Search Results (552)

In signalized urban road networks, periodic signal phase switching is a key factor influencing traffic-flow stability and operational efficiency. With the rapid development of Connected and Automated Vehicle (CAV) technologies, exploiting their enhanced perception, communication, and cooperative control capabilities has become an important research topic. To characterize the acceleration, deceleration, queueing, and discharge disturbances induced by signal phase transitions, this study proposes a Signal-Constrained Optimal Velocity Model (SC-OVM). By introducing a continuous signal decision function, the proposed model dynamically couples traffic signal states with vehicle-following behavior, including preceding-vehicle following and stop-line tracking within a unified optimal-velocity framework. Furthermore, linear stability analysis, boundary critical condition analysis, and disturbance probability modeling are integrated to reveal the instability mechanism caused by abrupt signal phase transitions, with extensions to stochastic prediction errors and adaptive Signal Phase and Timing (SPaT) inputs. Numerical simulations show that SC-OVM-controlled CAVs can smooth vehicle trajectories, reduce average delay, improve end-of-green passing performance, and achieve a balanced performance in efficiency, stability, and safety compared with the Full Velocity Difference Model (FVDM), Virtual Leading Vehicle model (VLV), and Intelligent Driver Model (IDM). The findings provide theoretical support and practical insights for stability modeling and cooperative control of mixed-traffic flow at signalized intersections. Full article

Background: Postoperative bleeding and prolonged drainage after head and neck surgery may delay drainage tube removal and hospital discharge, increasing complication risk and resource utilization. Optimizing intra and postoperative hemostasis is essential to facilitate early recovery and support enhanced recovery after surgery (ERAS) pathways. This study aimed to identify factors associated with postoperative drainage and length of hospital stay, with particular focus on energy-based device and fibrin sealant use. Methods: Adult patients who underwent neck surgery under general anesthesia with inpatient admission at a tertiary medical center between January 2024 and December 2025 were retrospectively analyzed. Surgical procedures included thyroidectomy (n = 99), parotidectomy (n = 43), submandibular gland excision (n = 25), neck dissection (n = 27) and other procedures (n = 22). Clinical variables, surgical factors, use of energy-based device, hemostatic agents, postoperative drainage volume, and length of hospital stay were collected. Logistic regression analysis was performed to evaluate predictors of early discharge (defined as discharge on postoperative day 1). Results: A total of 216 patients were included. Surgical procedure type was strongly associated with operative duration, postoperative day 1 drainage volume, and length of hospital stay. Neck dissection and total thyroidectomy were associated with increased drainage and prolonged hospitalization. The use of fibrin sealants was independently associated with lower postoperative drainage volume, shorter hospital stay, and a significantly higher likelihood of early discharge (adjusted odds ratio: 4.43, 95% CI 1.92–10.23, p < 0.001). Energy-based device use and patient-controlled analgesia were not associated with early discharge. Conclusions: Incorporating fibrin sealant into perioperative management may facilitate safer and earlier discharge, improve patient turnover, and optimize resource utilization within ERAS-based care pathways. Full article

Delayed discharge represents a persistent challenge in healthcare systems, contributing to inefficiencies in hospital bed utilization, increased costs, and reduced patient flow. In small and centralized healthcare systems, these effects may be further amplified due to limited post-acute care capacity and restricted patient redistribution. This study quantified the prevalence of inappropriate hospital days as a proxy for delayed discharge and examined their relationship with patient demographics, medical specialty, and associated costs in an acute general hospital. A quantitative analysis of 220 medical records was conducted using a modified Appropriateness Evaluation Protocol (AEP). Descriptive statistics and non-parametric tests were applied to identify significant associations between inappropriate hospital days and selected variables. According to the findings, within this intentionally enriched sample of patients with a length of stay exceeding seven days in the selected wards, nearly half of all accumulated inpatient bed days failed to meet acute necessity criteria, with the vast majority of these service backlogs stemming from placement delays in downstream rehabilitation facilities and long-term care institutions. Within this high-risk cohort, inappropriate hospital days, used here as a proxy for delayed discharge, were more common among older patients and among medical specialties than in other specialties, while no consistent relationship was observed with gender. Cost analysis (carried out over a three-month period) indicated an order-of-magnitude estimate of the acute bed day resources associated with inappropriate hospital days in the units studied. These findings are consistent with the interpretation that inappropriate hospital days, used here as a proxy indicator of delayed discharge, may be influenced by a combination of external capacity constraints and internal operational inefficiencies, although causality cannot be established from this observational design. While the findings cannot be generalised to the entire inpatient population or health system, within this intentionally enriched cohort of long stay inpatients the study highlights the need to strengthen post-acute care provision, improve discharge coordination processes, and enhance system integration to optimise hospital efficiency and patient flow in similar operational contexts. Full article

