Restoration Outcomes Research Articles

Objectives: This study aimed to compare the 5-year cumulative survival rates and clinical outcomes of zirconia and lithium disilicate restorations in both tooth- and implant-supported prostheses, focusing on survival, technical and biological complications, as well as patient-reported satisfaction. Materials and Methods: A retrospective cohort of 200 patients treated with either zirconia (n = 100) or lithium disilicate (n = 100) fixed restorations between 2020 and 2024 was analyzed. Only cases with a minimum follow-up of 5 years were included. Clinical parameters (fracture, chipping, retention loss, secondary caries, peri-implant complications), radiographic outcomes (marginal bone loss, periapical stability), and patient satisfaction (VAS scores for esthetics and function) were evaluated. Kaplan–Meier survival analysis and subgroup analyses (anterior/posterior, tooth-/implant-supported) were performed. Results: At 5 years, the cumulative survival rate was 94.0% for zirconia and 89.0% for lithium disilicate (p = 0.210). Technical complications were lower with zirconia (14.0% vs. 21.0%, p = 0.182), including fewer fractures (6.0% vs. 12.0%, p = 0.126). Chipping (5.0% vs. 7.0%) and debonding (3.0% vs. 2.0%) showed no significant differences. Biological outcomes were comparable: secondary caries (7.0% vs. 11.0%, p = 0.332), endodontic issues (4.0% vs. 6.0%, p = 0.516), peri-implant mucositis (9.0% vs. 12.0%, p = 0.495) and peri-implantitis (3.0% vs. 5.0%, p = 0.470). Radiographically, periapical stability was preserved in most cases (93.0% vs. 89.0%, p = 0.317), and the mean marginal bone loss was slightly lower with zirconia (0.46 ± 0.25 mm vs. 0.53 ± 0.30 mm, p = 0.148). Patient-reported outcomes were favorable in both groups, with esthetic VAS scores of 8.6 vs. 8.2 (p = 0.072) and functional scores of 8.4 vs. 8.0 (p = 0.085). Zirconia was rated higher in posterior/implant-supported cases, while lithium disilicate was preferred in anterior restorations. Conclusions: Both zirconia and lithium disilicate restorations demonstrated favorable long-term outcomes, with zirconia trending toward superior mechanical reliability in posterior and implant-supported restorations, and lithium disilicate excelling in esthetic performance, particularly in anterior regions. Material selection should be guided by clinical indication, occlusal load distribution, and esthetic requirements.

Proactive climate interventions, such as restoration and assisted adaptation, are increasingly being used to secure the persistence of populations under climate change. Such strategies are being proposed globally for declining kelp forests, yet there remains a lack of consideration for potential impacts to other key traits that underpin their immense values. Here we assess the outcome of restoration and assisted adaptation strategies on kelp productivity - a key component of kelp forest blue carbon, habitat provision and ecosystem service values. We combine empirical field data, climate projections and knowledge of underlying genomics to compare kelp productivity across restoration and assisted adaptation scenarios that are, and are not, informed by productivity-temperature relationships within source populations. Using Western Australian kelp (Ecklonia radiata) forests, we show that the productivity of restored kelp using traditional strategies for selecting source material may decline by 16-22% under mid-century ocean warming. However, drawing on knowledge of productivity-temperature relationships to strategically select individuals could enhance the productivity of restored kelp by up to 9% even under mid-century ocean warming, while simultaneously boosting thermal resilience. Optimising trait interactions when undertaking climate interventions will be key to sustaining values associated with restored kelp forests in a warming ocean.

ABSTRACTThe establishment of native grassland species is widely implemented on abandoned land as a strategy to restore degraded soils. However, its effects on soil properties are highly species‐specific, as plant‐driven physicochemical changes subsequently reshape microbial community structure. The linkages between soil physicochemical properties and microbial communities following native grassland establishment remain poorly understood. To address this knowledge gap, we examined the effects of 11 native grassland species on soil physicochemical properties and fungal community structure. Using co‐occurrence network analysis, we elucidate how plants drive fungal community reorganisation through soil‐mediated trophic pathways. The results showed that soil aggregate stability, chemical properties, and fungal communities differed significantly among the 11 species. Soil chemical properties, such as pH and EC, correlated with symbiotic fungi dominated modules; both soil aggregate stability and chemical properties were linked to pathogenic fungi dominated modules, while saprophytic fungi dominated modules displayed no linkage to either soil aggregate stability or chemical properties. These findings establish that fungal trophic modes govern species‐dependent restoration outcomes via modular soil–microbe linkages, thereby offering predictive frameworks for species‐specific management of abandoned soils.

