Search Results (8,627)

Background/Objectives: Anticoagulation in advanced chronic kidney disease (CKD) remains challenging due to limited representation in clinical trials, resulting in uncertainty regarding optimal drug selection, dosing, and monitoring strategies. Methods: We conducted a cross-sectional, web-based survey of clinicians involved in CKD care and anticoagulation prescribing. The questionnaire explored respondent characteristics, methods of renal function estimation, anticoagulant selection across common CKD scenarios, anticoagulants’ dosing and monitoring practices, and approaches to anticoagulation in nephrotic syndrome. Results: Fifty-seven clinicians participated in the survey. Unfractionated heparin was the preferred agent for venous thromboembolism (VTE) prophylaxis in patients with stage 4 and 5 CKD, or on dialysis. For acute VTE treatment, anticoagulant choice varied by CKD severity, with unfractionated heparin, direct oral anticoagulants (DOACs), and low-molecular-weight heparin (LMWH) all reported to be used depending on stages of CKD. Warfarin and DOACs were commonly used for treatment of chronic VTE and atrial fibrillation (AF), with warfarin more frequently selected in patients receiving dialysis. Apixaban was the most frequently reported DOAC, typically at a dose of 2.5 mg twice daily in advanced CKD and dialysis. Renal function estimation methods varied, with Cockcroft–Gault most used overall, while nephrologists more frequently reported MDRD or CKD-EPI equations. Most respondents reported not routinely monitoring DOAC levels, and the majority indicated the absence of a structured multidisciplinary team (MDT) for managing anticoagulated CKD patients. Clinical practice varied according to specialty, experience, and healthcare setting, particularly in anticoagulant selection, dosing strategies, and use of risk stratification tools. Conclusions: Anticoagulation practices in advanced CKD are highly heterogeneous, reflecting persistent evidence gaps. While unfractionated heparin and warfarin remain central in patients with stage 5 CKD or on dialysis, DOAC use—particularly apixaban—has expanded, often with empiric dose reduction. These findings underscore the need for clearer guidance, standardized approaches to renal function assessment, multidisciplinary care pathways, and prospective studies focusing on anticoagulation use in CKD populations. Full article

Under ground-based observation geometry, infrared radiant-intensity sequences of space objects are jointly influenced by object micromotion, thermal radiation, time-varying viewing conditions, and atmospheric propagation. Existing simulation studies often prescribe the line of sight or simplify the coupling between viewing geometry and atmospheric attenuation, which limits long-duration ground-based sequence analysis. This study develops a physics-informed framework for generating atmosphere-attenuated infrared radiant-intensity sequences of space objects undergoing precession or tumbling. The framework reconstructs observation geometry from azimuth–elevation–range trajectories, updates facet normals through a unified micromotion attitude model, computes visible projected area and transient facet temperature, and incorporates MODTRAN-derived elevation-dependent atmospheric transmittance. Using this framework, we construct IRPeriodic, an eight-class simulated dataset for long-duration univariate time-series classification. We further propose LPD-Net, which integrates large-kernel residual feature extraction, prototype-guided dynamic temporal alignment, and differential periodic representation to capture long-range waveform morphology, sample-dependent temporal correspondence, and segment-level local variation. On IRPeriodic, LPD-Net achieves an accuracy of 0.8618 ± 0.0057, a macro-F1 of 0.8615 ± 0.0061, and a Matthews correlation coefficient of 0.8426 ± 0.0065, outperforming the evaluated neural-network and ROCKET-type baselines. Ablation and synthetic-noise sensitivity analyses indicate that the performance gain is mainly associated with long-context feature extraction, with additional improvements from dynamic alignment and differential periodic statistics. Auxiliary experiments on selected public UCR datasets suggest that the representation is also competitive for univariate time-series classification. These results demonstrate the effectiveness of LPD-Net on the proposed physics-informed benchmark for long-duration ground-based infrared radiant-intensity sequence classification. Full article

