Search Results (35,998)

Electric vehicle (EV) transport by ship is expanding beyond industrial logistics centred on automobile production, trade, and pure car and truck carriers (PCTCs) into daily transportation for island tourism, commuting, and essential mobility. According to Korea Maritime Transportation Safety Authority (KOMSA) vessel status data as of March 2026, 104 of 146 domestic passenger ships were car-ferry passenger ships, accounting for 71.2% of the fleet and operating on 75 of 99 designated routes nationwide. Korea Shipping Association (KSA) operational records show that the EV transport rate on these routes increased from 0.76% in 2024 to 1.21% in 2025, with some routes exceeding 2.0–4.7%. Unlike enclosed multi-deck PCTC vehicle spaces, Korean coastal car-ferry passenger ships generally have single-tier open vehicle decks and bow ramp gates. Crosswinds on open decks may reduce smoke detector activation probability by 60–75%. Although Article 97 of the Standard for Ship Fire-Fighting Appliance newly requires dedicated EV fire-fighting equipment for car-ferry ships, it remains primarily equipment-prescriptive and does not yet provide open-deck-specific performance requirements for wind-resistant detection, fixed EV-zone cooling, EV-designated stowage arrangements, or passenger–operator safety management obligations. This study applies the five-step International Maritime Organization (IMO) Formal Safety Assessment (FSA) procedure to support improvements to EV fire-fighting equipment standards for coastal car-ferry passenger ships. Hazard identification (HAZID) was conducted with a 15-member advisory panel, and probability elicitation was performed through a Delphi survey with 10 core experts, showing strong consensus (Kendall’s W = 0.74, p < 0.01). Fault tree analysis (FTA) and event tree analysis (ETA) probabilities were derived from the Delphi results and the international literature. H-07, representing wind-induced smoke dilution, was identified as the dominant single-point vulnerability within the detection-failure branch. Monte Carlo-based FTA–ETA analysis (n = 10,000) estimated annual fire frequencies of 5.9 × 10⁻², 1.8 × 10⁻¹, and 2.9 × 10⁻¹ yr⁻¹ at EV loading ratios of 10%, 30%, and 50%, respectively, with 2.47 expected fatalities per fire. Risk entered the IMO ALARP band above a 30% EV loading ratio and exceeded the maximum tolerable crew risk above 50%. The combined application of risk control options (RCOs) 2, 3, and 4 reduced annual expected fatalities by 85.6%. Based on these results, six RCOs and institutional recommendations are proposed, including strengthened safety management obligations for passenger ship operators. Full article

Background/Objectives: Inflammation plays a central role in the pathophysiology of ST-elevation myocardial infarction (STEMI) and may influence myocardial injury, ventricular dysfunction and clinical outcomes. Simple inflammatory biomarkers derived from routine laboratory tests have been proposed as potential prognostic indicators in patients undergoing primary percutaneous coronary intervention (PCI). Objective: This study aimed to evaluate the association between admission inflammatory biomarkers, echocardiographic markers of ventricular dysfunction and in-hospital mortality in patients with STEMI treated with primary PCI. Methods: We conducted a retrospective observational study including 600 consecutive patients admitted with STEMI and treated with primary PCI between January 2021 and August 2025. Inflammatory biomarkers measured at admission included C-reactive protein (CRP); neutrophil-to-lymphocyte ratio (NLR); platelet-to-lymphocyte ratio (PLR); systemic immune-inflammation index (SII) and C-reactive protein-to-lymphocyte ratio (CLR). Echocardiographic parameters and clinical outcomes were recorded. Multivariable logistic regression analysis was performed to identify independent predictors of in-hospital mortality. Results: In-hospital mortality occurred in 54 patients (9.0%). Patients with reduced left ventricular ejection fraction (LVEF ≤ 40%) had significantly higher CRP and CLR levels (p < 0.01). Inflammatory biomarkers were associated with markers of ventricular dysfunction but were not independent predictors of mortality. Age, LVEF < 40% and the number of residual coronary lesions independently predicted in-hospital death. Conclusions: In STEMI patients undergoing primary PCI, early mortality is mainly determined by age; ventricular dysfunction and residual coronary disease burden, while inflammatory biomarkers primarily reflect the severity of myocardial injury rather than independently predicting short-term mortality. Full article

