Search Results (41,350)

Background/Objectives: Swift achievement of an optimal functional status after stroke may substantially reduce patients’ stay in a medical facility and enable their return home. The study aimed to assess the functional status in patients after their first stroke, depending on the time after stroke incident and the patient’s length of stay in the stroke rehabilitation ward. Methods: The data from 229 patients, aged 69.4 ± 11.3 years (120 men and 109 women), formed part of the analysis. Based on medical records, basic socio-demographic, clinical data, and the results of the tests—Mini Mental State Examination (MMSE), Barthel Index (BI), Time Walk Test 10 m (TWT), Trunk Control Test (TCT), Up and Go Test (TUG), and Berg Balance Scale (BBS)—were collected. Results: The risk groups for patients with longer post-stroke rehabilitation stays and poorer rehabilitation outcomes included women, older adults, those with poorer functional status, and patients admitted to the stroke rehabilitation ward after a longer period of time after stroke. Conclusions: The functional status and the length of stay in the post-stroke rehabilitation ward should be monitored and analyzed to find and support groups of patients who may rehabilitate more slowly and stay longer in the ward. A shorter patient stay can allow for more effective management of beds in the post-stroke rehabilitation wards. Full article

Room acoustics computer models based on geometrical acoustics usually handle the sound reflections by the assumption of plane waves. However, if the sound source is a point source, which is usually the case, the spherical wave reflection would be more correct. An approximate model for the spherical wave reflection is presented, starting with the assumption of an infinite plane. It was found that the errors caused due to the simplified plane wave assumption can be significant, especially for hard surfaces and near grazing incidence. As something new, the gradual transition from a spherical wave to a plane wave approximation was addressed. For sound propagation exceeding 50 times the wavelength, the plane wave approximation was found to be fully justified, but for shorter distances the spherical wave reflection model should be applied. In contrast to previous work on spherical wave reflection, the reflection from a finite-sized surface was studied. For the first time, the spherical wave reflection model was combined with the complex radiation impedance of a finite-sized surface. One interesting application example of the spherical reflection model is the attenuation of sound propagation above the audience area in a performance space. Finally, the extension of the spherical wave reflection model to higher order reflections was addressed. Full article

Crude oil spill incidents have emerged as a prominent source of environmental contamination, adversely affecting marine ecosystems. This paper undertakes a comprehensive examination of the efficiency of utilizing green surfactants followed by a solid biofoam material as a viable remedy to remove crude oil contamination from a simulated mangrove environment within the Bodo region of the Niger Delta, Nigeria. During the study, four distinct soil samples encompassing sand, mud, peat, and peat–mud were meticulously collected to simulate the prevailing conditions in Bodo. Subsequently, surfactants were introduced into contaminated matrices at similar concentration levels over a specific time frame under the same conditions as in Bodo. Afterwards, a lignin-based biofoam material was then created with the goal of advanced remediation improvement. The outcomes show positive potential, presenting an innovative path for researchers to explore further environmentally sustainable solutions for contaminated muddy soils. The findings from the investigation include the following: (1) the interfacial tension caused by the best-performing surfactants was reduced to a level of 10⁻¹ mN/m, demonstrating that the mobilization of contaminants and extraction are efficient using the studied formulations, especially for sand and muddy samples, and (2) advanced biofoam remediation showed an oil absorption level of 40%, with only brine water existing in the contaminated oil. Full article

Background. Nanoparticle-mediated radiotherapy is a promising approach to enhance tumor radiosensitivity while reducing damage to healthy tissues. Particularly, melanoma is a highly aggressive malignancy with an increasing global incidence and limited therapeutic options in advanced stages, due to its intrinsic radioresistance and narrow therapeutic window in metastatic settings. In this study, we developed a systematic library of gadolinium-doped iron oxide nanoparticles (Fe-Gd NPs) with controlled compositions (0–75% Gd) to investigate the functional and compositional determinants of radiosensitization in melanoma. Methods. The physicochemical properties of the Fe-Gd NPs, including the morphology, crystallinity, and composition, were thoroughly characterized and correlated with biological responses. The biological evaluation was performed using both 2D and tissue-relevant 3D melanoma models, integrating metabolic viability assays (MTT/MTS), mitochondrial function (ATP quantification, MitoTracker analysis), and clonogenic survival following low-energy X-Ray irradiation (150 kV, 4 Gy). In vivo systemic tolerance and response in non-tumor tissues were investigated in BALB/C mice. Results. Our results showed that radiosensitization did not increase linearly with the Gd content, with the 25% Fe-Gd NPs being identified as a therapeutic window and having the most pronounced effect in melanoma cell models, while maintaining good systemic safety in vivo. This study provides functional evidence that nanoparticle-mediated radiosensitization is not only determined by a high Z content, but also by tumor-specific metabolic adaptability and the nanoparticle composition. Conclusions. These findings support the rational design of Fe-Gd nanoparticles with optimized therapeutic windows and highlight the importance of metabolic and 3D tissue-relevant models in preclinical evaluation of nanoparticle-mediated radiotherapy. Full article

