Search Results (398)

Background: Delays in emergency cesarean section (CS) remain a major contributor to maternal and neonatal morbidity in low-resource settings. This study evaluated the combined effect of a mobile-based obstetric emergency system (MORES) and a midwife-led triage program on the decision-to-incision interval (DDI) and related outcomes in Liberia. Methods: A quasi-experimental study with an interrupted time series design was conducted in Bong County across two district hospitals receiving referrals from 20 rural health facilities. Seventy-two women referred for emergency CS were observed at baseline, midline, and endline. MORES used WhatsApp-based communication to improve referral coordination, while the triage program trained midwives to rapidly assess cases using a color-coded system. Data were analyzed using descriptive statistics, Wilcoxon rank-sum, chi-squared tests, and logistic regression. Results: By endline, the median DDI decreased by 117.5 min compared to baseline (95% CI: −205.1 to −29.9). Women were significantly more likely to receive a CS within 75 min (AOR: 11.7; 95% CI: 1.32 to 104.5). No maternal deaths occurred. Neonatal mortality was observed but not significantly associated with DDI. Conclusions: MORES and midwife-led triage substantially improved the timeliness of emergency CS in a resource-constrained setting. These low-cost, feasible strategies warrant further evaluation for sustainability and impact on neonatal outcomes. Full article

Emerging evidence highlights extracellular vesicles (EVs), especially exosomes, as critical molecular messengers linking pediatric obesity to multi-organ complications. This scoping review synthesizes current knowledge on EVs-mediated intercellular communication that exacerbates inflammation, insulin resistance, endothelial dysfunction and organ-specific damage. Data demonstrate that adipose- and endothelial-derived EVs carry bioactive cargo, microRNAs, proteins, and lipids, that modulate key pathways driving metabolic derangements and vascular injury, often preceding detectable clinical biomarkers. Notably, maternal obesity influences EVs composition in breast milk, shaping early-life metabolic programming and offspring risk of obesity. Recent studies underscore the diagnostic and therapeutic potential of EVs in obesity-related conditions such as metabolic-associated fatty liver disease (MAFLD), early renal injury, and cardiovascular dysfunction in children. Furthermore, EVs released in response to exercise or bariatric surgery may mediate systemic metabolic improvements, offering a novel window into personalized interventions. Despite promising findings, standardization of EV isolation and profiling in pediatric research is lacking, and large-scale longitudinal studies are urgently needed. By deepening our understanding of EVs biology, clinicians may advance early detection, risk stratification, and targeted therapies to interrupt the progression from childhood obesity to lifelong metabolic and cardiovascular disease. Full article

This paper proposes an economical scheme to provide redundancy for protection in digital power sub-transmission and distribution substations. The scheme is based on Ethernet communication networks and uses the International Electrotechnical Commission (IEC) standard 61850 sampled values (SV). This redundancy scheme develops a method for alternative sources of the SV measurements for feeder and bus relays. The objective is to use the same number of intelligent electronic devices (IEDs), also referred to as merging units (MUs), while improving the overall reliability of substation protection. The multisource-based proposed scheme does not require two sets of MUs for redundancy. Instead, each MU is used to back up an adjacent MU. For instance, in a substation using IEC 61850, the protection relay can automatically switch to another available SV stream without interrupting the protection function if an MU fails. This dynamic reconfiguration capability, which ensures the system’s adaptability to changing conditions, is particularly valuable in maintaining system reliability during equipment failures. It allows for real-time adaptation to changing conditions within the substation. The paper evaluates the reliability of the proposed scheme using fault tree analysis (FTA). For demonstration, commercially available MUs and relays are connected to the Real-Time Digital Simulator (RTDS) for hardware-in-the-loop testing. Full article

This paper proposes a novel microgrid (MG) architecture designed for telecommunication base stations in non-interconnected regions, with the main objective of mitigating mobile service interruptions caused by power outages. This research consists of three key modules: the first module on resources and components, the second module on characterization, and the third module on design and methodology. The first module presents a comprehensive identification and description of the resources and components of the microgrid within the base station; the second module characterizes the topology and specific configurations of the microgrid; and the last module covers a new methodology for the installation of microgrids in geographic areas lacking electrification, which becomes the contribution of this research work. The novelty of this research presents new control architectures, energy management, and system optimization, including technical–economic analysis. The research outcome highlights the economic and social benefits for both local communities and mobile phone service providers. This research aims to establish a guideline on how these factors affect the focus region of this research. With this technological proposal, a continuous and uninterrupted mobile service is achieved, thus improving the quality of service and minimizing the failures induced by electricity in non-interconnected areas. The tests and validation of the system were carried out with Homer Pro software, integrating socioeconomic and environmental factors. The results obtained present a key solution for this type of application, minimizing costs and increasing reliability for users. Full article