Self-management behaviors for the care transition of cardiac patients: A scoping review.

Abstract Grasslands cover over 50% of the Qinghai–Tibetan Plateau (QTP), playing a critical role in water conservation, soil retention, carbon sequestration, biodiversity, and supporting pastoral livelihoods. Due to the high-altitude and cold-climate conditions, the QTP is highly vulnerable to climate change. Understanding the relative importance of the drivers of grassland degradation is essential for developing adaptive management strategies. While numerous studies have explored these drivers, the impacts of large-scale ecological restoration efforts since 2000, particularly across different grassland types and degradation-recovery phases, remain underexplored. This study analyzes 40 years of grassland vegetation dynamics on the QTP, identifying key inflection points and classifying regions into four ‘degradation-restoration’ trajectory types. The effects of climatic and anthropogenic drivers across distinct temporal phases are quantified. The results indicate that 6.56% of grasslands are in continuous degradation, while 28.97% are at risk of potential degradation risk. Drought and grazing emerge as the primary drivers of vegetation change, while restoration and afforestation programs play a significant role in enhancing recovery. Our findings underscore the spatiotemporal variability of grassland responses and emphasize the need for targeted grazing management and integrated water resource planning to optimize restoration outcomes. This study provides a framework for differentiated grassland management in the face of climate change and human pressures on the QTP.

Seagrass ecosystems are vital for maintaining marine ecological balance, supporting the blue carbon cycle, offering habitat for marine organisms, and safeguarding coastal areas against erosion. Nevertheless, seagrass ecosystems worldwide are declining substantially due to human activities and climate change. This trend is also evident in Indonesia, where approximately 7% of seagrass coverage is lost annually. This research examines existing literature on seagrass restoration by focusing on three key approaches: spatial assessment of suitable habitats, advancements in physical restoration techniques, and the creation of predictive models for evaluating restoration outcomes. The goal is to offer comprehensive insights into the challenges and prospects for improving management and establishing more effective and sustainable restoration strategies in coastal environments. A Systematic Literature Review (SLR) combined with bibliometric analysis was conducted on 177 publications from the Scopus database spanning 2019 to 2024 to identify research trends, technological advancements, and existing challenges in seagrass restoration. The research emphasizes the necessity of a holistic approach to seagrass restoration, incorporating spatial analysis, developing flexible restoration techniques, and implementing predictive modeling and statistical assessments to enhance long-term planning and monitoring efforts. The case study in Jepara demonstrates the effectiveness of participatory approaches at the local scale, despite limitations in technology and long-term monitoring. Integrating spatial and digital technologies, strengthening local capacity, international collaboration, and multidisciplinary integration are key to improving the effectiveness and sustainability of seagrass restoration, while strengthening its contribution to coastal resilience and climate change mitigation.

Abstract Ecosystem restoration benefits biodiversity but restoration outcomes can vary widely. In forestry‐drained boreal peatlands, the limited success in restoration may arise from inadequate restoration of hydrological characteristics, most importantly water‐table (WT) level. We study (1) if the restoration effect on vascular plant and moss species communities is explained by WT level of restored sites, and (2) whether species groups predictions can be improved by using information on WT and nitrogen (N) levels. We use data on species communities, WT level and porewater quality before restoration and 2, 5 and 10 years after restoration from 24 restored and 16 pristine boreal peatland sites in Finland. Ten years after hydrological restoration, 70% of the variation in the restoration effect for species communities was explained by the median mid‐summer WT level of 2–5 years after restoration, peatland type and their interaction. Species group predictions were not consistently improved by WT or N levels. Synthesis and applications . The mid‐term (2–5 years after restoration) WT level can be used to assess whether hydrological restoration has been successful. A minimum mid‐summer WT level should be at least −25 cm from the peatland surface. A sufficient WT level is more likely to be gained in rich peatland types than in poor peatland types, and even with adequate WT level, poor sites have lower probability of positive restoration effects. Hence, rich site types could be prioritized in restoration planning.

