Search Results (119,615)

With the expansion of interconnection in power systems and the extensive adoption of phasor measurement units (PMUs), the secure operation of power systems has been increasingly covered in research. In this article, a unified online framework for pre-fault and post-fault dynamic security assessment (DSA) is proposed. First, maximum mutual information (MIC) and the random subspace method (RSM) are employed to select the key variables and enhance the diversity of input data, serving as feature engineering. Then, a deep forest (DF) regressor and classifier are utilized respectively to predict security margin (SM) and security state (SS) during online pre-fault and post-fault DSA based on the selected variables. In pre-fault DSA, scenarios with high SM are identified as stable, while those with low SM are forwarded to post-fault DSA. In addition, a time self-adaptive scheme is employed to balance low response time and high prediction accuracy. This approach prevents the misclassification of unstable scenarios as stable by either outputting high-credibility predictions of unstable SS or deferring decisions on SS until the end of the decision-making period. The unified framework, tested on an IEEE 39-bus system and a practical 1648-bus system provided by the PSS/E version 35 software, demonstrates significantly improved assessment accuracy and response times. Specifically, it achieves an average response time (ART) of 2.66 cycles for the IEEE 39-bus system and 3.13 cycles for the 1648-bus system while maintaining an accuracy exceeding 98%, surpassing the performance of currently widely used deep learning models. Full article

Background/Objectives: Point-of-care ultrasound (POCUS) is an accessible and low-cost diagnostic tool that is seldom used by orthopedic residents. This study aims to assess the efficacy of a POCUS training program within an orthopedic surgery residency curriculum in terms of knowledge retention and clinical usage among the group of residents. Methods: This study included didactic and hands-on teaching sessions. The impact of the teaching sessions was evaluated through surveys (pre-course, immediate post-course, and 6 months post-course). The surveys were divided into three sections: participant’s interest in and usage of POCUS, ultrasound-related knowledge, and perceived limitations related to the usage of ultrasound. All orthopedic residents who attended the teaching sessions and completed all the surveys were included. Results: There were 14 participants. There was a significant increase in interest in POCUS (scale 1 to 5) from 3.36 ± 0.50 in the pre-course survey to 3.93 ± 0.83 in the final post-course survey (p = 0.04). However, there was no significant change in the amount of POCUS usage in clinical settings. Levels of comfort with ultrasound-related procedures significantly increased immediately following the teaching session but did not stay significantly higher after 6 months. When tested on knowledge, the residents’ scores were still significantly greater than they were at the time of the pre-course test at 6 months (p = 0.01). Lack of ultrasound-related knowledge, lack of time, and site culture were the two most prevalent perceived barriers. Conclusions: This study demonstrates that POCUS teaching for orthopedic residents yields long-term benefits in terms of interest and knowledge. However, recurrent teaching sessions and further efforts are required to address perceived obstacles to PoCUS usage and increase clinical implementation. Full article

Background: Academic performance is related to cognitive functions and satisfied physiological needs such as proper sleep, a factor frequently overlooked by university students. Our aim was to investigate sleep-related variables, cognitive performance and stress level measured by heart rate variability among university students. Methods: A novel psychophysiological measurement system was used for data collection in which a screen-adapted questionnaire was used to collect data on sleep; gamified versions of standard psychological tests were used to assess cognitive performance, and ECG data were recorded by a wearable ECG sensor, all synchronized by a software. University students volunteered for anonymous testing that lasted approximately one hour. Results: Of the 107 students (mean age: 22.2 years, SD ± 2.22; 52% female), those who reported being well-rested achieved significantly higher overall cognitive performance (p = 0.024). Sleep duration did not correlate with cognitive performance but longer sleep duration was associated with feeling rested (rho = 0.326; p < 0.001). Cognitive performance showed significant association with two HRV parameters such as the Baevsky Stress Index (r = 0.195), higher values of which reflect higher autonomic stress load. Significant negative relation was found between cognitive performance and RMSSD (r = −0.195), another HRV parameter, higher values of which allude to higher parasympathetic activity (p = 0.050 for both). These findings suggest a link between mild arousal and performance. Conclusions: Being rested and lower autonomic stress load are positively correlated with cognitive performance. The novel psychophysiological measurement system integrating subjective and objective measurements of cognitive and physiological functions is feasible for assessing cognitive functions and stress levels in students. Full article