Reliable flood simulation in large cold-region basins requires understanding how meteorological forcing differences propagate through runoff generation and river routing. We compared CMFD, GSWP3v1, and CRUNCEPv7 using a controlled, uncalibrated offline CLM5–CaMa-Flood framework for the Songhua River Basin during 1996–2014, with all non-forcing settings fixed. Evaluation included daily and monthly discharge, seasonal hydrographs, annual maximum daily discharge (AMAX), observed Q95/Q99 thresholds, selected 1998 and 2013 warm-season high-flow cases, runoff-process diagnostics, event-window sensitivity tests, 5000 paired year-wise bootstrap resamples, and auxiliary water-level anomalies. CMFD generally produced the highest r, KGE, and daily NSE, but also the largest positive long-term Bias. CRUNCEPv7 systematically underestimated discharge, whereas GSWP3v1 more often yielded the smallest absolute Bias. For both selected events, CMFD reduced peak and volume underestimation, although peaks remained smoothed and delayed. Event-window precipitation differences did not translate proportionally into CLM5 runoff, and the larger CMFD response involved increases in both surface runoff and subsurface drainage. The event-magnitude ordering remained stable across ±30-, ±45-, and ±60-day windows. Bootstrap results showed a robust CMFD advantage over GSWP3v1 for temporal agreement and efficiency, while several CMFD–CRUNCEPv7 comparisons remained sample-dependent. Forcing-product performance was therefore scale-, metric-, and target-dependent and conditional on the fixed model configuration. Full article

Background/Objectives: Tuberculous constrictive pericarditis (TCP) is characterized by “backward failure” and systemic venous congestion, leading to secondary multi-organ dysfunction. The Model for End-Stage Liver Disease (MELD) 3.0 score assesses liver, renal, and nutritional status, yet its prognostic utility in TCP remains undefined. This study aimed to evaluate the preoperative MELD 3.0 score as a predictor of time to discharge in patients undergoing pericardiectomy for TCP. Methods: We analyzed 190 patients undergoing pericardiectomy for TCP between 2018 and 2024. The association between preoperative MELD 3.0 scores and time to discharge (ICU, postoperative, and total) was assessed using Fine–Gray competing risks regression to account for in-hospital mortality. Models were adjusted for age, albumin, and anti-tuberculosis therapy. Results: Each unit increase in MELD 3.0 was associated with higher operative mortality (OR 1.21, p = 0.013). In multivariable analysis, a high MELD 3.0 score (>median 9.6) was independently associated with a lower probability of discharge (i.e., delayed discharge) for total hospital stay (subdistribution hazard ratio [sHR] 0.606, 95% CI 0.453–0.811), postoperative stay (sHR 0.665), and ICU stay (sHR 0.658). Preoperative albumin was also a strong predictor of faster discharge. Conclusions: The preoperative MELD 3.0 score independently predicts delayed hospital discharge after pericardiectomy for TCP, even when accounting for mortality risk. It serves as a pragmatic tool for quantifying the systemic burden of congestion and stratifying perioperative risk. Full article