Background/Objectives: A variant of autism spectrum disorder (ASD) known as Asperger syndrome (AS) shows increasing incidence worldwide, affecting between 0.02% and 0.03% of children. Patients display abnormal conduct, are limited in social interaction and communication, and are more often affected by micturition disorders, incontinence, and voiding symptoms than typically developing children. Methods: The present study aimed to review the literature related to the current management of lower urinary tract conditions in children with Asperger syndrome and to present a case of a 14-year-old girl with ASD, with characteristic impairments, including communication challenges, stereotyped, repetitive behaviors, and chronic constipation with concomitant bladder dysfunction, presenting recurrent urinary tract infections (UTIs) and lower urinary tract symptoms (LUTS), including voiding and filling storage symptoms. For the AS, she was treated with a selective serotonin reuptake inhibitor (Sertraline). An abdominal ultrasound, PLUTTS—pediatric lower urinary symptoms scoring (21); QL-quality of life (3); voiding diary; and uroflowmetry were performed, revealing an incomplete urinary retention (incomplete bladder emptying of 120 mL), a prolonged and interrupted curve, a maximum urinary flow rate (Qmax) 7 mL/s, and a UTI with Enterococcus. Results: Besides psychiatric reevaluation and antibiotic therapy, functional magnetic stimulation (FMS) sessions were performed. After eight sessions (20 min, 35 MHz, every second day), the ultrasound control and the uroflowmetry showed no residual urine, and the Qmax was 17 mL/s. The curve continued to be interrupted: PLUTSS-11, QL-1. FMS was continued at two sessions per week. At the 3-month follow-up, no residual urine was detected, and Qmax reached 24 mL/s. Conclusions: ASD is an incapacitating/debilitating condition that significantly impairs social functioning. In many cases, in addition to psychological symptoms, other conditions such as LUTS and constipation may coexist. Antipsychotics and antidepressants are frequently prescribed for these patients, often leading to various side effects, including micturition disorders. Therefore, screening for LUTS is recommended, and, if indicated, treatment—especially non-pharmacological and non-invasive approaches, such as FMS—should be considered. Full article

Background: Urinary tract infections (UTIs) are among the most common hospital- and community-acquired infections, creating a substantial healthcare burden due to recurrence, complications, and rising antimicrobial resistance. Accurate diagnosis and timely antimicrobial therapy are essential. This study aimed to identify trends in the etiology, treatment, and resistance patterns of UTIs through a retrospective analysis of urine isolates processed at the Laboratory of Microbiology at University Hospital St. George in Plovdiv, the largest tertiary care and reference microbiology center in Bulgaria, between 2017 and 2022. Materials and Methods: A retrospective single-center study was performed at the hospital’s Microbiology Laboratory. During the study period, 74,417 urine samples from 25,087 hospitalized patients were screened with the HB&L UROQUATTRO system. Positive specimens were cultured on blood agar, Eosin-Methylene Blue, and chromogenic media. Identification was performed using biochemical assays, MALDI-TOF MS, and the Vitek 2 Compact system. Antimicrobial susceptibility testing included disk diffusion, MIC determination, broth microdilution (for colistin), and Vitek 2 Compact, interpreted according to EUCAST standards. Descriptive analysis and temporal resistance trends were evaluated with regression models, and interrupted time-series analysis was applied to assess COVID-19-related effects. Results: Out of 10,177 isolates, Gram-negative bacteria predominated (73%), with Escherichia coli, Klebsiella pneumoniae, and Proteus mirabilis as the leading pathogens. Among Gram-positives, Enterococcus faecalis was the most frequent. In the post-COVID-19 period, ESBL production increased in E. coli (34–38%), K. pneumoniae (66–77%), and P. mirabilis (13.5–24%). Carbapenem resistance rose in K. pneumoniae (to 40.6%) and P. aeruginosa (to 24%), while none was detected in E. coli. Colistin resistance increased in K. pneumoniae but remained absent in E. coli and P. aeruginosa. High-level aminoglycoside resistance in E. faecalis was stable (~70%), and vancomycin resistance in E. faecium rose from 4.6% to 8.9%. Conclusions: Both community- and hospital-acquired UTIs in Southeastern Bulgaria are increasingly linked to multidrug-resistant pathogens, particularly ESBL-producing and carbapenem-resistant Enterobacterales. Findings from the region’s largest referral center highlight the urgent need for continuous surveillance, rational antibiotic use, and novel therapeutic approaches. Full article

