Search Results (97,637)

Background and Objective: This study aimed to identify preoperative and intraoperative factors associated with thoracic complications after bilateral diaphragmatic stripping during cytoreductive surgery for advanced ovarian cancer. Materials and Methods: A retrospective observational study was conducted at the Gynecologic Oncology Unit of the National Cancer Institute “G. Pascale”, Naples, Italy. We included patients who underwent bilateral diaphragmatic stripping between July 2023 and October 2025. Demographic, surgical, and anesthesiologic parameters were recorded. Univariate logistic regression was performed, and a restricted multivariate model including only variables significant at univariate analysis was used to assess predictors of thoracic complications. Results: Forty-seven patients were analyzed, 10 (21%) of whom developed postoperative thoracic complications. Patients with thoracic complications had a higher body mass index (median 28.4 kg/m², IQR 26.4–29.3 vs. 23.9 kg/m², IQR 22.8–27.3; p = 0.003) and higher ASA scores (p = 0.033). In univariate analysis, ASA (odds ratio [OR] 3.90, 95% confidence interval [CI] 1.12–17.94, p = 0.046) and BMI (OR 1.45, 95% CI 1.14–2.02, p = 0.009) were significantly associated with thoracic complications. In multivariate analysis, only BMI remained an independent predictor (OR 1.599, 95% CI 1.13–2.68, p = 0.027). Conclusions: Elevated BMI was independently associated with an increased risk of thoracic complications after bilateral diaphragmatic stripping in cytoreductive surgery for ovarian cancer. Careful perioperative management and preventive strategies should be considered in overweight patients. Full article

Coastally Trapped disturbances (CTDs) are shifts in wind direction from the pre-dominant direction to equatorward to poleward for a period of time. These CTDs occur during the warm season off the California coast and impact coastal weather conditions and planned offshore wind plants. This study assesses the characteristics of CTD events as observed by lidar and other offshore buoys, then evaluates the ability of modeling systems to capture the correct characteristics, leveraging model output from the High-Resolution Rapid Refresh (HRRR) operational modeling system and the NOW-23 (National Offshore Wind) model dataset. CTDs were analyzed for October 2020 and May through to October of 2021, identifying 18 unique CTD events, confirmed by a nearby National Data Buoy Center (NDBC) buoy. The HRRR model captured most of these events, but the NOW-23 model output contained only 12 events. Composites of the wind, temperature, and pressure perturbations pre-, during, and post-event demonstrated the diminishment in wind speed, particularly for the alongshore component. Although the NOW-23 model captured the alongshore wind component and pressure perturbations well, the cross-shore wind component and temperature perturbations varied substantially. When the turbulent kinetic energy deviation and wind shear was positive across all levels pre-event, the NOW-23 modeling system was less likely to capture the CTD event. In contrast, the events that were captured by the model tended to have negative wind shear aloft pre-event. Full article

Internet advertising, while enabling unprecedented commercial reach, has become a pervasive vehicle for deceptive practices that inflict measurable harm on consumers. This study empirically investigates the structural relationships between internet advertising falsity and consumer harm by integrating analyses of the mediating role of consumer cognitive processes and the moderating role of consumer vulnerability within a unified structural framework. Survey data were collected from 600 adult consumers with online purchase experience in the Republic of Korea—an advanced digital economy characterized by exceptionally high mobile-commerce penetration, mature e-commerce infrastructure, and evolving digital consumer protection regulation—and analyzed using structural equation modeling (SEM) with AMOS 24.0, supplemented by Hayes’ PROCESS macro Model 59 for conditional process analysis. All 13 hypotheses were supported, although path magnitudes varied substantially across falsity dimensions and mediator pathways—with direct effects ranging from β = 0.156 (false scarcity) to β = 0.224 (performance exaggeration), and indirect effects dominated by the risk assessment distortion pathway. Among the four sub-dimensions of advertising falsity—factual misrepresentation, performance exaggeration, price deception, and false scarcity—performance exaggeration exerted the strongest direct effect on consumer harm. The three cognitive mediators—perceived advertising credibility, risk assessment distortion, and purchase decision pressure—all demonstrated significant partial mediation, with risk assessment distortion emerging as the most powerful indirect pathway. All four consumer vulnerability dimensions—digital literacy level, demographic vulnerability, prior victimization experience, and impulsive buying tendency—significantly moderated the falsity–harm relationship, with low-digital-literacy consumers experiencing approximately 1.7 times the adverse effect of high-literacy counterparts. Moderated mediation analysis revealed that the conditional indirect effect for the high-vulnerability group was approximately 2.3 times that of the low-vulnerability group, confirming that the cognitive harm mechanism intensifies systematically for vulnerable consumers. These findings advance consumer vulnerability theory in the digital context and offer evidence-based implications for consumer protection policy, platform governance, and digital literacy education. Full article