Pilonidal sinus is a chronic inflammatory skin condition predominantly found in the sacrococcygeal region, characterized by recurrent infections and sinus tract formation. Occurrences outside this area, particularly on the anterior chest wall, are exceedingly rare and prone to misdiagnosis. We report a rare case of a 24-year-old Chinese man presenting with a 3-year history of a recurrent, draining lesion on the anterior chest wall. Initial treatment via simple incision and drainage for a presumed sebaceous cyst resulted in delayed wound healing and persistent purulent discharge. Subsequent magnetic resonance imaging (MRI) and computed tomography (CT) revealed a localized superficial lesion. Definitive surgical debridement uncovered a sinus tract containing embedded hair fragments. Histopathological examination confirmed a pilonidal sinus with a robust foreign body giant cell reaction and chronic inflammation. After complete resection, during the nearly two-year follow-up period, the healing has been smooth, and no recurrence has been observed. This case highlights the necessity of detailed clinical history-taking and the inclusion of ectopic pilonidal sinus in the differential diagnosis of refractory chest wall abscesses to prevent repeated, ineffective interventions. Full article

This paper reviews numerical modeling approaches for Dielectric Barrier Discharge (DBD) plasma actuators in aircraft active flow control. While extensive experimental studies exist, a dedicated review of computational methodologies—covering macroscopic, microscopic, and empirical models—has been absent. This work systematically evaluates major models (Shyy, Suzen–Huang, Dorr–Kloker, Roth, Orlov–Corke, Massines), discussing their formulations, assumptions, computational cost, and applicability. It synthesizes simulation studies in aerodynamic applications such as separation control, drag reduction, transition delay, film cooling, and compressor stability. Key findings show that macroscopic models offer a practical balance between accuracy and cost for design-oriented studies, whereas microscopic models provide deeper physical insight at higher expense. The review highlights the effectiveness of DBD actuators in modifying boundary layers, delaying stall, and improving aerodynamic efficiency. Finally, persistent challenges are identified—including energy efficiency, scalability, and model calibration and future directions are suggested, such as hybrid modeling, multi-actuator arrays, and real-time control integration. Full article

Post-infarction left ventricular aneurysm is an uncommon but severe mechanical complication of transmural myocardial infarction, particularly in patients with delayed presentation or incomplete myocardial salvage. It may lead to profound distortion of left ventricular geometry, adverse remodelling, intraventricular thrombosis, mitral regurgitation, pulmonary hypertension, and advanced heart failure. We report the case of a 65-year-old male patient referred two months after a late-presenting anterior ST-segment elevation myocardial infarction caused by proximal occlusion of the left anterior descending coronary artery. At admission, the patient presented with severe decompensated heart failure, low-output status, multiorgan dysfunction, and a left ventricular ejection fraction of 12%. Transthoracic echocardiography and cardiac magnetic resonance imaging demonstrated a giant apical left ventricular aneurysm involving approximately 75% of the ventricular cavity, partial intraluminal thrombosis, extensive transmural scarring in the left anterior descending territory, and imaging features suggestive of a chronic contained free-wall rupture/pseudoaneurysmal component. Following multidisciplinary evaluation, the patient underwent surgical ventricular reconstruction using an endoventricular circular restoration technique guided by an intraventricular balloon sizer, combined with left internal thoracic artery bypass grafting to the left anterior descending artery. The early postoperative course required temporary inotropic, vasopressor, inhaled nitric oxide, and intra-aortic balloon pump support, followed by progressive haemodynamic recovery. The patient was discharged on postoperative day seven with functional improvement to NYHA class II. At six-month follow-up, he remained clinically stable without overt signs of heart failure, and echocardiography showed preserved ventricular geometry and improvement of left ventricular ejection fraction to 45%. This case highlights the potential role of carefully planned, balloon-guided surgical ventricular reconstruction in selected patients with giant post-infarction left ventricular aneurysms and end-stage heart failure when residual viable myocardium is present. Full article

