Search Results (36)

Background: The emergence of telehealth has transformed healthcare delivery across multiple disciplines, with tele-nutrition representing a rapidly evolving field that addresses nutritional assessment, counseling, and management through digital platforms. Objective: This narrative review examines the current landscape of pediatric tele-nutrition services, exploring technological platforms, clinical applications, evidence for effectiveness, implementation considerations, and future directions. Methods: A comprehensive literature search was conducted across PubMed, CINAHL, Embase, and Web of Science databases from January 2010 to October 2025. A total of 114 relevant sources were selected, encompassing randomized controlled trials, observational studies, systematic reviews, implementation studies, clinical guidelines, and policy documents. Results: This review synthesized 114 sources, predominantly from the United States (54%) and European nations (21%), with evidence expansion accelerating post-COVID-19 pandemic. Evidence suggests pediatric tele-nutrition demonstrates clinical outcomes comparable to traditional in-person care across diverse populations including obesity management, diabetes, gastrointestinal disorders, feeding difficulties, metabolic conditions, and preventive nutrition services. Multiple technology platforms are utilized, with synchronous video consultations most common (60–85% of encounters). Benefits include enhanced access to specialized care, increased frequency of contact, reduced family burden, and high satisfaction rates (>80% across most studies). Challenges include limitations in physical assessment, digital equity concerns affecting vulnerable populations, variable reimbursement policies, and the need for provider training. Hybrid models combining virtual and in-person care appear optimal for many conditions. Conclusions: Pediatric tele-nutrition represents a viable and effective care delivery model with particular advantages for families facing geographic, logistic, or access barriers. Continued attention to digital equity, provider training, regulatory frameworks, sustainable reimbursement policies, and rigorous evidence generation will optimize implementation and outcomes. Future directions include artificial intelligence applications, precision nutrition approaches, and expanded global health applications. Full article

Vehicular Ad Hoc Networks (VANETs) encounter significant hurdles in anomaly detection owing to their dynamic characteristics, scalability demands, and privacy issues. This research presents a new Adaptive Cluster-Based Federated Learning (ACFL) architecture to tackle these challenges. In contrast to conventional machine learning models, the ACFL framework dynamically organizes cars through the Context-Aware Cluster Manager (CACM), which adjusts clusters according to real-time variables like mobility, node density, and communication patterns. Each cluster utilizes Modified Temporal Neural Networks (MTNNs) for localized anomaly detection, employing time-series analysis to improve precision. Federated learning is enabled via the Hierarchical Aggregation Layer (HAL), which effectively consolidates updates across clusters, ensuring scalability and data confidentiality. The proposed framework was assessed in comparison to established machine learning models, including Support Vector Machines (SVM), Random Forest (RF), Logistic Regression (LR), K-Nearest Neighbor (KNN), and the K-Nearest Neighbors with Kernelized Feature Selection and Clustering(KNN-KFSC) approach, utilizing the VeReMi dataset. Findings demonstrate that ACFL surpasses existing models in identifying abnormalities, including Global Positioning System(GPS)spoofing and Denial of Service (DoS) assaults, exhibiting enhanced accuracy, adaptability, and scalability. This work emphasizes the capability of ACFL to tackle urgent security issues in VANET, facilitating the development of secure next-generation intelligent transportation systems. Full article

E-commerce platforms offering regional fresh produce often face a trade-off between logistics costs and product quality. Due to limited use of cold chain logistics, consumers frequently receive damaged goods, resulting in negative post-purchase experiences. This study examines how logistics service encounters, as reflected in consumer reviews, influence subsequent purchase behaviour, and how the alignment between review images and text moderates this relationship. We analyse sales and review data from 694 fruit products on Tmall between February and April 2024. Latent Dirichlet Allocation (LDA) is applied to extract logistics-related review content. At the same time, image–text similarity is assessed using the Chinese-CLIP model. Regression analysis reveals that positive logistics service encounters significantly enhance purchase intention. However, high image–text similarity weakens this positive effect, suggesting that overly repetitive content may reduce informational value for prospective buyers. These findings advance understanding of consumer behaviour in online fresh produce markets by highlighting the interactive effects of logistics experiences and user-generated content. The results offer practical implications for improving logistics services, enhancing content diversity in review systems, and increasing consumer trust in e-commerce environments. Full article