Background/Objectives: Depression is a mood disorder characterized by persistent sadness and loss of interest. Pharmacy students exhibit a relatively high prevalence of depressive symptoms, which may negatively impact quality of life, academic performance, and, in severe cases, lead to suicidal ideation. Given the increasing trend of medication use among young adults, we hypothesized that this behavior may be associated with depressive symptoms, potentially reflecting attempts to manage concurrent physical symptoms or reduced psychological well-being. Therefore, the objective of this study was to assess the association between depressive symptoms and medication use among pharmacy students. Methods: A cross-sectional study was conducted among students enrolled in pharmacy-related programs from University Center for Exact Sciences and Engineering (CUCEI), University of Guadalajara. Participants completed a personalized questionnaire assessing sociodemographic variables, medication use, comorbid conditions, and depressive symptoms using the Patient Health Questionnaire-9. Descriptive statistics were used to summarize participant characteristics. Categorical variables were reported as frequencies and percentages and compared using the chi-square test. Continuous variables were summarized as means and standard deviations and compared using Student t-test. To evaluate factors associated with moderate-to-severe depressive symptoms, logistic regression and multivariable linear regression analyses were performed. Results: A total of 365 students completed our personalized questionnaire; nearly half of the sample (47.3%) presented moderate-to-severe depressive symptoms. Multivariable analyses showed that insufficient sleep, academic stress, psychological support, and the number of medications used simultaneously were significantly associated with depressive symptoms. Logistic regression identified being in a relationship and receiving psychological support for at least one year as protective factors, while employment, insufficient sleep, academic stress, and a greater number of concomitant medications were associated with increased odds of moderate-to-severe depressive symptoms. Conclusions: A modest association was observed between self-reported medication use and moderate-to-severe depressive symptoms among pharmacy students. These findings suggest that medication use patterns may warrant further investigation as a potential marker of depressive symptoms in pharmacy students. Future longitudinal studies are needed to clarify the nature and direction of this association and to determine whether medication use could contribute to the identification of students at increased risk of depression. Full article

Background/Objective: This study evaluated the diagnostic performance of vertical growth patterns and mandibular morphology, alongside the anteroposterior dysplasia indicator (APDI), for classifying skeletal malocclusions in a Saudi adult population using cephalometric analysis. Materials and Methods: This retrospective cross-sectional discriminatory performance study analyzed 162 archived lateral cephalometric radiographs of Saudi adults aged 18–44 years. The assessed variables included Frankfort-mandibular plane angle (FMA), gonial angle, ANB angle, and APDI. Statistical analysis involved descriptive statistics, ANOVA with post hoc testing, Pearson correlation, logistic regression, and receiver operating characteristic (ROC) curve analysis. Results: Significant differences among skeletal classes were observed for all evaluated variables (p < 0.05). APDI showed the largest effect size and the highest diagnostic performance, particularly for Class III malocclusion, with excellent discriminatory ability reflected by area under the curve (AUC) values, high sensitivity, and acceptable specificity at optimal cutoff points. FMA showed moderate discriminatory performance, with higher specificity but limited sensitivity, while the gonial angle exhibited comparatively weaker diagnostic performance. In logistic regression analysis, APDI was the only significant independent associated variable of Class II malocclusion. Conclusions: Within the ANB-based classification framework used in this study, APDI showed the highest discriminatory performance for skeletal malocclusion classification, supporting its role as a primary sagittal indicator. FMA contributed adjunctive information on vertical skeletal pattern, while the gonial angle showed limited diagnostic value. Combined assessment of sagittal and vertical parameters may improve cephalometric diagnosis. Full article