The digital transformation of healthcare requires stronger digital competencies among pharmacists, yet evidence on the effectiveness of structured training remains scarce. This study examines the impact of a blended digital health training programme delivered to practicing pharmacists in Bihor County, Romania, as part of the Romanian pilot of the EU-funded European Health Professionals’ and the DigitAl team SkillS (H-PASS) project. A single-group pre–post educational design was applied to pharmacists from Bihor County, Romania, participating in a modular digital health training programme delivered between May and July 2025. A total of 84 pharmacists completed both pre-training and post-training self-reported competency assessments comprising 18 items across three modules: digital innovation and change management, communication and collaboration, and data management and digital literacy. Paired samples t-tests, Cohen’s d effect sizes, Cronbach’s alpha, moderator analyses, and ceiling effect analyses were conducted using Python-based statistical workflows. Statistically significant improvements were observed across all three modules (all p < 0.0001), with large effect sizes (d = 1.04–1.30). Post-training internal consistency increased substantially, with overall Cronbach’s alpha reaching 0.74. The greatest item-level gains were recorded in adaptive communication, cultural adaptation of care, and data protection ethics. No significant moderation effects were found for age, gender, or years of experience. Course satisfaction showed a moderate positive correlation with competency gains (r = 0.528), while perceived improvement was not significantly associated with observed score change. A ceiling effect indicated greater gains among participants with lower baseline competencies. The Romanian implementation of the H-PASS training programme was associated with improved self-reported digital health competencies among practicing pharmacists, high-lighting its potential as a scalable model for digital upskilling in healthcare. Full article

The Industrial Internet of Things (IIoT) has become a cornerstone of modern industrial automation, enabling real-time monitoring, intelligent decision-making, and large-scale connectivity across cyber–physical systems. However, the growing scale, heterogeneity, and dynamic behavior of IIoT environments significantly expand the attack surface and challenge the effectiveness of conventional security mechanisms. In this paper, we propose DeepSense, a hybrid and adaptive anomaly and intrusion detection framework specifically designed for resource-constrained and heterogeneous IIoT deployments. DeepSense integrates three complementary components: DataSense, a realistic data pipeline and experimental testbed supporting synchronized sensor and network data processing; RuleSense, a lightweight rule-based detection layer that provides fast, deterministic, and interpretable anomaly screening at the edge; and NeuroSense, a learning-driven detection module comprising an adaptive ensemble of 22 machine learning and deep learning models spanning classical, neural, hybrid, and Transformer-based architectures. NeuroSense operates as a second detection stage that validates suspicious events flagged by RuleSense and enables both coarse-grained and fine-grained attack classification. To support rigorous and practical assessment, this work further introduces a comprehensive performance evaluation framework that extends beyond accuracy-centric metrics by jointly considering detection quality, latency, resource efficiency, and detection coverage, alongside an optimization-based process for selecting Pareto-optimal model ensembles under realistic IIoT constraints. Extensive experiments across diverse detection scenarios demonstrate that DeepSense exhibits strong generalization, lower false positive rates, and robust performance under evolving attack behaviors. The proposed framework provides a scalable and efficient IIoT security solution that meets the operational requirements of Industry 4.0 and the resilience-oriented objectives of Industry 5.0. Full article

Heavy metal contamination in agricultural soils threatens ecosystem safety and sustainable land use, particularly in geologically sensitive areas. This study aimed to assess the pollution status, ecological risks and source contributions of eight heavy metals (Hg, Cd, Pb, As, Cr, Cu, Ni and Zn) in soils from a dry-hot agricultural region of central Yunnan, China. To improve source apportionment, this study applied and compared three models: APCS-MLR, PMF, and Random Forest. Analysis of 1790 soil samples showed mean concentrations (mg/kg) of 0.03 for Hg, 0.17 for Cd, 25.01 for Pb, 7.46 for As, 85.91 for Cr, 36.20 for Cu, 31.75 for Ni, and 69.24 for Zn. Pollution assessment indicated that Cu and Cd were the main pollutants, while ecological risk assessment identified Cd and Hg as the dominant ecological risk factors. Four major sources were identified: industrial hybrid sources, natural background, atmospheric deposition and agricultural activities, with industrial hybrid sources contributing the largest share. These results indicate that integrating APCS-MLR, PMF, and Random Forest provides a more reliable framework for source identification and supports targeted soil pollution control in regions affected by both natural and anthropogenic inputs. Full article