Background/Objectives: Violence is a significant occupational health issue for paramedics, yet underreporting limits efforts to identify and mitigate risk. Leveraging a novel, point-of-event violence reporting system, we aimed to identify characteristics of 9-1-1 calls associated with an increased risk of violence in a single paramedic service in Ontario, Canada. Methods: We retrospectively analyzed all electronic violence and patient care reports filed by paramedics in Peel Region and used logistic regression to identify call-level predictors of any violence and, more specifically, physical or sexual assault. Results: In total, 374 paramedics filed 974 violence reports, 40% of which documented an assault, corresponding to a rate of 4.18 violent encounters per 1000 9-1-1 calls. In adjusted models, the risk of violence was elevated for calls originating from non-residential locations (e.g., streets, hotels, bars), occurring during afternoon or overnight shifts, and involving young or working-age males. Presenting problems related to intoxication, mental health, or altered mental status were strongly associated with increased risk, with particularly high adjusted odds ratios for assault. Conclusions: These findings support the utility of near-miss and violence surveillance systems and highlight the need for multidisciplinary crisis response to high-risk calls, especially those involving mental health or substance use. Full article

Background/Objectives: This retrospective cohort study compared well-child visits (WCVs) and immunization encounters from birth to age three among rural and urban South Carolina (SC) Medicaid-enrolled children with neonatal opioid withdrawal syndrome (NOWS). Methods: We applied logistic and Poisson regression models to examine associations between rural status and the number of WCVs, WCV adherence, and immunization encounters. Results: The sample included 833 urban and 161 rural children with NOWS born between 2006 and 2014. Significant differences existed between groups in the number of WCVs and immunization encounters each year from birth to age three (p = < 0.01 for all the comparisons). After covariate adjustment, rural compared to urban status was associated with decreased WCVs from birth to 11 months (incidence rate ratio (IRR): 0.85; 95% CI: 0.77–0.93) and 12 to 23 months (IRR: 0.80; 95% CI: 0.69–0.93). Rural status was not significantly associated with decreased WCVs from 24 to 35 months (IRR: 0.81; 95% CI: 0.63–1.03). Rural compared to urban status was associated with a 34% lower odds of WCV adherence from 12 to 23 months (odds ratio (OR): 0.66; 95% CI: 0.44–0.99). Furthermore, rural compared to urban status was associated with decreased immunization encounters from birth to 11 months (IRR: 0.60; 95% CI: 0.52–0.69), 12 to 23 months (IRR: 0.61; 95% CI: 0.50–0.71), and 24 to 35 months (IRR: 0.55; 95% CI: 0.40–0.76). Conclusions: Rurality was associated with decreased WCVs and immunization encounters among children with a history of NOWS residing in SC. Policy interventions, including telehealth services and expanded Medicaid access, could improve WCV and immunization rates among these children. Full article

Background/Objectives: The outbreak of coronavirus disease 2019 (COVID-19) has restricted access to healthcare, increasing the risk of poor disease control among patients with COPD (Chronic Obstructive Pulmonary Disease). This study aimed to compare adherence to inhalers in patients with COPD before and during the COVID-19 lockdown and determine the characteristics of patients who were adherent to inhaler medications. Method: A retrospective analysis was conducted on a cohort of patients with severe COPD aged 40 or older using South Korea’s National Health Insurance Service (NHIS) database, which documents all healthcare utilization covered for insured individuals. Medication adherence, measured by the proportion of days covered (PDC), was compared before and during the COVID-19 lockdown using a paired t-test. A multivariable logistic regression model was conducted to identify the characteristics of the adherent patients (socio-demographic, including age, sex, income level, insurance type, and residential area), health-conditions (disease severity, underlying diseases, and disability), and pharmacotherapy characteristics (prescriber practice setting, polypharmacy, medication treatment duration, and inhaler type). Result: A total of 15,971 COPD patients were identified (79.2% men). During the COVID-19 lockdown in 2020, there was a significant decrease in medication adherence to COPD inhalers compared to 2019 (49.8% in 2020 vs. 56.3% in 2019, respectively; p < 0.001). Moreover, the proportion of those adherent (≥80%) during the COVID-19 lockdown decreased (22.0% → 18.0%). Patients who remained adherent to inhaler therapy during the COVID-19 lockdown were typically aged in their 60s, beneficiaries of Medical Aid, residents of rural areas, clinic users, and patients without cardiovascular disease. Conclusions: Patients with COPD encountered significant challenges in accessing inhalers during the COVID-19 lockdown. Healthcare authorities should develop targeted strategies to ensure continued medication access for patients at increased risk of poor medication adherence, particularly during periods of restricted healthcare access, such as public health emergencies or pandemic lockdowns. Full article

