Search Results (847)

Equipment renewal and replacement strategy as well as smart capital investment is a vital focus in engineering asset management, particularly for water utilities aiming to improve asset reliability, water quality, service continuity and affordability. This study presents a novel decision support model that integrates whole-life costing principles across all asset lifecycle phases—from capital delivery and daily operations to long-term maintenance. The proposed model uniquely combines asset degradation and failure patterns, operating and maintenance costs, and the impact of technological advancements to provide a holistic and comprehensive asset management decision-making tool. These dimensions are jointly analysed using a hybrid approach that combines optimisation with stochastic dynamic programming, allowing for the determination of optimal asset renewal and replacement timing. The model’s performance was validated using historical data from eight critical wastewater pump stations within a township’s sewerage network. This was performed by comparing the model’s cost-saving results to those achieved by the water utility’s current strategy. Results revealed that the proposed model achieved an average cost saving of 12%, demonstrating its effectiveness in supporting sustainable and cost-efficient asset renewal decisions. Full article

Urinary incontinence (UI) is a widespread worldwide gynecological pathology with a negative impact on women’s quality of life. We performed a narrative review and present a general, descriptive, and comprehensive perspective about surgical techniques for urinary incontinence in young women. Even though parity and vaginal births represent important risk factors for the occurrence of UI, it is also common among young women who are nulliparous. Lifestyle, obesity, smoking, alcohol consumption, and excessive stretching exercises can contribute to the occurrence of UI. Correct diagnosis and treatment may reduce the negative effects of UI on daily activities. Disease management varies depending on the three types of UI: stress, urge, and mixed. Conservative treatment involves lifestyle changes, pharmacological therapy, and pelvic floor muscle training. If symptoms persist, surgical techniques such as midurethral/suburethral slings, anterior colporrhaphy, and retropubic/laparoscopic colposuspension are necessary. Transvaginal tension-free vaginal tape obturator (TVT-O) is the most common surgical technique for the treatment of UI. Its effectiveness has been proven by reducing symptoms and improving quality of life. Alternative modern treatment methods are vaginal laser therapy, periurethral bulking agents injection, or local injection with autologous platelet-rich plasma. Surgical techniques for the treatment of UI are in continuous development and improvement considering the increased incidence of this pathology and the need of patients to improve symptoms and quality of life. Full article

This study conducts a detailed analysis of cybersecurity threats, including artificial intelligence (AI)-driven cyber-attacks targeting vehicle-to-vehicle (V2V) and electric vehicle (EV) communications within the rapidly evolving field of connected and autonomous vehicles (CAVs). As autonomous and electric vehicles become increasingly integrated into daily life, their susceptibility to cyber threats such as replay, jamming, spoofing, and denial-of-service (DoS) attacks necessitates the development of robust cybersecurity measures. Additionally, EV-specific threats, including battery management system (BMS) exploitation and compromised charging interfaces, introduce distinct vulnerabilities requiring specialized attention. This research proposes a comprehensive and integrated cybersecurity framework that rigorously examines current V2V, vehicle-to-everything (V2X), and EV-specific systems through systematic threat assessments, vulnerability analyses, and the deployment of advanced security controls. Unlike previous state-of-the-art approaches, which primarily focus on isolated threats or specific components such as V2V protocols, the proposed framework provides a holistic cybersecurity strategy addressing the entire communication stack, EV subsystems, and incorporates AI-driven threat detection mechanisms. This comprehensive and integrated approach addresses critical gaps found in the existing literature, making it significantly more adaptable and resilient against evolving cyber-attacks. Our framework aligns with industry standards and regulatory requirements, significantly enhancing the security, safety, and reliability of modern transportation systems. By incorporating specialized cryptographic techniques, secure protocols, and continuous monitoring mechanisms, the proposed approach ensures robust protection against sophisticated cyber threats, thereby safeguarding vehicle operations and user privacy. Full article

