. MRI confirmed these findings, along with surrounding edema. The laboratory results were mostly normal, but the bone formation marker osteocalcin was significantly reduced. The patient had a history of insufficiency fractures in the ipsilateral tibia and contralateral femur, previously treated conservatively with teriparatide. A similar conservative approach was attempted but failed, leading to surgical intervention with intramedullary nailing and supplementary plating. At the 8-month follow-up, the patient showed successful fracture union and resolution of symptoms. Conclusion: Long-term use of bisphosphonates, though effective for osteoporosis, can lead to atypical insufficiency fractures, primarily in the femur but also occasionally in the tibia. Clinicians should consider this possibility when patients present with pain in weight-bearing bones without a history of trauma. Prompt diagnosis through thorough history-taking, physical examination, and appropriate imaging is essential to ensure timely management. Full article

Introduction: Peripheral arterial disease (PAD) impedes the ability to recover from lower extremity arthroplasties (LEA) while simultaneously increasing risks of peri- and postoperative complications, morbidity, and mortality. Despite the known risks that PAD presents, there are currently no standards outlining how practitioners should screen patients prior to undergoing LEA. The purpose of this manuscript is to facilitate the improved diagnosis of PAD, leading to appropriate vascular surgery consultation prior to undergoing orthopedic surgeries. Recommendations for Preoperative Assessment: Screening begins with a succinct history and physical exam, looking for signs and symptoms of diminished vascular integrity. A heightened suspicion for PAD should prompt the immediate enactment of an ankle brachial index, or alternatively, a pressure volume recording or the skin perfusion pressure technique. Full article