University campus teaching areas are essential spaces for students’ daily learning and recovery, in which soundscapes play a crucial role in shaping restorative experiences. This study aimed to explore the restorative effects of soundscapes in campus teaching areas and the factors influencing these effects. Field surveys, psychological assessments, and physiological experiments were conducted to evaluate restorative perceptions, which were characterized by three dimensions: Attractiveness, Coherence, and Being Away. The findings indicate that both the visual environment and acoustic characteristics significantly shaped restorative outcomes. Natural landscapes, particularly green areas and waterscapes, enhanced the restorative potential of soundscapes, while natural sounds, such as birdsong, fountain sound, and rustling leaves, were perceived as more restorative. In contrast, traffic noise, crowd noise, and class bell sound reduced restorative perceptions. Furthermore, the signal-to-noise ratio (SNR) played a critical role, with the higher SNR values of birdsong relative to traffic noise being associated with stronger restorative effects. These results suggest that campus soundscape design should prioritize green landscapes, introduce or amplify natural sounds, and optimize the SNR of restorative sounds. Overall, this research provides both theoretical support and practical guidance for designing healthier campus environments that foster students’ recovery and well-being.

Gap percentage at the restoration-tooth interface and internal voids remain significant limitations in resin-based composite restorations, contributing to marginal leakage, secondary caries, and restoration failure. Preheating composite resins has been proposed as a strategy to enhance adaptation and reduce polymerization-induced stress. To evaluate the influence of preheating resin composites and varying light-curing durations on gap percentage at the restoration-tooth interface, internal adaptation, and void formation in Class II restorations using high-resolution Nano-CT imaging. Fifteen human maxillary premolars were prepared with standardized Class II cavities and allocated into three groups (n = 5). Group 1 received room-temperature composite cured for 20s. Groups 2 and 3 received composite preheated to 68°C using the Compex HD warmer, cured for 20 and 5s, respectively. All restorations were bulk-filled. Internal adaptation (gap percentage) and voids were assessed using a Bruker Skyscan 2214 Nano-CT, followed by quantitative analysis with ImageJ and CTAnalyser software. Statistical comparisons were performed using one-way ANOVA with Tukey's post hoc test. Preheated composites (Groups 2 and 3) demonstrated significantly reduced gap percentages compared to room-temperature controls (p < 0.0001). Group 3 exhibited the lowest gap percentages and void volume, even with a 5s curing protocol. No significant differences were observed in void frequency between groups. Preheating resin composites enhances internal adaptation and reduces interfacial gap percentage and void volume, even with reduced curing time. This technique offers a promising, efficient approach for improving posterior composite restoration outcomes.

BackgroundOver the last decade, a paradigm shift has been initiated in the field of nature management and conservation with shifting the focus from traditional, more static conservation efforts to dynamic conservation efforts. To promote dynamic restoration efforts, it is essential to provide nature managers with tools to measure the impact and effectiveness of relevant interventions. However, despite increasing practice, quantifying restoration management in a relevant and measurable way remains challenging. Therefore, this systematic map aims to elucidate which metrics are being used to measure the impact of dynamic nature management working with natural processes.MethodsTo assess which metrics are being used to measure this impact, we will perform a systematic map in Web of Science, Scopus and Agricola. In addition, we will search for grey literature through directed visits to organizational websites, search ProQuest for relevant PhD theses on the topic and perform a search in Google Scholar. For the latter, we will only consider the first 200 articles. We will include articles conducted based on research in natural areas within temperate zones, where natural dynamics (e.g., grazing, hydrology, fire) are present, introduced or restored, and are assessed using before/after or control/impact study designs. The selected studies should mention measurements of the natural process restoration outcome related to relevant biodiversity metrics (e.g., richness, diversity, abundance). Literature from review studies will be included to identify other relevant articles. All studies positively assessed as relevant through the criteria above will be subject to critical appraisal. Hereafter, we will use the critical appraisal tool as issued by Environmental Evidence. The data obtained will be used to create an overview of restoration and conservation current practices in order to identify knowledge gaps. We will disseminate our results to nature managers and provide a time- and cost- assessment of each measurement to create a guide on monitoring of dynamic nature management.Supplementary InformationThe online version contains supplementary material available at 10.1186/s13750-025-00373-6.

Patient-specific Implants in Post-traumatic Orbital Reconstruction: A Systematic Review.