Background/Objectives: Infective endocarditis (IE) carries substantial mortality, particularly in middle-income settings where patient profiles and microbial ecology differ from those of cohorts used to derive international prognostic scores. Syndrome-specific, locally grounded decision aids for empirical therapy are also scarce. We aimed to identify predictors of in-hospital mortality, externally evaluate the RiskE and ICE scores, and construct a Bayesian weighted-incidence syndromic combination antibiogram (WISCA) for IE. Methods: We conducted a retrospective cohort study of consecutive adults with definite or possible IE admitted between January 2019 and January 2026. Candidate predictors were screened in two phases, and a clinically specified model was estimated with maximum-likelihood and Firth penalization, with 1000-replicate bootstrap optimism correction. Calibration was assessed with bootstrap calibration plots and the Hosmer–Lemeshow test. Discrimination was compared against RiskE and ICE using DeLong’s test and reclassification metrics. For empirical coverage, we built a WISCA using identified pathogens, reporting both non-Bayesian bootstrap estimates and Bayesian hierarchical partial-pooling estimates with species- and antibiotic-level random intercepts; analyses were also stratified by IE type. Results: In-hospital mortality was 22.9% in a young cohort (median 37 years) characterized by high hemodialysis prevalence (47.4%), substantial right-sided IE (46.4%), and Staphylococcus aureus predominance (32%) with no methicillin-resistant isolates. Vasopressor-requiring shock (Firth OR 9.23, 95% CI 2.40–40.61) and acute heart failure (OR 10.01, 95% CI 2.78–41.07) were the strongest predictors; the final model achieved an AUC of 0.922 (optimism-corrected 0.908), significantly outperforming RiskE (0.598) and ICE (0.632). The Bayesian WISCA identified multiple carbapenem-sparing and anti-MRSA–sparing regimens with adequate coverage (≥80%), particularly for community-acquired IE, supporting stewardship-oriented empirical selection. Coverage was consistently lower in healthcare-associated IE. Conclusions: A parsimonious three-variable model provided strong, locally valid mortality prediction in this hemodialysis-predominant, MRSA-free cohort, substantially outperforming European-derived scores. External validation in independent cohorts is required before clinical adoption. The Bayesian WISCA demonstrated that adequate empirical coverage is achievable without routine broad-spectrum agents, offering institution-specific guidance for stewardship-compatible regimen selection; multicenter validation is warranted. Full article

The present work aimed to obtain antibacterial wound dressings using bacterial cellulose (BC) as a support, to improve wound treatment and reduce the incidence of infections. To enhance the antibacterial activity of the synthesized dressings, the introduction of ZnO nanoparticles into the BC network by precipitation was pursued. The method chosen to develop ZnO NPs was green synthesis, an ecological and sustainable method for obtaining nanomaterials using plant extracts as reducing agents or stabilizers. Thus, the chosen plants were Ginger rhizomes, Bay leaves, and Rose hips, in both fresh and dry form, due to the natural benefits they possess, and the Soxhlet method was used to obtain the plant extracts desired to be used in the synthesis. The composite dressings were developed in two distinct sample series, differentiated by the immersion time of BC in the precursor Zn²⁺ solution. The samples in the first series were obtained by precipitation in a mixture of Zn²⁺ solution and natural extract, whereas the samples in the second series were obtained by successive immersion in Zn²⁺ solution and then in natural extract, which demonstrated a considerable difference. The best antimicrobial activity tested against Gram-negative bacterium Escherichia coli was recorded for the composite material obtained in the presence of fresh rose hip extract, an aspect most likely related to the morphological and crystalline features of the ZnO phase, but also to the phytochemical profile of the extract used. Such eco-friendly materials represent valuable candidates for wound dressing applications due to their ability to support wound healing, relief burns, and skin irritation, provide antimicrobial protection, promote skin regeneration and reduce scarring, protect sensitive skin, and act as a barrier against external contaminants. Full article

