Search Results (298)

Background/Objective: Hand hygiene is a cornerstone of infection prevention; however, compliance is inconsistent in intensive care units (ICUs), particularly in resource-constrained settings. This study evaluated whether a low-cost, multimodal quality improvement intervention could improve process-level hand hygiene compliance using routine, episode-based audits embedded in the ICU practice. Methods: We conducted a single-cycle Plan-Do-Study-Act quality improvement project in a 12-bed mixed medical–surgical ICU in Pakistan (December 2023–January 2024). Hand hygiene performance was assessed using the unit’s routine weekly episode-based audit protocol, aligned with the WHO Five Moments framework. A targeted multimodal intervention comprising education, point-of-care visual reminders, audit feedback, and leadership engagement was implemented between the pre- and post-intervention phases (four weeks each). Non-applicable moments were scored as “compliant by default” according to the institutional protocol. A sensitivity analysis was performed excluding these moments to calculate pure adherence. Compliance proportions were summarized using exact 95% Clopper–Pearson confidence intervals without inferential testing. Results: A total of 942 audit episodes (471 per phase) generated 4710 moment-level assessments were generated. Composite hand hygiene compliance increased from 63.1% pre-intervention to 82.0% post-intervention [absolute increase: 18.9 percentage points (pp)]. Sensitivity analysis excluding non-applicable moments demonstrated pure adherence improvement from 54.2% to 82.5% (+28.3 pp), confirming a genuine behavioral change rather than a measurement artifact. Compliance improved across all five WHO moments, with the largest gains in awareness-dependent moments targeted by the intervention: before touching the patient (+27.0 pp) and after touching patient surroundings (+40.0 pp). Week-by-week compliance remained stable within both phases, without immediate post-intervention decay. Conclusions: A pragmatic, low-cost multimodal intervention embedded in routine ICU workflows was associated with substantial short-term improvements in hand hygiene compliance over a four-week observation period, particularly for awareness-dependent behaviors. Episode-based audit systems can support directional process monitoring in resource-limited critical care settings without the need for electronic surveillance. However, its long-term sustainability beyond one month and generalizability to other settings remain unknown. Sensitivity analyses are essential when using “compliant by default” scoring to distinguish adherence patterns from measurement artifacts. Full article

Under the dual pressures of global climate change and anthropogenic activities, enhancing the ecological functions of hydraulic structures has become a critical direction for sustainable watershed management. While traditional spur dike designs primarily focus on bank protection and flood control, current demands require additional consideration of river ecosystem restoration. Numerical simulations were performed using the RNG k-ε turbulence model to solve the three-dimensional Reynolds-averaged Navier–Stokes equations, a formulation that enhances prediction accuracy for complex flows in curved channels, including separation and reattachment. Following a grid independence study and the application of standard wall functions for near-wall treatment, a comparative analysis was conducted to examine the flow characteristics and ecological effects within a 180° channel bend under three configurations: no spur dikes, a single-side arrangement, and a staggered arrangement of non-submerged, flow-aligned, rectangular thin-walled spur dikes. The results demonstrate that staggered spur dikes significantly reduce the lateral water surface gradient by concentrating the main flow, thereby balancing water levels along the concave and convex banks and suppressing lateral channel migration. Their synergistic flow-contracting effect enhances the kinetic energy of the main flow and generates multi-scale turbulent vortices, which not only increase sediment transport capacity in the main channel but also create diverse habitat conditions. Specifically, the bed shear stress in the central channel region reached 2.3 times the natural level. Flow separation near the dike heads generated a high-velocity zone, elevating velocity and turbulent kinetic energy by factors of 2.3 and 6.8, respectively. This shift promoted bed sediment coarsening and consequently increased scour resistance. In contrast, the low-shear wake zones behind the dikes, with weakened hydrodynamic forces, facilitated fine-sediment deposition and the growth of point bars. Furthermore, this study identifies a critical interface (observed at approximately 60% of the water depth) that serves as a key interface for vertical energy conversion. Below this height, turbulence intensity intermittently increases, whereas above it, energy dissipates markedly. This critical elevation, controlled by both the spur dike configuration and flow conditions, embodies the transition mechanism of kinetic energy from the mean flow to turbulent motions. These findings provide a theoretical basis and engineering reference for optimizing eco-friendly spur dike designs in meandering rivers. Full article