Tallgrass prairies are important yet endangered ecosystems of central North America and subjects of many ecological restoration projects. Prairie restorations commonly succeed in establishing native grasses but can stagnate in the early stages of succession with limited diversity and composition of native forbs. Establishment of desirable forbs introduced into grass-dominated restorations can be difficult because of intense competition. Late-successional arbuscular mycorrhizal (AM) fungi cultured from undisturbed, remnant prairies have been shown to improve restoration outcomes, with most previous tests introducing AM fungi during initial establishment of prairie restoration in post-agricultural fields. Much less research has been performed on the benefits of AM fungi in older restorations. In this experiment, we determined whether inoculation with native AM fungi would improve the establishment of 12 native prairie forb species in a decades-old, restored prairie dominated by native grasses. We followed the survival and growth of uninoculated and AM fungi-inoculated plants over two growing seasons. We found that most species, including high-conservation-value species such as purple prairie clover (Dalea purpurea) and lead plant (Amorpha canescens) benefited in terms of increased survival and/or growth. By showing that inoculation with native, late successional AM fungi improved establishment of desirable native plants even in a decades-old restored prairie, this study adds to confidence in the benefits of native AM fungi to prairie restoration in general, and specifically demonstrates the potential value of native AM fungi to efforts to enrich existing grass-dominated restored prairies with high conservation value plant species.

BackgroundA subset of people living with HIV (PLWH) exhibit poor immune recovery despite effective antiretroviral therapy (ART), remaining at risk of disease progression. The immunometabolic mechanisms underlying this immunological non‐response remain unclear.MethodsWe integrated transcriptomic and immunophenotypic approaches to characterise immune differences between immunological responders (IRs) and non‐responders (INRs). Public datasets were analysed to identify differentially expressed genes (DEGs), followed by enrichment analysis, predictive modelling, immune infiltration assessment, and regulatory network construction. In parallel, flow cytometry was performed to assess T and B cell subsets in an independent cohort including IRs, INRs, treatment‐naïve patients (TNPs), and healthy controls (HCs).ResultsDEGs between IRs and INRs were enriched in mitochondrial and ribosomal pathways. INRs showed reduced Th1, Th17, and Tfh cells, alongside increased markers of immune activation and exhaustion. Predictive modelling identified five hub genes (ATP5O, PIGY, UQCRQ, COX7C, and BLVRB) associated with immune recovery, and clustering based on their expression defined two transcriptionally distinct subtypes. Flow cytometry further confirmed that INRs exhibited diminished CD4⁺ T cell counts, increased PD‐1⁺ and HLA‐DR⁺ expression, and reduced resting memory B cells, reflecting persistent immune dysfunction.ConclusionsThis study underscores the pivotal role of immunometabolic dysregulation in shaping heterogeneous immune responses to ART. By integrating computational and experimental data, we identified key biomarkers and regulatory pathways associated with immune recovery. Our findings highlight the central influence of metabolic processes on immune restoration outcomes and propose personalised metabolic interventions as a promising strategy to enhance therapeutic efficacy in HIV‐infected individuals.

Calls for social-ecological restoration have emerged to help transcend traditional ecological boundaries by including plural values as well as transdisciplinary processes. Inspired by the IPBES values typology, we used questionnaires to assess four multi-layered perspectives characterizing local actors in two transdisciplinary grassland restoration projects in Germany: Broad values, specific values, knowledge, and visions for restoration outcomes. Varimax rotated principal component analysis yielded 16 factors across these dimensions. A subsequent hierarchical cluster analysis revealed three clusters based on these factors compatible with the Life Framework of Values: restoration for… (1) living with nature, (2) living in nature, and (3) living from nature. The three clusters demonstrate the diversity of values-based perspectives among participants of the real-world laboratories. These perspectives capture the multi-layered values underpinning engagement in restoration. Accounting for these perspectives without jeopardizing one perspective over the others provides a basis for more inclusive restoration efforts.

