Search Results (21,824)

Climate change has significantly influenced regional precipitation patterns, affecting agricultural productivity and water-resource sustainability in monsoon-dependent regions. Reliable climate projections are therefore essential for climate impact assessment and adaptation planning. However, the performance of Regional Climate Models (RCMs) varies considerably across regions and climatic conditions, necessitating rigorous evaluation before their application in local-scale studies. In this study, eight CORDEX-CORE South Asia (0.22°) RCMs were evaluated for their ability to reproduce historical precipitation over Thanjavur district, Tamil Nadu, India, during 1976–2005 using observed rainfall data from 13 rain gauge stations. Model performance was assessed using seven statistical metrics integrated through the Compromise Programming Index (CPI), together with evaluations of precipitation occurrence, rainfall intensity occurrence, and cumulative precipitation distribution. The results revealed considerable variability among the RCMs. RegCM-based models generally exhibited wet biases, whereas REMO and CCLIM tended to underestimate seasonal rainfall. Based on the selected metrics and CPI framework, NorESM–RegCM, NorESM-CCLIM, and NorESM-REMO demonstrated comparatively better overall performance. However, analyses of precipitation occurrence and distribution showed that model performance depended on the precipitation characteristic considered, with no single RCM consistently outperforming the others across all evaluation criteria. These findings demonstrate that a multi-criteria evaluation framework provides a more comprehensive assessment of RCM performance than conventional statistical metrics alone and offers a robust basis for selecting suitable RCMs for future climate projections and agro-hydrological applications in the Cauvery Delta region. Full article

Background: To evaluate whether quantitative signal intensity (SI) measured on the hepatobiliary phase (HBP) of gadoxetic-acid-enhanced MRI is associated with disease control rate (DCR) after conventional transarterial chemoembolization (cTACE) in patients with hepatocellular carcinoma (HCC). Methods: In this retrospective single-center study, 112 patients with HCC treated with cTACE between April 2018 and September 2020 and with available pre-treatment gadoxetic acid-enhanced MRI were included, with one target HCC lesion analyzed per patient. Mean HBP SI was quantitatively measured using manually drawn regions of interest (ROIs) within the target tumor, adjacent liver parenchyma, and reference tissues. Treatment response was assessed using mRECIST criteria at 1, 3, and 6 months. Logistic regression and receiver operating characteristic analyses were performed to evaluate the association between HBP SI and DCR. Results: Lower tumor HBP SI was associated with DCR at 6 months after cTACE (unadjusted p = 0.010; Bonferroni-adjusted p = 0.030), whereas no significant association was observed at 1 or 3 months. A tumor HBP SI cut-off value of 580 demonstrated moderate discriminatory performance for DCR (AUC = 0.714, 95% CI: 0.585–0.843; p = 0.008), with 69.1% sensitivity and 80.0% specificity. Conclusions: Lower baseline tumor HBP SI was associated with 6-month radiological disease control after cTACE in this exploratory single-center cohort. However, its moderate discriminatory performance, the absence of significant associations at earlier response assessments, and the methodological limitations of the study preclude its use as a stand-alone clinical decision-making tool. HBP SI should therefore be regarded as a potential imaging biomarker, and these findings should be considered hypothesis-generating and require validation in larger, independent cohorts. Full article