Despite many efforts to curtail drunk driving, alcohol-related traffic fatalities and injuries continue to be a major public health problem in the United States (U.S.) and most of the world. Technologies exist that prevent an automobile from starting if the driver’s breath alcohol exceeds 20 milligrams per deciliter (mg/dL), but these devices are only fitted to vehicles of individuals who have been convicted of Driving Under the Influence (DUI). A new approach must be taken to reduce the incidence of drunk driving by integrating an alcohol sensor system in vehicles as part of the delivered hardware. The system must be fast, accurate, and contactless—meaning that a forced exhalation is not required to measure the concentration of alcohol on the breath. We report on a novel device, the Driver Alcohol Detection System for Safety (DADSS) Breath Alcohol Sensor System, which uses the mid-infrared region of the electromagnetic spectrum to concurrently monitor alcohol and expired carbon dioxide (CO₂) to accurately quantify the breath alcohol concentration in samples that have been diluted in the atmosphere before being measured. The system was validated in a research laboratory with 70 male and female volunteers in 187 individual study days. Participants were given various doses of alcohol to consume and then breath and blood samples were collected simultaneously. Pearson correlation coefficients between the DADSS Breath Alcohol Sensor system and blood samples indicate a strong correlation between the measures, with an overall Pearson correlation of 0.8875 over an alcohol concentration range of 0–220 mg/dL. These results indicate that incorporating the DADSS system into motor vehicles has the potential to reduce the incidence of drunk driving. Full article

This paper addresses the challenge of accurately measuring liquid level interfaces in multiphase mixed media by proposing a detection method based on ultrasonic transmission. First, a mathematical model of the ultrasonic measurement system was established, and the acoustic field characteristics of transducers with different frequencies and diameters in slurry were simulated and analyzed to determine the optimal excitation frequency and probe diameter. On this basis, an echo sound pressure calculation model based on the side-incidence method was constructed, and a formula for calculating the liquid level interface height was derived. Finally, an experimental test platform with a multi-layer steel container was built to measure the propagation velocity, attenuation coefficient, and acoustic impedance coefficient of ultrasound in the slurry, verifying the feasibility of the liquid level interface measurement method. Full article

Background: Pulsed field ablation (PFA) has shown promising results for atrial fibrillation (AF), with efficacy comparable to established ablation techniques. High-power short-duration (HPSD) ablation has also emerged as a potential alternative. However, the relative superiority between these approaches remains uncertain. We performed a systematic review and meta-analysis to address this gap. Methods: Three databases were searched. The primary outcome was freedom from AF recurrence. Secondary outcomes included tamponade and other complications, procedure and fluoroscopy durations. Time-to-event data were reconstructed, and a random-effects model was employed. Given variability in post-ablation blanking periods across studies, landmark analyses were performed using a 3-month cut-off to account for the potential under-detection of early recurrence events. Results: Eight studies (1369 patients [PFA: 642; HPSD: 727]) were included. PFA was associated with greater freedom from AF recurrence (HR 0.751; 95% CI 0.57 to 0.99; p = 0.044). Landmark analyses showed no difference in the 0–3 month period; a significant benefit of PFA was observed thereafter (HR 0.72; 95% CI 0.54 to 0.98; p = 0.033). There were no significant differences between groups in the incidence of tamponade (p = 0.73) or overall complications (p = 0.99). PFA was associated with shorter procedure duration (MD 37.05; 95% CI 27.69 to 46.41; p < 0.01), whereas fluoroscopy duration was significantly shorter in the HPSD group (MD −9.04; 95% CI −11.71 to −6.37; p < 0.001). Conclusion: PFA was associated with a lower risk of AF recurrence compared to HPSD, particularly beyond the late post-ablation period, with similar rates of complications. Although PFA was associated with shorter procedure duration, HPSD demonstrated reduced fluoroscopy time. Full article