The decarbonization of maritime transportation requires shipboard energy systems to coordinate conventional generators, renewable energy sources, energy storage devices, and thermal energy units under voyage-dependent operating constraints. This paper develops a configurable hybrid multienergy ship system for coordinated electrical and thermal energy scheduling. The proposed framework functionally separates the propulsion subsystem from the service and thermal subsystem while retaining system-level coordination among photovoltaic generation, wind generation, diesel generators, micro gas turbines, energy storage batteries, and thermal energy units. A convolutional neural network is employed to provide short-term photovoltaic power forecasts for day-ahead scheduling. The resulting scheduling problem simultaneously considers voyage completion, power balance, equipment operating limits, ramp-rate constraints, battery charging and discharging restrictions, operating costs, and pollutant emission treatment costs. The nonlinear operating logic is reformulated as a mixed-integer optimization problem and solved using CPLEX. A representative coastal voyage case study is used to evaluate the proposed framework. The results demonstrate that the method can coordinate multiple shipboard energy sources, satisfy the prescribed electrical and thermal demands, and provide a set of Pareto-optimal solutions describing the trade-off between operating cost and emission-related cost. The proposed framework provides a system-level scheduling approach for supporting the economic and low-carbon operation of hybrid multienergy ships under increasingly stringent maritime emission reduction requirements. Full article

Background: Amoxicillin–clavulanate (AC) is the antibiotic most frequently implicated in idiosyncratic drug-induced liver injury (DILI) worldwide, and it characteristically produces a cholestatic or mixed pattern in older adults. A predominantly hepatocellular presentation is distinctly less common in this age group, and reports from the Arabian Peninsula are scarce. Case presentation: A 66-year-old Saudi man developed painless, progressive jaundice after a seven-day course of oral AC (500/125 mg three times daily) prescribed for a thumb laceration. He described a similar self-limiting jaundice after the same antibiotic approximately five years earlier, an episode that was never investigated and had not been entered in his allergy record, so the drug was prescribed again unknowingly. Liver biochemistry, documented as normal four months earlier, showed alanine aminotransferase (ALT) peaking at 587 U/L (14.3 × the upper limit of normal, ULN) and aspartate aminotransferase at 335 U/L, with total bilirubin 249 µmol/L (11.9 × ULN) and a 69% conjugated fraction, whereas alkaline phosphatase (ALP) never exceeded 245 U/L (1.9 × ULN). The R-value at the ALT peak was 19.3 using the same-day ALP, and 7.6 even when the peak ALT is paired with the highest ALP recorded at any point in the illness; the pattern was therefore hepatocellular (R > 5) throughout the injury phase. Hy’s law criteria were met, although the international normalised ratio remained 1.0 and no encephalopathy developed. Peripheral eosinophilia (peak 1.05 × 10⁹/L) was documented. Hepatitis B surface antigen, hepatitis B core antibody, hepatitis C antibody and HIV serology were non-reactive; antinuclear, anti-smooth-muscle, anti-liver-kidney microsomal type 1 and antimitochondrial antibodies were negative and serum ceruloplasmin was normal; ultrasound with contrast-enhanced triphasic computed tomography excluded biliary obstruction and malignancy. Hepatitis A and E serology and cytomegalovirus/Epstein–Barr studies were unavailable at our institution, which we report as a limitation. AC was withdrawn and management was supportive. Liver biochemistry normalised completely over the following three months (ALT 25 U/L, ALP 103 U/L, and total bilirubin 22 µmol/L). Updated Roussel Uclaf Causality Assessment Method (RUCAM) scoring on the hepatocellular scale gave 7 points (probable); no credit was taken for the historical episode, since RUCAM requires documented enzyme re-elevation for a positive re-administration response. Conclusions: AC can cause hepatocellular, Hy’s-law-positive injury in older adults, not only the cholestatic phenotype emphasised in the literature. The decisive failure here was administrative rather than diagnostic: an adverse drug reaction that is never recorded will be repeated. Full article