Acute respiratory infections (ARIs) remain one of the leading causes of pediatric consultations, emergency department visits, and hospital admissions worldwide, imposing a substantial clinical, organizational, and economic burden on healthcare systems. Although most ARIs are self-limiting viral illnesses, their high incidence during childhood continues to challenge both primary care pediatricians and hospital services. In recent years, the epidemiology and prevention of pediatric respiratory infections have evolved considerably following the COVID-19 pandemic and the introduction of nirsevimab immunization against RSV, while RespiVirNet has strengthened national respiratory-virus surveillance. These developments reinforce the need for integrated models of care. This narrative perspective discusses the current epidemiology and burden of pediatric ARIs, predominantly within the Italian healthcare setting, and examines the complementary roles of family and hospital pediatricians in clinical assessment, risk stratification, appropriate referral, and continuity of care. Particular attention is paid to antimicrobial stewardship and strategies to reduce inappropriate antibiotic prescribing. Preventive strategies, including RSV prevention and influenza, pneumococcal, and pertussis vaccination, are also considered as integral components of coordinated pediatric respiratory care. Finally, we discuss how surveillance, preventive interventions, shared referral criteria, structured information transfer, and measurable quality indicators could support more coordinated primary–hospital care and provide a framework for prospective evaluation. Full article

Drawing on ERA5 reanalysis data for 2005–2025, this study examines long-term environmental change across China’s eight major deserts and on this basis develops a data-informed framework for integrating geoscientific evidence into geographical fieldwork education. Temperature change, surface radiation and vertical soil moisture profiles are used to construct inquiry tasks on regional warming, land–atmosphere interactions and dryland hydrology. A four-dimensional resource assessment integrating solar resource abundance, thermal stability, soil moisture support and wind exposure stability is then applied using multi-criteria decision analysis (MCDA) to compare relative resource characteristics and ecological constraints across desert regions. The contrasting resource profiles of the Taklimakan, Tengger, and Kubuqi Deserts provide the basis for a scenario-based decision-making activity incorporating equal-weight, energy-priority, and ecology-priority perspectives on renewable energy development and ecological protection. Rather than treating deserts as static landscapes, the proposed framework positions them as dynamic coupled human–environment systems and is designed to engage students in interpreting long-term datasets, comparing regional processes and evaluating sustainability trade-offs. The study illustrates how environmental datasets can be organised into fieldwork questions, analytical tasks and decision scenarios, offering an adaptable framework in which quantitative reasoning, systems thinking and evidence-based sustainability learning are specified as intended educational outcomes in higher geographical education. Full article

Non-cirrhotic portal hypertension (NCPHT) is defined as portal hypertension (PHT) occurring in the absence of cirrhosis. Major etiological causes of NCPHT include immunological disorders, chronic infections, exposure to medications or toxins, prothrombotic conditions, and several genetic syndromes, highlighting that NCPHT is not a single disease but a shared phenotype arising from diverse underlying pathways. NCPHT is frequently misdiagnosed, largely due to inconsistent nomenclature and limited scientific literature. The broader term non-cirrhotic portal fibrosis (NCPF) or porto-sinusoidal vascular disease (PSVD) includes patients in a preclinical stage who demonstrate histological features similar to NCPHT but lack clinical evidence of PHT. Early detection is linked to a favorable prognosis and improved clinical outcomes. Management strategies in pediatrics continue to rely on extrapolations from adult practice, with sparse evidence to guide pediatric care. Liver biopsy remains the cornerstone of diagnosis, demonstrating nodular regenerative hyperplasia, obliterative portal venopathy, or incomplete septal fibrosis. Management focuses on prophylactic and symptomatic care, with endoscopic therapy for controlling variceal bleeding. Porto-systemic shunts and, ultimately, liver transplantation therapies may be needed for advanced stages. A pressing need exists for standardized diagnostic criteria and multicenter studies to define natural history, refine risk stratification, and evaluate therapeutic approaches in the pediatric population. This review provides an overview of the pediatric causes of NCPHT, outlines the current understanding of pathophysiology, and discusses the clinical presentations and management strategies, while highlighting existing research gaps. Full article