Background and Objectives: Stroke remains a major contributor to global morbidity and mortality, with substantial geographic variation in incidence and outcomes. Although declining trends in stroke incidence and mortality have been documented in several Western European populations, countries in Eastern Europe have historically experienced a disproportionately high cardiovascular disease burden. Comprehensive long-term evaluations assessing simultaneous trends in stroke attack rates, mortality, and case-fatality in Lithuania are limited. This study aimed to investigate 24-year trends (2000–2023) in stroke epidemiology among working-age residents of Kaunas city. Materials and Methods: Data were derived from the Kaunas population-based stroke registry and included individuals aged 25–64 years. Age-standardized attack rates, mortality rates, and case-fatality rates per 100,000 population were calculated using the World Health Organization standard population. Temporal trends were assessed using Joinpoint regression analysis to estimate annual percentage changes (APCs) with corresponding 95% confidence intervals (CIs). Analyses were stratified by sex, age group (25–54 and 55–64 years), and stroke subtype (ischemic and hemorrhagic). Results: During 2000–2023, overall stroke attack rates declined significantly in both sexes, with a more pronounced reduction observed among females. Stroke mortality decreased significantly among females over the entire study period, whereas no significant overall change was observed among males, largely due to increases during 2010–2021 that attenuated earlier and subsequent improvements. Case-fatality rates demonstrated no significant overall long-term trend in either sex but exhibited marked temporal variability, including significant increases during 2010–2021 followed by substantial declines after 2021. Age-stratified analyses confirmed significant reductions in attack rates across both age groups. Ischemic stroke incidence declined significantly in both sexes, while hemorrhagic stroke mortality decreased significantly among males and females. The period 2021–2023 was characterized by pronounced reductions in mortality and case-fatality across multiple subgroups. Conclusions: Over the past two decades, the stroke burden among working-age residents of Kaunas has declined substantially, particularly among females. Despite period-specific deteriorations, recent improvements underscore the impact of advances in stroke prevention and acute care. Sustained risk factor control and continued healthcare system development remain essential to maintain favourable trends. Full article

Purpose: To investigate the association between COVID-19 infection and the 1-year risk of acute urinary retention (AUR) and related urological complications in patients with benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTs). Materials and Methods: Using the TriNetX global network, patients with BPH and LUTs between January 2020 and January 2024 were identified. Participants were classified into a COVID-19 cohort (N = 32,948) and a non-COVID control cohort (N = 434,123). Propensity score matching (1:1) balanced demographics, comorbidities, medications, and laboratory parameters. The primary outcome was AUR within one year. Secondary outcomes included Foley catheterization, urinary tract infection (UTI), gross hematuria, bladder stones, and prostate-related surgery. Results: After matching, 32,918 patients remained in each cohort. The COVID-19 group showed a significantly higher 1-year incidence of AUR compared with controls (2.18% vs. 0.32%; aHR 6.89, 95% CI 5.62–8.45; p < 0.0001). Increased risks were also observed for Foley catheterization (aHR 4.10), UTI (aHR 3.52), and prostate-related surgery (aHR 6.02). Kaplan–Meier analysis demonstrated persistent divergence in AUR-free survival. Conclusion: COVID-19 infection is independently associated with a markedly increased risk of AUR and urological complications in patients with BPH, highlighting the need for closer post-infection monitoring. Full article

Background/Objectives: Type 2 diabetes mellitus (T2DM) is a multisystemic disease with overlapping metabolic, renal, and cardiovascular effects. Within the Diabetic@ project, which aims to characterize individuals with T2DM using real-world data extracted from electronic health records (EHRs), this substudy sought to develop a predictive model for two-year heart failure (HF) risk. Methods: Multicenter, retrospective study including T2DM individuals across eight Spanish hospitals (2013–2018). Data were extracted exclusively from EHRs’ unstructured free text using clinical natural language processing (cNLP) and mapped to SNOMED CT. At inclusion, individuals were categorized as having or not prevalent HF (pHF). Predictive modeling was performed in non-pHF to assess two-year risk of developing HF, termed incident HF (iHF). Logistic regression (LR), decision trees, random forest, and XGBoost were compared, selecting for accuracy and interpretability. Results: Of 588,756 individuals with T2DM, 84,197 (14.3%) had pHF. Among non-pHF, 353,371 (60%) were used for model development (90.7% training, 9.3% validation). iHF occurred in 13.6% of the training set and 11.4% of the validation set. Ischemic heart disease was present in 16.2% overall, 37.9% in pHF, and 12.6% in non-pHF. Glycosylated hemoglobin data was rarely reported (<15%). LR achieved the best performance (AUC-ROC 0.73) using 27 predictors. Reduced 12- and clinically refined 9-predictor models performed similarly, with the latter implemented in a web-based tool. Conclusions: Unstructured data from EHRs enabled development of a two-year HF risk model for individuals with T2DM, underscoring the potential of cNLP for risk stratification across the cardiovascular–renal–metabolic spectrum. Full article

