Search Results (6,502)

Despite increasing use of continuous glucose monitoring (CGM) and automated insulin delivery, most children and adolescents living with type 1 diabetes (T1D) in the US do not achieve recommended glycemic targets. Structured, proactive support improves glycemic outcomes, but diabetes teams have historically lacked reimbursement pathways and scalable workflows to support between-visit care. The introduction of remote patient monitoring (RPM) billing codes has created new opportunities to align clinical need with care delivery models, although adoption remains limited. We describe implementation experiences from three pediatric diabetes centers that developed RPM programs across distinct clinical populations and institutional environments. Each site developed workflows for data review, patient outreach, documentation, and billing, supported by digital platforms designed to facilitate population-level management. Common themes emerged around needs for structured patient onboarding, multidisciplinary team alignment, standardized documentation, efficient data aggregation and population health management tools, adaptable communication pathways, and financial alignment. This practice-informed commentary synthesizes common themes across these programs and outlines key considerations for RPM implementation, including workflow design, digital infrastructure, communication strategies, and reimbursement structures. We also highlight practical challenges related to equity, patient engagement, and operational feasibility. This report aims to contextualize early clinical experience with RPM and identify factors that may influence its integration into pediatric diabetes care. Full article

Near-fault ground motions influenced by rupture directivity impose seismic demands that differ fundamentally from those associated with conventional far-field earthquakes, particularly in terms of displacement-controlled response. This study presents a performance-based seismic assessment of existing reinforced concrete (RC) buildings subjected to near-fault ground motions in the Sivrice–Pütürge segment of the Malatya–Ovacık Fault Zone, Eastern Anatolia. A probabilistic seismic hazard analysis (PSHA) was performed using NGA-West2 ground-motion prediction equations together with a regionally defined fault model, and the resulting hazard was evaluated within the framework of the Turkish Building Earthquake Code (TBEC-2018). Code-compatible earthquake records were selected and scaled for the DD-2 design earthquake level, while rupture directivity was represented using a literature-based median amplification factor. Nonlinear time-history analyses were subsequently carried out for three existing RC buildings representing low-, mid-, and high-rise structural typologies. Structural performance was evaluated in terms of roof displacement, interstory drift ratio, base shear, and element-level damage states. The maximum roof displacements reached 0.070 m, 0.107 m, and 0.138 m for the low-, mid-, and high-rise buildings, respectively, corresponding to maximum drift ratios of 0.60%, 0.46%, and 0.34%. The results indicate that rupture directivity has only a limited influence on base shear demand but substantially increases displacement-related response quantities and promotes a redistribution of structural damage from predominantly beam-controlled behavior toward increased participation of columns and shear walls, particularly in medium- and high-rise buildings. These findings demonstrate that conventional code-based assessment procedures may underestimate deformation demands in fault-proximal regions and highlight the importance of explicitly considering rupture directivity in the seismic performance assessment of existing reinforced concrete buildings. Full article

The exponential growth of digital video traffic over satellite networks demands innovative approaches to optimize spectral efficiency while ensuring high quality of experience (QoE). Conventional Adaptive Coding and Modulation (ACM) schemes respond solely to Channel State Information (CSI), neglecting the perceptual importance of video content. This paper proposes a comprehensive Quality-Driven Adaptive Coding and Modulation (QACM) framework that dynamically allocates physical-layer resources based on joint channel conditions and content-aware quality metrics. The framework introduces a Quality Significance Factor (QSF) that quantifies video complexity and priority, enabling intelligent trade-offs between spectral efficiency and quality robustness. We implement a complete simulation testbed incorporating DVB-S2X-compliant ModCods with multiple code rates (1/2, 3/4, and 5/6) and higher-order constellations (up to 64QAM) over Additive White Gaussian Noise (AWGN) channels. Extensive experimental results using H.264/AVC sequences demonstrate that, while standard ACM achieves 30.14 dB PSNR for high-motion football sequences at 16 dB SNR with 64QAM-1/2, QACM improves this to 41.40 dB by switching to QPSK-1/2, representing an 11.26 dB gain. We provide comprehensive BER analyses across the 0–20 dB SNR range, statistical significance validation (p < 0.01 for quality improvements), computational complexity analysis showing 15.2% overhead, and detailed comparisons with prior arts. The framework demonstrates scalability to higher-order modulations while maintaining 23% weighted QoE improvement over conventional ACM. This work provides a validated, implementable cross-layer solution for next-generation satellite broadcasting systems. Full article