Reservoir characterization of the Abu Roash “G” (AR/G) Member in the Karama Field, Abu Gharadig Basin, Western Desert of Egypt, is complicated by structural deformation, facies variability, and lithologic heterogeneity, which introduce uncertainties in reservoir evaluation and hydrocarbon estimation. This study aims to provide a comprehensive reservoir assessment through an integrated three-dimensional (3D) static modeling workflow. Well-log data from four wells were combined with the interpretation of seventeen seismic lines to construct structural, stratigraphic, and petrophysical models of the AR/G reservoir. The results indicate that reservoir thickness ranges from 9 to 14 ft and is structurally controlled by nine normal faults forming a horst–graben configuration that significantly influences compartmentalization and hydrocarbon distribution. Petrophysical modeling reveals favorable reservoir quality, with effective porosity ranging from 14% to 20%, an average shale volume of approximately 19%, and hydrocarbon saturation averaging 56%. Two prospective zones were identified, with estimated original oil in place (OOIP) of 10.76 MMSTB and 3.23 MMSTB, respectively, representing recoverable volumes within structurally defined closures rather than the entire field volume. The model also explains the relatively poor performance of Karama-5 and Karama-11 wells due to their peripheral structural positions outside the main closures and their higher water saturation (44–53%). These findings demonstrate that integrated structural and petrophysical modeling improves reservoir understanding and helps identify optimal drilling targets in structurally complex reservoirs of the Abu Gharadig Basin and comparable North African settings. Although the estimated volumes correspond to relatively small accumulations, they are considered economically viable within mature basins such as the Abu Gharadig Basin, where existing infrastructure and optimized development strategies enable efficient exploitation of marginal reserves. Full article

The electrical system is a crucial infrastructure of modern society. It provides the energy needed for society to continue its development. However, this critical infrastructure is increasingly threatened by the extreme weather events driven by the escalating climate crisis, posing significant challenges to sustainable development and energy security. Therefore, it is important to conduct comprehensive risk analyses of the electrical system to prepare for future challenges. This paper presents an electrical risk assessment conducted within the European project ICARIA, aiming to evaluate the effects of global climate change on critical infrastructure resilience. The study improves on the first risk assessment conducted, evaluating the electrical system’s vulnerability to flooding events, such as heavy rains or rising sea levels, in the Metropolitan Area of Barcelona. A key contribution to this research is the integration of direct impact assessments and cascading effect analyses, which identify how localised failures in electrical assets can spread throughout the system, potentially leading to a blackout. The research focuses on modelling various flood projections, using extreme weather scenarios and return periods ranging from 1 to 100 years. These projections are employed to evaluate the risk assessment methodology and quantify potential impacts on the electrical grid, including Expected Annual Damage (EAD) and Energy Not Supplied Cost (ENSC). The results aim to provide policymakers and grid operators with valuable insights, enabling the development of data-driven adaptation strategies and climate-resilient infrastructure planning to mitigate the risks posed by extreme weather events. Full article

Prestressed concrete railway sleepers are key structural components that determine the safety, durability, and serviceability of modern railway infrastructure. This study presents a comprehensive investigation of the design, testing, and acceptance of prestressed concrete sleepers in accordance with EN 13230, with particular reference to the requirements applied on the Polish railway network. The analysis integrates normative provisions, analytical calculations, finite element modeling, and experimental verification, including static, dynamic, and fatigue load tests. Special attention is given to the k_t coefficient, which accounts for prestress losses, fatigue degradation, and the development of concrete strength throughout the service life. This coefficient plays a critical role in the acceptance criteria for sleepers during mandatory product testing. The influence of concrete age on the variability of k_t is examined, showing that the highest variability occurs within the first 180 days of curing. Full-scale laboratory tests performed on PS-94 sleepers confirm compliance with standard requirements regarding cracking loads, crack width limits, and ultimate load capacity under both exceptional and fatigue loading conditions. Numerical simulations provide additional insight into stress and displacement distributions in critical cross-sections, supporting the experimental findings. The results indicate that most of prestressing force losses occur during the early service period. This observation supports the application of age-dependent acceptance criteria, which may improve conformity assessment procedures for prestressed concrete railway sleepers in contemporary railway engineering practice. Full article