Fresh edible mushrooms deteriorate rapidly during distribution, leading to quality loss, retail rejection, and avoidable waste of product, packaging, and refrigeration resources. Here, we developed a probability-based sensory shelf-life framework for commercially packaged Flammulina filiformis under controlled storage. Three hundred retail packages were stored at 4, 15 and 25 °C. Four sensory defects were scored and integrated into a composite overall quality index (OQ), and the endpoint attainment probability, p (OQ ≥ 3), was modeled by temperature-specific logistic regression. Whiteness, weight loss, polyphenol oxidase (PPO) activity, malondialdehyde (MDA) content, and soluble protein content were measured as supporting quality indices. Sensory rejection increased progressively and was accelerated at higher temperatures. Off-odor emerged earlier than the other defects and governed overall acceptability. Logistic models closely tracked endpoint progression and estimated shelf lives of 31.9 h (25 °C), 104.7 h (15 °C), and 261.4 h (4 °C), with relative errors within 3% compared with observed values. This sensory-centered framework provides an interpretable basis for shelf-life prediction and quality management of packaged enoki mushrooms. Full article

In bank-dominated financial systems, the accumulation of non-performing loans is a recognised source of systemic vulnerability, as correlated corporate defaults can erode bank capital, impair liquidity, and propagate stress across interconnected portfolios. Firm-level default detection thus constitutes a microprudential foundation of macroprudential stability: the reliable early identification of risky borrowers reduces both individual credit losses and the aggregate exposures that drive system-level fragility. Yet the use of structured data-mining pipelines for this task remains underexplored in Central and Eastern Europe. This study applies the CRISP-DM methodology to predict corporate loan default using data on 302 Slovak corporate borrowers, combining financial ratios from publicly available financial statements with selected company and loan-related information from internal bank records. Seven individual classifiers were developed and compared: decision trees (CART, CHAID, C5.0), logistic regression, discriminant analysis, and neural networks (MLP, RBF), together with a stacked ensemble based on their outputs. Model performance was evaluated using sensitivity, overall classification accuracy, and area under the ROC curve (AUC), with sensitivity treated as the primary criterion because of the asymmetric costs of misclassification in credit risk assessment. The results confirm that historical firm-level information provides a reliable basis for default prediction, with tree-based models consistently outperforming statistical and neural network approaches. The stacked ensemble achieved the strongest overall performance, whereas C5.0 and CHAID showed that interpretable classifiers can also deliver competitive predictive accuracy. A champion–challenger deployment architecture is proposed, in which the ensemble serves as the performance-oriented champion and interpretable models act as challengers; this arrangement contributes to the operational resilience of the credit-risk assessment process and aligns with macroprudential expectations of model governance, auditability, and explainability. The study offers a replicable methodological framework for integrating data-driven decision support into credit evaluation in comparable banking settings. Full article

Smoking and central obesity have both been linked to periodontitis, but their combined relationship with periodontal disease may be influenced by demographic and behavioral factors. This cross-sectional study analyzed records of 420 adult dental patients attending the College of Dentistry at the University of Baghdad. Data included demographic characteristics, smoking status, periodontal clinical findings, body mass index (BMI), and waist-to-height ratio (WHtR). Periodontitis was defined according to the 2018 classification framework, and logistic regression models were used to examine the associations of smoking and obesity-related indicators with periodontitis. The overall prevalence of periodontitis was 36.4%. Participants with periodontitis were significantly older than those without periodontitis (46.0 vs. 28.9 years; p < 0.0001). In the fully adjusted model, age remained the strongest factor associated with periodontitis (OR = 1.15 per year; 95% CI: 1.11–1.18; p < 0.001). The apparent association between smoking and periodontitis was substantially influenced by age, as current smoking was more common among younger participants in this sample. The association between smoking status and periodontitis appeared to differ according to WHtR category (interaction term p = 0.016); however, this finding should be interpreted cautiously because of the cross-sectional design and age imbalance across exposure groups. Overall, the findings suggest that age was the dominant factor associated with periodontitis in this dental patient sample, while the relationship between smoking, central obesity, and periodontitis requires further investigation in longitudinal studies with detailed smoking and metabolic data. Full article