Subglacial topography is a critical boundary condition for ice sheet models projecting past and future ice sheet–climate interactions. Contemporary ice-sheet-wide bed topography datasets are partially derived using mass conservation, but approximately 75% of the most widely used Greenland Ice Sheet (GrIS) dataset is based on simple interpolation of airborne radio-echo sounding (RES) measurements, such as kriging or streamline diffusion. Due to limited independent validation data, the errors and biases in this approach are poorly understood, creating largely unknown uncertainties in subglacial topography. Here, we interpolated synthetic RES observations of bed topography over ice-free areas with a known topography at a 5 m spatial resolution and quantify discrepancies. We found that the absolute error in kriged bed topography increases with distance from the input data, though at a reduced rate than previously estimated. The difference between an interpolated elevation estimate and the local mean elevation is a strong predictor of real bed errors (R² = 0.72), with further improvement as input observation sparsity increases (R² > 0.82). We propose a method to quantify and reduce uncertainty in kriged bed topography in sparsely surveyed regions, reducing uncertainty for at least 56% of the kriged interior at a 99% confidence interval. Our results suggest that subglacial depth is on average 5 m deeper than previous estimates, though individual areas may be shallower or deeper (σ = 41 m). Consequently, the area grounded below sea level is likely underestimated by 2%, increasing to 29% for regions deeper than 200 m. These findings have potential implications for the future stability of the GrIS under climate change. Full article

Background/Objectives: Intensive care units (ICU) immobility and weakness impair recovery, yet practice for Physical Therapist (PT)-led therapeutic exercise and mobility varies in definitions, dosing, safety, and documentation, which limits comparability and complicates quality assessment. This study aims to integrate adult ICU evidence and present PT-led operational definitions, dose progression principles, safety parameters, outcome measurement, and a documentation minimum dataset. Methods: A scoping review following PRISMA-ScR is used. Eligibility used Population, Concept, and Context: adults in ICU; PT-led therapeutic exercise or mobility; and ICU-initiated or directed care. Primary studies and prespecified quality-improvement reports were included. Data were extracted with a standardized form and summarized descriptively without meta-analysis. Results: Sixty studies were included. Based on the extracted data, this review synthesizes current evidence to propose standardized PT-led operational definitions and a graded progression from in-bed exercise to ambulation. While the individual components are derived from the literature, the conceptual framework for safety parameters and the stop rules were integrated and elaborated to guide clinical decision-making. Adverse events were uncommon and manageable. Outcome measurement centered on validated mobility and function measures at prespecified time points. A concise electronic record minimum dataset specifies provider attribution, timing and duration, activity level with assistance or device, planned and delivered dose with progression, in-session responses, and adverse events, supporting unit-level quality review and comparisons across ICU. Conclusions: A PT-led, graded program that applies shared thresholds, uses validated outcome measures, and employs standardized electronic documentation is feasible and supports safe delivery, clinically meaningful change, and quality improvement across adult ICU. Full article

Malaria control in sub-Saharan Africa lies at the intersection of changing climate suitability and the scale-up of vector control and case management. Drawing on recent evidence from Kenya, we argue that climate variability already exerts effects on malaria outcomes comparable to, and sometimes stronger than, those of commonly measured interventions at local scales. Transmission dynamics display non-linear, lagged relationships with temperature and rainfall. As a result, climate change is expected to alter prevailing conditions and extremes, reshaping the geography and seasonality of malaria risk. At the same time, socio-economic development and vector control intervention such as insecticide-treated bed nets (ITNs) and timely case management continue to reduce malaria incidence and deaths, especially among young children. However, their population-level impact depends on when and where interventions are deployed relative to climate-favoured windows of transmission. We propose a practical agenda for “climate-smart” malaria control in Kenya advocating for dynamic targeting of interventions according to observed climate lags and thresholds, sustaining protection for the youngest, and innovating approaches for school-age reservoirs of infection. Access to effective care should be re-conceptualized as a climate-adaptation strategy, and short-term, locally tailored forecasts should be embedded into routine planning to support anticipatory and equitable malaria control. Full article

