Search Results (32,565)

Background/Objectives: Exclusive breastfeeding offers optimal benefits for infant nutrition and health and increases maternal involvement, bonding and interactions. This study aimed to explore breastfeeding practices among mothers in Romania and identify risk factors associated with low exclusive breastfeeding rates. Methods: A cross-sectional online survey was conducted between September and December 2025, targeting mothers in Romania via social media platforms. The questionnaire, developed specifically for this study, collected data on sociodemographic characteristics, birth and neonatology variables, hospital practices, feeding intentions, community influences, and breastfeeding outcomes. Responses were analyzed using Fisher’s exact tests and multivariable logistic regression. Results: A total of 357 complete questionnaires were analyzed. Cesarean section was the most frequent mode of delivery (54.6%), while immediate mother–infant contact after birth was reported by only 35.6% of mothers, and breastfeeding initiation within the first hour occurred in 10.6% of cases. Overall, 49.3% of mothers reported exclusive breastfeeding, 35.3% mixed feeding, and 15.4% exclusive formula feeding. Women who delivered in private hospitals reported earlier mother–infant contact, more frequent encouragement to initiate breastfeeding, and earlier breastfeeding initiation compared with those delivering in public hospitals. Preterm birth was associated with delayed breastfeeding initiation, reduced rooming-in, and lower rates of exclusive breastfeeding up to six months. In multivariable logistic regression, rooming-in was independently associated with higher odds of exclusive breastfeeding (aOR = 2.798, 95% CI: 1.779–4.401), while lack of lactation support was associated with lower odds (aOR = 0.546, 95% CI: 0.302–0.987). No significant associations were observed for timing of initial maternal–infant contact (aOR = 1.084, 95% CI: 0.679–1.733) or encouragement from medical staff to initiate breastfeeding (aOR = 1.207, 95% CI: 0.721–2.020). Conclusions: Our study highlights current breastfeeding practices and associated hospital factors in Romania. However, significant challenges remain in supporting and encouraging mothers to optimally feed their infants. Additional investment and bold policy action are needed to promote and support breastfeeding from the first hour of life, for both term and preterm infants, in all maternity hospitals in Romania. Full article

Flood risk assessment is essential for flood control and disaster mitigation in arid and semi-arid river basins, where conventional univariate and bivariate frequency analyses struggle to capture nonlinear dependence among flood variables and often underestimate extreme synergistic risks. This study focuses on the Wulanmulun River Basin in Inner Mongolia and employs long-term observations from the Zuanlongwan and Wangdaohengta hydrological stations. A trivariate D-vine Copula model was constructed to jointly characterize peak discharge, total flood volume, and water level. Optimal vine structures differ between the stations (Qp–H–W and W–Qp–H) and outperform traditional Copula models in representing extreme joint risks. The ternary joint return periods reveal two distinct flood risk transmission modes, “jump” and “accumulation”, and joint exceedance probabilities under low, medium, high, and ultra-high-risk scenarios are 6.4%, 31.95%, 37.64%, and 5.75% at Zuanlongwan, and 4.7%, 35.24%, 45.78%, and 0.53% at Wangdaohengta, indicating concentration in medium-to-high risk ranges. The validation at Longtouguai Station showed an error RSME of 0.0630 and an R² of 0.905, confirming the reliability of the model framework. These results indicate that the proposed framework can effectively capture multivariate flood dependencies and provide a scientific basis for flood control design, risk zoning, and emergency management of small and medium rivers in arid and semi-arid regions. Full article