Background/Objectives: Orlistat is a gastrointestinal lipase inhibitor used for weight management. Although its established safety profile is largely characterised by fat malabsorption-related gastrointestinal events, post-marketing reports suggest a broader spectrum of adverse events. Given the increasing intersection between obesity pharmacotherapy and the management of non-alcoholic fatty liver disease/metabolic dysfunction-associated steatotic liver disease (NAFLD/MASLD), this study evaluated gastrointestinal, hepatobiliary, pancreatic, and anorectal adverse-event reporting signals associated with orlistat in the U.S. Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS) and assessed concordance with regulatory prescribing information. Methods: Quarterly FAERS files from 2004 Q1 through 2026 Q1 were analysed; some retained reports had Initial FDA Received Date (FDA_DT) values dating back to 1999. Descriptive analyses included all orlistat-associated reports, whereas disproportionality analyses were restricted to primary-suspect reports. Sixty-five prespecified Medical Dictionary for Regulatory Activities (MedDRA) preferred terms (PTs) were screened. Reporting odds ratios (RORs), 95% confidence intervals (CIs), and proportional reporting ratios (PRRs) were calculated. A signal was defined as ROR > 2.0, lower bound of the 95% CI > 1.0, and n ≥ 3. Two-sided p values calculated using Fisher’s exact test on the corresponding 2 × 2 contingency tables were adjusted using the Benjamini–Hochberg false discovery rate procedure to address multiple testing. Signal-positive PTs were cross-referenced with prescribing information from three jurisdictions. Results: Overall, 30,454 deduplicated orlistat-associated reports were identified, including 16,684 primary-suspect reports. Thirty-eight of the 65 prespecified MedDRA PTs met the signal criteria, and all remained statistically significant after Benjamini–Hochberg false discovery rate correction (q < 0.05). The strongest signals were rectal discharge (ROR 1175.53; 95% CI 1093.44–1263.78) and steatorrhoea (ROR 1147.99; 95% CI 1058.12–1245.50); change in bowel habit also showed a high ROR (47.32; 95% CI 38.27–58.51). Unlabelled signal-positive PTs included constipation, faeces hard, cholecystitis, and irritable bowel syndrome; change in bowel habit showed jurisdiction-specific labelling discordance. Conclusions: Orlistat-associated FAERS signals included both expected fat-malabsorption-related events and additional gastrointestinal, hepatobiliary, pancreatic, and anorectal PTs, several of which were not explicitly represented in the evaluated regulatory labels. These findings reflect disproportionate reporting rather than incidence, absolute risk, or causality and require confirmation in independent clinical or epidemiological data sources. They do not, by themselves, support regulatory labelling changes. Full article

Background/Objectives: Hospital performance is a multidimensional construct that cannot be adequately assessed using isolated financial, clinical, organizational, or patient-reported indicators. This study aimed to develop and evaluate an Integrated Multidimensional Hospital Performance Assessment Framework combining organizational management, healthcare quality, patient satisfaction, and cost efficiency. Methods: An observational, descriptive, comparative study was conducted using data collected during 2018–2019 from two Romanian public hospitals with different organizational profiles: a multidisciplinary general hospital and a monospecialty hospital. Organizational, operational, financial, and clinical indicators were analyzed comparatively. Patient satisfaction was assessed in 184 hospitalized patients, including 130 from the general hospital and 54 from the monospecialty hospital, using a structured questionnaire with excellent internal consistency (Cronbach’s α = 0.92). Cost efficiency was estimated using Stochastic Frontier Analysis based on hospital expenditure, activity, resource utilization, case complexity, and quality-related variables. Results: Significant differences were identified between the hospitals in staff composition, bed occupancy, outpatient activity, case-mix complexity, surgical activity, healthcare quality, and financial performance. Patient satisfaction was generally high in both institutions, although several dimensions differed significantly, particularly overall satisfaction, waiting time, physician consultation, treatment received, and adherence to the prescribed medication schedule. The general hospital had a lower mean cost-inefficiency score than the monospecialty hospital (0.253 vs. 0.395), corresponding to higher estimated cost efficiency (0.747 vs. 0.605; p < 0.001). Conclusions: The proposed framework offers a comprehensive and practical approach to hospital performance assessment, and its application in two public hospitals provides a proof-of-concept demonstration of feasibility. Further multicenter studies are required for external validation and assessment of its generalizability across different hospital settings. Full article