Dark fermentation (DF) has gained increasing interest over the past two decades as a sustainable route for biohydrogen production; however, understanding how reproducible the process can be, both from macro- and microbiological perspectives, remains limited. This study assessed the reproducibility of a parallel continuous DF system using fruit-vegetable waste as a substrate under strictly controlled operational conditions. Three stirred-tank reactors were operated in parallel for 90 days, monitoring key process performance indicators. In addition to baseline operation, different process enhancement strategies were tested, including bioaugmentation, supplementation with nutrients and/or additional fermentable carbohydrates, and modification of key operational parameters such as pH and hydraulic retention time, all widely used in the field to improve DF performance. Microbial community structure was also analyzed to evaluate its reproducibility and potential relationship with process performance and metabolic patterns. Under these conditions, key performance indicators and core microbial features were reproducible to a large extent, yet full consistency across reactors was not achieved. During operation, unforeseen operational issues such as feed line clogging, pH control failures, and mixing interruptions were encountered. Despite these disturbances, the system maintained an average hydrogen productivity of 3.2 NL H₂/L-d, with peak values exceeding 6 NL H₂/L-d under optimal conditions. The dominant microbial core included Bacteroides, Lactobacillus, Veillonella, Enterococcus, Eubacterium, and Clostridium, though their relative abundances varied notably over time and between reactors. An inverse correlation was observed between lactate concentration in the fermentation broth and the amount of hydrogen produced, suggesting it can serve as a precursor for hydrogen. Overall, the findings presented here demonstrate that DF processes can be resilient and broadly reproducible. However, they also emphasize the sensitivity of these processes to operational disturbances and microbial shifts. This underscores the necessity for refined control strategies and further systematic research to translate these insights into stable, high-performance real-world systems. Full article

The uplink of 5G networks allows selecting the transmit waveform between cyclic prefix orthogonal frequency division multiplexing (CP-OFDM) and discrete Fourier transform spread OFDM (DFT-S-OFDM) to cope with the diverse operational conditions of the power amplifiers (PAs) in different user equipment (UEs). CP-OFDM leads to higher throughput when the PAs are operating in their linear region, which is mostly the case for cell-interior users, whereas DFT-S-OFDM is more appealing when PAs are exhibiting non-linear behavior, which is associated with cell-edge users. Therefore, existing waveform selection solutions rely on predefined signal-to-noise ratio (SNR) thresholds that are computed offline. However, the varying user and channel dynamics, as well as their interactions with power control, require an adaptable threshold selection mechanism. In this paper, we propose an intelligent waveform-switching mechanism based on deep reinforcement learning (DRL) that learns optimal switching thresholds for the current operational conditions. In this proposal, a learning agent aims at maximizing a function built using available throughput percentiles in real networks. Said percentiles are weighted so as to improve the cell-edge users’ service without dramatically reducing the cell average. Aggregated measurements of signal-to-noise ratio (SNR) and timing advance (TA), available in real networks, are used in the procedure. In addition, the solution accounts for the switching cost, which is related to the interruption of the communication after every switch due to implementation issues, which has not been considered in existing solutions. Results show that our proposed scheme achieves remarkable gains in terms of throughput for cell-edge users without degrading the average throughput. Full article

