Search Results (8,226)

Objective: This study aimed to develop a performance evaluation index system for a district-level public hospital in Chongqing, China, based on Diagnosis-Related Groups (DRGs), to provide a benchmark for performance assessment in similar hospitals. The system was constructed using a literature analysis, the Delphi method, and the Analytic Hierarchy Process (AHP) to identify and weight relevant indicators. Results: The evaluation system consists of three primary indicators and eighteen secondary indicators. Key secondary indicators include the Case Mix Index (CMI), cost consumption index, low-risk group mortality rate, the proportion of patients with three- or four-level surgeries at discharge, and the proportion of medical service revenue to medical income. In 2020, significant improvements were observed in several indicators, such as a decrease in the low-risk group mortality rate to 0% and increases in the proportion of patients with three- or four-level surgeries and CMI by nearly 10% and 13%, respectively. Conclusions: This study successfully developed a comprehensive and scientifically sound performance evaluation index system for a district-level public hospital in Chongqing. The system has proven effective in objectively assessing inpatient medical care performance and providing valuable guidance for improving healthcare services in similar settings. Full article

Urban vegetation monitoring is essential for sustainable city planning but is often constrained by the high cost and limited frequency of field-based inventories. This study evaluates the use of the Normalized Difference Vegetation Index (NDVI), derived from Sino-Brazilian CBERS-4A satellite imagery, as a spatially explicit and low-cost proxy for urban tree census data. CBERS-4A provides medium-resolution multispectral data freely accessible across South America, yet remains underutilized in urban environmental applications. Focusing on Aracaju, a metropolitan region in northeastern Brazil, we compared NDVI-based classification results with official municipal tree census data from 2022. The analysis revealed a strong spatial correlation, supporting the use of NDVI as a reliable indicator of canopy presence at the urban block scale. In addition to mapping vegetation distribution, the NDVI results identified areas with insufficient canopy coverage, directly informing urban greening priorities. By validating remote sensing data against field inventories, this study demonstrates how CBERS-4A imagery and vegetation indices can support municipal tree management and serve as scalable tools for environmental planning and policy. Full article

Background/Objectives: An influenza pandemic is likely to occur in the coming decades and will be associated with substantial healthcare and financial burdens. In this study, we evaluated the potential economic costs of different vaccination scenarios for the US population in the context of a moderate or severe influenza pandemic. Methods: Economic analysis was performed for initiation of pandemic vaccination from 3 months vs. 6 months in the US after declaration of a pandemic. We evaluated three vaccine effectiveness levels (high, moderate, low) and two pandemic severity levels (moderate and severe). Results: No vaccination would lead to total direct and indirect costs of $116 bn in a moderate pandemic and $823 bn in a severe pandemic. Initiation of vaccination at 3 months would result in cost savings versus no vaccination (excluding vaccine price) of $30–84 bn and $260–709 bn in a moderate and severe pandemic, respectively, whereas initiation of vaccination at 6 months would result in cost savings of $4–11 bn and $36–97 bn, respectively. Cost savings of $20 bn and $162 bn would occur in a moderate or severe pandemic, respectively, from use of a low effectiveness vaccine from 3 months instead of a high effectiveness vaccine from 6 months. Conclusions: Rapid initiation of vaccination would have a greater impact than increased vaccine effectiveness in reducing the economic impacts of an influenza pandemic. Full article