Background and Objectives: Breast cancer surgery is increasingly performed in older patients with multimorbidity, in whom cardiovascular disease and frailty may substantially modify perioperative risk, including vulnerability to heart failure decompensation and other major medical complications. However, most available studies report global perioperative complication rates and composite medical endpoints, with heart failure events only rarely captured as dedicated outcomes, and operative technique, cardiovascular comorbidity, and frailty are often treated as separate domains rather than components of an integrated risk framework. Materials and Methods: We conducted a systematized narrative review with a structured literature search in PubMed/MEDLINE, Scopus, and Web of Science from inception to 31 January 2026, including original studies of adult patients undergoing breast-conserving surgery, mastectomy, and/or reconstruction that reported early postoperative outcomes in relation to comorbidities, cardiovascular risk, or frailty. Eligibility assessment, data extraction, and qualitative synthesis followed key PRISMA 2020 principles, and findings were organized into three prespecified domains: surgical complexity, cardiovascular vulnerability (including patients with heart failure where reported), and frailty. Results: Nineteen studies (retrospective cohorts, registry-based analyses, and large database studies, primarily ACS NSQIP) met inclusion criteria, encompassing diverse breast surgery populations, including elderly, metastatic, and reconstructive cohorts. Across datasets, escalation from breast-conserving surgery to mastectomy and then to increasingly complex reconstruction was associated with a stepwise increase in perioperative complications, reoperations, bleeding, and, in selected series, catastrophic events. Preexisting cardiovascular disease and systemic vascular pathology significantly amplified postoperative morbidity even in procedures considered low or intermediate cardiac risk, with signals that patients with underlying heart failure carry particularly heightened vulnerability, although HF-specific events were infrequently reported as separate endpoints. Frailty, mainly assessed using modified frailty indices, consistently emerged as a strong, age-independent predictor of 30-day complications, mortality, and readmissions across surgical types, including both breast-conserving and reconstructive procedures. Conclusions: Early postoperative outcomes after breast cancer surgery are associated with the interaction between surgical complexity, cardiovascular comorbidity (with limited HF-specific reporting), and frailty rather than by operative technique alone. In this context, our synthesis primarily reflects overall cardiovascular vulnerability in comorbid and frail patients, with heart failure risk inferred indirectly from the available data. These findings support a patient-centered, risk-adapted surgical strategy in which the extent and timing of surgery and reconstruction are tailored to each patient’s cardiovascular profile and frailty status, with preferential use of breast-conserving or less complex procedures in vulnerable individuals. Integrating standardized frailty assessment and cardio-oncologic evaluation into preoperative workflows, and prospectively validating this tri-axial framework in dedicated cohorts, may improve perioperative risk stratification and reduce the burden of postoperative medical complications in an aging breast cancer population. Full article

Background/Objectives: Uncorrected refractive errors (UREs) are a primary cause of preventable visual impairment in children globally, impacting education and quality of life. In Jakarta, prevalence has surged to 40% post-pandemic, categorizing it as a serious public health problem. This study aimed to develop and validate the CIPSEL questionnaire as a rapid, culturally adapted screening tool for identifying visual impairment consistent with possible UREs among Indonesian school-aged children. Methods: A cross-sectional study was conducted in South Jakarta with 131 students aged 8–12 years. The 10-item CIPSEL questionnaire, exploring visual behaviors and symptoms, was administered via face-to-face interviews. Visual acuity was assessed using a standard Snellen chart by medical personnel blinded to the questionnaire results. Diagnostic accuracy was assessed using receiver operating characteristic (ROC) curve analysis, with optimal thresholds determined via the Youden Index and the shortest distance to (0, 1). Results: Visual impairment was identified in 26 students (19.8%). Mean CIPSEL scores were significantly higher in students with visual impairment (4.73) compared to those with normal vision (1.95). ROC analysis showed considerable diagnostic accuracy with an AUC of 0.887 (95% CI: 0.829–0.946). A safety-first cutoff of 2.5 prioritized sensitivity (96.2%), while a balanced cutoff of 3.5 provided 80.8% sensitivity and 79.0% specificity. A tiered risk system (Low, Medium, and High) demonstrated a robust statistical association with actual clinical findings (Cramer’s V = 0.534, p < 0.001). Conclusions: CIPSEL is a reliable and scalable screening tool for the early detection of visual impairment in Indonesian children. Its tiered risk stratification framework facilitates nuanced clinical decision-making and efficient resource allocation in school-based settings. Its accessibility for non-medical personnel and potential for digital integration support national efforts toward universal eye health. Full article