Aero-engine quality assessment under the RAMS framework faces two persistent challenges: the inherent epistemic and linguistic uncertainty in expert evaluation, and the systematic neglect of inter-dimensional coupling. This paper proposes an integrated assessment method that combines Interval Type-2 Fuzzy Sets (IT2FS)-based group decision-making with Partial Least Squares Structural Equation Modeling (PLS-SEM). At the measurement level, IT2FS encodes dual-layered uncertainty through the Footprint of Uncertainty (FOU); multi-expert judgments are aggregated via the fuzzy weighted geometric average operator and defuzzified using the Karnik–Mendel algorithm. At the structural level, a reflective second-order PLS-SEM model built on the RAMS framework enables parametric estimation and significance testing of inter-dimensional coupling. Validation on a 63-engine turbofan dataset confirms that all measurement model criteria are satisfied, the second-order model explains 82.4% of the variance in overall quality (R² = 0.824), and predictive relevance is strong (Q² = 0.567). Comparative experiments against three benchmark methods demonstrate consistent advantages in quality grade discrimination, information richness, sensitivity to technical improvements, and ranking robustness. These properties position the framework as a statistically rigorous, model-based complement to existing condition-monitoring and digital health management systems for complex propulsion systems, supporting quantitative decision-making within digital engineering programmes. Full article

Background/Objectives: Excess consumption of energy-dense foods (EDF; ultra-processed snacks, sweets, and sugar-sweetened beverages) among preschool-aged children is a public health concern, particularly in low-income families. Caregiver parenting style, psychological stress, and food-parenting practices (FPP) may shape children’s EDF consumption, yet little is known about how these factors operate in real time. This exploratory pilot study examined (1) associations between baseline characteristics and EDF feeding episodes across 1 week and (2) whether caregivers’ momentary stress during EDF episodes related to FPP used. Methods: In total, 22 caregivers of Head Start children (ages 3–5) completed baseline measures and 7 days of ecological momentary assessment (up to seven prompts/day). At each prompt, caregivers reported child EDF consumption in the past hour; if confirmed, they reported FPP used and rated momentary stress. Aim 1 used Poisson regression to model caregiver-level EDF episode counts. Aim 2 tested momentary stress–practice associations during EDF episodes using GEE, with within-person and between-person stress modeled separately. Results: Authoritarian parenting was associated with a higher weekly rate of EDF episodes (RR = 1.43, 95% CI 1.23–1.66, p < 0.001); authoritative parenting trended lower (RR = 0.90, p = 0.065). Higher baseline stress was associated with more EDF episodes (RR = 1.25, p = 0.001). Momentarily, elevated stress above a caregiver’s own average increased odds of using food as a reward (OR = 1.08 per +10 points, p = 0.011), while higher average momentary stress was associated with co-eating (OR = 1.59, p = 0.042). Domain-level FPP composites showed no association with momentary stress. Conclusions: Authoritarian parenting and higher caregiver stress were associated with increased EDF feeding, and momentary stress was linked to reward-based feeding during those episodes. These hypothesis-generating findings suggest potential behavioral targets for just-in-time adaptive intervention, pending replication in adequately powered studies. Full article

Background: Intrahepatic cholangiocarcinoma (ihCC) is a rare aggressive liver malignancy with rising incidence. For resectable cases, surgery is the only curative approach, but recurrence rates remain high. These challenges highlight the need for personalized, evidence-based clinical decision-making to improve patient outcomes. To address this, we developed the Multiphasic Evidential Decision-making Matrix (MedMax) to support systematic, individualized therapeutic strategies for ihCC. Methods: In this retrospective single-center study, between 2010 and 2020, we assessed the ability of the MedMax matrix to make treatment decisions in 489 consecutive patients with ihCC or suspected ihCC. Patients were divided into two cohorts depending on whether their tumor was operable (surgical cohort, n = 335) or non-operable (non-surgical cohort, n = 154). We assessed the accuracy of diagnostic confirmation and treatment allocation by MedMax and evaluated how the model’s recommendations corresponded to those made by the tumor board. Results: In the surgical cohort, MedMax achieved 100% accuracy in diagnostic confirmation and 97.9% accuracy in treatment allocation. There was 74.3% concordance between the resection type proposed by MedMax and actual extent of resection. This discrepancy was caused by deviations from the preoperative plan based on intraoperative findings, which could not have been predicted preoperatively. In the non-surgical cohort, MedMax again achieved 100% accuracy in diagnostic confirmation and 98.7% accuracy in treatment allocation. All discrepancies between the decisions made by MedMax and those made by the tumor board were attributed complex, high-risk patient profiles. MedMax reliably identified risk factors (such as advanced comorbidities and multifocal disease) in both cohorts. Conclusions: The MedMax matrix can make accurate, reliable and transparent decisions about the diagnosis and treatment of patients with ihCC thanks to its modular, evidence-based approach. It can also stratify and document risks in both surgical and non-surgical settings. Full article