Reservoir bank collapse is a critical geological hazard during the operation of large-scale water conservancy projects, controlled by unique hydrodynamic mechanisms induced by reservoir impoundment, and differs significantly from ordinary landslides. Traditional risk assessment methods, however, often struggle to achieve effective integration between macro-regional zoning and micro-mechanical analysis. Against this limitation, this study proposes a GIS-integrated multi-scale risk screening framework to achieve the preliminary integration of qualitative regional evaluation and quantitative site-specific analysis. Compared with traditional multi-scale studies, the innovations of this research are as follows: (1) a customized GIS component was developed to realize semi-automatic profile extraction from high-resolution DEMs and batch Bishop stability calculations, overcoming the bottleneck of spatializing micro-models over large areas; (2) a “bottom-up” dynamic feedback mechanism was established, utilizing the quantitative safety factor from site-specific evaluations as an explicit indicator for the conservative screening correction of the macro-regional risk map. Applied to the Xiluodu Reservoir, this framework illustrates a potential multi-scale approach for cross-scale risk screening driven by physical–mechanical mechanisms. This provides both a global perspective and a localized physical basis, offering a strategic screening tool for reservoir management. By linking failure mechanisms directly to spatial impacts, the framework provides a plausible conservative feedback rule for risk-informed decision-making in complex reservoir settings. Full article

Urban Heat Island effects and the general rise in outdoor temperatures are increasing the cooling demand in buildings. As a consequence, electrical cooling systems are becoming more common, increasing energy consumption and thus resulting in negative environmental impacts. Optimizing passive solutions that require no energy input can provide substantial benefits for building energy efficiency and urban sustainability. This study presents a research activity, financed by the EU-funded project LIFE SUPERHERO, that enhances existing roofing technologies based on passive cooling; defines an experimental method to assess their benefits in terms of energy savings; and finally evaluates their effectiveness in future climate scenarios based on greenhouse gas Representative Concentration Pathways across a set of mid-temperate/hot climate locations, also in comparison with traditional unventilated roofs. A new Climate Adaptation Efficiency Index (CAEI) was introduced to evaluate the energy efficiency potential of buildings equipped with highly ventilated and permeable clay tile roofs compared to a baseline scenario without the intervention. The results confirm the potential of ventilated and air-permeable roofs to reduce incoming heat flux and support cooling energy-efficiency planning. Indeed, CAEI values were above 20%, reaching 45–50% in hot Mediterranean and arid climates and 28–33% in cooler/temperate contexts. Under future climate scenarios, benefits further increase in the hottest Mediterranean locations, reaching up to 66%, while rising to about 44% in temperate climates, with an average increase of 10–15 percentage points, highlighting the strong potential of highly ventilated and air-permeable clay tile roofs as an effective, affordable, sustainable, and easy-to-install climate adaptation strategy. Full article