Background/Objectives: Effective cardiovascular prevention requires improved risk perception and appropriate communication strategies that support cost-effective interventions. This study evaluated one-year changes in cardiovascular risk estimation accuracy and examined associations between communication strategies, accuracy, and health outcomes. Methods: We analyzed 200 participants (mean age: 56.06 ± 6.26; 32.2% male) in a population-based study conducted in Hungary. Cardiovascular risk was calculated using the Framingham Risk Score based on laboratory and anthropometric measures, and subjective risk perception was assessed and categorized as realistic, optimistic, or pessimistic relative to objective risk. All participants received written risk feedback, while subgroups additionally participated in individual or group-based risk communication. Results: After 12 months, the proportion of participants with accurate risk perception increased from 39.0% to 50.5% (p = 0.012), accompanied by a significant reduction in pessimistic estimations (p = 0.013). We could not observe significant differences in estimation accuracy between communication strategies. The written-only communication group showed a significant decrease in cardiovascular risk factors (weight (p = 0.014), BMI (p = 0.042), blood pressure (p = 0.035), and LDL levels (p = 0.001)). No significant differences were found in health outcomes between risk communication groups. Conclusions: These results demonstrate that even written-only communication may be an effective way to improve cardiovascular health outcomes, possibly by correcting risk perception gaps, suggesting that cost-effective, low-intensity communication strategies may be sufficient to support primary prevention efforts. Full article

Background/Objectives: Neonatal sepsis remains a major contributor to neonatal morbidity and mortality worldwide, yet diagnostic uncertainty and heterogeneous clinical presentation continue to challenge early recognition and management. Early-onset sepsis (EOS), typically arising within the first 72 h of life, is strongly influenced by maternal and perinatal factors. Limited data exist on the temporal evolution of clinical system involvement during the first week of life. This study aimed to identify the predominant clinical systems involved in preterm and term neonates with suspected or confirmed sepsis and to determine maternal and neonatal risk factors associated with early disease severity, persistent sepsis, and adverse outcomes. Methods: A total of 297 neonates met the inclusion criteria. Most infants (99.3%) were admitted before 72 h of life. Clinical system involvement was recorded daily, and maternal–neonatal risk factors were analyzed to identify predictors of advanced sepsis at presentation, persistent sepsis at Day 7, and mortality. Results: Respiratory involvement was the predominant clinical system affected on Day 1 (57.2%) and remained common through Day 3. CNS, gastrointestinal, and skin involvement were infrequent. Lower gestational age (p = 0.035) and prolonged rupture of membranes >18 h (p = 0.043) independently predicted sepsis at Day 1. Advanced sepsis at admission was associated with lower birth weight, lower gestational age, older maternal age, and absence of intrapartum antibiotics (all p ≤ 0.001). Persistent sepsis at Day 7 was linked to prematurity (p = 0.008), higher mortality (p < 0.001), and prolonged hospitalization (p = 0.001). Conclusions: Respiratory involvement was the most common clinical system affected in neonates with EOS. Prematurity, low birth weight, prolonged rupture of membranes, and maternal intrapartum infection significantly increased the risk of severe disease. Understanding the evolution of clinical system involvement during the first days of life may support more precise risk stratification and reduce unnecessary antibiotic exposure. Full article

Groundwater is a critical lifeline for ecosystems and human settlements in arid and semi-arid regions, yet it is increasingly vulnerable to the dual pressures of extreme climatic conditions and intensifying anthropogenic activities. This study investigated 24 groundwater and 4 river water samples to discuss the hydrogeochemical evolution and water quality suitability in the Tianjun Basin, a typical high-altitude arid basin on the northeastern Tibetan Plateau. The results indicate that groundwater is mildly alkaline (pH: 7.65–8.35) and predominantly fresh (TDS: 233.77–1061.42 mg/L). Hydrochemical facies evolve from HCO₃-Ca type in upstream areas to Mixed HCO₃-Na·Ca and Cl-Na types. Hydrochemical analysis suggests that silicate weathering and carbonate dissolution are the dominant natural processes, while cation exchange further modifies the ionic composition. Notably, anthropogenic nitrogen (NO₃⁻ and NH₄⁺) contamination, primarily from domestic sewage in the Tianjun Basin, has significantly impacted groundwater quality. Health risk assessment shows that infants are the most vulnerable group, with 16.67% of samples posing a non-carcinogenic risk via the oral pathway. Regarding irrigation suitability, while sodium hazards are generally low, a significant salinity hazard is identified due to elevated electrical conductivity in the arid environment. This poses a substantial risk of secondary soil salinization, necessitating strict salt management strategies to preserve long-term land productivity. These findings provide critical insights for the sustainable management of fragile groundwater resources in extreme arid environments. Full article