ObjectivesThe objective of this prospective, randomized, parallel-group clinical study was to compare the 6- and 12-month clinical performances of direct composite restorations with or without fiber-reinforced composite applied to endodontically treated posterior teeth (ETpT) in bruxists.Materials and methodsThirty-two ETpT were randomly restored with only posterior composite (gneal posterior, GC; CR group) or fiber-reinforced composite (EverX flow, GC) + posterior composite (FRCR group) in bruxists aged 18–65 years (n = 16). The inclusion criteria were as follows: bruxists with ETpT; class 1/2 cavities; the remaining functional wall at least 3 mm thick; teeth with a natural tooth in the opposite arch; and adjacent teeth on both approximal sides. The presence of periapical symptoms, posterior teeth with tubercule loss, and teeth with root canal fillings at least 2 mm short of the radiographic apex were excluded.ResultsAll restorations were evaluated at 6 and 12 months on the basis of the World Dental Federation (FDI) criteria. No failure was reported, and clinical success was recorded for all aesthetic, functional, and biological criteria at 6 and 12 months of follow-up in both groups.ConclusionsSmall/medium-sized direct composite restorations with or without fiber-reinforced composites demonstrated excellent and similar clinical performances at 12 months in bruxists.Clinical relevanceSince parafunctional forces can be significantly higher than normal chewing forces, the study focused exclusively on patients with bruxism. The 12-month clinically successful outcomes of direct composite restorations both with and without SFRC in this study will guide future long-terms studies in evaluating restorations of ETpT in bruxists.Date of registration2025-03-11 (retrospectively registered).Clinical trial registrationThis prospective, randomized, parallel-group clinical study was registered in a publicly accessible database with clinicalTriald.gov.ID No. NCT06870188.

Ulcerative colitis (UC) is a chronic, recurrent inflammatory bowel disease (IBD) marked by inflammation of the colonic mucosa. While its precise aetiology remains unclear, emerging evidence underscores the pivotal role of gut microbiota in UC pathogenesis. In healthy individuals, the gut microbiota contributes to immune modulation, nutrient absorption, and maintenance of intestinal barrier integrity. In contrast, individuals with UC exhibit gut dysbiosis-characterized by a reduction in beneficial bacteria such as Faecalibacterium prausnitzii and Bifidobacterium, and an increase in potentially pathogenic microbes like Escherichia coli. This microbial imbalance disrupts mucosal homeostasis, promotes persistent inflammation, and impairs epithelial healing. Contributing factors include genetic predisposition, antibiotic exposure, diet, and environmental influences. Novel microbiota-targeted interventions-such as probiotics, prebiotics, dietary modifications, and faecal microbiota transplantation (FMT)-are being actively explored, with promising preliminary outcomes in symptom relief and microbiome restoration. However, challenges persist in defining a "healthy" microbiome and standardizing therapeutic protocols. This study highlights the potential of microbiome modulation as a transformative approach in UC management and calls for further research into host-microbe interactions to advance precision-based, microbiota-oriented therapies.

The Lower Rio Grande Valley (LRGV) of Texas is a biodiversity hotspot due to its high alpha, beta, and gamma diversity and high regional endemism, which are at high risk of degradation. The region has lost 95% of its native thornforest habitat primarily due to agricultural and urban expansion. This study aims to evaluate the current vegetative structure and composition of restored thornforest sites located in the LRGV to identify restoration methods and site characteristics that affect forest restoration outcomes. Twelve restored thornforest sites were selected for this study that varied in time since restoration, patch size, degree of isolation, and method of restoration. Canopy, understory, and ground layer vegetation were evaluated at six survey points per restored site (n = 72), and 17 environmental variables were incorporated into univariate and multivariate analyses to identify factors influencing restored plant communities. Actively restored sites showed higher overall richness, abundance, and diversity than passively restored sites. More isolated patches had higher overall richness, abundance, and diversity, and longer times since restoration began increased richness and diversity. Higher abundances of Urochloa maxima, an invasive grass, altered community composition and reduced diversity in each forest layer and overall and reduced richness in the canopy and ground layers. Important considerations for thornforest restoration in the LRGV should include invasive grass prevalence; proximity to riparian and seasonal wetland habitats; landscape factors that influence water availability; and patch geography, including shape, size, and proximity to other forest patches.