Cutaneous wound healing is governed by dynamically interacting mechanical, redox, and bioelectrical signals that regulate cell migration, inflammation, angiogenesis, extracellular-matrix remodeling, and tissue regeneration. Hydrogels are increasingly engineered to modulate these cues; however, most systems are still described through independently measured properties such as stiffness, antioxidant activity, and conductivity, without demonstrating functional coupling among them. This review examines regenerative hydrogels from a cross-domain perspective, integrating the biological basis of mechanotransduction, redox signaling, endogenous bioelectricity, and their molecular convergence with the network-level mechanisms that control hydrogel behavior. Particular emphasis is placed on dynamic crosslinking, viscoelastic relaxation, hydration, redox-active chemistry, ionic and electronic transport, conductive and piezoelectric phases, and degradation-dependent evolution of material function. A conceptual hierarchy is proposed to distinguish property coexistence, structural integration, directional transduction, and adaptive feedback, together with experimental criteria and quantitative approaches for evaluating coupling. Current evidence indicates that mechanoelectrical coupling is the most mature, whereas mechanoredox and redox–electrical interactions remain less systematically quantified. Moving beyond descriptive multifunctionality toward controllable cross-domain transduction may enable hydrogels to function as adaptive soft interfaces capable of responding to the evolving physicochemical conditions of cutaneous regeneration. Full article

Quantitative risk assessment (QRA) of high-pressure CO₂ pipelines depends on a chain of assumptions concerning failure frequencies, transient release modelling, near-field transformation, atmospheric dispersion, and human-harm criteria. This paper presents a problem-oriented review of these modelling stages and proposes criteria for evaluating model applicability, validation range, computational requirements, and coupling consistency. The review is supplemented by an illustrative case using the DNV Phast 8.61 Long Pipeline model and Unified Dispersion Model for five perforation diameters and four concentration levels. Dangerous toxic load calculations yielded equivalent constant concentrations of 64,033–114,353 ppm for fatality probabilities of 1–50% and exposure durations of 5–30 min. Increasing the assumed exposure duration from 5 to 30 min reduced the equivalent thresholds by approximately 20.1%. Under the adopted perforation-size weighting, the 30 mm class accounted for 69.4% of punctures, showing that the largest analysed perforation does not necessarily carry the largest frequency contribution. The case is illustrative rather than site-specific and does not benchmark alternative models. The proposed framework supports transparent, proportionate QRA for pipeline design, land-use planning, emergency preparedness, and sustainable CCUS deployment. Full article

Background: Quality assurance (QA) is a cornerstone of safe and effective postgraduate training in gynecological laparoscopic surgery, where clinical outcomes depend on procedural complexity, equipment sophistication, and the coordinated competence of an entire surgical team. This article is a narrative review of the conceptual, professional, and regulatory foundations of QA in healthcare education, complemented by a structured synthesis of the collective teaching and clinical experience of the author group. It is not an empirical study, and the sections that follow present a conceptual mapping supported by expert perspective rather than original outcome data. Methods: Sources were identified through targeted searches of PubMed/MEDLINE and Google Scholar, supplemented by hand-searching of policy and curriculum documents issued by professional bodies and by backward citation tracking, without date restriction. Approximately 480 records were screened at title and abstract level, 112 were assessed as full text, and 41 sources were retained against predefined inclusion and exclusion criteria, with five further sources added during peer review. In a second and separate step, the ten co-authors, who hold teaching and supervisory roles in gynecological laparoscopy across academic centers in Romania and Germany, each completed the same six-item written prompt on training provision, trainer development, trainee assessment, and institutional QA practice; responses were coded thematically by two authors independently and consolidated into explicit points of convergence and divergence. Results: We describe how QA principles, originally articulated in general quality-management and health-promotion literature, have been adapted by professional and regulatory bodies, including the European Board and College of Obstetrics and Gynecology (EBCOG), European Society for Gynecological Endoscopy (ESGE), American Society for Gastrointestinal Endoscopy (ASGE), and the UK General Medical Council, into concrete standards for training providers, trainers, and trainees. We outline the structures used to monitor and audit training quality, including Kirkpatrick’s four-level evaluation model and periodic institutional review cycles, alongside documentation and certification pathways such as the Gynecological Endoscopic Surgical Education and Assessment (GESEA) program, with governance and financing as cross-cutting determinants of sustainability. The author synthesis converged on a consistent gap between documented standards and their routine enforcement and diverged on whether external review and formal certification should become mandatory. Conclusions: The conceptual architecture of QA in gynecological laparoscopy is coherent and broadly fit for purpose, but we identified no study linking the implementation of a specific QA standard to measurable gains in trainee competency or patient outcomes in this field. Proposals for harmonized, outcome-oriented, and where appropriate, mandatory external review should therefore be read as reasoned positions awaiting prospective evaluation rather than as evidence-based recommendations; generating that evidence, with the trainee’s own perspective collected rather than inferred, is the principal task for future research. Full article