Background/Objectives: Postpartum depression and anxiety affect up to 20% of women worldwide, yet remain understudied in Eastern Europe. Romania, one of Europe’s most religious countries, provides a unique context for examining how coping strategies and religiosity influence perinatal mental health. This cross-sectional study characterized coping styles, depressive and anxiety symptoms, and religiosity among postpartum women from two western Romanian counties (Bihor and Timiș) and examined associations between coping dimensions and psychological outcomes. Methods: A cross-sectional study was conducted among 201 postpartum women recruited from two public maternity hospitals between 2024 and 2025. Sociodemographic, obstetric, neonatal, coping (COPE Inventory), depressive (EPDS; PHQ-9), anxiety (GAD-7), and religiosity (RCI-10) data were collected through questionnaires and medical record extraction. Associations between coping dimensions and psychological symptoms were examined using Pearson correlations. Analyses were performed in RStudio. Results: Prevalence of possible depression (EPDS ≥ 10) was 32.8% overall, with no regional difference (Bihor 32.0% vs. Timiș 33.7%, p = 0.920). EPDS demonstrated strong convergent validity with PHQ-9 (r = 0.58, p < 0.001) and GAD-7 (r = 0.61, p < 0.001). In bivariate analyses, avoidant coping showed the strongest association with depressive symptoms (r = 0.28, p < 0.001), particularly in Bihor (r = 0.35, p < 0.001). Multiple regression analysis (R² = 0.196, p < 0.001) identified avoidant coping as the strongest independent predictor (β = 2.82, 95% CI [1.16, 4.48], p < 0.001), followed by social support coping (β = 2.46, 95% CI [1.09, 3.83], p < 0.001). Emotion-focused coping showed an unexpected protective effect (β = −2.97, p = 0.004). Problem-focused coping and religiosity were not significant predictors. Critically, county was non-significant after controlling for coping strategies (p = 0.732), indicating regional differences are mediated by coping patterns rather than geographic location. Conclusions: Postpartum depression prevalence in Romania aligns with international estimates. Avoidant coping emerged as the primary modifiable risk factor. Findings support integrating coping assessment into postpartum screening and developing interventions targeting avoidant strategies in Romanian perinatal care. Full article

Introduction: Nursing informatics aims to improve patient care through rapid access to patient data, systematic assessment, a reduction in clinical errors, evidence-based practice, cost-effectiveness, and improved patient outcomes and safety. Background: Despite being the largest workforce in healthcare, nurses are not being adequately prepared to use nursing informatics, and this has been attributed to poor digital literacy, limited professional development, and a lack of undergraduate informatics education. Objectives: This scoping review aims to review contemporary published literature on the benefits, barriers, and enablers for embedding nursing informatics into undergraduate nursing education with a focus on the Australian healthcare context. Methods: A scoping review was conducted using the PRISMA-ScR checklist and the JBI Manual for evidence synthesis in adherence with an a priori scoping review protocol. A comprehensive search of JBI, Cochrane, CINAHL, Ovid, ProQuest, PubMed, and Scopus databases was performed. Two reviewers independently screened the results via Covidence, with discrepancies resolved via a third reviewer. Results: Two searches were conducted for this scoping review. In the first search, a total of 3227 articles were identified through database searches, with an additional 76 articles identified through bibliographic and grey literature searches. Following duplicate removal and screening, 46 articles met the inclusion criteria. In the second search, a total of 1555 articles were identified, and after duplicate removal and screening, 16 articles met the inclusion criteria. Duplicate removal during the second search round included those articles identified in the first search. The combined searches resulted in a total of 62 sources for this review. Conclusions: Despite the early adoption of nursing informatics in Australia in the 1980s, barriers remain to effective nursing informatics engagement and proficiency, including a lack of understanding of nursing informatics, limited infrastructure and resources, inadequate digital literacy of students and faculty, and the evolving nature of nursing informatics. Definitions of nursing informatics and associated fields, development of university faculty competency, access to digital health technologies, competency standards, digital literacy of the student cohort, faculty digital proficiency, and leadership from professional nursing bodies are all viewed as integral foundations for the development of student competency in nursing informatics. Full article

Background/Objectives: Otoscopic examination is essential for the evaluation of ear diseases; however, conventional diagnostic devices have limitations related to portability, cost, and patient comfort. This study aimed to evaluate the feasibility and diagnostic performance of a newly developed pen-shaped otoscope compared with conventional otologic examination equipment. Methods: In this prospective study, 19 patients (28 ears) who underwent otologic examination at a tertiary referral center between April and June 2024 were included. Images of the external auditory canal and tympanic membrane were obtained using a pen-shaped otoscope, a video endoscope, and a microscope. Visualization of key tympanic membrane structures was assessed by physicians, and patients completed questionnaires evaluating pain, fear, image quality, and understanding of their disease. This prospective pilot feasibility study assessed the safety, usability, and preliminary diagnostic performance of the device. Results: Visualization rates of tympanic membrane structures using the pen-shaped otoscope, video endoscope, and microscope, respectively, were as follows: annulus tympanicus (57.1% vs. 89.3% vs. 9.1%), pars flaccida (89.3% vs. 96.4% vs. 45.5%), handle of the malleus (96.4% vs. 100% vs. 81.8%), and tympanic membrane vasculature (89.3% vs. 100% vs. 100%). No patients reported pain with the pen-shaped otoscope, whereas one patient reported pain with the video endoscope. Despite slightly lower image quality and disease understanding scores, several patients preferred the pen-shaped otoscope because of its ease of use and lack of discomfort. Conclusions: The pen-shaped otoscope provided clear visualization of key tympanic membrane structures, albeit with slightly lower image quality than the endoscope, while demonstrating high safety, portability, and ease of use. Its markedly lower cost supports its potential utility in smaller hospitals, outpatient clinics, and telemedicine applications. Further validation in larger cohorts and pediatric populations is warranted. Full article

