Search Results (72)

Background: Hypotension following epidural labor analgesia (ELA) is its most common complication, affecting approximately 20% of patients and posing risks to both maternal and fetal health. As digital tools and predictive analytics increasingly shape perioperative and obstetric anesthesia practices, real-world implementation data are needed to guide their integration into clinical care. Current monitoring practices rely on intermittent non-invasive blood pressure (NIBP) measurements, which may delay recognition and treatment of hypotension. The Hypotension Prediction Index (HPI) algorithm uses continuous arterial waveform monitoring to predict hypotension for potentially earlier intervention. This clinical trial evaluated the feasibility, acceptability, and efficacy of continuous HPI-guided treatment in reducing time-to-treatment for ELA-associated hypotension and improving maternal hemodynamics. Methods: This was a prospective randomized controlled trial design involving healthy pregnant individuals receiving ELA. Participants were randomized into two groups: Group CM (conventional monitoring with NIBP) and Group HPI (continuous noninvasive blood pressure monitoring). In Group HPI, hypotension treatment was guided by HPI output; in Group CM, treatment was based on NIBP readings. Feasibility, appropriateness, and acceptability outcomes were assessed among subjects and their bedside nurse using the Acceptability of Intervention Measure (AIM), Intervention Appropriateness Measure (IAM), and Feasibility of Intervention Measure (FIM) instruments. The primary efficacy outcome was time-to-treatment of hypotension, defined as the duration between onset of hypotension and administration of a vasopressor or fluid therapy. This outcome was chosen to evaluate the clinical responsiveness enabled by HPI monitoring. Hypotension is defined as a mean arterial pressure (MAP) < 65 mmHg for more than 1 min in Group CM and an HPI threshold < 75 for more than 1 min in Group HPI. Secondary outcomes included total time in hypotension, vasopressor doses, and hemodynamic parameters. Results: There were 30 patients (Group HPI, n = 16; Group CM, n = 14) included in the final analysis. Subjects and clinicians alike rated the acceptability, appropriateness, and feasibility of the continuous monitoring device highly, with median scores ≥ 4 across all domains, indicating favorable perceptions of the intervention. The cumulative probability of time-to-treatment of hypotension was lower by 75 min after ELA initiation in Group HPI (65%) than Group CM (71%), although this difference was not statistically significant (log-rank p = 0.66). Mixed models indicated trends that Group HPI had higher cardiac output (β = 0.58, 95% confidence interval −0.18 to 1.34, p = 0.13) and lower systemic vascular resistance (β = −97.22, 95% confidence interval −200.84 to 6.40, p = 0.07) throughout the monitoring period. No differences were found in total vasopressor use or intravenous fluid administration. Conclusions: Continuous monitoring and precision hypotension treatment is feasible, appropriate, and acceptable to both patients and clinicians in a labor and delivery setting. These hypothesis-generating results support that HPI-guided treatment may be associated with hemodynamic trends that warrant further investigation to determine definitive efficacy in labor analgesia contexts. Full article

Background/Objectives: Auditory capacity plays a fundamental role in human emotional development from prenatal stages and persists as the last sensory modality to fade during terminal phases. In palliative sedation, uncertainty about preserved hearing—despite potential unconsciousness—underscores the need to evaluate current care recommendations for this critical sensory dimension. This review examines European guidelines to (i) assess auditory care integration in palliative sedation protocols and (ii) propose humanization strategies for sensory-preserving end-of-life care. Methods: Narrative review of evidence from the European Palliative Sedation Repository and the European Association for Palliative Care (EAPC). Results: Three key findings emerged: (i) lack of explicit protocols for auditory care despite acknowledging environmental sound management (e.g., music, family communication); (ii) limited consensus exists regarding hearing preservation during unconsciousness. Conclusions: Although auditory perception during palliative sedation remains scientifically uncertain, the precautionary principle warrants integrating auditory care into palliative sedation through (i) family education on potential hearing preservation; (ii) therapeutic sound protocols; and (iii) staff training in sensory-inclusive practices. This approach addresses current gaps in the guidelines while enhancing patient dignity and family support during end-of-life care. Further research should clarify auditory perception thresholds during sedation. Full article