Background/Objectives: Pediatric postoperative respiratory failure in the United States is increasingly considered a significant adverse event due to the increased risk of co-morbidities, suffering, and cost of healthcare. This study investigates associations between pediatric adverse events (PAEs) and hospital and patient characteristics within the inpatient hospital setting, focusing solely on the framework of pediatric quality indicators (PDIs) from the Agency for Healthcare Research and Quality (AHRQ). Specifically, the study focuses on PDI 09-Postoperative Respiratory Failure (PORF). Methods: This quantitative research analyzed the inpatient discharge data from the Healthcare Cost and Utilization Project (HCUP) Kids’ Inpatient Databases (KID) for 2019. We performed multivariate logistic regression to analyze patient-level encounters with PORF. Results: The results indicate that smaller, rural, and non-teaching hospitals exhibit significantly lower odds of PDI 09 than large, urban, and urban teaching hospitals, reflecting a concentration of operative procedures. In comparison, the Western United States exhibits higher odds of PDI 09. Various individual factors such as gender, age, race, service lines, payment sources, and major operating room procedures demonstrate differing levels of significance concerning PDI 09, warranting further investigation into confounding factors. In contrast, hospital ownership consistently shows lower odds of PORF risk for private, investor-owned hospitals. Conclusions: This study provides contextual expansion on the findings and offers valuable insights into PAEs in the inpatient hospital setting. It highlights areas for developing evidence-based interventions and guidelines for clinicians and policymakers. Ultimately, the findings contribute to the growing understanding of factors influencing PORF and emphasize the importance of targeted strategies for improving pediatric patient safety. Full article

The use of electric vehicles in urban transportation is increasing daily due to their energy efficiency and environmental friendliness. In last-mile logistics, route optimization must consider charging station locations while balancing operational costs and customer satisfaction. In this context, solutions for cost-oriented route optimization have been presented in the literature. On the other hand, customer satisfaction is also important for third-party logistics companies. This study discusses the Capacitated Electric Vehicle Routing Problem with Time Windows (CEVRPTW) encountered in last-mile logistics. This article defines the objective function of minimizing total tardiness and compares the routes between the service provider logistics company and the customer receiving the service. In this study, the CEVRPTW was solved for the minimum total tardiness objective function with the hybrid adaptive large neighborhood search (ALNS) algorithm. The success of ALNS was proven by comparing the differences between the optimal solutions obtained with the CPLEX Solver and the ALNS solutions. Tardiness objective function-specific operators for ALNS are proposed and supported by local search and VNS algorithms. The findings of this study contribute to the literature by analyzing the balance trade-offs between customer-oriented and cost-oriented and the effect of time windows on the number of vehicles. Full article

Puerto Rico has faced significant damage from natural disasters and the COVID-19 pandemic, disrupting clinical services and scientific research logistics. In response, the RCMI-CCRHD Program at the UPR-MSC organized a retreat with the objective of understanding the challenges faced by its research network during the pandemic and strategies to overcome them. The retreat featured presentations on COVID-19 supplemental projects and included a discussion group. Twenty attendees identified the challenges they encountered and the strategies developed through an open-ended question and a satisfaction survey, implementing a mixed-method approach. We performed a content analysis on the open-ended survey questions and used descriptive statistics for the satisfaction survey. Key challenges included remote work implementation, recruitment difficulties, and mental health concerns. Attendees shared actions taken to address these issues, such as modifying protocols for remote planning and using digital platforms for improving communication. They also recognized opportunities that arose from remote work, which allowed them to focus on publishing and adapting mental health support tools. The retreat received positive feedback, with 93.8% of attendees giving a five-star rating. By reflecting on these experiences, investigators can refine strategies and implement effective solutions. Recommendations include flexible IRB protocols, improved digital tools, community involvement, and robust emergency preparedness plans. Full article