The Internet of Things (IoT) has become an integral part of today’s smart and digitally connected world. IoT devices and technologies now connect almost every aspect of daily life, generating, storing, and analysing vast amounts of data. One important use of IoT is in utility management, where essential services such as water are supplied through IoT-enabled infrastructure to ensure fair, efficient, and sustainable delivery. The large volumes of data produced by water distribution networks must be safeguarded against manipulation, theft, and other malicious activities. Incidents such as the Queensland user data breach (2020–21), the Oldsmar water treatment plant attack (2021), and the Texas water system overflow (2024) show that attacks on water treatment plants, distribution networks, and supply infrastructure are common in Australia and worldwide, often due to inadequate security measures and limited technical resources. Lightweight cryptographic algorithms are particularly valuable in this context, as they are well-suited for resource-constrained hardware commonly used in IoT systems. This study focuses on the in-house developed ChaosFortress lightweight cryptographic algorithm, comparing its performance with other widely used lightweight cryptographic algorithms. The evaluation and comparative testing used an Arduino and a LoRa-based transmitter/receiver pair, along with the NIST Statistical Test Suite (STS). These tests assessed the performance of ChaosFortress against popular lightweight cryptographic algorithms, including ACORN, Ascon, ChaChaPoly, Speck, tinyAES, and tinyECC. ChaosFortress was equal in performance to the other algorithms in overall memory management but outperformed five of the six in execution speed. ChaosFortress achieved the quickest transmission time and topped the NIST STS results, highlighting its strong suitability for IoT applications. Full article

Floods pose a substantial risk to human well-being. These risks encompass economic losses, infrastructural damage, disruption of daily life, and potential loss of life. This study presents a state-wide and county-level spatial exposure assessment of the Iowa railway network, emphasizing the resilience and reliability of essential services during such disasters. In the United States, the railway network is vital for the distribution of goods and services. This research specifically targets the railway network in Iowa, a state where the impact of flooding on railways has not been extensively studied. We employ comprehensive GIS analysis to assess the vulnerability of the railway network, bridges, rail crossings, and facilities under 100- and 500-year flood scenarios at the state level. Additionally, we conducted a detailed investigation into the most flood-affected counties, focusing on the susceptibility of railway bridges. Our state-wide analysis reveals that, in a 100-year flood scenario, up to 9% of railroads, 8% of rail crossings, 58% of bridges, and 6% of facilities are impacted. In a 500-year flood scenario, these figures increase to 16%, 14%, 61%, and 13%, respectively. Furthermore, our secondary analysis using flood depth maps indicates that approximately half of the railway bridges in the flood zones of the studied counties could become non-functional in both flood scenarios. These findings are crucial for developing effective disaster risk management plans and strategies, ensuring adequate preparedness for the impacts of flooding on railway infrastructure. Full article

The use of long-acting cabotegravir and rilpivirine (LA CAB/RPV) is a novel approach to manage human immunodeficiency virus (HIV). This injectable regimen offers benefits such as an improved quality of life, reduced stigma and enhanced treatment satisfaction by minimising the need for daily medication adherence. This review summarises the findings of clinical trials and real-world studies on the safety, tolerability and metabolic effects of LA CAB/RPV, which are areas that have received less extensive coverage in previous reviews. Clinical trial data suggest that LA CAB/RPV is generally safe and well tolerated. The most common side effects were injection site reactions, affecting 70–97% of participants. However, these were typically mild and short lived, rarely leading to treatment discontinuation in fewer than 2–3% of cases. Systemic side effects were minimal and comparable to those observed with traditional oral antiretroviral therapy. Real-world studies corroborated these findings, reporting low discontinuation rates due to adverse events. Regarding metabolic impact, clinical trials showed minimal weight gain (an average increase of 1–2 kg over 48–96 weeks) with no significant differences or impact on lipid and glucose levels. Although real-world data are still emerging, they suggest similar trends, including a possible improvement in lipid profiles. Overall, LA CAB/RPV appears to be a safe, well-tolerated and effective treatment option, although longer-term follow-up is needed. Full article

Objectives: Depressive symptoms are highly prevalent among individuals with chronic kidney disease (CKD). This study explores their associated factors and gender differences among middle-aged and older CKD patients in China. Methods: Based on the health ecology model (HEM), this study utilized the 2018 cross-sectional data from the China Health and Retirement Longitudinal Study (CHARLS) to examine gender differences in CKD patients across demographic groups. A multivariate logistic regression identified factors associated with depressive symptoms and gender differences among middle-aged and older patients with CKD in China. Additionally, a random forest model was constructed to rank the importance of key predictors based on the Gini index. Results: Among 1422 CKD patients, 50.35% reported depressive symptoms (42.97% of males and 59.56% of females). Factors significantly associated with higher depressive symptoms included female gender, rural residence, poor self-reported health, sleep duration < 7 h, and limitations in Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs). The association of smoking and ADLs on depressive symptoms in CKD patients varied considerably between genders. Self-reported health and life satisfaction were the two variables most strongly associated with depressive symptoms among CKD patients. Conclusions: The study shows that female CKD patients have a higher prevalence of depressive symptoms than males. Several factors are significantly associated with depressive symptoms in patients with CKD. These findings provide valuable insights that potentially inform the development of targeted prevention and management strategies for depressive symptoms in middle-aged and older CKD patients in China. Full article