Background/Objectives: Medication-related osteonecrosis of the jaw (MRONJ) is a severe complication of antiresorptive and antiangiogenic therapies, and identifying specific risk factors for recurrence remains a significant clinical challenge. This study aimed to evaluate the clinical characteristics and independent risk factors for recurrence in a large-scale cohort of MRONJ patients. Methods: This single-center retrospective study analyzed 812 patients diagnosed with MRONJ according to the 2022 AAOMS criteria at Chosun University Dental Hospital between 2020 and 2024. Demographic, clinical, radiographic, and medication-related variables were collected. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors associated with recurrence. Results: The majority of patients were female (89.9%), with a mean age of 72.9 years, and mandibular involvement was most frequent (70.8%). Tooth extraction was the most common local precipitating factor (47.0%). The overall recurrence rate was 10.1%. Multivariate analysis identified bilateral jaw involvement (OR = 4.555, p = 0.006), mandibular ramus involvement (OR = 8.222, p = 0.008), and systemic liver disease (OR = 3.703, p = 0.037) as significant independent risk factors. Conversely, routes of prior antiresorptive medication administration involving intravenous-only or combined oral/intravenous therapy, as well as hyperlipidemia and a history of dental implant surgery, were associated with lower recurrence rates. Conclusions: Anatomical complexity and systemic health status are critical predictors of MRONJ recurrence. Patients presenting with bilateral or mandibular ramus involvement, or with compromised liver function, require more aggressive surgical debridement and individualized treatment planning to reduce the risk of recurrence. Given the small affected subgroups, the effect sizes for mandibular ramus involvement and liver disease should be interpreted with caution. Full article

Background/Objectives: Against the background of the rapid aging of the population, the symptoms of depression are a major health problem for middle-aged and older adults. This study analyzes the relationship between social participation and the trajectory of depressive symptoms and whether this association varies by gender. Methods: The data comes from five rounds of surveys conducted by the China Health and Retirement Longitudinal Study (CHARLS) from 2011 to 2020, including a total of 5796 participants aged 45 or above. The depressive symptoms of each wave are measured using the 10-item Center for Epidemiologic Studies Depression Scale (CESD-10). Social participation was defined as the number of reported activities (0, 1, or ≥2). The development trajectory of depressive symptoms was analyzed through Group-Based Trajectory Modeling (GBTM), and their links with social participation level were subsequently quantified using multinomial logistic regression. Gender differences were assessed via interaction tests and stratified models. Results: GBTM identified four distinct depressive symptom trajectories: low (29.71%), moderate (42.72%), increasing (22.07%), and high (5.50%). Compared with no participation, engaging in one activity was linked to lower odds of falling into the moderate, increasing, and high trajectories; the association was stronger for ≥2 activities. Gender-stratified analyses revealed substantial heterogeneity (all interaction p < 0.01). Among women, single-activity participation was associated with lower odds across all three adverse trajectories. Among men, similar associations required ≥2 activities, with single-activity participation linked only to lower odds of the high trajectory. Conclusions: Higher levels of social participation have significantly reduced the depressive symptoms of middle-aged and older adults, and the gender differences are pronounced. Interventions should improve access to social participation for older women and promote activity diversity for older men. Full article