Background: Pain is a complex phenomenon characterized by unpleasant experiences with profound heterogeneity influenced by biological, psychological, and social factors. According to the National Health Interview Survey, 50.2 million U.S. adults (20.5%) experience pain on most days, with the annual cost of prescription medication for pain reaching approximately USD 17.8 billion. Theranostic pain nanomedicine therefore emerges as an attractive analgesic strategy with the potential for increased efficacy, reduced side-effects, and treatment personalization. Theranostic nanomedicine combines drug delivery and diagnostic features, allowing for real-time monitoring of analgesic efficacy in vivo using molecular imaging. However, clinical translation of these nanomedicines are challenging due to complex manufacturing methodologies, lack of standardized quality control, and potentially high costs. Quality by Design (QbD) can navigate these challenges and lead to the development of an optimal pain nanomedicine. Our lab previously reported a macrophage-targeted perfluorocarbon nanoemulsion (PFC NE) that demonstrated analgesic efficacy across multiple rodent pain models in both sexes. Here, we report PFC-free, biphasic nanoemulsions formulated with a biocompatible and non-immunogenic plant-based coconut oil loaded with a COX-2 inhibitor and a clinical-grade, indocyanine green (ICG) near-infrared fluorescent (NIRF) dye for parenteral theranostic analgesic nanomedicine. Methods: Critical process parameters and material attributes were identified through the FMECA (Failure, Modes, Effects, and Criticality Analysis) method and optimized using a 3 × 2 full-factorial design of experiments. We investigated the impact of the oil-to-surfactant ratio (w/w) with three different surfactant systems on the colloidal properties of NE. Small-scale (100 mL) batches were manufactured using sonication and microfluidization, and the final formulation was scaled up to 500 mL with microfluidization. The colloidal stability of NE was assessed using dynamic light scattering (DLS) and drug quantification was conducted through reverse-phase HPLC. An in vitro drug release study was conducted using the dialysis bag method, accompanied by HPLC quantification. The formulation was further evaluated for cell viability, cellular uptake, and COX-2 inhibition in the RAW 264.7 macrophage cell line. Results: Nanoemulsion droplet size increased with a higher oil-to-surfactant ratio (w/w) but was no significant impact by the type of surfactant system used. Thermal cycling and serum stability studies confirmed NE colloidal stability upon exposure to high and low temperatures and biological fluids. We also demonstrated the necessity of a solubilizer for long-term fluorescence stability of ICG. The nanoemulsion showed no cellular toxicity and effectively inhibited PGE2 in activated macrophages. Conclusions: To our knowledge, this is the first instance of a celecoxib-loaded theranostic platform developed using a plant-derived hydrocarbon oil, applying the QbD approach that demonstrated COX-2 inhibition. Full article

The detection of trace chemicals at low and ultra-low concentrations is critical for applications in environmental monitoring, medical diagnostics, food safety and other fields. Conventional detection techniques often lack the required sensitivity, specificity, or cost-effectiveness, making real-time, in situ analysis challenging. Surface-enhanced Raman spectroscopy (SERS) is a powerful analytical tool, offering improved sensitivity through the enhancement of Raman scattering by plasmonic nanostructures. While noble metals such as Ag and Au are currently the reference choices for SERS substrates, fabrication methods should balance enhancement efficiency, reproducibility and scalability. In this study, we propose a novel approach for SERS substrate fabrication using reactive Aerosol Jet Printing (r-AJP) as an innovative additive manufacturing technique. The r-AJP process enables in-flight Ag seed reduction and nucleation of Ag nanoparticles (NPs) by mixing silver nitrate and ascorbic acid aerosols before deposition, as suggested by computational fluid dynamics (CFD) simulations. The resulting coatings were characterized by X-ray diffraction (XRD) and scanning electron microscopy (SEM) analyses, revealing the formation of nanoporous crystalline Ag agglomerates partially covered by residual matter. The as-prepared SERS substrates exhibited remarkable SERS activity, demonstrating a high enhancement factor (10⁶) for rhodamine (R6G) detection. Our findings highlight the potential of r-AJP as a scalable and cost-effective fabrication strategy for next-generation SERS sensors, paving the way for the development of a new additive manufacturing tool for noble metal material deposition. Full article

This paper presents a comprehensive analysis comparing the implementation of electric and diesel buses for public transport services in the low-density area of the City of Jastrebarsko in Croatia. It utilizes a multidimensional approach and incorporates direct and indirect costs, such as vehicle acquisition, operation, charging, maintenance, and environmental impact costs during the lifecycle of the buses. The results show that, despite the higher initial investment in electric buses, these vehicles offer savings, especially when coupled with significantly reduced emissions of pollutants, which decreases indirect costs. However, local contexts differ, leading to a need to revise whether or not a municipality can finance the procurement and operations of such a fleet. The paper utilizes a robust methodological framework, integrating a proposal based on real-world data and demand and combining it with predictive analytics to forecast long-term benefits. The findings of the paper support the introduction of buses as a sustainable solution for Jastrebarsko, which provides insights for public transport planners, urban planners, and policymakers, with a discussion about the specific issues regarding the introduction, procurement, and operations of buses of different propulsion in a low-density area. Full article