Severe asthma imposes a significant burden on public health worldwide, mainly due to its morbidity and high cost. The management of severe asthma has dramatically changed in the past few years with the introduction of biologics. Zero exacerbations, zero systemic corticosteroids, better asthma control, and better lung function are the outcomes that the era of biologics has made attainable in a large proportion of severe asthmatics, ending up in a better quality of life. Still, even today, the changes at the tissue level that reflect these outcomes are not that clear. As a chronic inflammatory disease, asthma often involves airway remodeling in its severe forms; endobronchial biopsies may provide critical insights into these tissue-level changes before and after biologic treatment. However, bronchoscopy is an invasive tool for severe asthma, thus limiting its use in daily clinical practice. This review focuses on summarizing the changes that biologics exert in biopsies obtained from severe asthmatics under biological treatment, providing an opportunity to shed light on what really happens there where it is not easy to see, and especially on what does not happen in patients under biologics who fail to respond as expected. Moreover, the armamentarium of biomarkers used for making the proper choice in patients eligible for more than one biologic needs to be enriched. Biopsy-related markers could be an ideal adjunct to the current ones—blood eosinophils, FeNO, and IgE—to assist the clinician to choose the right biologic for the right patient with severe asthma to achieve disease remission. Full article

Background: Ulcerative colitis (UC) requires life-long disease management. This study aimed to investigate the disease burden and unmet medical needs in UC patients in Greece. Methods: Between October 2023 and January 2024, adult UC patients who were members of the Hellenic Society of Crohn’s Disease and Ulcerative Colitis Patients (HELLESCC) completed a structured self-reported questionnaire. The survey questionnaire included sociodemographic characteristics, smoking habits, history of comorbidities, disease activity, disease characteristics, medications, and patient-reported outcomes (PROs; Short Inflammatory Bowel Disease Questionnaire [SIBDQ], Work Productivity and Activity Impairment [WPAI], Patient Health Questionnaire-9 [PHQ-9], treatment satisfaction, and treatment adherence). Univariate and multivariate logistic regression analyses were used to identify associated factors. Results: Datasets were obtained from 181 UC patients, of whom 48% were on advanced therapies (biological/small-molecule agents) and 54% had active disease. Around 74% reported impaired quality of life (QoL) (SIBDQ < 60), 25% work productivity loss, and 29% daily activity impairment. About 40% reported moderate to severe depressive symptoms (PHQ-9 ≥ 10). Reduced adherence and treatment dissatisfaction were reported by approximately one-third of patients. Female gender and disease activity were associated with moderately to severely impaired QoL, work productivity, and mental health. Interestingly, three out of four patients receiving advanced therapy reported moderately to severely impaired QoL and had increased odds of experiencing moderate to severe depression. Conclusions: The disease burden remains very high in UC, characterized by poor QoL and increased work impairment, depression, and disease activity among Greek patients. Marked treatment dissatisfaction and non-adherence were observed in approximately one-third of patients. Full article

Background/Objective: Executive functions (EFs) are essential in the daily management of arthritis, as they influence treatment adherence, decision-making, and the ability to cope with disease-related challenges. The objective of this study was to compare EFs alongside functional status and quality of life in patients with rheumatoid arthritis (RA) and psoriatic arthritis (PsA) and examine their associations with disease activity and clinical variables. Methods: In this cross-sectional study, 140 patients (70 RA, 70 PsA) were assessed using the Stroop-TBAG, Wisconsin Card Sorting Test (WCST), and Adult Executive Functioning Inventory (ADEXI). Functional status and quality of life were measured with the Health Assessment Questionnaire (HAQ) and WHOQOL-BREF, respectively. Correlations with disease activity (DAS28-CRP), age, and disease duration were examined. Results: RA patients had significantly higher disease activity and longer disease duration. They showed poorer performance on the Stroop Test (color–word time: 61.6 ± 14.8 vs. 52.4 ± 10.9 s, p < 0.001; errors: 3.2 ± 2.1 vs. 2.1 ± 1.5, p = 0.001), more WCST perseverative errors (p = 0.002), and higher ADEXI inhibition scores (13.9 ± 2.5 vs. 12.9 ± 3.0, p = 0.013). DAS28-CRP was correlated with EF impairments, disability, and poorer quality of life in RA (p < 0.05). In PsA, EFs remained relatively stable, although higher disease activity was associated with worse HAQ scores (p = 0.001). Treatment type was not linked to EF, but patients on combination therapy reported lower physical (p = 0.009) and psychological (p = 0.014) quality of life, along with higher HAQ scores (p = 0.016). Conclusions: This study revealed that patients with RA exhibit more pronounced executive dysfunction, along with lower ADL skills and quality of life compared to those with PsA. These findings highlight the need for multidimensional assessment strategies in inflammatory arthritis, especially in RA, where cognitive and functional outcomes are closely tied to clinical burden. Full article