Background/Objectives: Post-coronavirus syndrome (long-COVID) refers to a multi-systemic range of symptoms that follows acute SARS-CoV-3 infection. Long-COVID has been linked with autonomic neuropathy as well as dry-eye disease (DED), an umbrella term that includes a variety of ocular symptoms and signs. Despite these associations, little is known about the co-occurrence of DED and dysautonomia symptoms in individuals with long-COVID. This study aims to examine relationships between dysautonomia and ocular symptoms in a long-COVID patient population. Methods: Cross-sectional study of 162 veterans with long-COVID. The Composite Autonomic Symptom Score-31 (COMPASS-31) assessed dysautonomia symptoms, and the NASA lean test and heart-rate variability metrics captured dysautonomia signs. Dry-eye disease (DED) symptoms were measured with the 5-Item Dry-Eye Questionnaire (DEQ5) and the Ocular Surface Disease Index (OSDI), while ocular pain intensity and neuropathic pain descriptors were evaluated using a Numerical Rating Scale (NRS) and select questions from the Neuropathic Pain Symptom Inventory modified for the Eye (NPSI-Eye), respectively. Results: Most participants (78%) reported DED symptoms (DEQ5 ≥ 6). Nearly all COMPASS-31 domains were associated with DED symptoms, with the strongest correlation observed between the OSDI and pupillomotor scores (r = 0.67, p < 0.001). Among the autonomic signs, the strongest associations were observed between the change in systolic and diastolic blood pressure from baseline to 8 min and ocular pain triggered by temperature (r = −0.44 and r = −0.48, respectively, p < 0.01 for both). On linear regression analyses, pupillomotor and secretomotor symptoms remained positively associated with DED symptoms, while autonomic signs were most closely related to ocular pain metrics, with fluctuating blood pressure changes during orthostasis relating to neuropathic symptoms. Conclusions: DED symptoms, including ocular pain intensity, relate to autonomic symptoms in a long-COVID cohort. While associations with autonomic signs were less consistent, these data suggest that subtle autonomic variability relates to ocular pain in the long-COVID setting. Full article

Basic fibroblast growth factor (bFGF) and Transforming growth factor-beta (TGF-β) are key regulators of human pluripotent stem cell (hPSC) maintenance, supporting pluripotency and self-renewal. bFGF is particularly critical for sustaining the undifferentiated state and is commonly supplied through feeder-derived conditioned media. Similarly, TGF-β promotes hPSC expansion by modulating signaling pathways and contributing to a supportive stem cell niche. In this study, we investigated how the quality and variability of these growth factors influence hPSC culture performance. To address this, we developed and applied multiple physicochemical characterization methods—including size exclusion and reverse-phase chromatography—to assess growth factor purity and identify impurities across different material sources. Our findings show that certain post-translational modifications in TGF-β (e.g., oxidized variants) did not measurably affect hPSC culture. However, high temperature-dependent instability of bFGF preparations significantly altered hPSC morphology and growth. These findings underscore the need for improved quality control of growth factor components in culture media to ensure consistent hPSC maintenance, thus decreasing variability across experiments. This study highlights the value of correlating analytical physicochemical data with process performance, thereby advancing material understanding, enabling more efficient process development, and facilitating the identification of critical material attributes that affect the quality of cell therapy products. Full article