Background/Objectives: Y chromosome microdeletions in the azoospermia factor (AZF) regions are a major genetic cause of severe male infertility, yet their relationship with hormonal profiles in azoospermic men remains unclear. This study aimed to investigate AZF microdeletions and associated hormonal parameters in azoospermic patients. Methods: Azoospermic patients were screened for AZFa, AZFb, and AZFc microdeletions using multiplex real-time PCR targeting sequence-tagged site (STS) markers (sY84, sY127, and sY254). Patients were categorized into AZF-negative and AZF-positive groups, with the latter further stratified according to their deletion subtype. Serum follicle-stimulating hormone (FSH), testosterone, and inhibin B levels were measured. Hormonal parameters were compared between groups using the Mann–Whitney U test, and a logistic regression analysis was performed to evaluate associations between hormonal variables and AZF deletion status. Results: AZF microdeletions were detected in 18.7% (17/91) of patients. Patients without AZF deletions showed a median FSH level of 17.40 (7.12–31.27) IU/L. In contrast, AZFc deletion carriers exhibited an intermediate median FSH level of 21.10 (16.11–26.10) IU/L and lower median inhibin B concentrations (25.50 [25.25–26.00] pg/mL) compared with AZF-negative patients (56.00 [33.50–106.50] pg/mL). Median testosterone levels in AZFc patients (3.61 [2.87–4.35] ng/mL) remained within the expected physiological range. However, no statistically significant differences were observed between the AZF subgroups for age (p = 0.262), FSH (p = 0.506), testosterone (p = 0.615), or inhibin B (p = 0.524). The logistic regression analysis also showed no significant association between hormonal parameters and AZF deletion status. Conclusions: Hormonal parameters alone are insufficient to predict the presence of AZF microdeletions in azoospermic men. These findings highlight the importance of routine genetic screening for accurate diagnosis, clinical management, and reproductive counseling in male infertility. Full article

Background/Objectives: Type 2 diabetes (T2D) remission can be defined as a return to a HbA1c < 6.5% (<48 mmol/mol) sustained without ongoing treatment for at least 3 months. Prevalence estimates and factors associated remain unknown for LMIC and resource-limited settings. Methods: We conducted a retrospective observational analysis of electronic medical records from 8463 adults who received multidisciplinary care at Mexico’s primary care specialized units (UNEMES-EC) between 2015 and 2019 and who were referred for inadequate metabolic control. Remission was defined per 2021 ADA criteria as HbA1c <6.5% sustained for ≥3 months without glucose-lowering medications. After estimating the prevalence of T2D remission, logistic regression models were used to evaluate its sociodemographic and clinical predictors, with particular attention to weight change and baseline adiposity interactions. Results: RT2D prevalence was 0.87% (95% CI: 0.68–1.10) over a median 393-day follow-up. Weight loss ≥10% (adjusted OR 2.75; 95% CI: 1.21-6.27) and systolic blood pressure (tertile 3 vs tertile 1: OR 2.49; 95% CI: 1.17–5.26) were positively associated with RT2D, while elevated baseline HbA1c (tertile 3 vs. tertile 1: OR 0.09; 95% CI: 0.02–0.33), triglyceride levels (tertile 3 vs. tertile 1: OR 0.49; 95% CI: 0.24–0.98) and intensive pharmacotherapy were inversely associated with RT2D. No associations with HDL and total cholesterol were found. Age, sex, educational attainment, and income demonstrated no independent associations with remission. Among lifestyle-treated patients achieving ≥5% weight loss, remission prevalence reached approximately 11%. No significant interaction between baseline BMI and weight change was detected (p = 0.60). Conclusions: This first large-scale Mexican study establishes RT2D as an achievable endpoint in patients with poor baseline metabolic control. The findings suggest that remission could be achieved with equity-focused, weight-centered interventions even in resource-constrained health systems and populations. Full article

This study examines motivational and capability barriers to internet non-adoption in Thailand’s near-saturated digital economy. Using the 2025 Q4 ICT Household Survey conducted by Thailand’s National Statistical Office, the analysis focuses on 20,633 adult non-adopters who report either motivational or capability-related barriers. The dependent variable distinguishes capability non-adoption, defined as lack of skill or awareness, from motivational non-adoption, defined as lack of perceived need or privacy/security concerns. Weighted logistic regression with normalised population weights, PSU-clustered robust standard errors, and average marginal effects is used to estimate associations between household ICT access, age, education, employment, smartphone access, and barrier type. Motivational barriers account for 56.2% of the two-category non-adopter population and capability barriers for 43.8%. Although motivational reasons are the more common, household ICT access is positively—if modestly—associated with capability rather than motivational barriers (average marginal effect +1.7 percentage points): capability-constrained non-adopters are concentrated in connected households, the compositional signature predicted by the second-level digital divide. Age does not significantly moderate this association. Among older non-adopters, education, employment, and smartphone access are negatively associated with capability barriers, while household ICT access is not. The findings suggest that in post-access digital economies, household connectivity is insufficient for digital market inclusion; individual-level skills and device access become central to expanding effective digital market reach. Full article