Background: Effective nurse–patient communication is fundamental to quality care delivery, yet language barriers pose significant challenges in multicultural healthcare environments. In Saudi Arabia’s diverse healthcare landscape, nurses frequently encounter patients who do not speak Arabic, potentially compromising care quality and patient safety. Objective: To explore multilevel factors influencing communication between Saudi nurses and non-Arabic-speaking patients, using Bronfenbrenner’s ecological systems theory as a conceptual framework. Design: A qualitative descriptive study employing semi-structured interviews analyzed through reflexive thematic analysis. Setting: Four healthcare facilities (two governmental and two private hospitals) across Saudi Arabia. Participants: Eighteen Saudi registered nurses with experience caring for non-Arabic-speaking patients, recruited through purposive sampling. Methods: Semi-structured interviews (n = 18) were conducted in Arabic or English between November 2025 and February 2026. Data were analyzed using Braun and Clarke’s reflexive thematic analysis, organized within Bronfenbrenner’s ecological levels. Collaborative reflexive coding and member-checking with six participants supported analytical rigor. Results: Five main themes emerged: (1) Individual-level competencies and preparedness (microsystem), (2) Interpersonal dynamics and cultural sensitivity (microsystem), (3) Unit-level resources and organizational support (mesosystem), (4) Institutional policies and language services (exosystem), and (5) Healthcare system and societal influences (macrosystem). Participants identified language proficiency gaps, cultural misunderstandings, inadequate interpreter services, and systemic barriers as primary challenges affecting communication quality. Conclusions: Communication between Saudi nurses and non-Arabic-speaking patients is influenced by complex, interconnected factors across multiple ecological levels. Interventions should address individual competency development, organizational support systems, and policy-level changes to ensure equitable, safe, and effective communication for all patients. Full article

The fragmentation of clinical information across health systems, community pharmacies, and specialty providers continues to undermine medication safety and emergency care, particularly when patients are unconscious or otherwise unable to communicate their history. The dominant response to this fragmentation has been the construction of a centralized data infrastructure—health information exchanges, prescription drug monitoring programs (PDMPs), and federated electronic health record (EHR) networks—that aggregates clinical information into institutional databases that are queryable by providers, insurers, regulators, and, in many jurisdictions, law enforcement. This article argues that the same care-coordination problems can be addressed through an architecturally different approach in which the patient, not the institution, holds the integrative artifact. The proposed design, here labeled the Guardian Card (a conceptual architecture, not a commercial product), pairs an HL7 Fast Healthcare Interoperability Resources (FHIR) clinical payload with the SMART Health Cards verifiable-credential framework and a dual-modality (QR code plus near-field communication) physical carrier. After describing the technical architecture, hardware options, and a five-phase deployment roadmap, the design is situated within the surveillance-critical scholarship that has documented PDMP function creep, third-party doctrine erosion, racial disparities in algorithmic prescribing oversight, and the surveillance-instrumentarian repackaging of nominally de-identified prescription data. The Guardian Card is offered as one operational implementation of a patient-controlled medication-record architecture, with community pharmacy and long-term post-acute care, where the Pharmacist eCare Plan integration is most feasible as a recommended first-deployment venue. Full article

Intelligent transportation systems (ITSs) and traffic control promise substantial efficiency and safety improvements but frequently face public resistance and driver compliance issues. Many drivers perceive such control measures as unfair or unnecessary, despite measurable system-wide benefits. This study investigates how chronoception—the subjective perception of time—affects user acceptance of ITS control strategies and how signal design can be adapted to reduce perceived delays. We introduce a chronoceptive design framework that integrates insights from cognitive psychology into traffic-control design. Using ramp metering as a case study, we conduct virtual experience stated preference experiments with 101 participants, comparing standard and chronoceptive ramp metering designs featuring shorter signal cycles, three-phase lights, and countdown timers. The results show that chronoceptive signal designs significantly improve user acceptance (by up to 12%) and reduce perceived waiting times, despite identical or slightly longer objective travel times. These findings reveal a systematic bias between factual and perceived benefits and highlight the potential of chronoceptive design to enhance compliance and fairness perception. This study contributes a new human-centred design paradigm for traffic control that aligns objective performance with user perception and outlines how chronoception and perceived fairness can be operationalised in traffic control. The source code and survey data can be found open-source on GitHub. Full article