Background/Objectives: Foot mobility is considered an intrinsic risk factor for lower-limb injury, yet commonly used pronated/neutral/supinated classifications rely on arbitrary cut-points. This study aimed to develop a data-driven framework for characterizing a continuous SSNDT–injury risk gradient and deriving clinically interpretable relative-risk bands that define practical injury risk zones along the sit-to-stand navicular drop test (SSNDT) continuum. Methods: Data from 137 physically active male students (274 feet) were analyzed. Intra-rater reliability of the sit-to-stand navicular drop test (SSNDT) was assessed using ICC(3,1). A quadratic mixed-effects logistic regression model was used to characterize the SSNDT–injury relationship and derive odds-ratio-based risk bands for interpretive and screening purposes. Results: SSNDT demonstrated good intra-rater reliability (ICC(3,1) = 0.82). Model comparison supported a non-linear, U-shaped association between SSNDT and injury risk, with a minimum risk value at approximately 5.5 mm. Bootstrap analysis supported a smooth continuous risk gradient. Four representative OR levels (1.2, 1.5, 1.8, and 2.0) were selected to define SSNDT-based interpretative risk bands. Injury prevalence showed an overall increasing trend across these zones, ranging from 4.2% in the Safe zone to 52.4% in the Extreme zone. Conclusions: SSNDT provides a robust, data-driven basis for quantifying foot-mobility–related injury risk along a continuous non-linear gradient and for deriving clinically interpretable relative-risk bands grounded in a validated model. The proposed framework avoids arbitrary cut-points and supports individualized risk screening. Full article

Circular economy (CE) strategies in the agri-food sector hold strong potential for reducing waste, enhancing resource efficiency, and promoting sustainable value creation. However, early-stage assessment of innovative valorisation pathways remains challenging due to limited data availability and heterogeneous sustainability trade-offs. This study presents a multi-criteria evaluation tool designed to identify sustainability hotspots and support the preliminary screening of CE solutions based on easily obtainable information. The tool combines a structured literature review with expert-based scoring across environmental (ENV), economic (EC), and social (SOC) dimensions. Its applicability was demonstrated through the following three case studies: (i) reconstitution of cheese approaching expiration, (ii) extraction of polyphenols from grape-wine residues via subcritical water extraction, and (iii) biodegradable mulching film production from grape-wine pomace. Results show that the tool successfully differentiates sustainability performance across value chain areas Residue, Final Product, and Process (RES, FP, and PRO) and reveals critical gaps requiring further investigation. Scenario 3 achieved the higher overall score (69.7%) due to fewer regulatory constraints, whereas Scenarios 1 and 2 (61.2% and 54.5%, respectively) are penalised due to the more regulations for human consumption. The proposed tool offers a practical and efficient method to support researchers and industry stakeholders in identifying CE strategies with the highest potential for sustainable development. Full article

Introduction: Operative time is commonly used as a surrogate marker for operative difficulty in liver resection, but the contribution of other intraoperative factors is less understood. This study aimed to develop an objective, composite score to assess operative difficulty and evaluate its association with postoperative and oncological outcomes in liver surgery. Methods: A retrospective cohort study was conducted on patients who underwent liver resection for malignant disease between 1999 and 2023 at an Australian tertiary hospital, using a prospectively maintained database. Principal component analysis (PCA) was applied to operative time, estimated blood loss, total time of hepatic inflow occlusion and the number of packed red bloods transfused intraoperatively to derive a composite operative difficulty score. Patients were then stratified into low, moderate and high difficult groups using Gaussian mixture models (GMM). Comparison of textbook oncological outcomes (TOO) achievement and futile resection rates were assessed using Chi-squared analysis. Kaplan-Meier analysis was used to assess recurrence-free and overall survival in subgroup analysis. Results: Of 729 patients, 699 met the inclusion criteria. GMM identified three distinct operative difficulty groups: low (n = 540), moderate (n = 143), and high (n = 16). TOO and non-futile resection rates declined with increasing difficulty: 77% and 58% (low), 47% and 52% (moderate), and 6% and 19% (high), respectively (p < 0.001, p = 0.004 respectively). Among patients with cholangiocarcinoma, median overall survival was inversely correlated with operative difficulty (40 months low, 16 months moderate, 7 months high, p = 0.004). In patients with colorectal liver metastases, there was a trend towards worse overall survival and disease-free survival with increasing operative difficulty, however, this did not reach statistical significance. Conclusions: An objective intraoperative difficulty score was developed and demonstrated a significant inverse association with both quality and oncological outcomes. While external validation is required, these findings support the potential of operative difficulty assessment to enhance perioperative decision-making, inform patient counselling, and optimise postoperative care planning. Full article