Background: Biography writing services are increasingly being used with adult palliative care patients, helping them document their stories in a way that provides meaning for themselves, family, and friends. However, the feasibility of applying a biography program to a pediatric palliative care context is less well known. Methods: A narrative review of the literature was conducted, drawing on existing adult biography programs, while noting differences between the pediatric and adult contexts. The Story Project is outlined in this manuscript as an example of a pediatric biography writing approach, with pilot survey data from six volunteer biographers presented. Thematic analysis was conducted on qualitative data elicited from volunteer biographers regarding challenges experienced and the perceived benefits of the program. Descriptive information is provided for other aspects of their experience of the Story Project. Results: The challenges identified by the volunteer biographers were grouped into seven themes, namely, (1) delays encountered, (2) rapport/interactions with family, (3) family distress, (4) logistics, (5) transcribing-specific issues, (6) identifying themes, and (7) finalizing the biography. The perceived benefits of the Story Project, as perceived by the volunteer biographers, were grouped into four main themes: (1) beneficial processes for families, (2) benefits for the volunteers, (3) intrinsic value of the final product, and (4) beneficial uses of the product. Biographies took between 3–20 months to complete, with most taking 12 months or less. Conclusions: Biography writing is a potentially valuable approach for use with pediatric palliative care patients and their families, with the Story Project being one example of such an intervention, with promising early feasibility data. Full article

In today’s digital era, the abundance of online services presents users with a daunting array of choices, spanning from streaming platforms to e-commerce websites, leading to decision fatigue. Recommendation algorithms play a pivotal role in aiding users in navigating this plethora of options, among which collaborative filtering (CF) stands out as a prevalent technique. However, CF encounters several challenges, including scalability issues, privacy implications, and the well-known cold start problem. This study endeavors to mitigate the cold start problem by harnessing the capabilities of natural language processing (NLP) applied to user-generated reviews. A unique methodology is introduced, integrating both supervised and unsupervised NLP approaches facilitated by sci-kit learn, utilizing benchmark datasets across diverse domains. This study offers scientific contributions through its novel approach, ensuring rigor, precision, scalability, and real-world relevance. It tackles the cold start problem in recommendation systems by combining natural language processing (NLP) with machine learning and collaborative filtering techniques, addressing data sparsity effectively. This study emphasizes reproducibility and accuracy while proposing an advanced solution that improves personalization in recommendation models. The proposed NLP-based strategy enhances the quality of user-generated content, consequently refining the accuracy of Collaborative Filtering-Based Recommender Systems (CFBRSs). The authors conducted experiments to test the performance of the proposed approach on benchmark datasets like MovieLens, Jester, Book-Crossing, Last.fm, Amazon Product Reviews, Yelp, Netflix Prize, Goodreads, IMDb (Internet movie Database) Data, CiteULike, Epinions, and Etsy to measure global accuracy, global loss, F-1 Score, and AUC (area under curve) values. Assessment through various techniques such as random forest, Naïve Bayes, and Logistic Regression on heterogeneous benchmark datasets indicates that random forest is the most effective method, achieving an accuracy rate exceeding 90%. Further, the proposed approach received a global accuracy above 95%, a global loss of 1.50%, an F-1 Score of 0.78, and an AUC value of 92%. Furthermore, the experiments conducted on distributed and global differential privacy (GDP) further optimize the system’s efficacy. Full article

Background: This study explores the associations between pediatric adverse events (PAEs) and both hospital and patient characteristics within the inpatient hospital setting, specifically focusing on Neonatal Blood Stream Infection (NBSI) as defined by pediatric quality indicators (PDIs) from the Agency for Healthcare Research and Quality (AHRQ). This research aims to answer questions regarding the relationship between hospital characteristics and patient demographics with the occurrence of NBSI. Methods: This study utilized discharge data from the Healthcare Cost and Utilization Project (HCUP) Kids’ Inpatient Databases (KID) for the year 2019. Bivariate and multivariate logistic regression models were employed to analyze patient-level encounters of NBSIs. The analysis examined various factors including hospital size, location, and teaching status, as well as patient-specific variables such as gender, age, race, service lines, payment sources, and major operating room procedures. Results: The results indicate that Public and Private not-for-profit hospitals showed significantly lower odds of experiencing NBSIs when compared to Private investor-owned hospitals, as did smaller, rural, and nonteaching hospitals when compared to large hospitals. Additionally, individual factors such as gender, age, race, service lines, payment sources, and types of major operating room procedures were found to have varying levels of significance in relation to NBSI. Conclusions: This study provides important insights into PAEs within the inpatient hospital setting, particularly focusing on NBSIs within the PDI framework. The findings highlight critical areas for the development of evidence-based interventions and guidelines, which are essential for clinicians and policymakers. Ultimately, this study contributes to the understanding and improvement of pediatric patient safety by emphasizing the necessity for targeted strategies to mitigate the risk of NBSI. Full article