Background: Patients with spontaneous coronary artery dissection (SCAD) are at increased risk of cardiovascular events, including dissection in other arterial territories such as cervical arteries. Those with combined coronary and cervical arterial dissection (CACAD) may have more widespread arterial abnormalities and worse outcomes, underscoring the need for better risk stratification and personalized care. Objective: This study examined the prevalence of cervical artery dissection (CvAD) in patients diagnosed with SCAD, evaluated potential risk factors for developing CvAD, and assessed their impact on clinical outcomes, including all-cause mortality, SCAD recurrence, and stroke. The goal was to enhance risk stratification by identifying SCAD patients at increased risk for CvAD. Design: In this retrospective cohort study, patients diagnosed with SCAD between 2018 and 2024 across Mayo Clinic sites were identified using ICD-10 codes. Manual chart review confirmed CvAD diagnoses. Patients were stratified based on the presence or absence of CvAD. Chi-square and independent t-tests were used to compare risk factors and comorbidities. Univariate screening and multivariable logistic regression were used to identify predictors of CvAD. Results: Among 1380 patients with SCAD, 131 (9.5%) had CvAD. The median follow-up was 2.02 years (IQR: 1.1–5.2 years). All CvAD diagnoses were identified after the index SCAD event through systematic post-SCAD vascular imaging. The mean age was similar between groups (51.5 ± 11.3 years in CACAD vs. 50.9 ± 10.7 years in SCAD-only, p = 0.540), and the majority were female (93.9% vs. 91.9%, p = 0.529). Multivariable regression identified extremity arterial dissection (OR: 8.13, 95% CI: 3.41–19.36, p < 0.001), fibromuscular dysplasia (FMD) (OR: 7.52, 95% CI: 4.67–12.10, p < 0.001), connective tissue disorders (CTDs) (OR: 6.85, 95% CI: 2.35–19.98, p < 0.001), and anxiety (OR: 1.69, 95% CI: 1.01–2.81, p = 0.044) as significant predictors of CvAD. CvAD was a strong independent predictor of stroke (OR: 6.37, 95% CI: 2.93–13.87, p < 0.001). Mortality and SCAD recurrence did not differ significantly between groups. Conclusions: Patients with CACAD demonstrate a systemic vascular phenotype with significantly higher rates of FMD, connective tissue disease, extremity arterial dissection, and stroke. These findings highlight the importance of comprehensive vascular screening and individualized monitoring in at-risk SCAD patients. Full article

Artificial intelligence (AI) agents increasingly need credentials such as application programming interface (API) keys and Secure Shell (SSH) credentials, but placing those secrets in the agent process exposes them to prompt injection, tool misuse, and exfiltration through ordinary agent outputs. We present CapSeal, a capability-based broker that replaces direct secret access with session-bound, non-exportable handles. Agents request policy-evaluated actions, while the broker performs credential-bearing Hypertext Transfer Protocol (HTTP) and SSH execution through typed executors with schema validation, replay protection, revocation epochs, and tamper-evident audit logging. We extend this design to hosted settings where the broker operator is not trusted with tenant secrets. Our main contribution is operator-blind secret mediation: a split-broker architecture in which a small trusted tenant gateway cooperates with an untrusted operator service that stores the master secret only as a fully homomorphic encryption (FHE) ciphertext and evaluates per-request derivations without decrypting it. We formalize the model and prove computational operator blindness from indistinguishability under chosen-plaintext attack (IND-CPA) security of the FHE scheme, together with conditional capability binding for any secure pseudorandom function/message authentication code (PRF/MAC) instantiation. We implement an end-to-end TFHE-rs prototype that exercises split-broker derivation, multi-tenant revocation and rate limiting, audit integration, and HTTP/SSH mediation. The prototype uses a non-cryptographic homomorphic stand-in and measures the cost of crossing the operator-untrusted boundary at about 9 s per request, roughly 17 million times slower than the plaintext path. We also give LowMC and Rasta transciphering designs and compare FHE with trusted execution environment (TEE)- and secure multiparty computation (MPC)-based alternatives, positioning each trust boundary by assurance and performance. Full article

Pre-bored grouted planted pile has been increasingly applied in infrastructure construction in soft soil areas in recent years owing to its high bearing performance, low construction disturbance, and reduced slurry discharge. However, the synergistic load-bearing mechanism between the inner core pile and the surrounding cement soil is relatively complex, and the design calculation methods provided in existing studies and specifications for this pile type remain incomplete. Therefore, based on field tests, this study investigates the compressive bearing performance and load transfer behavior of pre-bored grouted planted piles, and further develops calculation methods for bearing capacity and settlement. The results show that, in this test field, due to grouting and slurry penetration reinforcement, the ultimate shaft resistance at the cement soil–soil interface is significantly improved, reaching 1.49–3.21 times the recommended values for bored cast-in-place piles in current codes. The enlarged base effectively enhances pile tip bearing capacity, while a nodular core pile near the pile base promotes the mobilization of base resistance. Furthermore, shaft resistance and base resistance models, together with their corresponding calculation methods, are established by considering both the enhancement effect of grouting on interface shaft resistance and the contribution of the enlarged pile base. Calculation methods for total bearing capacity and settlement are also summarized based on the two field test piles at this test site. The findings of this study can provide experimental support, theoretical basis and methodological reference for the bearing mechanism analysis, bearing capacity and settlement calculation, and engineering application of pre-bored grouted planted piles and similar composite pile foundations. Because the conclusions are based on only two field test piles at a single site, further validation with more field test data under different geological conditions is still needed. Full article