Deploying post-quantum cryptography on highly constrained devices remains challenging due to the large key sizes and substantial storage and memory-traffic demands of leading lattice-based schemes. Although constructions such as Kyber, Dilithium, and NTRU offer strong resistance against quantum adversaries, their multi-kilobyte public keys and intensive memory access patterns limit practical adoption in microcontrollers, smart cards, and low-power edge environments. This work proposes a hybrid key-encapsulation mechanism that integrates a compact, seed-generated Module-LWE structure with a quantum-secure hash-based authentication layer. The design employs a small public seed to instantiate lattice matrices on demand via a lightweight pseudorandom generator and incorporates a Merkle-tree commitment to represent compressed auxiliary error information. Additional design considerations—including sparsity-aware secret keys, SIMD-friendly polynomial operations, and cache-efficient decryption paths—are intended to reduce runtime memory usage and computational overhead. The security of the proposed construction is analysed under both Module-LWE and hash-based one-way assumptions, with further consideration of constant-time execution and cache-line alignment to mitigate side-channel risks. This hybrid approach outlines a design pathway toward post-quantum key-encapsulation mechanisms suitable for deployment on memory-limited and energy-constrained platforms. Full article

Solid oxide fuel cells (SOFCs) are a promising near-zero-emission propulsion source for Northern Sea Route (NSR) vessels, but their yttria-stabilized zirconia (YSZ) electrolyte and Ni-cermet anode are susceptible to thermomechanical degradation under repetitive start–stop thermal cycling. We develop a hierarchical Bayesian competing-risk framework built on a dual degradation model that decomposes area-specific resistance (ASR) growth into cycle-induced fatigue and time-dependent electrochemical aging and apply it across six NSR duty-cycle scenarios spanning f = 1–27 cycles/month. Posterior inference via the No-U-Turn Sampler (NUTS) yields 17 estimated parameters meeting standard convergence criteria (R̂ ≤ 1.01, ESS_bulk ≥ 479, zero divergent transitions). The analysis identifies a failure-mode transition at f ≈ 3–6 cycles/month: high-frequency routes are crack-dominated (S1a: 10/15 cells fail by crack within the 600-cycle window with 5/15 right-censored), whereas low-frequency routes are ASR-dominated (S3b: 100% ASR). Global sensitivity analysis indicates the time-dependent rate coefficient k_time as the primary remaining-useful-life driver (S_T = 0.37–0.46). Cycle-based maintenance thresholds span 160 cycles (S3b) to ≥600 cycles (S2b), bracketed by S1a (270 cycles, 10.0 months, crack-dominant) and S3a (480 cycles, 160 months, transition regime); qualitative consistency with published experimental data supports physical plausibility. Full article

Background and Objectives: The microbiome plays a pivotal role in male infertility, with distinct microbial species exerting both beneficial and deleterious effects on reproductive function. Sexually transmitted bacteria and several viruses, including human papillomavirus (HPV), have been identified in semen. This cross-sectional study aimed to examine the prevalence of single and co-infections of sexually transmitted bacteria (STB)—such as Chlamydia trachomatis, Mycoplasma spp., and Ureaplasma spp.—with various HPV subtypes in Greek male partners of infertile couples and to evaluate their potential impact on sperm parameters. In addition, the possible effect of cryopreservation on the maintenance of these pathogens was assessed. Materials and Methods: Eighty-two semen samples were initially collected from 82 individuals undergoing routine sperm analysis. In total, 80/82 (97.6%) participants proceeded to further analysis, as 2/82 (2.4%) were excluded due to poor DNA quality. Results: A total of 18/80 (22.5%) sperm samples tested positive for STB, with Ureaplasma spp. representing the most frequently detected pathogen. Co-infection of Ureaplasma spp. and Mycoplasma hominis was observed in 4/80 (5%) samples. Twelve samples (12/80, 15%) were positive for HPV, including low-risk (LR) and high-risk (HR) types, and HPV 16 was the predominant HR genotype. Notably, a co-infection of STB and HPV was not found in our specimens. STB-positive samples demonstrated significantly higher sperm concentration and improved progressive motility compared with STB-negative samples. HPV-positive samples exhibited lower sperm volume and concentration and increased non-progressive motility compared with HPV-negative samples. Following three months of cryopreservation, LR HPV and STB were no longer detectable, whereas HR HPV types remained detectable. Conclusions: These preliminary findings are interesting, as they could be useful for routine screening of HPV and STB in sperm samples preserved in sperm banks and highlight the need for future research. Full article