This study presents an application-oriented CFD–FEM integrated workflow for analyzing chamber-side field non-uniformity and kelp-side thermal response during infrared drying. A three-dimensional steady-state CFD model was first established to reconstruct the chamber temperature, airflow, and incident radiation fields under certain operating conditions. Numerical consistency was checked through residual convergence; monitored variables; and global mass balance, for which the net mass imbalance was 0.004077 kg s⁻¹. The reconstructed mid-plane fields were then processed in MATLAB to extract the mean values, extrema, and coefficients of variation, and a composite objective function was used to screen the tested operating conditions in terms of field uniformity, temperature band compliance, and overheating risk. The thermal loads obtained via CFD were subsequently mapped onto a kelp finite element model to simulate the transient surface temperature evolution. Among the tested cases, case01 yielded the lowest composite objective value (J = 0.4535); its mapped kelp response showed a mean surface temperature of 62.23 °C and a maximum temperature of 63.57 °C at the exported time step. The proposed framework is therefore suitable for thermal response assessment and operating condition screening, although determining the full drying behavior still requires coupling of moisture transfer and improved experimental validation. Full article

Background: Vancomycin-resistant Enterococcus (VRE) bacteremia represents a major therapeutic and epidemiological challenge, particularly in regions with high antimicrobial resistance rates such as Southern Europe. Longitudinal local data are essential to guide infection control and antimicrobial stewardship strategies. This study aimed to evaluate temporal trends in incidence, management, and mortality of VRE bacteremia in a tertiary care center in Greece over a six-year period, including comparison before and after the coronavirus disease 2019 (COVID-19) pandemic. Methods: This retrospective observational study included adult patients with VRE bacteremia at the University Hospital of Heraklion, Greece, from 2018 to 2023. Demographic and clinical data, such as the Pitt Bacteremia Index (PBI), as well as microbiological, and treatment data were collected from patient records. Incidence was calculated per 10,000 patient-days. Comparisons were performed between survivors and non-survivors and between pre- and post-COVID-19 eras. Multivariate regression analysis was used to identify predictors of in-hospital mortality. Results: A total of 96 patients were included (mean age 68.6 ± 14.5 years; 56.3% male). The incidence of VRE bacteremia increased more than five-fold during the study period, from 0.242 cases per 10,000 patient-days in 2018 to a peak of 1.344 per 10,000 patient-days in 2022, remaining elevated in 2023 (1.001 per 10,000 patient-days). The overall in-hospital mortality was 54.2%. Non-survivors had significantly higher PBI scores compared to survivors (median 2.5 vs. 0, p = 0.005). In the multivariate analysis, higher PBI was independently associated with in-hospital mortality [odds ratio: 1.449 (95% confidence intervals: 1.166–1.801)]. Appropriate empirical therapy was administered in 41.7% of cases and was not significantly associated with survival. Post-COVID-19 patients were older (69.9 vs. 61.4 years, p = 0.0365), and antimicrobial regimens were more frequently adjusted according to susceptibility testing (55.7% vs. 18.2%, p = 0.0141), but mortality did not significantly differ between periods. Conclusion: VRE bacteremia incidence increased dramatically over the six-year study period in our tertiary center, with persistently high mortality exceeding 50%. Severity of illness at the diagnosis of bacteremia, as measured by the PBI, was an independent predictor of in-hospital mortality. Strengthened infection prevention measures, optimized antimicrobial stewardship, and early aggressive management are urgently needed to mitigate the growing burden of VRE bacteremia. Full article

Tool-using AI agents couple a language model with controller logic, memory, and external tools such as browsers, email, calendars, file systems, and transaction APIs. This architecture expands capability, but it also enlarges the security boundary: agents routinely ingest untrusted content while holding privileges that can reveal private data and trigger external side effects. The resulting failures are not limited to poor text generation; they include prompt injection, indirect injection through tool outputs, confused-deputy behavior, unauthorized actions, and misleading claims about the tool state. Because large-scale testing on deployed products is difficult, vendor-specific, and ethically sensitive, we present a transparent, theoretical simulation-based framework for evaluating user-facing risk in tool-using agents. The methodological contribution is a formal threat model that separates compromise, harm, and severity, and a Monte Carlo evaluation pipeline that maps architectural choices (permissions, retrieval, memory exposure, and approvals) and defensive controls to comparable outcome metrics. We instantiate the framework for six representative threat scenarios and nine defense configurations, reporting attack success rate (ASR), benign task success, latency overhead, and severity-weighted harm. Across scenarios, the least-privilege tool design is the strongest single broad control, human-in-the-loop approvals sharply reduce high-impact actions and exports but degrade under user error and habituation, retrieval allowlisting nearly eliminates indirect injection while leaving other channels largely unaffected, and rate limiting reduces tail severity more than ASR. These results position agent safety as an architectural and operational problem and because they arise from an assumption-explicit simulator rather than field measurements, should be read as comparative design guidance rather than incident-rate estimates for any deployed product. Full article