The logistics industry faces challenges from evolving consumer expectations, technological advances, sustainability demands, and market disruptions. Logistics collaboration is in theory perceived as one of the most promising solutions to solve these issues, but here are still a lot of challenges that needs to be better understood and addressed. While vertical collaboration among supply chain actors is well advanced, horizontal collaboration among competing service providers remains under-explored. This study developed a novel methodology based on the COM-B behaviour-change framework to better understand the main challenges, opportunities, capabilities and drivers that would motivate competing companies to exploit the potential of horizontal logistics collaboration. A survey was designed and conducted among 71 logistics service providers in Slovenia, chosen for its fragmented market and low willingness to collaborate. Statistical analysis reveals cost reduction (M = 4.21/5) and improved vehicle utilization (M = 4.29/5) as the primary motivators. On the other hand, maintaining company reputation (M = 4.64/5), fair resource sharing (M = 4.20/5), and transparency of logistics processes (M = 4.17/5) all persist as key enabling conditions. These findings underscore the pivotal role of behavioural drivers and suggest strategies that combine economic incentives with targeted trust-building measures. Future research should employ experimental designs in diverse national contexts and integrate vertical–horizontal approaches to validate causal pathways and advance theory. Full article

This study aims to develop an optimal underwriting strategy for affordable (H1 and M1) and premium (L1 and M2) electric vehicles (EVs), balancing financial risk and sustainability commitments. The research is motivated by regulatory pressures, risk management needs, and sustainability goals, necessitating an adaptation of traditional underwriting models. The study employs a modified Delphi method with industry experts to identify key risk factors, including accident risk, repair costs, battery safety, driver behavior, and PCAF carbon impact. A sensitivity analysis was conducted to examine premium adjustments under different risk scenarios, categorizing EVs into four risk segments: Low-Risk, Low-Carbon (L1); Medium-Risk, Low-Carbon (M1); Medium-Risk, High-Carbon (M2); and High-Risk, High-Carbon (H1). Findings indicate that premium EVs (L1 and M2) exhibit lower volatility in underwriting costs, benefiting from advanced safety features, lower accident rates, and reduced carbon attribution penalties. Conversely, budget EVs (H1 and M1) experience higher premium fluctuations due to greater accident risks, costly repairs, and higher carbon costs under PCAF implementation. The worst-case scenario showed a 14.5% premium increase, while the best-case scenario led to a 10.5% premium reduction. The study recommends prioritizing premium EVs for insurance coverage due to their lower underwriting risks and carbon efficiency. For budget EVs, insurers should implement selective underwriting based on safety features, driver risk profiling, and energy efficiency. Additionally, incentive-based pricing such as telematics discounts, green repair incentives, and low-carbon charging rewards can mitigate financial risks and align with net-zero insurance commitments. This research provides a structured framework for insurers to optimize EV underwriting while ensuring long-term profitability and regulatory compliance. Full article

Anion exchange membrane (AEM) water electrolysis is a potentially inexpensive and efficient source of hydrogen production as it uses effective low-cost catalysts. The catalytic activity and performance of nickel iron oxide (NiFeO_x) catalysts for hydrogen production in AEM water electrolyzers were investigated. The NiFeO_x catalysts were synthesized with various iron content weight percentages, and at the stoichiometric ratio for nickel ferrite (NiFe₂O₄). The catalytic activity of NiFeO_x catalyst was evaluated by linear sweep voltammetry (LSV) and chronoamperometry for the oxygen evolution reaction (OER). NiFe₂O₄ showed the highest activity for the OER in a three-electrode system, with 320 mA cm⁻² at 2 V in 1 M KOH solution. NiFe₂O₄ displayed strong stability over a 600 h period at 50 mA cm⁻² in a three-electrode setup, with a degradation rate of 15 μV/h. In single-cell electrolysis using a X-37 T membrane, at 2.2 V in 1 M KOH, the NiFe₂O₄ catalyst had the highest activity of 1100 mA cm⁻² at 45 °C, which increased with the temperature to 1503 mA cm⁻² at 55 °C. The performance of various membranes was examined, and the highest performance of the tested membranes was determined to be that of the Fumatech FAA-3-50 and FAS-50 membranes, implying that membrane performance is strongly correlated with membrane conductivity. The obtained Nyquist plots and equivalent circuit analysis were used to determine cell resistances. It was found that ohmic resistance decreases with an increase in temperature from 45 °C to 55 °C, implying the positive effect of temperature on AEM electrolysis. The FAA-3-50 and FAS-50 membranes were determined to have lower activation and ohmic resistances, indicative of higher conductivity and faster membrane charge transfer. NiFe₂O₄ in an AEM water electrolyzer displayed strong stability, with a voltage degradation rate of 0.833 mV/h over the 12 h durability test. Full article