Multi-criteria decision-making methods conventionally rank alternatives by aggregating normalized criterion values into a composite score, an approach that depends on the normalization scheme, requires externally determined criterion weights, and evaluates performance in absolute terms without accounting for inter-criteria dependencies. This paper proposes machine learning-based Peer-Prediction Trees for multi-criteria decision-making, a novel method that ranks alternatives by their excess performance over data-driven peer expectations. For each criterion, a leave-one-out cross-validated decision tree predicts each alternative’s value from its performance on all other criteria; the residual between observed and predicted values extracts how much the alternative outperforms the empirical trade-off structure constraining its peers. Residuals are standardized, aligned with the preferred criterion direction, and aggregated into an Excess Performance Index using uniqueness-based weights derived endogenously from the cross-validated predictive fit. The method is validated on three real-world datasets: a numeric vehicle selection problem (22 alternatives, five criteria), a fully linguistic financial performance evaluation of Turkish listed firms (32 alternatives, four criteria), and a mixed numeric-linguistic exchange-traded fund selection problem (12 alternatives, nine criteria). The contributions of this work are fourfold: (1) the introduction of peer prediction via leave-one-out cross-validated decision trees as a multi-criteria decision-making ranking paradigm that evaluates excess performance rather than absolute scores; (2) a uniqueness-based criterion weighting scheme embedded into the method, eliminating the need for separate weighting procedures; (3) native handling of numeric, linguistic, and mixed decision matrices within a single unified framework; and (4) empirical validation across three heterogeneous real-world applications demonstrating the method’s versatility and interpretability. Full article

Robotic waste sorting requires end-effectors capable of handling objects with highly variable geometry, stiffness, surface condition and leakage characteristics. In such applications, the performance of a vacuum suction cup cannot be evaluated only on the basis of nominal holding force, since grasp initiation, contact compliance, airflow conditions and cyclic durability are strongly coupled. This paper presents a combined numerical and experimental assessment of elastomeric vacuum suction cups intended for robotic waste-sorting applications. Seven suction cup configurations were compared using computational fluid dynamics, finite element analysis and functional gripping tests performed on representative plastic waste objects. The CFD analysis was used to evaluate airflow velocity and generated vacuum level, while FEM simulations provided information on stress distribution and deformation under axial compression. For the selected suction cup, a durability-oriented wear prediction was additionally performed using stress data exported from the FEM model and processed with a dedicated Python tool. The complete vacuum system supplied by a side-channel blower was also analysed in Hopsan to assess leakage sensitivity and pressure margins for grasp initiation and secure holding. The results showed that the best flow performance was obtained for suction cups 1 and 2, but suction cup 2 provided the most favourable overall balance, combining the highest vacuum level, limited deformation, stable gripping performance and acceptable durability indicators. The study demonstrates that multi-criteria evaluation is necessary for selecting vacuum end-effectors for robotic waste sorting, especially when objects are deformable, contaminated or imperfectly sealed. Full article