This study reframes closure intention in small- and medium-sized enterprises (SMEs) as an ex ante diagnostic signal rather than a post-mortem symptom of failure. The survey evidence from 385 Ecuadorian SMEs was analyzed in two stages; confirmatory factor analysis validated the scales capturing environmental pessimism and personal pressures, and a structural equation model confirmed that both latent constructs directly heighten exit propensity. A binomial logistic regression model correctly classified 71% of the cases and explained 30% of variance. Five variables proved decisive: low-level liquidity (OR = 0.84), a high debt-to-equity ratio (1.41), weak profitability (0.14), negative environmental perceptions (1.72), and a shorter operating tenure (0.91); the sector and the firm size were non-significant. The combined CFA-SEM-logit sequence yields practical early warning thresholds—debt-to-equity ratio > 1.4, current ratio < 1.0, and ROA < 0.15—that lenders, advisers, and entrepreneurs can embed in dashboards or credit screens. Recognizing closure intention as a rational, strategic step challenges the stigma surrounding exit and links financial distress and the strategic exit theory. Policymakers can use the findings to pair debt relief and liquidity programs with cognitive bias training that helps owners interpret risk signals realistically. For scholars, the results highlight closure intention as a dynamic learning process, especially pertinent in emerging economies characterized by informality and institutional fragility. Full article

Pulsed eddy current (PEC) testing technology has been widely used in the field of non-destructive testing of metal grounding structures due to its wide-band excitation and response characteristics. However, multi-source noise in industrial environments can significantly degrade the performance of PEC sensors, thereby limiting their detection accuracy. This study proposes a multi-modal joint pulsed eddy current signal sensor denoising method that integrates the inductive disturbance mechanism. This method constructs the Improved Whale Optimization -Variational Mode Decomposition-Singular Value Decomposition-Wavelet Threshold Denoising (IWOA-VMD-SVD-WTD) fourth-order processing architecture: IWOA adaptively optimizes the VMD essential variables (K, α) and employs the optimized VMD to decompose the perception coefficient (IMF) of the PEC signal. It utilizes the correlation coefficient criterion to filter and identify the primary noise components within the signal, and the SVD-WTD joint denoising model is established to reconstruct each component to remove the noise signal received by the PEC sensor. To ascertain the efficacy of this approach, we compared the IWOA-VMD-SVD-WTD method with other denoising methods under three different noise levels through experiments. The test results show that compared with other VMD-based denoising techniques, the average signal-to-noise ratio (SNR) of the PEC signal received by the receiving coil for 200 noise signals in different noise environments is 24.31 dB, 29.72 dB and 29.64 dB, respectively. The average SNR of the other two denoising techniques in different noise environments is 15.48 dB, 18.87 dB, 18.46 dB and 19.32 dB, 27.13 dB, 26.78 dB, respectively, which is significantly better than other denoising methods. In addition, in practical applications, this method is better than other technologies in denoising PEC signals and successfully achieves noise reduction and signal feature extraction. This study provides a new technical solution for extracting pure and impurity-free PEC signals in complex electromagnetic environments. Full article

This study proposes and examines the dynamics of a susceptible–exposed–infectious–recovered (SEIR) model for the spread of seasonal influenza. The population is categorized into four distinct groups: susceptible (S), exposed (E), infectious (I), and recovered (R) individuals. The symmetric model integrates a bilinear incidence rate alongside a nonlinear recovery rate that depends on the quality of healthcare services. Additionally, it accounts for the impact of fear related to the disease and includes a constant vaccination rate as well as a nonlinear treatment function. The model advances current epidemiological frameworks by simultaneously accounting for these interrelated mechanisms, which are typically studied in isolation. We derive the expression for the basic reproduction number and analyze the essential stability properties of the model. Key analytical results demonstrate that the system exhibits rich dynamic behavior, including backward bifurcation (where stable endemic equilibria persist even when the basic reproduction number is less than one) and Hopf bifurcation. These phenomena emerge from the interplay between fear-induced suppression of transmission, treatment saturation, and healthcare quality. Numerical simulations using Saudi Arabian demographic and epidemiological data quantify how increased fear perception shrinks the bistability region, facilitating eradication. Healthcare capacity improvements, on the other hand, reduce the critical reproduction number threshold while treatment accessibility suppresses infection loads. The model’s practical significance lies in its ability to identify intervention points where small parameter changes yield disproportionate control benefits and evaluate trade-offs between pharmaceutical (vaccination/treatment) and non-pharmaceutical (fear-driven distancing) strategies. This work establishes a versatile framework for public health decision making and the integrated approach offers policymakers a tool to simulate combined intervention scenarios and anticipate nonlinear system responses that simpler models cannot capture. Full article