(1) Background: One-lung ventilation (OLV) is frequently required during thoracic surgery, but hypoxemia remains a common intraoperative complication. Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have emerged as inexpensive inflammatory biomarkers, although their role in predicting hypoxemia during OLV remains unclear. This study evaluated the association between preoperative NLR, PLR, and severe intraoperative hypoxemia during OLV. (2) This interim analysis included 103 patients undergoing elective thoracic surgery with OLV in a prospective observational cohort. Severe hypoxemia was defined as PaO₂/FiO₂ < 100. Group comparisons were performed using Mann–Whitney U and chi-square/Fisher’s exact tests. Hierarchical logistic regression and ROC analysis were used to evaluate predictors and model performance. (3) Results: Preoperative PLR significantly improved the predictive performance of the clinical model for severe intraoperative hypoxemia, while NLR was not associated with the outcome. BMI remained an independent predictor of hypoxemia. (4) Conclusions: PLR improved the predictive performance of the clinical model, although its inverse association with hypoxemia should be interpreted cautiously. NLR was not associated with hypoxemia during OLV. Full article

While individual determinants of students’ well-being are well established, less is known about the association with the institutional context. This study evaluates institutional-level factors associated with students’ mental health while controlling for individual characteristics. The cross-sectional analysis used data from 12 German institutions (n = 13,715) collected in the StudiBiFra survey on study conditions and student mental health. Individual-level variables included gender, age, study subject group, and four mental health variables (general well-being, depressiveness, cognitive stress, and exhaustion). Institution-level variables comprised institution type, excellence status, multi-campus structure, size, and satisfaction with the quality of health promotion services. Multilevel binary logistic regression models were applied to examine associations between institutional characteristics and mental health outcomes, adjusting for individual factors. Students enrolled at universities of applied sciences showed a lower likelihood of reporting depressiveness and exhaustion. Higher levels of depressiveness and cognitive stress were observed among students at medium-sized institutions compared to small ones. Students not enrolled at institutions with excellence status had lower risks of depressiveness, stress, and exhaustion. Additionally, higher satisfaction with institutional health promotion services was associated with reduced odds of depressiveness. Institutional factors are related to students’ mental health beyond individual characteristics, highlighting the need for a holistic, setting-based approach. Full article

This paper proposes an integrated formation control framework with a finite-time nonlinear disturbance observer (FT-NDO) for automated guided vehicles (AGVs) operating in port environments, where constrained workspace, narrow formation spacing, and complex external disturbances pose significant challenges. An adaptive leader–follower formation strategy with dynamic inter-vehicle spacing is developed to enhance maneuverability during turning. Within a hierarchical control structure that decouples lateral and longitudinal dynamics, two sliding mode controllers (SMCs) are designed: (a) a lateral SMC that prioritizes heading accuracy, limiting yaw angle error to within ±2°; and (b) a nonsingular terminal SMC (NTSMC) for longitudinal control, improving error convergence speed compared to conventional SMC. An FT-NDO is further incorporated into both control loops to estimate and compensate for external disturbances in real time, achieving a disturbance estimation accuracy of over 95% and significantly attenuating the impact of environmental disturbances. Validation through simulation and physical experiment of a dual-AGV formation in a realistic port scenario demonstrates that the proposed approach restricts formation deviation to 0.015 m and maintains stable operation under various disturbance conditions. This study provides a practical solution for dual-AGV collaborative transportation in spatially constrained and dynamically disturbed environments, with direct implications for improving operational efficiency and safety in port logistics. Full article