Landslides are among the most hazardous natural phenomena affecting Greater Abidjan, causing significant economic and social damage. Strategic planning supported by geographic information systems (GIS) can help mitigate potential losses and enhance disaster resilience. This study evaluates landslide susceptibility using logistic regression and frequency ratio models. The analysis is based on a dataset comprising 54 mapped landslide scarps collected from June 2015 to July 2023, along with 16 thematic predictor variables, including altitude, slope, aspect, profile curvature, plan curvature, drainage area, distance to the drainage network, normalized difference vegetation index (NDVI), and an urban-related layer. A high-resolution (5-m) digital elevation model (DEM), derived from multiple data sources, supports the spatial analysis. The landslide inventory was randomly divided into two subsets: 80% for model calibration and 20% for validation. After optimization and statistical testing, the selected thematic layers were integrated to produce a susceptibility map. The results indicate that 6.3% (0.7 km²) of the study area is classified as very highly susceptible. The proportion of the sample (61.2%) in this class had a frequency ratio estimated to be 20.2. Among the predictive indicators, altitude, slope, SE, S, NW, and NDVI were found to have a positive impact on landslide occurrence. Model performance was assessed using the area under the receiver operating characteristic curve (AUC), demonstrating strong predictive capability. These findings can support informed land-use planning and risk reduction strategies in urban areas. Furthermore, the prediction model should be communicated to and understood by local authorities to facilitate disaster management. The cost function was adopted as a novel approach to delineate hazardous zones. Considering the landslide inventory period, the increasing hazard due to climate change, and the intensification of human activities, a reasoned choice of sample size was made. This informed decision enabled the production of an updated prediction map. Optimal thresholds were then derived to classify areas into high- and low-susceptibility categories. The prediction map will be useful to planners in helping them make decisions and implement protective measures. Full article

Multimodal object detection leverages the complementary characteristics of visible (RGB) and infrared (IR) imagery, making it well-suited for challenging scenarios such as low illumination, occlusion, and complex backgrounds. However, most existing fusion-based methods rely on static or heuristic strategies, limiting their adaptability to dynamic environments. To address this limitation, we propose CLSANet, a cognitive learning-based self-adaptive network that enhances detection performance by dynamically selecting and integrating modality-specific features. CLSANet consists of three key modules: (1) a Dominant Modality Identification Module that selects the most informative modality based on global scene analysis; (2) a Modality Enhancement Module that disentangles and strengthens shared and modality-specific representations; and (3) a Self-Adaptive Fusion Module that adjusts fusion weights spatially according to local scene complexity. Compared to existing methods, CLSANet achieves state-of-the-art detection performance with significantly fewer parameters and lower computational cost. Ablation studies further demonstrate the individual effectiveness of each module under different environmental conditions, particularly in low-light and occluded scenes. CLSANet offers a compact, interpretable, and practical solution for multimodal object detection in resource-constrained settings. Full article

Ceramic pastes used in additive manufacturing offer several advantages, including low production costs due to the availability of raw materials and efficient processing methods, as well as a reduced environmental footprint through minimized material waste, optimized resource use, and the inclusion of recyclable or sustainably sourced components. This study evaluates the effect of diatomite content in a ceramic paste composed of carboxymethyl cellulose, kaolinite, and feldspar on its extrusion behavior and thermal conductivity, with additional analysis of its implications for microstructure, mechanical properties, and thermal performance. Four ceramic pastes were prepared with diatomite additions of 0, 10, 30, and 60% by weight. Thermal conductivity, extrusion behavior, morphology, and distribution were examined using scanning electron microscopy (SEM), while thermal degradation was assessed through thermogravimetric analysis (TGA) and differential scanning calorimetry (DSC). The results show that increasing diatomite content leads to a reduction in thermal conductivity, which ranged from 0.719 W/(m·°C) for the control sample to 0.515 W/(m·°C) for the 60% diatomite sample, as well as an improvement in extrusion behavior. The ceramic paste demonstrated adequate extrusion performance for 3D printing at diatomite contents above 30%. These findings lay the groundwork for future research and optimization in the development of functional ceramic pastes for advanced manufacturing applications. Full article