Introduction: Pain perception and management differ by sex, with women frequently experiencing more acute and chronic pain and greater disability than men. Yet, anesthesiology and pain control often overlook the physiological, hormonal, and psychological factors shaping women’s pain. Methods: This narrative review explores essential considerations from current literature to optimize pain management in women. We examine evidence about the impact of hormonal changes, reproductive transitions, and psychosocial factors on pain perception and responses to analgesics. By highlighting key insights and practical strategies, we aim to support the development of personalized pain management approaches tailored to women’s unique needs. Results: Hormonal changes, including variations in estrogen and progesterone levels, significantly influence pain thresholds and the effectiveness of analgesics and anesthetics. The menstrual cycle, menopausal transitions, and pregnancy each alter pain responses, necessitating personalized approaches to pain management. Postmenopausal women are particularly vulnerable to chronic pain conditions, such as those associated with osteoporosis, which require adjustments in long-term treatment strategies. Furthermore, psychosocial factors like anxiety and emotional distress can intensify pain, highlighting the need for holistic, integrative care. Conclusions: The existing gaps in women’s pain management across the lifespan highlight the need to revise both anesthesia and pain management protocols to better account for sex-specific biological and psychosocial factors. Addressing the unique biological and psychosocial factors that influence pain in women can enhance both the effectiveness and equity of care. By tailoring treatment strategies in women, clinicians can not only enhance pain management but also greatly improve their overall quality of life. Full article

Aiming at the problem of reduced positioning accuracy of unmanned swarm navigation systems due to dynamic abrupt noise in a complex electromagnetic environment, this paper proposes an adaptive Kalman filtering positioning and calibration method based on dynamic mutation perception and collaborative correction. This method optimizes the performance of Kalman filtering by monitoring the mutation of acceleration and velocity in real time, designing a dynamic threshold detection mechanism, adaptively adjusting the covariance matrix, and using multidimensional scaling analysis to calculate the similarity of trajectories and collaboratively correct the current state. The experiment uses simulation and real scene data and compares algorithms such as the traditional extended Kalman filter to verify the effectiveness of the proposed method, providing an effective solution for the collaborative positioning of an unmanned swarm under complex electromagnetic interference. Full article

Lidar SLAM (simultaneous localization and mapping) systems provide vehicles with high-precision maps and localization for environmental perception. However, sensor noise and dynamic changes can lead to the localization drift or localization failure of the SLAM system. Identifying such anomalies currently relies on post-trajectory analysis with subjective parameter thresholds. To address this issue, we propose an unsupervised real-time localization anomaly detection model based on the isolation forest algorithm. We first determined the necessity of variable research through variable correlation analysis. Then, we enhanced the scoring mechanism of the isolation forest by introducing a path-weighting method, improving sensitivity to complex variables and anomalies. Finally, to further increase the model’s reliability, we employed an adaptive OTSU (Otsu’s method) algorithm for automatic score classification. Experimental results show that our proposed model can effectively detect positioning anomalies by determining variable thresholds in four scenarios of the KITTI dataset. The results show excellent real-time performance, with an average running time of about 0.02 s, which is shorter than the time required to process a single data frame. Using the mean, RMSE, and standard deviation as evaluation metrics, data comparisons confirmed the algorithm’s accuracy. Compared with several SOTA (state-of-the-art) algorithms and ablation studies, our algorithm also showed higher sensitivity. Full article

Background/Objectives: Unilateral hearing loss (UHL) is a relatively common disability condition comprising around 20–50% of all congenital hearing loss (HL). The adverse effects of UHL affect the typical development of auditory function with implications for communication, speech and language acquisition, academic development and quality of life. Current literature suggests an early intervention treatment in order to avoid developmental delays, but there is a lack of evidence about the effectiveness and use of hearing devices. The purpose of the present study was to evaluate the benefits of rehabilitative strategies such as hearing aid (HA) and cochlear implant (CI) in UHL children by exploring audiological and parent-reported outcomes. Methods: A total of 18 UHL children, between the ages of 3 and 17, were enrolled in the study designed as a prospective longitudinal study from July 2023 to July 2024. All children were evaluated for speech perception in quiet and noise and subjective benefits before and after rehabilitative treatment with HA in 15 (83.3%) children and with CI in 3 (16.7%) children. Results: The evaluation of audiological outcomes in children with UHL, based on assessment of aided sound field thresholds and speech perception scores assessment versus unaided, shows improvements in audiometric thresholds and how the hearing devices adequately support listening and spoken language. Scores with hearing devices were significantly higher than baseline-only scores when averaging both SSQ and CHILD questionnaires, pointing to an overall rehabilitative benefit. Conclusions: Rehabilitative interventions, particularly HA and CI, offer notable benefits when introduced early, but achieving optimal outcomes requires a multidisciplinary and individualized approach. Full article