Background/Objectives: Preterm birth is associated with increased risk of motor delay and broader neurodevelopmental vulnerability. Existing reviews have examined neonatal therapy, family-centered care, or early developmental intervention broadly, but the independent evidence for physiotherapy-based interventions in which parents actively deliver or support motor or sensorimotor activities remains uncertain. This review evaluated the effects of early physiotherapy with structured, guided parental involvement on motor development in preterm infants and examined intervention content, parental burden, safety, adherence, and durability of effects. Methods: The review followed PRISMA 2020 and a prespecified PICO framework. The original PubMed, Scopus, and PEDro search was updated through 9 July 2026 using PubMed/MEDLINE, PEDro, Cochrane CENTRAL, ClinicalTrials.gov, backward and forward citation tracking, and linked-report searches. Eligible studies were randomized controlled trials of early physiotherapy, motor, or structured sensorimotor intervention with an active parent-delivered or parent-supported component and a validated motor or neurodevelopmental outcome. Multiple publications from the same randomized cohort were linked and participants were counted once. Risk of bias was evaluated with Cochrane RoB 2, intervention reporting with TIDieR, and certainty with GRADE. Results: Ten reports represented five independent randomized cohorts and 393 unique randomized infants. The Norwegian Parent-Administered Physical Therapy Intervention (NOPPI) produced a moderate short-term improvement in TIMP performance at term-equivalent age, but no consistent advantage in general movements, motor performance at 3 or 24 months, or school-age motor outcomes. COPCA and a NICU-to-home physiotherapy program produced developmental improvement over time or selected short-term gains, without consistent superiority over active or developmental care comparators. A parent-administered sensorimotor intervention by Fucile et al. improved oral-feeding outcomes but not TIMP motor performance, and its linked 18-month follow-up did not demonstrate a clear developmental advantage. Badura et al. found no significant effect of a 10-week parent-delivered general-movement-based program on MOS-R or Bayley-III motor outcomes; adherence was variable, and a transient increase in maternal depressive symptoms at discharge highlighted the importance of treatment burden. Conclusions: Guided parental involvement is feasible and may enhance short-term motor performance when activities are individualized, active, cue-responsive, and closely supervised. However, current evidence does not establish sustained superiority over well-structured usual or traditional care, developmental normalization, or benefit from passive sensorimotor input alone. Clinical implementation should combine competency-based parent training, explicit infant stress cues and stopping rules, realistic dose targets, ongoing professional support, and monitoring of adherence, parental well-being, and adverse events. Full article

Smart and sustainable construction requires methods that jointly manage construction processes, carbon emissions, energy supply, and decision-making. This study develops a renewable energy (RE)-aware carbon digital twin using Siemens Tecnomatix Plant Simulation, version 2022 (Siemens Digital Industries Software, Plano, TX, USA), hereafter referred to as STPS, and artificial intelligence (AI)-based multi-objective optimization. The framework integrates activity records, equipment-demand profiles, renewable-generation data, battery-storage states, emission factors, cost parameters, schedule indicators, and reinforcement learning (RL) state–action–reward records within a discrete-event simulation environment. Construction activities are represented through event-driven source, queue, buffer, processor, resource-pool, transporter, event-controller, table-file, and sink objects, enabling predecessor validation, resource allocation, processing, completion tracking, and key performance indicator (KPI) updates. The energy layer coordinates equipment demand, solar photovoltaic (PV) generation, battery charging and discharging, grid electricity, diesel backup, RE share, battery state of charge (SOC), and emissions. The AI-control layer observes carbon, cost, delay, queue length, utilization, idle time, renewable share, and SOC; filters infeasible actions; evaluates corrective interventions; and ranks policies under carbon, delay, and SOC constraints. Three scenarios are evaluated: diesel–grid baseline operation, rule-based solar-battery operation, and AI-controlled renewable-aware operation. The AI-controlled scenario achieved 16,850 kg carbon dioxide equivalent (kg CO₂e), a cost of 2.28 million United States dollars (M USD), a delay of 4.2 h, an 81.6% RE share, 86.7% resource utilization, and 8.6% idle time. Relative to the diesel–grid baseline, it reduced emissions by 32.2%, cost by 18.0%, delay by 66.7%, and diesel-equivalent energy by 97.7%, while increasing RE share by 69.3 percentage points. Reward-weight sensitivity results show that the balanced policy preserves low-carbon performance across stakeholder priorities. The findings demonstrate that integrating digital twins, RE dispatch, and AI-based decision control can support data-driven, optimized low-carbon construction management. Full article