Withthe widespread deployment of intelligent terminals, mobile payment platforms, and Internet of Things devices, security systems are being progressively transformed from traditional transaction outcome analysis toward an intelligent perception paradigm centered on user behavior, device states, and environmental context. To address the challenges of multimodal data heterogeneity, non-independent and identically distributed data across nodes, and the difficulty of centralized modeling under privacy constraints in distributed scenarios, an artificial intelligence-driven federated multimodal security perception framework, namely FMS-LLM, is proposed. At its core, the framework introduces a Non-IID adaptive federated fusion mechanism that achieves dual-level alignment—structural alignment via parameter-level masks and semantic alignment via feature consistency constraints—to effectively mitigate cross-node distribution discrepancies. Additionally, an LLM-driven semantic enhancement module is developed, utilizing trend-guided token selection and inertia-suppression to map low-level sensing features into high-level risk semantic representations, thereby supporting logical reasoning and explainable decision-making. This framework takes user behavioral sensing data, device state information, environmental context data, and transaction behavior data as inputs, and constructs an integrated security analysis pipeline of “perception–collaboration–reasoning”. Experimental results on the distributed multimodal security perception task demonstrate that the proposed method achieves an Accuracy of 91.62%, a Precision of 91.04%, a Recall of 90.37%, an F1-score of 90.70%, and a ROC-AUC of 94.73%, consistently outperforming baseline methods including Logistic Regression, Random Forest, LSTM, the centralized multimodal deep model, FedAvg, FedProx, and MOON. Under strongly Non-IID conditions, when $\alpha =0.1$, the model still maintains an Accuracy of 88.47% and an F1-score of 87.11%, demonstrating stronger cross-node robustness. The ablation study further indicates that the complete model attains the best classification performance while reducing communication cost to 18.92 MB/Round. These results demonstrate that the proposed method can effectively fuse multi-source sensing information under privacy-preserving conditions and support intelligent security perception tasks with higher accuracy, stronger robustness, and improved interpretability. Full article

The accelerated processes of industrialization and urbanization have led to increasingly prominent environmental risks by emerging organic contaminants (EOCs) in wastewater. These contaminants are characterized by low concentrations, high toxicity, and complex composition, making their efficient removal crucial for safeguarding ecological security and human health. Advanced oxidation processes exhibit significant potential for the removal of EOCs due to their high degradation efficiency. However, current treatment paradigms remain constrained by several critical issues. Notably, the routine over-oxidation of low-toxicity small-molecule organics solely aims to satisfy chemical oxygen demand (COD) compliance standards. This unnecessary practice not only increases operational costs and carbon footprint but also leads to energy waste and reduced overall treatment efficiency. Based on the current technological landscape, this paper analyzes the core challenges in the removal of EOCs at present. In light of policy orientations and technological trends, it outlines future research directions and industrial development pathways, providing insights for achieving the synergistic goals of efficient removal of EOCs, low carbon emissions, and cost-effective operation. Full article