The COVID-19 pandemic precipitated unprecedented social isolation measures, profoundly disrupting daily life, educational routines, and mental health worldwide. University students, already susceptible to psychological distress, encountered intensified challenges under remote learning and prolonged confinement. This longitudinal study examined fluctuations in anxiety and mood among 102 Brazilian university students during the pandemic, distinguishing between those solely engaged in academic pursuits and those simultaneously balancing work and study. Data collected via the Brunel Mood Scale and State-Trait Anxiety Inventory in April and July 2021 revealed that students exclusively focused on studies exhibited significant increases in depressive symptoms, anger, confusion, and anxiety, alongside diminished vigor. Conversely, participants who combined work and study reported reduced tension, fatigue, confusion, and overall mood disturbance, coupled with heightened vigor across the same period. Notably, women demonstrated greater vulnerability to anxiety and mood fluctuations, with socioeconomic disparities particularly pronounced among females managing dual roles, who reported lower family income. These findings suggest that occupational engagement may serve as a protective factor against psychological distress during crises, underscoring the urgent need for tailored mental health interventions and institutional support to mitigate the enduring impacts of pandemic-related adversities on the student population. Full article

Background: The progression of Alzheimer’s Disease (AD) deeply affects not only the diagnosed person but also their close relatives, who are often called to take on the role of informal caregivers. This transition is frequently unplanned and emotionally complex, yet poorly understood in its deeper processual dimensions. This study aims to explore and theorize the transition experienced by a family member becoming the primary informal caregiver for a person with advanced AD. Methods: A qualitative study based on the Constructivist Grounded Theory according to Charmaz’s approach (2006) was conducted. In-depth interviews were carried out with 10 participants who had become informal caregivers for a loved one with advanced AD. Data were analyzed using initial coding, focused coding, the constant comparative method, and theoretical coding. Results: Ten caregivers (mean age 39 years, range 35–54; nine females) of patients with advanced AD participated in the study. The analysis revealed a complex, emotionally intense caregiving experience marked by sacrifice, feelings of powerlessness, identity loss, and the necessity of sharing caregiving responsibilities. A core category emerged: A Silent and Certain Willingness to Care, representing the caregivers’ deep, often unconscious commitment to prioritize the care of their loved ones above their own needs. Four interconnected phases characterized the caregiving process: (1) The Changing Daily Life—involving significant sacrifices in personal and social life; (2) Feeling Powerless—confronting the inevitable decline without means to alter the course; (3) Losing Oneself—experiencing physical and psychological exhaustion and a sense of identity loss; and (4) Sharing with Others—seeking external support to sustain caregiving. These findings highlight the evolving nature of becoming a caregiver and the enduring dedication that sustains this role despite the challenges. Conclusions: The progression of AD deeply transforms the lives of caregivers, who become co-sufferers and active participants in the disease’s management. The results underscore the urgency of designing integrative care strategies—including psychological, social, and potentially technological support—that can enhance both patient outcomes and caregiver resilience. Grounded in real-world experiences, this study contributes to the broader neurodegeneration discourse by emphasizing caregiving as a critical factor in long-term disease management and therapeutic success. Full article