Background: Streptococcus pneumoniae (Spn) is a leading bacterial pathogen responsible for severe invasive diseases, including meningitis, sepsis, and pneumonia. Current pneumococcal vaccines, which are all based on capsular polysaccharide antigens, provide limited protection and are further compromised by post-vaccination serotype replacement. Pneumococcal surface protein A (PspA), a highly conserved virulence factor expressed across diverse serotypes, has emerged as a promising candidate antigen for novel protein-based vaccines. However, progress in this field has been hindered by the absence of standardized in vitro functional antibody assays. Methods: This study established a robust functional antibody detection method for PspA-based protein vaccines by modifying the conventional multiplex opsonophagocytic killing assay (MOPA), originally designed for polysaccharide-based vaccines. Using polymerase chain reaction (PCR) and enzyme-linked immunosorbent assay (ELISA) typing, a target strain panel was selected and developed to include representative strains from PspA Family 1-Clade 2 and Family 2-Clades 3 and 4. The MOPA protocol was optimized by extending the phagocytic reaction time to enhance sensitivity. Specificity was confirmed through recombinant PspA competitive inhibition assays. Results: The assay demonstrated high linearity (R² ≥ 0.98) between opsonophagocytic index (OI) and serum dilution, along with acceptable repeatability (CV ≤ 30%) and intermediate precision (CV ≤ 50%). Both preclinical and clinical serum samples exhibited potent bactericidal activity against diverse PspA families, independent of capsule type. Conclusion: This study provided a standardized framework to support the development and regulatory assessment of protein-based pneumococcal vaccines. Full article

Background/Objectives: Cigarette smoking is a well-established risk factor for periodontal tissue damage caused by oxidative stress and increased proteolytic activity. Electronic cigarettes (e-cigarettes), marketed as less harmful alternatives, deliver nicotine and reactive compounds that may similarly disrupt periodontal health. However, their molecular effects on clinically healthy periodontal tissues remain unclear. This study aimed to compare oxidative stress-related and matrix-degradative biomarkers in the gingival crevicular fluid (GCF) of cigarette smokers (CS), e-cigarette (EC) users, and non-smokers (NS), and to examine the relationships among these markers. Methods: Sixty individuals, who were systemically and periodontally healthy (20 CS, 20 EC, and 20 NS), were examined. Clinical parameters, including probing depth (PD), clinical attachment level (CAL), plaque index (PI), and bleeding on probing (BOP), were recorded. GCF samples were analyzed for reactive oxygen species (ROS), matrix metalloproteinase-9 (MMP-9), and forkhead box protein O-1 (FOXO-1) using ELISA. Initial group comparisons were descriptive, followed by analysis of covariance (ANCOVA) to adjust for age; PI and PD were included as covariates in separate models. Correlations were assessed using Spearman’s analysis. Results: PD was significantly higher in both EC users and CS compared with NS (p = 0.022). MMP-9 levels were significantly higher in CS than in EC users and NS (p < 0.05), while FOXO-1 concentrations were significantly lower in CS compared with NS (p = 0.0227). ROS levels did not differ significantly among groups (p > 0.05). After adjustment for age, PI, or PD, group differences in MMP-9 and FOXO-1 remained statistically significant, whereas ROS levels remained comparable. FOXO-1 demonstrated positive correlations with ROS and MMP-9 within exposure groups; these associations were considered exploratory. Conclusions: In this cross-sectional study, CS and EC use were associated with altered matrix-regulatory biomarker profiles in clinically healthy periodontal tissues, independent of age and periodontal indices. Causal or temporal inferences cannot be drawn, and longitudinal studies are needed to clarify the long-term periodontal implications of these findings. Full article