During flood disasters, on-site operations often face the “triple disruption” of network outages, power cuts and blocked roads. This renders terrestrial cellular infrastructure inoperable and disrupts communication links. Satellite internet can partially restore emergency communications thanks to its wide-area coverage and resistance to ground damage. However, limited computing power, memory and unstable bandwidth at the terminal prevent cloud-based flood segmentation from providing near-real-time situational awareness. This paper therefore proposes a lightweight semantic flood segmentation framework for emergency terminals that uses satellite internet. This comprises a parallel dual-branch design with a lightweight U-Net-style convolutional neural network (CNN) branch for local boundary details and a compact Transformer branch for global context. A dynamic gated fusion mechanism (DGFM) balances local texture and global information adaptively. Experiments on the public synthetic aperture radar (SAR) dataset Sen1Floods11 demonstrate that the hybrid architecture strikes a balance between accuracy and inference efficiency. The proposed method combines gated fusion with quality-aware training. Compared to a lightweight CNN baseline and state-of-the-art segmentation models using the same protocol, the proposed configuration (Hybrid-Gated with Quality-Aware Training) achieves the highest mean intersection over union and F1 score among the compared fusion variants, while maintaining competitive false alarm and risk-sensitive performance under deployment constraints. This aligns with the preferences of emergency decision makers. The framework provides a deployable perception module for emergency systems supported by low-orbit satellites and terrestrial networks under triple-disruption conditions. Full article

This study examines whether tourism students’ self-reported time–money use patterns are related to their readiness to collaborate on idea development, and whether sustainability emerges spontaneously in their tourism innovation ideas. Using an anonymised dataset of open-ended questionnaire responses from Slovenian higher education tourism students (N = 597; 2019–2025), we applied deterministic rule-based coding to classify the presence of actionable ideas and sustainability framing, as well as collaboration readiness and conditions. Actionable ideas were common (53.4%), but sustainability framing was uncommon (7.5%). Most respondents were unconditionally willing to collaborate (69.3%), while 30.7% expressed conditional willingness or unwillingness. Time–money behavioural segments were significantly associated with collaboration reservations, whereas segment differences in ideation and sustainability framing were not significant. Among students expressing reservations, topic match and perceived team quality were the most frequently stated conditions. These findings indicate that sustainability-oriented tourism education should support both sustainability integration and low-risk collaboration through clear project briefs, topic-based matching, and team-process supports. The conclusions should be interpreted with reasonable caution as they are context-specific evidence based on self-reported, rule-coded responses, particularly for sustainability framing, where positive cases were rare. In this context, segmentation should be regarded as a diagnostic tool for course design rather than as a basis for labelling students. Full article

The Papanicolaou (Pap) smear, a cornerstone of cervical cancer prevention, has emerged as a compelling, though unconventional, biospecimen for the detection of ovarian cancer (OC). This structured narrative review synthesizes the evolving evidence on the utility of cervicovaginal cytology and molecular analysis of Pap test material for OC detection. While conventional cytology provides a proof of concept, its sensitivity is low, ranging from incidental detection of OC in 0.004% of routine screens to 19.3% in patients with known OC. Specific cytologic findings, however, carry significant predictive value: atypical glandular cells (AGC) confer a two-fold increased OC risk, and psammoma bodies (PB) are strongly associated with serous malignancies. Driven by the sensitivity limitations of morphology, the field has undergone a paradigm shift towards molecular detection. Foundational studies confirmed tumor-derived DNA, including hallmark TP53 mutations, is detectable in Pap samples years before diagnosis, though sensitivity is constrained by low DNA abundance and confounded by background clonal mutations. To overcome this, strategies have expanded to target broader genomic signatures, such as somatic copy number alterations (EVA test: 75% sensitivity, 96% specificity), and multi-gene mutation panels (PapSEEK: 33–45% sensitivity). The most promising advances lie in multi-omic approaches, particularly DNA methylation biomarkers, which have demonstrated sensitivities up to 81% with high specificity. Collectively, this evidence argues against repurposing the Pap test as a standalone OC screen but supports its strategic integration into a risk-stratified clinical algorithm. We propose a “reflex-to-molecular” model where high-risk cytology (e.g., AGC, PB) automatically triggers advanced molecular testing on the same sample. This model efficiently leverages existing infrastructure to triage high-risk women for definitive diagnostics. Prospective validation of this integrated approach is the essential next step toward transforming this test into a sentinel for malignancies of the upper female reproductive tract. Full article