Background: Current international regulations for cargo securing rely on simplified assumptions that may not accurately represent the behavior of oversized cargo, particularly regarding rotational inertia and ship motion effects, which are critical under tipping conditions. Methods: This study presents a methodology for the evaluation, modeling and optimization of lashing systems for large cargo units. A comparative analysis between the CSS Code and DNV guidelines is performed to assess differences in the estimation of ship-induced accelerations and the resulting tipping moments. Simulations are performed considering different stowage positions, environmental conditions, and lashing configurations. Predictive mathematical models are developed using Design of Experiments (DOE) and Response Surface Methodology (RSM). Results: The results reveal that the CSS Code systematically leads to more conservative requirements, significantly increasing the number of required lashing devices compared to DNV guidelines. The influence of lashing angles is quantified, identifying optimal configurations that minimize securing effort while ensuring tipping equilibrium. The developed models accurately estimate the number of lashing devices required for both longitudinal and transverse tipping. Conclusions: The methodology is validated through a real case study involving heavy offshore cargo and provides practical decision-support tools. The proposed approach enables more efficient and reliable securing design in maritime cargo transport. Full article

Karpathy’s proposal to replace Retrieval-Augmented Generation (RAG) with plain-text knowledge bases maintained directly by language agents (Agentic Knowledge Curation) has gained traction in industrial applications yet lacks systematic empirical evaluation. To our knowledge, this study presents the first comparative evaluation of this paradigm using blind human assessment by two independent external reviewers. The corpus comprises the technical documentation of a production semantic search system for Spanish legal documents (11 files, ~19,300 tokens) alongside 100 questions verified against source code, distributed across direct retrieval, multi-document synthesis, and reasoning about absence. Claude 3.5 Sonnet was utilized as the reference model to isolate the retrieval architecture’s effect. While overall accuracy was statistically indistinguishable between paradigms, agentic curation showed a significant advantage in direct retrieval over long documents. Conversely, error analysis revealed RAG false negatives associated with the lost-in-the-middle phenomenon, whereas agentic curation exhibited localized degradation in textual fidelity for queries requiring exact reproduction of formulas or sequences. These results characterize the differential error profiles of both paradigms, providing actionable design criteria for engineers managing technical documentation with language models in cloud environments. Full article

Railway station buildings increasingly operate as civic landmarks, public interiors, and cultural interfaces as well as mobility infrastructure. This study asks how architectural design integrates transport performance, public-space formation, and cultural meaning. A qualitative multiple-case study examines St Pancras International (London, United Kingdom), Rotterdam Centraal (Rotterdam, the Netherlands), Liège-Guillemins Station (Liège, Belgium), and Hong Kong West Kowloon Station (Hong Kong, China). Cases were selected for maximum variation in design logic and documented evidence. Official, heritage, practice, and scholarly sources were triangulated; documented features were deductively coded through a Node–Place–Narrative protocol and then compared across cases. Node captures movement and connectivity, Place captures public use and urban integration, and Narrative captures the meanings attributed to heritage, structure, materiality, landscape, and arrival. The analysis identifies four mechanisms: heritage reactivation, urban legibility, structural symbolism, and landscape-civic integration. Across the cases, transport performance is a necessary enabling condition, whereas cultural distinctiveness emerges when public-space and narrative strategies are spatially integrated. The study extends the node-place model at the building scale, clarifies the boundary between place performance and narrative interpretation, and offers transferable—but context-dependent—principles for culturally responsive transport architecture. Because the evidence is documentary rather than user-based, the framework supports analytical comparison rather than performance scoring. Full article