Background and Aim: Type 2 diabetes (T2D) continues to pose a significant public health challenge worldwide. Among therapeutic options, glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have proven effective in optimizing glycemic control and improving cardiometabolic profiles. Semaglutide, now available in an oral formulation, represents a modern strategy to improve patient adherence while supporting glucose and weight regulation. This study primarily investigated the effects of oral semaglutide on key metabolic indicators and secondary endpoints included cardiovascular risk markers (blood pressure and lipid profile) and patient-reported quality of life (QoL). Study Design and Methods: A longitudinal, prospective observational study was conducted involving patients with T2D across two Italian healthcare facilities. Participants were assessed at baseline (T0) and at three subsequent intervals—6 months (T1), 12 months (T2), and 18 months (T3)—following the initiation of oral semaglutide use. Key Findings: Out of 116 participants enrolled, 97 had complete and analyzable data. Across the 18-month follow-up, significant improvements were observed in glycemic parameters, with a notable reduction in HbA1c levels (T0 vs. T3, p = 0.0028; p ≤ 0.05, statistically significant). Self-reported outcomes showed enhanced quality of life, especially in treatment satisfaction and perceived flexibility (T0 vs. T3, p < 0.001). Conclusions: Daily administration of 14 mg oral semaglutide in individuals with T2D resulted in substantial benefits in glycemic regulation, weight reduction, cardiovascular risk management, and overall patient satisfaction. These findings reinforce its potential role as a sustainable and effective option in long-term diabetes care from both a clinical and public health perspective. Full article

Freezing of gait (FoG) impairs mobility and daily functioning and increases the risk of falls, leading to a reduced quality of life (QoL) in people with Parkinson’s disease (PD). The Cue2walk, a wearable smart cueing device, can detect FoG and hereupon provides rhythmic cues to help people with PD manage FoG in daily life. This study investigated the user experiences and device usage of the Cue2walk, and its impact on health-related QoL, FoG and daily activities. Twenty-five users of the Cue2walk were invited to fill out an online survey, which included a modified version of the EQ-5D-5L, tailored to the use of the Cue2walk, and its scale for health-related QoL, three FoG-related questions, and a question about customer satisfaction. Sixteen users of the Cue2walk completed the survey. Average device usage per day was 9 h (SD 4). Health-related QoL significantly increased from 5.2/10 (SD 1.3) to 6.2/10 (SD 1.3) (p = 0.005), with a large effect size (Cohen’s d = 0.83). A total of 13/16 respondents reported a positive effect on FoG duration, 12/16 on falls, and 10/16 on daily activities and self-confidence. Customer satisfaction was 7.8/10 (SD 1.7). This pilot study showed that Cue2walk usage per day is high and that 15/16 respondents experienced a variety of positive effects since using the device. To validate these findings, future studies should include a larger sample size and a more extensive set of questionnaires and physical measurements monitored over time. Full article

Background/Objectives: Obstructive sleep apnea (OSA) is a highly prevalent disorder that significantly impacts quality of life and daily functioning. While continuous positive airway pressure (CPAP) therapy is effective, long-term adherence remains a challenge. This single-arm observational study aimed to evaluate clinical outcomes and adherence patterns during telemedicine-supported CPAP therapy and identify distinct phenotypic response clusters in Romanian patients with OSA. Methods: This prospective observational study included 86 adults diagnosed with OSA, treated with ResMed Auto CPAP devices at “Victor Babeș” University Hospital in Timișoara, Romania. All patients were remotely monitored via the AirView™ platform and received monthly telephone interventions to promote adherence when necessary. Clinical outcomes were assessed through objective telemonitoring data. K-means clustering and t-distributed stochastic neighbor embedding (t-SNE) were employed to explore phenotypic response patterns. Results: During telemedicine-supported CPAP therapy, significant clinical improvements were observed. The apnea–hypopnea index (AHI) decreased from 42.0 ± 21.1 to 1.9 ± 1.3 events/hour. CPAP adherence improved from 75.5% to 90.5% over six months. Average daily usage increased from 348.4 ± 85.8 to 384.2 ± 65.2 min. However, post hoc analysis revealed significant concerns about the validity of self-reported psychological improvements. Self-esteem changes showed negligible correlation with objective clinical measures (r < 0.2, all p > 0.1), with only 3.3% of variance being explained by measurable therapeutic factors (R² = 0.033). Clustering analysis identified four distinct adherence and outcome profiles, yet paradoxically, patients with lower adherence showed greater self-esteem improvements, contradicting therapeutic causation. Conclusions: Telemedicine-supported CPAP therapy with structured monthly interventions was associated with substantial clinical improvements, including excellent AHI reduction (22-fold) and high adherence rates (+15% after 6 months). Data-driven phenotyping successfully identified distinct patient response profiles, supporting personalized management approaches. However, the single-arm design prevents definitive attribution of improvements to telemonitoring versus natural adaptation or placebo effects. Self-reported psychological outcomes showed concerning patterns suggesting predominant placebo responses rather than therapeutic benefits. While the overall findings demonstrate the potential value of structured telemonitoring for objective CPAP outcomes, controlled trials are essential to establishing true therapeutic efficacy and distinguishing intervention effects from measurement bias. Full article