Mediterranean water systems face intensifying drought pressure under climate change, yet the long-term macroeconomic consequences of recurrent water restrictions remain largely unquantified at the metropolitan scale. This study estimates the cumulative economic costs of drought-induced water restrictions in the Barcelona Metropolitan Area (AMB) over 2016–2099 using a supply-driven Input–Output (Ghosh) model driven by six hydro-climatic projections. Drought conditions persist in more than half of all simulated months across all climate projections, generating substantial cumulative undiscounted losses of €52–61 billion through repeated restriction episodes rather than isolated extreme events. The present value of total GDP losses ranges between €8.4 and €41.4 billion depending on the discount rate applied (1%, 3% and 5%). Losses concentrate in service sectors due to strong intersectoral propagation effects, despite agriculture exhibiting the highest direct water dependence. The framework provides a transferable approach for assessing long-term climate-driven drought costs in metropolitan urban or regional economies. Full article

SiO₂ aerogel cement composites (SACCs) are promising for building insulation, but how their residual thermal performance evolves after high-temperature exposure remains unclear, limiting fire protection assessment. In this study, SACC specimen with aerogel contents of 0%, 5%, 7%, and 10% were heat-treated at 400, 600, 700, 800, and 1000 °C. After cooling, their post-exposure thermal performance and microstructure were characterized via mass loss, density, thermal conductivity, MIP, and SEM. Results obtained at room temperature showed that with increasing treatment temperature, thermal conductivity first decreases and then increases, reaching a minimum after 700 °C treatment for the A7 specimens (from 0.092 to 0.063 W/(m·K)). Microstructural analysis of cooled specimens revealed that this non-monotonic behavior arises from three heat-induced changes: the cement matrix, aerogel aggregates, and the interfacial gap between them. After treatment at 700 °C, the gap corresponds to a Knudsen number of 0.01–0.02, entering the slip-flow regime. Combined with the low thermal conductivity of the cement matrix, this yields the best insulation. After treatment at 800 °C and above, the gap exceeded 60 μm, shifting heat transfer to the continuum regime and reducing insulation capacity. A thermal conductivity prediction model based on these post-exposure mechanisms agreed well with the experimental results. Full article

Objective: To evaluate the relationship between legume intake and incident hyperuricemia among Chinese adults using large-scale prospective cohort data. Methods: Baseline and follow-up information from the Shanghai Suburban Adult Cohort and Biobank (SSACB) were used to assess diet and hyperuricemia incidence [serum uric acid (SUA) ≥ 420 μmol/L in males and ≥ 360 μmol/L in females]. A Food Frequency Questionnaire (FFQ) covering 29 food categories quantified food consumption during the previous 12 months. Legume intake was calculated by multiplying the reported consumption of each item by (1 − water content), and participants were classified into tertiles with the lowest third (Q1) as the reference. Cox proportional-hazards models estimated hazard ratios (HRs) and 95% confidence intervals (CIs), and restricted cubic splines (RCSs) with three knots (10th, 50th, and 90th percentiles) visualized the dose–response relation. Results: Among 43,371 participants, 1456 new cases of hyperuricemia were documented over 225,002.40 person-years (incidence density 6.47/1000 person-years; 95% CI 6.14–6.80). Incidence density decreased with higher legume intake: each 1 g/day increment was associated with a 2% lower risk (HR 0.98; 95% CI 0.97–0.99; p < 0.05). Compared with Q1, the highest tertile (Q3) showed a 26% risk reduction in the fully adjusted model (HR 0.74; 95% CI 0.64–0.86; p < 0.05). RCS revealed a significant nonlinear relationship (p-overall < 0.001, p-nonlinear = 0.0013), with the significant benefit in risk observed at 6–28 g/day. Conclusions: Legume intake is nonlinearly and inversely associated with hyperuricemia risk among Shanghai suburban adults. Given that the current low median intake, comprehensive strategies are needed to rationally adjust the dietary structure, improve legume intake, and provide sustainable development strategies for effective prevention and control of hyperuricemia. Full article