Stimulation-induced sensations including the perception of flickering lights (phosphenes) and scalp tingling are commonly reported in studies on transcranial alternating current stimulation (tACS). So far, these sensations have been considered benign side-effects of stimulation that may interfere with the blinding of participants in trials. It remains unknown what shapes the susceptibility to such side-effects. We hypothesized that cortical excitability predicts their intensity. Hence, we investigated the relationship between sensations during tACS and the motor threshold measured by transcranial magnetic stimulation (TMS). Nine healthy participants aged 50 and older underwent two tACS sessions at 21 Hz and 40 Hz as part of a cross-over pilot study. The stimulation amplitude was individualized to tolerability. Sensations were assessed post-session to calculate correlation with TMS-determined motor thresholds. Stimulation sensations (a flickering light and tingling scalp sensation) correlated with brain excitability as determined by the TMS motor threshold (r = −0.51, p = 0.03, N = 9). The findings suggest a relationship between the intensity of tACS-induced sensations and cortical excitability. Tailoring tACS intensity to individual tolerability and excitability thresholds may enhance the efficacy of tACS by ensuring a more consistent and effective dose relative to endogenous cortical excitability. Full article

Outdoor thermal environments significantly influence residents’ outdoor activities, yet current urban design often lacks sufficient attention to thermal comfort, and existing design methods remain inadequate. This study addresses these gaps by first demonstrating the crucial impact of outdoor thermal environments on human activity through a combination of field measurements and resident surveys. Using the Yangtze River Delta region as a case study, we propose a set of design optimization strategies based on local residents’ thermal perception characteristics. By conducting a quantitative analysis of local residents’ thermal perception, this study identifies their seasonal thermal comfort needs and translates these insights into refined outdoor space optimization strategies. The results highlight significant seasonal variations in outdoor thermal preferences, with autumn providing the highest satisfaction, followed by winter and summer. Based on these findings, we propose precision-driven design optimizations that align outdoor spatial configurations with residents’ comfort thresholds. Strategies such as dynamic shading arrangements for summer cooling and wind-shielding structures for winter warmth were tailored to actual usage patterns, enhancing the functionality and livability of outdoor spaces. This research offers a data-driven approach to climate-responsive and human-centered residential outdoor space design, providing valuable guidance for urban planners and designers. Full article

Beyond their metabolic effect, sodium–glucose cotransporter-2 (SGLT-2) inhibitors reduce the risk of heart failure and have cardiovascular and nephroprotective effects, yet their exact mechanism of action remains unclear. This prospective study included 40 patients with type 2 diabetes whose physician initiated SGLT-2 inhibitor therapy. Prior to and 4 weeks after the initiation of SGLT-2 inhibitors, in addition to routine clinical and laboratory measurements, hydroxyl free radical and neuropathic evaluations were performed. Body weight, body mass index (BMI), fasting glucose, fructosamine, and albuminuria decreased significantly, whereas red blood cell (RBC) count, hemoglobin, hematocrit, mean corpuscular volume (MCV), and platelet count increased significantly. Urinary o-tyrosine/p-tyrosine and (m-tyrosine+o-tyrosine)/p-tyrosine ratios were significantly reduced, suggesting diminished hydroxyl free radical production. Patients with neuropathy, identified by abnormal baseline current perception threshold (CPT) values, showed significant improvements. Significant correlations between RBCs, platelet parameters, albuminuria, and hydroxyl free radical markers disappeared after SGLT-2 treatment and changes in hydroxyl free radical markers correlated positively with CPT changes. Our results suggest that short-term SGLT-2 inhibition recalibrates metabolic, hematologic, renal, and neuropathic endpoints simultaneously, presumably through attenuating abnormal ortho- and meta-tyrosine incorporation into signaling proteins. Further studies are required to confirm long-term durability and examine whether additional strategies, such as supplementation of the physiological p-tyrosine, could amplify these benefits. Full article