Background: Key populations (KPs), particularly female sex workers (FSWs), continue to face significant barriers in accessing HIV-related healthcare services in South Africa. Structural challenges have historically hindered equitable HIV treatment access, worsened by the COVID-19 pandemic. Overburdened clinics, staff shortages, and travel constraints disrupted HIV services and ART adherence. In response, the Differentiated Service Delivery (DSD) model was rapidly scaled up to decentralise care and improve treatment continuity. Objective: To solicit the views of stakeholders regarding their interests, roles and experiences in the implementation of the HIV treatment DSD model among FSWs in South Africa, as well as associated successes and barriers thereof. Methods: We purposively selected and interviewed eight stakeholders, comprising government officials, implementers and sex workers’ advocacy organizations. Thematic analysis was used to explore the perceived impact of DSD models and associated successes and barriers in the current service delivery landscape. Results: The study found that decentralization of DSD models improved access to services for FSWs. However, the criminalization of sex work perpetuates fear and marginalization, while stigma and discrimination within healthcare settings remain significant deterrents to HIV treatment uptake. High mobility among FSWs also disrupts continuity of care, contributing to treatment interruptions and lack of data on loss to follow-up. Participants highlighted the need for legal reform, increased healthcare provider sensitization, and the integration of mental health and psychosocial support in HIV services. Peer-led interventions and digital health innovations, such as biometric systems and electronic medical records, emerged as promising strategies for enhancing patient tracking and retention. Nonetheless, the sustainability of DSD models is threatened by an overreliance on external donor funding and insufficient government ownership. Conclusions: To achieve equitable healthcare access and improved HIV outcomes for KPs, especially FSWs, a multi-pronged, rights-based approach is essential. This must include community engagement, structural and legal reforms, integrated support services, and sustainable financing mechanisms to ensure the long-term impact and scalability of DSD models. Full article

In 2024, a significant pertussis surge in Queensland, Australia, strained public health resources. To improve investigation efficiency, the Wide Bay Public Health Unit introduced an online survey for pertussis cases on 1 August 2024, which collected data and provided automated health advice. This retrospective evaluation assessed survey acceptance and staff workload. A controlled interrupted time series (ITS) analysis compared pertussis incidence in the intervention region against a control group of four other de-identified regional hospital and health services in Queensland where the survey was not implemented. Of the 298 eligible cases, 140 responded (47.0%); a total of 67.9% of these required no further staff follow-up, a subgroup for whom time savings were statistically significant (p < 0.01). The ITS analysis for the total population revealed a significant 4.9% weekly reduction in the notification trend compared to the control group (Rate Ratio: 0.95, p = 0.001), with a non-significant immediate level change. The online survey is a practical and effective tool for pertussis investigation in a regional setting. It is associated with significant workload efficiencies and a favourable, statistically significant impact on community disease transmission trends. Full article

The global energy crisis demands efficient electricity production solutions, especially for isolated communities where hydraulic energy can be harnessed sustainably. This paper presents a case study analyzing the efficiency of a 13,330 kW hydrogenerator, consisting of a bulb-type hydro-aggregate using the calorimetric method—a viable alternative when testing at nominal load is not feasible due to technical limitations. The method involves measuring the thermal energy absorbed by the cooling water under three operating conditions: no-load unexcited, no-load excited, and symmetric three-phase short-circuit. Measurements followed IEC standards and were conducted with high-precision instruments for temperature, flow, voltage, and current. The results quantify mechanical, ventilation, iron, and copper losses, as well as additional losses via radiation and convection. Thermal analysis revealed significant heat accumulation in the rotor and stator windings, indicating the need for improved cooling solutions. The calorimetric method enables efficiency evaluation without interrupting generator operation, offering a valuable tool for diagnostics, predictive maintenance, and informed decisions on modernization. Furthermore, integrating an intelligent operational control system could enhance efficiency and improve the quality of the supplied energy, supporting long-term sustainability in hydroelectric power generation. Full article

Autism Spectrum Disorder (ASD) is a complex neurodevelopmental condition characterized by deficits in social communication, repetitive behaviors, and sensory sensitivities. While genetic factors contribute significantly to ASD risk, a growing body of evidence implicates environmental exposures and immune-mediated mechanisms in the etiology and severity of ASD. This review synthesizes peer-reviewed findings on (1) maternal immune activation, (2) environmental toxicant co-exposures, (3) maternal autoimmune disease, and (4) cerebral folate deficiency (via folate receptor alpha autoantibodies), detailing their mechanistic contributions to core and associated ASD symptoms. Collectively, these findings illuminate converging neuroimmune and metabolic pathways that, when disrupted in utero, substantially alter the developmental trajectory of the brain and increase the likelihood of ASD. Such interruptions leading to developmental changes can trigger immune activation from environmental sources of infection and pollution, with these triggers compounded in cases of autoimmune disease or cerebral folate deficiency. Understanding these mechanisms provides a foundation for early identification, stratified risk assessment, and the development of targeted prenatal interventions. Thus, a lesson we learn from autism is that neurodevelopmental disorders should be understood as the product of combined genetic vulnerabilities and modifiable prenatal and postnatal influences. Further exploration of this framework will open paths for precision intervention and prevention. Full article