The increasing adoption of Retrieval-Augmented Generation (RAG) in the oil and gas industry has created a growing need for systematic evaluation of domain-specific knowledge bases, particularly with respect to retrieval failures, numerical and entity inconsistencies, knowledge timeliness, and unsupported generation. This study presents a domain-adapted evaluation and optimization framework for industrial RAG knowledge bases based on an LLM-as-a-Judge paradigm. The framework organizes evaluation into four dimensions—Data, Retrieval, Generation, and Utility (DAAE)—and combines deterministic metrics with LLM-based semantic assessment. A two-tier evaluation procedure combines retrieval-based screening with fine-grained LLM judging while retaining retrieval failures in end-to-end evaluation statistics. Rather than introducing new retrieval or generation algorithms, the framework integrates established RAG techniques with evaluation criteria motivated by oil-and-gas knowledge characteristics, including domain-entity and numerical consistency, temporal validity, chunk-level semantic integrity, and controlled abstention. Evaluation results are mapped to corresponding optimization actions across the data, retrieval, and generation layers, including semantic-aware chunking, metadata augmentation, hybrid sparse–dense retrieval, Cross-Encoder reranking, and structured evidence-grounded prompting. The framework was evaluated using the Intelligent Knowledge Base for Natural Gas Economic Research and an expert-annotated benchmark comprising 150 domain questions. In the industrial before–after comparison, Retrieval Hit@5 increased from 58.0% (87/150) to 89.3% (134/150), Context Precision increased from 0.64 to 0.88, and Faithfulness increased from 0.65 to 0.94. These values are reported as system-level point estimates rather than as component-wise causal effects. The results demonstrate the practical value of evaluation-guided optimization for improving the reliability of domain-specific RAG systems in natural-gas economic research and provide an industrial case for systematic RAG assessment and iterative optimization in the energy sector. Full article

Background: Women with chronic medical conditions are at increased risk of adverse pregnancy outcomes, making contraceptive counselling an essential component of comprehensive chronic disease management. However, evidence regarding the knowledge and clinical practices of non-obstetric physicians remains limited. This study evaluated physicians’ knowledge, attitudes, and practices regarding contraceptive counselling for women with chronic medical conditions in a tertiary referral hospital in Türkiye. Methods: A cross-sectional Knowledge–Attitude–Practice survey was conducted among 264 non-obstetric physicians at İzmir City Hospital between July and October 2025. The questionnaire assessed contraceptive counselling practices, awareness of the World Health Organization Medical Eligibility Criteria for Contraceptive Use (WHO MEC), postgraduate contraception training, perceived barriers, and educational needs. Categorical associations were examined using chi-square or exact procedures as appropriate, and multivariable binary logistic regression was performed to evaluate factors associated with self-reported routine contraceptive counselling while accounting for potential confounding. Results: Among the 260 physicians who responded to the relevant item, 89.2% agreed that contraceptive method selection may influence the course of chronic disease, whereas 37.9% of the total sample reported routinely providing contraceptive counselling. Awareness of the WHO MEC was limited, with 75.8% reporting no prior awareness, and 18.2% had received postgraduate contraception training. In the adjusted analysis, WHO MEC awareness (aOR = 2.76, 95% CI: 1.39–5.46; p = 0.004), postgraduate contraception training (aOR = 2.38, 95% CI: 1.12–5.07; p = 0.024), seeing ≥30 women of reproductive age per week (aOR = 2.07, 95% CI: 1.15–3.73; p = 0.016), female sex (aOR = 3.81, 95% CI: 1.90–7.65; p < 0.001), and >10 years of clinical practice (aOR = 2.38, 95% CI: 1.23–4.62; p = 0.010) were associated with higher odds of self-reported routine counselling. Specialty was not significantly associated after adjustment. Conclusions: Self-reported routine contraceptive counselling remained limited despite broad recognition of the relevance of contraception in chronic disease care. Guideline awareness, postgraduate training, clinical exposure, sex, and clinical experience were associated with routine counselling after adjustment, although causal relationships cannot be inferred from this cross-sectional study. These findings support further evaluation of educational and organizational strategies for integrating reproductive healthcare into chronic disease management. Full article