The rapid expansion of photovoltaic installations in arid and semi-arid regions has altered regional water–heat regimes, triggering complex responses in vegetation recovery and soil processes. However, systematic assessments of ecological restoration under varying operational durations and microenvironmental interactions remain insufficient. Therefore, this study examines photovoltaic power stations operating for 1, 7, and 13 years within China’s temperate desert regions, alongside undeveloped control areas, to compare differences across four microenvironments: the front eave of photovoltaic panels (FP), underneath photovoltaic panels (UP), back eave of photovoltaic panels (BP), and interval between photovoltaic panels (IP). Combining analysis of variance, correlation analysis, variance partitioning analysis (VPA), and generalised additive models (GAMs), the study evaluates the coupling mechanisms between vegetation and soil. The results indicate that operational duration significantly enhances vegetation cover, biomass, and species diversity, with the 13 year operational zone demonstrating optimal restoration outcomes. Microenvironmental variations were pronounced, with vegetation and soil quality in the front eave zone surpassing other areas, while the inter-panel zone exhibited the weakest recovery. Key soil factors shifted with recovery stages: early-stage vegetation showed heightened sensitivity to soil water content (SWC), whereas later stages relied more heavily on soil organic matter (SOM) and nutrient supply. Variation Partial Analysis (VPA) revealed that soil factors in the 13 year operational zone accounted for 71.9% of the variation in vegetation cover. The operational lifespan of photovoltaic power stations, microenvironmental variations, and key soil factors collectively drive the restoration of thermophilic desert vegetation. This research reveals phased regulatory mechanisms during the restoration process, providing scientific grounds for optimising photovoltaic layouts and enhancing desert ecosystem stability.

Wetlands play significant roles in the environment as filters of water, storehouses of carbon, flood-control zones, and habitat providers of wildlife- and they continue to be degraded. An example is Rugezi Wetland in north Rwanda: this is a Ramsar site that feeds into downstream lakes but was significantly degraded by both agriculture and drainage. This paper examines the progress of recent restoration there with an eye towards biodiversity and the structuring of the food web. A mixed-methods research approach was employed by the research team: systematic field surveys in and after the restoration, metrics of water quality (water nutrient concentrations, dissolved oxygen, turbidity) and maps of the habitats using GIS analysis were developed. They also tallied important figures of biodiversity (species richness, Shannon-Wiener index) and monitored the presence of the species in case of plants, birds, fish, amphibians, and invertebrates. Results show marked improvements post-restoration. The Shannon-Wiener index for wetland vegetation rose from ~1.0 to &gt;2.0, and overall plant species richness increased (e.g. the return of diverse aquatic plants such as Lemna spp. and Vossia spp.). Bird species count climbed from 35 (in 2007) to 85 (in 2023), including recoveries of specialists like the Grey Crowned Crane (Balearica regulorum) and Shoebill (Balaeniceps rex). Fish populations (notably Oreochromis and Barbus spp.) rose from ~15,000 (in 2017) to 22,000 (in 2024), and invertebrate species richness expanded by 72 species. Hydrological and habitat restoration increased the open water area by ~12% and improved water quality: dissolved oxygen rose from ~4.2 to 7.8 mg/L, while nitrogen and phosphorus concentrations fell by ~56% and ~63%, respectively, reducing eutrophication risk. Illegal extraction of wetland resources declined, and over 3,500 community members adopted sustainable activities (beekeeping, ecotourism). The restoration of Rugezi Wetland has markedly enhanced biodiversity and strengthened food web interactions. Increases in diversity indices and higher trophic populations demonstrate recovery of ecological functions. Sustained conservation measures, including protection of habitat, invasive species control, and community engagement, will be essential to maintain these gains.

Urban green spaces are essential for promoting human health and well-being, especially in cities facing increasing noise pollution and ecological stress. This study investigates the effects of audio-visual interaction on restorative outcomes across three soundscape types (park, residential, and street), focusing on the compensatory role of positive visual stimuli in low-quality soundscape environments. Thirty-two university students participated in a controlled evaluation using soundscapes and corresponding visual materials derived from 30 urban green spaces. A two-way repeated measures ANOVA revealed significant main effects of soundscape type and modality (auditory vs. audio-visual), as well as a significant interaction between these factors. Audio-visual conditions consistently outperformed auditory conditions, with the strongest restorative effects observed in noisy street soundscapes when paired with positive visual stimuli. Further analysis highlighted that visual cleanliness and structural clarity significantly enhanced restorative outcomes in challenging environments. These findings align with existing theories of sensory integration and extend their application to large-scale urban settings. This study shows that multi-sensory optimization can mitigate urban environmental stressors, supporting healthier, more resilient, and sustainable urban environments. Future research should explore long-term and cross-cultural applications to inform evidence-based urban planning and public health policies.