The endoscopic capsule is a miniaturized device used for medical diagnosis, which is less invasive compared to traditional gastrointestinal endoscopy and can reduce patient discomfort. However, it faces challenges in communication transmission, such as high power consumption, serious signal interference, and low data transmission rate. To address these issues, this paper proposes an optimized modulation scheme that is low-cost, low-power, and robust in harsh environments, aiming to improve its transmission rate. The scheme is analyzed in terms of the in-body channel. The analysis and discussion for the scheme in wireless body area networks (WBANs) are divided into three aspects: bit error rate (BER) performance, energy efficiency (EE), and spectrum efficiency (SE), and complexity. These correspond to the following issues: transmission rate, communication quality, and low power consumption. The results demonstrate that the optimized scheme is more suitable for improving the communication performance of endoscopic capsules. Full article

As the global energy transition accelerates, the integration of solar power and artificial intelligence (AI) technologies offers new pathways for sustainable local development. This study examines four Serbian municipalities—Šabac, Sombor, Pirot, and Čačak—to assess how AI-enabled solar power systems can enhance energy resilience, reduce emissions, and support community-level sustainability goals. Using a mixed-method approach combining spatial analysis, predictive modeling, and stakeholder interviews, this research study evaluates the performance and institutional readiness of local governments in terms of implementing intelligent solar infrastructure. Key AI applications included solar potential mapping, demand-side management, and predictive maintenance of photovoltaic (PV) systems. Quantitative results show an improvement >60% in forecasting accuracy, a 64% reduction in system downtime, and a 9.7% increase in energy cost savings. These technical gains were accompanied by positive trends in SDG-aligned indicators, such as improved electricity access and local job creation in the green economy. Despite challenges related to data infrastructure, regulatory gaps, and limited AI literacy, this study finds that institutional coordination and leadership commitment are decisive for successful implementation. The proposed AI–Solar Integration for Local Sustainability (AISILS) framework offers a replicable model for emerging economies. Policy recommendations include investing in foundational digital infrastructure, promoting low-code AI platforms, and aligning AI–solar projects with SDG targets to attract EU and national funding. This study contributes new empirical evidence on the digital–renewable energy nexus in Southeast Europe and underscores the strategic role of AI in accelerating inclusive, data-driven energy transitions at the municipal level. Full article

Accurate diagnosis of gastrointestinal (GI) diseases typically requires invasive procedures or imaging studies that pose the risk of various post-procedural complications or involve radiation exposure. Bowel sounds (BSs), though typically described during a GI-focused physical exam, are highly inaccurate and variable, with low clinical value in diagnosis. Interpretation of the acoustic characteristics of BSs, i.e., using a phonoenterogram (PEG), may aid in diagnosing various GI conditions non-invasively. Use of artificial intelligence (AI) and improvements in computational analysis can enhance the use of PEGs in different GI diseases and lead to a non-invasive, cost-effective diagnostic modality that has not been explored before. The purpose of this work was to develop an automated AI model, You Only Listen Once (YOLO), to detect prominent bowel sounds that can enable real-time analysis for future GI disease detection and diagnosis. A total of 110 2-minute PEGs sampled at 44.1 kHz were recorded using the Eko DUO^® stethoscope from eight healthy volunteers at two locations, namely, left upper quadrant (LUQ) and right lower quadrant (RLQ) after IRB approval. The datasets were annotated by trained physicians, categorizing BSs as prominent or obscure using version 1.7 of Label Studio Software^®. Each BS recording was split up into 375 ms segments with 200 ms overlap for real-time BS detection. Each segment was binned based on whether it contained a prominent BS, resulting in a dataset of 36,149 non-prominent segments and 6435 prominent segments. Our dataset was divided into training, validation, and test sets (60/20/20% split). A 1D-CNN augmented transformer was trained to classify these segments via the input of Mel-frequency cepstral coefficients. The developed AI model achieved area under the receiver operating curve (ROC) of 0.92, accuracy of 86.6%, precision of 86.85%, and recall of 86.08%. This shows that the 1D-CNN augmented transformer with Mel-frequency cepstral coefficients achieved creditable performance metrics, signifying the YOLO model’s capability to classify prominent bowel sounds that can be further analyzed for various GI diseases. This proof-of-concept study in healthy volunteers demonstrates that automated BS detection can pave the way for developing more intuitive and efficient AI-PEG devices that can be trained and utilized to diagnose various GI conditions. To ensure the robustness and generalizability of these findings, further investigations encompassing a broader cohort, inclusive of both healthy and disease states are needed. Full article