Foamed concrete is susceptible to drying shrinkage and environmental deterioration because of its porous structure. This study evaluated the effects of fly ash–ground granulated blast-furnace slag blends and polyvinyl alcohol fibres on the dimensional stability and durability of FC. Sixteen mixtures with SCM replacement levels of 0–35% and PVA fibre contents of 0–0.3 vol.% were tested for accelerated drying shrinkage, freeze–thaw resistance, sulfate wet–dry resistance, chloride penetration, and visible pore structure. A normalised multi-criteria evaluation was used to compare the mixtures across five performance indicators, with sensitivity analysis performed for six weighting schemes. Increasing SCM replacement generally increased the drying shrinkage but reduced the chloride penetration depth by 26.7%, 33.3%, and 56.7% at 15%, 25%, and 35% replacement, respectively. At 25% SCM replacement, PVA fibres reduced freeze–thaw-induced compressive strength loss by 62.12–98.48% relative to the corresponding fibre-free mixture. Optical microscopy identified a local stratified region in one of three C0.3 specimens, which was not considered a systematic feature. C0.3 achieved the highest overall score under equal weighting and remained among the top three mixtures under all six weighting schemes. Within the investigated mixture range, C0.3 showed consistently high overall performance, although longer-term durability assessment is required. Full article

This PRISMA 2020 systematic literature review analyzes efficient transformer-based video object detection (VOD). Across five databases through August 2025, 1343 records were identified, with 16 studies meeting the final inclusion criteria after full-text screening. Backward citation tracking added five additional eligible studies, yielding a small final evidence base of 21 studies (22 reports). This review’s major contributions are (i) a focused narrative synthesis at the intersection of efficient model design, temporal modeling, and video object detection transformers, due to methodological heterogeneity in the corpus; (ii) ROB-CVA, a proposed risk-of-bias framework for computer vision; and (iii) an evidence-based analysis of temporal modeling strategies and evaluation practices. Furthermore, we examine evaluation inconsistencies, including dataset fragmentation and risk-of-bias. Fifty-two percent of studies were rated as low risk-of-bias using the review-specific, non-validated ROB-CVA framework, driven mainly by non-public code and datasets; this distribution is sensitive to our risk-of-bias aggregation rule. The certainty of evidence is low to moderate. The review outlines open challenges and future directions. This review is registered on OSF (doi: 10.17605/OSF.IO/Q9PJ4), supported by project AEOLUS (PHD IN INDUSTRY/1123/0145), and funded by the Republic of Cyprus through the Research and Innovation Foundation. Full article

Heart rate variability (HRV) is a useful non-invasive tool for studying autonomic nervous system modulation under emotional stimulation; however, accurate estimation of dominant frequencies in HRV signals remains challenging due to their non-stationary nature and the sensitivity of some spectral methods to configuration parameters. This work presents a methodology for the spectral characterization of HRV signals derived from ECG recordings from the DREAMER database, with emphasis on optimizing the model order of the MUSIC algorithm to improve dominant frequency localization within the physiological low-frequency (LF) and high-frequency (HF) bands. The proposed methodology included ECG signal preprocessing, R-peak detection, RR interval extraction, HRV interpolation, and spectral analysis using MUSIC, while evaluating different model orders through a signal-driven composite criterion based on AIC, MDL, ESTER, eigengap, and model complexity. The criteria were normalized using min–max normalization and combined using equal predefined weights. The results showed that the signal-driven selection of the parameter p produced recording-dependent model order configurations and different dominant frequency estimates across the analyzed stimuli. The resulting LF/HF agreement was evaluated independently after model order selection and showed non-uniform correspondence across stimuli and spectral estimators. Overall, these findings indicate that model order selection can substantially influence the spectral characterization obtained with MUSIC and provide a signal-driven framework for examining this dependence in HRV recordings. Full article