The stage-discharge relationship in the Jingjiang Reach of the Yangtze River has undergone significant alterations due to post-Three Gorges Reservoir (TGR) operation effects, notably bed erosion and roughness variation. This study employs a calibrated 1D hydrodynamic model based on Saint-Venant equations. The model was validated with high accuracy (Nash-Sutcliffe efficiency >0.94 at key stations) using long-term hydrological data (1996–2022). Four scenarios were simulated: pre-dam conditions, post-dam topography with pre-dam roughness, pre-dam topography with increased roughness, and coupled post-dam changes. A novel scenario-based decomposition framework was developed to isolate individual and coupled factor contributions, advancing beyond traditional descriptive approaches. The results indicate that upstream water level changes are mainly controlled by riverbed erosion (e.g., at the Zhicheng Station: the topographic contribution rate exceeds 80% at a flow rate of 5000 m³/s, resulting in a water level drop of approximately 1.7 m), while downstream, an increase in roughness becomes the dominant factor (e.g., at the Jianli Station: causing a water level rise of about 1.0 m at a flow rate of 13,000 m³/s, with such changes being particularly pronounced under low-flow conditions). Spatially, topographic influence attenuates downstream, whereas roughness sensitivity amplifies in high-sinuosity reaches (bend coefficient: 3.0). Seasonally, the topographic contribution rate remains stable overall during the low-flow period, e.g., within a narrow range of 0.88–0.98 at Zhicheng Station, while roughness effects exhibit negative values in dry periods (November) due to fine sediment deposition. The coupling effect in mid-discharge ranges (15,000–20,000 m³/s) at Jianli partially offsets stage reductions. These findings not only provide critical insights for flood forecasting and navigation management in the Jingjiang Reach but also offer a transferable methodology for quantifying hydro-morphodynamic interactions in global regulated rivers, highlighting the model’s utility in predictive water resource management. Full article

New theropod tracks found in the Papo-Seco Formation (lower Barremian, Lusitanian Basin, Portugal) are presented. In 2022, thirteen theropod tracks were identified on the lowermost bed of this formation, preserved as natural cast infillings on the bedding surface. Two different morphotypes of theropod footprints have been identified, which occur at two different levels of this layer. The first morphotype, consisting of smaller footprints with narrow digits, is attributed to theropoda indet; the other morphotype, consisting only of one footprint, is assigned provisionally to the ichnogenus Megalosauripus isp. It is suggested that they were produced by medium-sized theropods, on a carbonate mud substrate, probably in a coastal environment associated with a lagoon. These tracks, and others previously described in the underlying Areia do Mastro Formation, suggest a temporal continuity of the groups of dinosaurs that frequented this area, during the early Barremian. However, the morphotypes now described differ from those of the theropods tracks from the Areia do Mastro Formation, which may indicate a change in faunal types within the theropod group. Full article

Access to accurate and reliable information on the cost of COVID-19 is essential for informed socio-economic policy decisions. This paper analyses the economic costs associated with the COVID-19/SARS-CoV-2 pandemic, with a particular focus on Australia. This study examined both the macroeconomic costs measured as the foregone gross domestic product attributable to the pandemic and the direct and indirect costs to society. Using a bottom-up costing approach and the WHO-CHOICE model, this study estimates the direct and indirect economic impacts of COVID-19 on the Australian economy. The analysis draws on quarterly and fortnightly data from 2020 to 2022, the period during which the pandemic exerted its most severe economic effects. The results indicate that the per-day inpatient unit cost is estimated at AUD 836, representing the minimum benchmark for direct health costs. The WHO-CHOICE model identifies key determinants of inpatient hospital costs, including hospital bed occupancy, GDP per capita, and hospital admissions, which are found to be highly responsive to changes in inpatient costs. In terms of indirect effects, GDP fell by 1.9 percent below its projected no-COVID level in the first quarter of 2021. Based on these empirical findings, this study proposes several important policy recommendations to enhance economic resilience and healthcare preparedness in future public health crises. Full article