Underwater optical sensor networks are essential for fish monitoring, yet imagery is often affected by illumination variability, low contrast, and complex backgrounds. Attention mechanisms are vital for feature representation in deep networks, yet existing approaches often struggle with spatial information loss and limited multi-scale interaction under such challenging conditions. This paper introduces Convolution to Interactive Capture and Recalibration Enhancement (C2ICARE), a lightweight attention module designed to overcome these challenges. The principal contribution of C2ICARE is the adaptation of memory interaction principles into an edge-oriented attention framework that enhances feature discrimination while maintaining computational efficiency. The architecture employs three core innovations: a 1:3 memory-feature split to preserve context while reducing cost, parallel multi-scale depthwise convolutions (3 × 3 and 7 × 7) for fine-grained and broad feature extraction, and a cross-branch interaction mechanism coupled with a ConvNeXt-style feed-forward network that avoids dimensionality reduction. Experimental results on an underwater fish dataset demonstrate that YOLO26n with C2ICARE achieves a mean average precision (mAP@0.5:0.95) of 0.7033, outperforming Coordinate Attention (+3.8%), FasterBlock (+1.7%), and CBAM (+0.4%) while adding only 0.05M parameters and 0.16 GFLOPs. Multi-objective Pareto Frontier analysis confirms that C2ICARE provides an effective balance between accuracy, efficiency, and generalization for resource-constrained deployment. EigenCAM visualizations further validate that the model focuses on biological morphology rather than background noise. Its lightweight design enables seamless integration with underwater sensor networks and fog platforms for real-time fish detection in aquaculture, commercial fisheries, and scientific research. Future work will investigate broader marine applications and cross-platform deployment scenarios. The code is available on GitHub. Full article

Background: Humanitarian logistics decisions extend beyond immediate relief delivery to include preparedness, recovery, service continuity and the development of durable local capabilities. Simulation can support these decisions under uncertainty, yet the evidence remains fragmented across logistics domains, modelling approaches and phases of the relief–development continuum. This review synthesises how simulation has been used in humanitarian logistics and identifies where the evidence is concentrated and where important gaps remain. Methods: A systematic scoping review was conducted in accordance with PRISMA-ScR and PRISMA-S, using multi-disciplinary and specialist database searches supplemented by backward and forward citation searching. Included studies were coded by logistics decision problem, continuum phase, decision level, performance outcome, simulation approach and operational grounding. Results: The literature is concentrated in preparedness and response, particularly around coordination, network design, inventory, allocation, transport and capacity. System dynamics, agent-based modelling and discrete-event simulation are well established, whereas hybrid simulation and digital twin applications remain limited. Early recovery, reconstruction, development-oriented transition and practice-embedded modelling are comparatively underdeveloped. Conclusions: Simulation-supported humanitarian logistics is strongest for structured preparedness and response problems. Future research should connect decisions across phases and strengthen beneficiary-sensitive, operationally grounded modelling of recovery, localisation, service continuity and longer-term logistics capability. Full article

Background: Breast cancer comprises 31.4% of all female cancers in Saudi Arabia (2020 Cancer Registry). Despite free national screening services existing since 2005, mammography utilization remains critically low. This study assessed breast cancer knowledge, attitudes, and practices (KAP) among females in Saudi Arabia and identified independent predictors of screening behavior. Methods: A cross-sectional study (December 2024–February 2025) enrolled 426 females aged ≥20 years from all 13 Saudi administrative regions using a quota-based design combining facility-based and online recruitment. Attitude and barrier domains were adapted from Champion’s Health Belief Model Scale (CHBMS), validated in Arabic; knowledge items used validated regional instruments. Knowledge-score reliability: KR-20 = 0.45; attitude subscale: α = 0.74. Binary logistic regression identified independent predictors of screening uptake (outcome: any screening in the preceding five years, coded as screened = 1; not screened = 0). Results: Mean composite knowledge score: 4.51 ± 1.52/7 (KR-20 = 0.45); 54.0% achieved high knowledge (≥5). Mammography uptake was 30.5% overall and 52.2% among women aged ≥40 (n = 136; the recommended target group). Predominant barriers: Fear of diagnosis (83.6%), belief in incurability (76.3%), radiation concern (73.2%), and pain anxiety (72.3%). Logistic regression (χ²(8) = 188.96, p < 0.001; McFadden’s pseudo R² = 0.323) identified older age (OR = 1.52; 95% CI: 1.21–1.92), higher income (OR = 1.57; 95% CI: 1.25–1.99), transportation barriers (OR = 3.39; 95% CI: 1.95–5.89), and family discouragement (OR = 3.03; 95% CI: 1.72–5.34) as significant predictors (all p < 0.001). Conclusions: A significant knowledge–practice gap persists across all 13 Saudi regions. These findings suggest several implications for a multi-level public health response to be evaluated through future intervention research; multi-level strategies targeting CHBMS Barriers are needed. Full article