The Lower Ganjiang River is a multi-branch delta with highly uneven spatial and temporal flow distribution, and conventional static diversion or threshold-based operation fails to stabilise the water level or optimise flow allocation under varying inflows. This study develops a hydrodynamic regulation framework that couples an improved integral time-delay model and model predictive control (MPC). A nonlinear state-space equation is constructed using a quadratic storage–water level relationship and rolling optimisation is solved with CasADi-IPOPT to minimise water-level tracking error, discharge deviation and control effort. The framework is validated offline against MIKE21 simulations for three historical flow scenarios (September 2016, February 2017 and March 2018). Under these scenarios, the Waizhou water level is maintained at 15.5 ± 0.2 m, daily water level variation is limited to ≤0.5 m/d, and the diversion ratio deviation is ≤5%. Compared with the natural state, water level fluctuation is reduced by 21.3% (September 2016 storage scenario). The proposed MPC framework effectively alleviates the spatiotemporal hydrodynamic imbalance of the Lower Ganjiang River, showing satisfactory model accuracy, constraint compliance, and engineering applicability, and offers a promising approach for advanced regulation of complex multi-branch river networks. Full article

Smartphone time-to-empty (TTE) estimation is vulnerable to residual battery-drain effects after short-duration user activities, which can cause runtime predictions to fluctuate. This paper proposes a continuous-time battery-drain model that separates instantaneous and delayed drain effects in operating-system logs. The discharge process is decomposed into baseline drain, direct drain induced by the current usage state, and delayed tail drain triggered by transient events. Multi-exponential recursive states are used to represent network communication, location requests, background wake-ups, and related events as residual drain terms that decay over time. Non-negative sparse estimation is adopted to preserve the interpretability of the individual contributions. Experiments are conducted on a public smartphone-log dataset with strict separation between the training and test sets. The results show that the proposed method achieves stable TTE prediction performance on the test set, with short-horizon $R^2$ values above 0.963 and scenario-level MAPE of 2.42–5.03%. These findings indicate that explicit modeling of delayed residual drain can improve the accuracy and stability of smartphone remaining-runtime prediction. Full article

Assessing nitrate sensitivity to hydroclimatic variability is important for evaluating water-quality vulnerability under hydroclimatic variations in coupled surface-water and groundwater systems. This study applies a hybrid, scenario-based projection framework combining a Long Short-Term Memory (LSTM) model and Weighted Regression on Time, Discharge, and Season with Projections (WRTDS-P) to examine nitrate plus nitrite responses under idealized wet and dry conditions across seven U.S. river basins and three associated groundwater wells. LSTM projections evaluate conditional sensitivity to altered precipitation forcing, while WRTDS-P projections assess discharge-conditioned responses based on empirically derived concentration–discharge relationships. Results show strong basin-scale heterogeneity in nitrate sensitivity. Agriculturally dominated Midwestern and central U.S. basins generally exhibit higher nitrate concentrations under the idealized wet scenarios, whereas basins influenced by groundwater buffering, flow regulation, or managed hydrology show weak or slightly negative wet–dry responses. For the three evaluated wells, groundwater projections show site-specific damped or delayed responses relative to nearby surface-water systems, reflecting aquifer storage and legacy nitrogen effects, although the Illinois well shows a larger projected wet–dry amplitude than the associated river. Cross-framework comparison reveals moderate agreement in response direction but notable differences in magnitude, highlighting sensitivity to model structure and forcing assumptions. These findings emphasize the value of hybrid projection frameworks for cross-framework sensitivity analysis and for interpreting nitrate vulnerability under hydroclimatic variation while accounting for uncertainty across surface-water and groundwater systems. Full article