Misophonia is a condition characterized by intense, involuntary distress or anger in response to specific sounds, often leading to irritation or aggression. While the condition is recognized for its emotional and behavioral impacts, little is known about its physiological and perceptual effects. The current study aimed to explore the physiological correlates and perceptual consequences of misophonia through a combination of electrophysiological, perceptual, and cognitive assessments. Seventeen individuals with misophonia and sixteen control participants without the condition were compared. Participants completed a comprehensive battery of tests, including (a) cortical event-related potentials (ERPs) to assess neural responses to standard and deviant auditory stimuli, (b) the spatial release from the speech-on-speech masking (SRM) paradigm to evaluate speech segregation in background noise, and (c) the flanker task to measure selective attention and cognitive control. The results revealed that individuals with misophonia exhibited significantly smaller mean peak amplitudes of the N1 and N2 components in response to oddball tones compared to controls. This suggests a potential underlying neurobiological deficit in misophonia patients, as these components are associated with early auditory processing. However, no significant differences between each group were observed in the P1 and P2 components regarding oddball tones or in any ERP components in response to standard tones. Despite these altered neural responses, the misophonia group did not show differences in hearing thresholds, speech perception abilities, or cognitive function compared to the controls. These findings suggest that while misophonia may involve distinct neurophysiological changes, particularly in early auditory processing, it does not necessarily lead to perceptual deficits in speech perception or cognitive function. Full article

Background/Objectives: Type 2 diabetes mellitus (T2DM) and its macro- and microvascular complications are major health concerns with multiple factors, like advanced end glycation products (AGEs), in the background. AGEs induce long-lasting functional modification of the proteins and collagen in the vascular wall and nerve tissue. We investigated the effect of alpha-lipoic acid (ALA) treatment on AGEs, soluble AGE receptor (sRAGE), the AGE/sRAGE ratio, and the parameters of endothelial dysfunction and their correlations. Methods: In our 6-month intervention study, 54 T2DM patients with neuropathy treated according to the actual therapeutic guidelines with unchanged oral antidiabetic drugs were included and treated by daily oral administration of 600 mg ALA. A total of 24 gender and age-matched T2DM patients without neuropathy served as controls. Results: In our work, we first demonstrated the attenuating effect of alpha lipoic acid therapy on AGEs in humans (11.89 (9.44–12.88) to 10.95 (9.81–12.82) AU/μg (p = 0.017)). sRAGE levels or the AGEs/sRAGE ratio were not affected by ALA treatment or by the presence of neuropathy. We found a correlation between the changes of AGEs and the improvement of current perception threshold and progranulin levels, and an inverse correlation with the change of asymmetric dimethylarginine. Conclusions: According to our results, ALA decreases AGEs, which may contribute to the clinically well-known beneficial effect in diabetic neuropathy and improvement of endothelial function. Full article

The food and agriculture sector is a cornerstone of critical infrastructure (CI), underpinning global food security, public health, and economic stability. However, the increasing digitalization and connectivity of operational technologies (OTs) in this sector expose it to significant cybersecurity risks. Blockchain technology (BT) has emerged as a transformative solution for addressing these challenges by enhancing network security, traceability, and system resilience. This study presents a comprehensive review of BT applications in OT security for food and agriculture CI, employing bibliometric and content analysis methods. A total of 124 relevant articles were identified from six databases, including the Web of Science Core Collection and MEDLINE^®. Bibliometric analysis was conducted across five dimensions: publication year, literature type, journal distribution, country contributions, and keyword trends. The findings are meticulously organized through tables, charts, and graphs. The year 2018 marked a surge in research within this domain, with the IEEE Internet of Things Journal and IEEE ACESS emerging as the most prolific journals, each boasting nine publications. The United States, China, and India are at the forefront in terms of journal citation counts. Our analysis determined that a reference count of 37 serves as an appropriate threshold. Otoum Safa stands out as the author with the highest number of published articles, totaling four. Keywords such as “blockchain”, “internet of things”, “smart contract”, “security”, and “critical infrastructure” appear with significant frequency. The statistics, trends, and insights gleaned from this bibliometric analysis can guide researchers in the OTCI field to forge a coherent and logical research trajectory. Content analysis further identified six key research areas within this domain: identity authentication and data verification, secure access control, attack detection and perception, data security and protection, data backup and recovery, and attack assessment and attribution. Based on these insights, a general framework is proposed to guide future research and practical applications of BT in securing OT within food and agriculture CI. This study systematically analyzes the current research landscape, challenges, and opportunities for BT in securing the OT critical to food and agriculture CI. By bridging the gap between blockchain innovations and the operational needs of the food and agriculture sector, this work contributes to advancing strategic implementation and improving the security of CI systems. Full article