The confined space of coal mines characterized by curved tunnels with rough surfaces and a variety of deployed production equipment induces severe signal attenuation and interruption, which significantly degrades the accuracy of conventional channel estimation algorithms applied in coal mine wireless communication systems. To address these challenges, we propose a modified Bilinear Generalized Approximate Message Passing (mBiGAMP) algorithm enhanced by intelligent reflecting surface (IRS) technology to improve channel estimation accuracy in coal mine scenarios. Due to the presence of abundant coal-carrying belt conveyors, we establish a hybrid channel model integrating both fast-varying and quasi-static components to accurately model the unique propagation environment in coal mines. Specifically, the fast-varying channel captures the varying signal paths affected by moving conveyors, while the quasi-static channel represents stable direct links. Since this hybrid structure necessitates an augmented factor graph, we introduce two additional factor nodes and variable nodes to characterize the distinct message-passing behaviors and then rigorously derive the mBiGAMP algorithm. Simulation results demonstrate that the proposed mBiGAMP algorithm achieves superior channel estimation accuracy in dynamic conveyor-affected coal mine scenarios compared with other state-of-the-art methods, showing significant improvements in both separated and cascaded channel estimation. Specifically, when the NMSE is ${10}^{-3}$, the SNR of mBiGAMP is improved by approximately 5 dB, 6 dB, and 14 dB compared with the Dual-Structure Orthogonal Matching Pursuit (DS-OMP), Parallel Factor (PARAFAC), and Least Squares (LS) algorithms, respectively. We also verify the convergence behavior of the proposed mBiGAMP algorithm across the operational signal-to-noise ratios range. Furthermore, we investigate the impact of the number of pilots on the channel estimation performance, which reveals that the proposed mBiGAMP algorithm consumes fewer number of pilots to accurately recover channel state information than other methods while preserving estimation fidelity. Full article

Young people under the care of child protection agencies are at increased risk of entering the criminal justice system. Residential youth organisations support young people who are unable to reside with their families or in foster care. Youth workers in these environments ensure the safety and wellbeing of young people in their care, consequently supporting the wellbeing of the overall community. This research explored the views and experiences of Queensland residential youth workers via a focus group interview. The data captured a thick description of service delivery practices. Constructivist Grounded Theory was used to conceptualise a theoretical framework based on the various empirical realities of participants. The findings highlight occasions where complex power dynamics had damaging consequences for youth workers and young people. Participants explored systemic constraints and structural inequalities, thus detailing the implications of top-down organisational structures on their service delivery, safety, and outcomes for young people. Participants were concerned about the implications of interrupted attachment and young people’s progression into crime. Practice recommendations centre around improving the disconnection between front-line realities and systemic hierarchies. Residential out-of-home care service delivery should focus on building community connection and belonging; mental, emotional and physical safety; collaborative care; and support. Full article

Non-contact vital signs detection of the survivors based on bio-radar to identify their life states is significant for field search and rescue. However, when transportation is interrupted, rescue workers and equipment are unable to arrive at the disaster area promptly. In this paper, we report a hovering airborne radar for non-contact vital signs detection to overcome this challenge. The airborne radar system supports a wireless data link, enabling remote control and communication over distances of up to 3 km. In addition, a novel framework based on blind source separation is proposed for vital signals extraction. First, range migration caused by the platform motion is compensated for by the envelope alignment. Then, the respiratory waveform of the human target is extracted by the joint approximative diagonalization of eigenmatrices algorithm. Finally, the heartbeat signal is recovered by respiratory harmonic suppression through a feedback notch filter. The field experiment results demonstrate that the proposed method is capable of precisely extracting vital signals with outstanding robustness and adaptation in more cluttered environments. The work provides a technical basis for remote high-resolution vital signs detection to meet the increasing demands of actual rescue applications. Full article