The booming development of e-commerce has promoted the diversified development of logistics distribution services (LDS). For LDS, e-commerce retailers (e-retailers) often choose either the outsourced logistics distribution services strategy (OLDSS) or the self-built logistics distribution services strategy (SBLDSS). Although there are problems such as products getting lost and damaged during the logistics distribution process, the high transparency and traceability characteristics of blockchain technology (BT) can help solve the problem of products being lost and damaged in the logistics distribution process. However, due to the high cost of BT, e-retailers may encounter reduced sales, which causes the supply chain corporate profits to decrease. To encourage the BT investment enthusiasm of the e-retailers and regulate corporate profits, the government implements subsidies for e-retailers’ BT, namely, the government blockchain subsidy (GBS). In addition, in recent years, environmental degradation has become increasingly severe, causing negative impacts on people’s lives. To promote sustainable development, we use variational inequality to establish an e-commerce closed-loop supply chain (E-CLSC) network equilibrium model in which the network equilibrium decisions of e-retailers choosing the OLDSS and those choosing the SBLDSS are obtained. Then, we analyze the impact of the BT input cost and the GBS quota on equilibrium decisions by studying their properties and verifying the theoretical results by performing numerical examples. Finally, we analyze the profits of the e-retailers to obtain the impact of the BT input cost and the GBS quota on e-retailers’ choice of the optimal LDS strategy; in this way, we provide a scientific basis for e-retailers to choose the optimal LDS strategy. The results show that increasing the BT input costs reduces e-retailers’ product sales under the two LDS strategies, which decreases the production rate and the recovery rate of the products. When the BT input cost is low, SBLDSS is the best choice for e-retailers. When the BT input cost is high, OLDSS is the best choice for e-retailers. Moreover, there is a positive correlation between GBS and e-retailers’ product sales; thus, GBS is conducive to expanding market demand, regulating the profits of manufacturers, increasing the e-retailers’ profits, improving the enthusiasm of the e-retailers for BT investment, and promoting the overall development of supply chain enterprises. For e-retailers, choosing the OLDSS can lead to a better development of the E-CLSC. Full article

Pesticide residues are a significant problem affecting the quality and safety of agricultural products in Turkey. This study aims to investigate farmers’ risk perception regarding pesticide residues, including the primary factors that influence their behavior from the farmers’ perspective. In addition, the main characteristics of pesticide residues encountered in the production of agricultural products against the current policy background is investigated to provide decision support to the Turkish government for improving the safe production of agricultural products. This paper uses a binary logistic model to analyze farmers’ perceptions of pesticide residues using a cross-sectional dataset of 323 vegetable growers in Bursa, Turkey. Farmer characteristics and pesticide application behavior were more effective in reducing residual risk perceptions than farm characteristics. The effects of membership in a cooperative, average amount of pesticide used, location where the pesticide was purchased, application timing, and adherence to last spraying and harvest timing on the perception of residues were the largest. Farmers receive helpful but limited information from pesticide distributors. However, the primary source of information is not the advisors, which is why these grievances exist. The study results show that policymakers should support cooperatives, expand pesticide training, and make public extension services more effective and that pesticide dealers should conduct more frequent inspections. Full article

Introduction: Palliative care (PC) utilization remains low among pancreatic cancer patients. This study explores the association of PC with mental health service and pharmacotherapy utilization among pancreatic cancer patients. Methods: Retrospective analysis was conducted on a sample of patients in the United States with newly diagnosed pancreatic cancer using Electronic Health Record data from Optum’s Integrated Claims-Clinical data set. Subsequent diagnoses of anxiety and depression and PC consultation encounters were determined using ICD-9/10 codes. Adjusted associations of mental health treatments with PC and patient characteristics were quantified using multiple logistic regression. Results: Among newly diagnosed pancreatic cancer patients (n = 4029), those with PC consultations exhibited a higher prevalence of anxiety (33.9% vs. 22.8%) and depression (36.2% vs. 23.2%). Mental health service use and pharmacotherapy varied, with the highest utilization among patients having both anxiety and depression. Treatment pattern was also influenced by age (aOR 1.832 for age <55 vs. 65–70 years). Notably, PC consultations showed no significant effect on the likelihood of documented treatment. Discussion: Our study emphasizes underutilization of PC and MH treatment for pancreatic cancer patients. These findings imply a crucial need for further investigation into palliative care’s role in addressing mental health concerns among pancreatic cancer patients. Full article