Vegetated intertidal ecosystems, such as seagrass meadows, salt marshes, and macroalgal beds, are vital for biodiversity, coastal protection, and climate regulation; however, they remain highly vulnerable to anthropogenic and climate-induced stressors. This study aims to assess interannual changes in intertidal vegetation cover along the Portuguese mainland coast from 2015 to 2024 using Sentinel-2 satellite imagery calibrated with high-resolution multispectral unoccupied aerial vehicle (UAV) data, to determine the most accurate index for mapping intertidal vegetation. Among the 16 indices tested, the Atmospherically Resilient Vegetation Index (ARVI) showed the highest predictive performance. Based on a model relating intertidal vegetation cover to this index, an ARVI value greater than or equal to 0.214 was established to estimate the area covered with intertidal vegetation. Applying this threshold to time-series data revealed considerable spatial and temporal variability in vegetation cover, with estuarine systems such as the Ria de Aveiro and the Ria Formosa showing the greatest extents and marked fluctuations. At the national level, no consistent overall trend was identified for the study period. Despite limitations related to satellite image resolution and single-site validation, the results demonstrate the feasibility and utility of combining UAV data and satellite indices for long-term, large-scale monitoring of intertidal vegetation. Full article

Predicting how vegetation–debris interactions reshape alternate sandbars under a steady subcritical flow remains poorly understood in laboratory-to-field scaling. This study quantified how vegetation density and layout interact with debris geometry to control scouring and deposition and developed an empirical tool to predict normalized bed-level changes. Flume experiments investigated how vegetation–debris interactions regulate the hydromorphodynamics of non-migrating alternate sandbars under a steady subcritical flow (Q = 0.003 m³/s; slope = 1/200). Vegetation patches were configured in two spatial layouts—upstream (apex) and river line (edge), at varying densities, with and without debris (I-type: wall-like; U-type: horseshoe-shaped). Results indicated that dense upstream vegetation combined with I-type debris produced the strongest morphodynamic response, generating maximum scour, corresponding to the maximum bed-elevation changes (Δz) normalized by water depth (h) (dimensionless Δz/h) values of −1.55 and 1.05, and sustaining more than 70% of the downstream morphodynamic amplitude. In contrast, U-type debris promoted distributed deposition with a milder scour, while sparse vegetation yielded weaker, more transient responses. Debris geometry-controlled flow partitioning: the I-type enhanced frontal acceleration, whereas the U-type facilitated partial penetration and redistribution. To integrate these findings into predictive frameworks, an empirical regression model was developed to estimate Δz/h from the vegetation density, distribution, and debris geometry, with an additional blockage index to capture synergistic effects. The model achieved 87.5% prediction within ±20% error, providing a practical tool for anticipating scour and deposition intensity across eco-hydraulic configurations. These insights advance intelligent water management by linking morphodynamic responses with predictive modeling, supporting flood-resilient river engineering, adaptive channel stability assessments, and nature-based solutions. Full article

Background: Metabolic syndrome is a constellation of medical conditions including central obesity, high blood sugar, and high triglycerides known to increase the risk of heart disease, stroke, and type 2 diabetes, with significant sex differences in the syndrome’s incidence and prevalence. These clinical symptoms may be accompanied by cognitive impairment. Methods: In the present experiment, we fed rabbits a diet high in fat and sugar (HFSD), assessed symptoms, and measured changes in cognition using trace eyeblink conditioning. Results: We show that a range of symptoms of metabolic syndrome resulted from HFSD in male and female rabbits and obesity, high blood sugar, and glucose intolerance were higher in male than female rabbits. Specifically, HFSD male rabbits gained more weight and had a higher body-mass index, more body fat, higher fasting glucose levels, and greater glucose intolerance. Importantly, using trace and delay eyeblink conditioning, we show that there was cognitive impairment because of the high-fat and high-sugar diet in both male and female rabbits, but this was greater in HFSD male rabbits than HFSD female rabbits. Conclusions: Metabolic syndrome modeled in rabbits fed a diet high in fat and sugar reflects trends in the adult population including central obesity, high blood sugar, and high triglycerides and cognitive impairment and provides an important model and test bed for assessing interventions. Full article