Background: Advances in neonatal intensive care in Kazakhstan have improved the survival of preterm infants, including those with very low birth weight (VLBW) and extremely low birth weight (ELBW). However, after hospital discharge, these medically vulnerable children may remain insufficiently protected against vaccine-preventable infections because of prolonged temporary medical exemptions, clinical caution, parental concerns, and fragmented coordination between specialized follow-up services and primary health care. Objective: This study aimed to assess vaccination coverage in a 10-year cohort of high-risk preterm infants and to identify clinical, parental, and organizational factors associated with delayed immunization. Methods: We conducted a retrospective cohort study of 331 high-risk preterm infants followed at a specialized pediatric center in Astana, Kazakhstan, between 2015 and 2024. Vaccination status at hospital discharge and at 24 months of chronological age, documented temporary medical exemptions, reasons for delayed or missed vaccination, and confirmed cases of pertussis and measles were analyzed. A supplementary cross-sectional survey of parents, physicians, and health care managers was conducted to further explore barriers to catch-up immunization. Results: At hospital discharge, 259 infants (78.2%) had not received the BCG or hepatitis B vaccine. By 24 months of age, 34.1% (n = 113) were fully vaccinated according to age, whereas 49.8% (n = 165) remained completely unvaccinated. During the observation period, 30 cases of measles and 17 cases of pertussis were recorded within the cohort, primarily during nationwide outbreaks. Among the 10 children with a history of measles before 12 months of age, 2 developed subacute sclerosing panencephalitis (SSPE), 1 developed profound hearing loss, and 1 required prolonged oxygen therapy following pneumonia. In addition, 2 children with periventricular leukomalacia (PVL) experienced clinical deterioration, while 1 infant with pertussis required hospitalization during the acute phase of illness. Conclusion: High-risk preterm infants in this cohort experienced substantial and persistent gaps in immunization after hospital discharge. These findings underscore the importance of regular reassessment of temporary medical exemptions, improved coordination between specialized follow-up services and primary health care, and strengthened catch-up immunization strategies for medically vulnerable children. Full article

Off-grid residential microgrids in tropical regions require storage architectures capable of maintaining renewable electricity supply under variable solar resources, evening demand peaks, and diverse household consumption levels. In PV–battery–hydrogen systems, however, economic indicators can be difficult to interpret when software-reported costs are compared directly with externally calculated LCOE values based on different accounting conventions. This study presents a metric-reconciled techno-economic reconstruction approach for retained PV–battery–hydrogen microgrid configurations serving off-grid residential demand in Chetumal, Mexico. The objective is not to introduce a new global optimization or to claim the universal superiority of a specific architecture, but to separate archived HOMER Pro benchmark outputs from an external techno-economic model (TEM). The TEM reconstructs net present cost, scheduled replacements, salvage treatment, discounted delivered electricity, HOMER-derived LCOE, TEM-derived LCOE, sensitivity indicators, and storage role metrics using declared accounting assumptions. The approach is applied to two representative residential demand scenarios of 16.67 and 53.42 kWh/day. Both retained configurations achieved a 100% renewable fraction with negligible unmet load. Battery discharge increased from 827.12 kWh/year in the low-demand case to 6125.52 kWh/year in the high-demand case, highlighting the increasing role of the battery in short-duration balancing. In contrast, the hydrogen pathway acted as a delayed-backup layer by converting surplus PV electricity into hydrogen and later recovering it through PEM fuel cell generation. The TEM closely matched the HOMER-derived LCOE benchmark, with deviations below 4%, yielding TEM-derived LCOE values of 0.3320 and 0.3571 USD/kWh for the low- and high-demand cases, respectively. Sensitivity analysis showed that delivered electricity, discount rate, PV cost, and battery cost were the main LCOE drivers, while deterministic multi-parameter scenarios confirmed the combined influence of financing, component costs, O&M, PV degradation, and electricity delivered. Overall, the proposed approach provides an auditable basis for metric reconciliation, early-stage technology assessment, and storage role interpretation in tropical off-grid microgrids. Future extensions should include architecture-level re-optimization, flexible loads, degradation-aware modeling, and part-load component behavior. Full article