Microgravity exposure during spaceflight has been linked to cognitive impairments, including deficits in attention, executive function, and spatial memory. Both space missions and ground-based analogs—such as head-down bed rest, dry immersion, and hindlimb unloading—consistently demonstrate that altered gravity disrupts brain structure and neural plasticity. Neuroimaging data reveal significant changes in brain morphology, functional connectivity, and cerebrospinal fluid dynamics. At the cellular level, simulated microgravity impairs synaptic plasticity, alters dendritic spine architecture, and compromises neurotransmitter release. These changes are accompanied by dysregulation of neuroendocrine signaling, decreased expression of neurotrophic factors, and activation of oxidative stress and neuroinflammatory pathways. Molecular and omics-level analyses further point to mitochondrial dysfunction and disruptions in key signaling cascades governing synaptic integrity, energy metabolism, and neuronal survival. Despite these advances, discrepancies across studies—due to differences in models, durations, and endpoints—limit mechanistic clarity and translational relevance. Human data remain scarce, emphasizing the need for standardized, longitudinal, and multimodal investigations. This review provides an integrated synthesis of current evidence on the cognitive and neurobiological effects of microgravity, spanning behavioral, structural, cellular, and molecular domains. By identifying consistent patterns and unresolved questions, we highlight critical targets for future research and the development of effective neuroprotective strategies for long-duration space missions. Full article

Travel policies during crises strongly reshape mobility patterns, raising the challenge of protecting public health while minimizing socio-economic disruption—an essential concern for sustainable development. Most evaluations quantify changes in travel volume, which hampers cross-city comparison and policy monitoring. This study proposes a distance-based sustainability metric—distance equivalence (DE)—that translates policy-induced mobility frictions into interpretable “added distance” within a gravity framework, enabling consistent measurement and monitoring of policy impacts. Using inter-city flows for 358 Chinese cities during the Stay-in-Place for Lunar New Year (SIP) guidance, we map DE, test spatial dependence (Moran’s I; LISA), and apply fuzzy-set Qualitative Comparative Analysis (fsQCA) to identify city-level configurations associated with high DE. DE exhibits significant spatial clustering, concentrating east of the Hu line, where dense urban networks amplify advisory checks. Three recurrent configurations—combining case counts, health-care capacity (hospital beds), and average inter-city distance—are linked to high DE. As a sustainability assessment tool, DE supports adaptive management, region-differentiated strategies, and ex-ante risk assessment for governments, public-health authorities, and transport agencies. The framework generalizes to short-term mobility interventions under crisis conditions, advancing the quantification of policy impacts on sustainable mobility and urban resilience. Full article

Understanding the morphodynamic evolution of muddy coasts under complex wave–tidal forcing is crucial for effective coastal management, particularly under the unstable hydrodynamic conditions associated with global climate change. This study employs a one-dimensional Delft3D model to investigate a tidal flat north of Dafeng Port, Jiangsu Province, China, validated with multi-year profile measurements. Under typical conditions, the profile consistently exhibits upper-flat accretion and lower-flat erosion, with threshold values of Hs ≈ 1.2 m and Tp ≈ 4.5 s triggering nonlinear bed-level changes. During storm tides, the profile displays a distinct upper flood-tide and lower ebb-tide response. Long-term simulations suggest that the profile will likely reach dynamic equilibrium by 2026. Overall, this study demonstrates the capability of one-dimensional modeling to capture nonlinear tidal flat evolution and provides valuable insights into the spatially variable morphodynamics of muddy coasts for adaptive management. Full article

The following article presents the results of research on the assessment of the effect of FDM printing process conditions on the properties of the obtained products. During the research, unmodified PLA and a PLA/PHA mixture were subjected to comparative analysis. Both materials exhibit excellent processability under standard FDM process conditions; however, the PLA/PHA blend is gaining attention due to its potential as a more thermally resistant and less brittle alternative to unmodified PLA. The printing procedure conducted at high bed platform temperature confirmed that for standard PLA varieties and the PLA/PHA blend, it is possible to obtain improved thermomechanical properties only by modifying the machine parameters of the printing process. The increase in the Vicat softening temperature value was about 80 °C, reaching above 130 °C. Interestingly, for materials based on pure PLA, most mechanical properties exhibit noticeable improvement, with the improvement in impact strength being particularly beneficial. For most materials, the measurements revealed significant anisotropy of properties within the tested samples, which was particularly due to the use of different bed platform temperatures. The apparent effect of this was the change in the thermal conditions of the PLA phase crystallization process, with crystallinity levels ranging from 17 to 33% for selected samples. The obtained results confirm that PLA/PHA blends are an interesting alternative for the PLA-based material; however, further research is needed to improve the application potential further. Full article