A prescribed time-adaptive event-triggered sliding mode control method is proposed for a second-order aircraft antiskid braking system with unmeasurable longitudinal velocity, subject to unknown actuator faults and external disturbances. Based on the time scale transformation technique, a prescribed-time observer is constructed to estimate the unmeasurable longitudinal velocity. A practical prescribed-time super-twisting observer with a saturated gain is designed to estimate the disturbance. Within the prescribed time convergence framework, an adaptive update law and a nonsingular integral sliding surface are developed to compensate for actuator faults. Building on this, a time-varying dynamic threshold event-triggering mechanism is incorporated into the prescribed time-sliding mode control process, while excluding Zeno behavior and reducing the control update frequency. The aforementioned prescribed-time observers and the event-triggered adaptive sliding mode controller form a strict temporal hierarchical architecture. Based on Lyapunov stability theory, it is proved that the closed-loop system is practically prescribed-time stable and that all closed-loop signals are uniformly ultimately bounded. Comparative simulation results verify the effectiveness of the proposed method. Full article

Coal-based solid wastes, including coal gangue and fly ash, can be extensively utilised in cemented backfill materials. However, the slump, bleeding rate, and mechanical strength of these materials depend nonlinearly on the mixture composition, particle size, solids concentration, and curing conditions, complicating the multi-performance mixture design. This study developed an ensemble-learning framework for the target-specific performance prediction and empirical-uncertainty-aware inverse design of coal-based solid-waste cemented backfill materials. A literature-derived database containing 720 observations and 11 predictors was established. After the target-specific filtering of missing responses, 214 observations were available for the slump, 284 for the bleeding rate, and 711 for the uniaxial compressive strength (UCS). Support vector regression (SVR), Bagging-SVR, AdaBoost-SVR, and Stacking-SVR were evaluated using 20 repeated random 80:20 holdout partitions to assess the within-database predictive performance. Bagging-SVR achieved the lowest mean inner-cross-validation RMSE for all three responses. Its mean test R² values were 0.969, 0.871, and 0.965 for the slump, bleeding rate, and UCS, respectively, with corresponding RMSE values of 2.228 cm, 1.206 percentage points, and 1.575 MPa. SHAP analysis showed that the coal-gangue particle size and solids concentration received the largest model attributions for the slump and bleeding-rate predictions, whereas the cement content and curing time received the largest attributions for the UCS prediction. The selected Bagging-SVR models were subsequently coupled with multi-objective differential evolution incorporating empirical prediction bounds, component mass balance, and target-specific five-nearest-neighbour applicability-domain constraints. The selected compromise candidate had a solids concentration of 79.46% and coal-gangue, fly-ash, and cement dry-solid mass fractions of 63.29%, 24.95%, and 11.76%, respectively. Its predicted slump, bleeding rate, and 28 d UCS were 21.19 cm, 1.85%, and 6.36 MPa, respectively. The nominal empirical upper bound of the bleeding rate was 3.83%, and the lower bound of the UCS was 3.74 MPa, both satisfying their prescribed limits. However, the nominal slump interval of 15.70–26.65 cm was not fully contained within the prescribed range of 18–26 cm. Full article

This paper presents an adaptive event-triggered nonsingular fast terminal sliding-mode control (AETSMC) framework for quadrotor unmanned aerial vehicles subject to aerodynamic disturbances, actuator loss of effectiveness (LOE) of up to 60%, and intermittent denial-of-service (DoS) attacks. First, a nonsingular fast terminal sliding-mode (NFTSM) surface is constructed using fractional powers of the tracking error rather than fractional-order derivatives. This design ensures finite-time convergence while avoiding the singularity associated with conventional terminal sliding-mode schemes. Second, a smooth positive-semidefinite barrier function (Smooth-PSBF) is incorporated into the adaptive gain law. The resulting law provides only the compensation required to maintain the prescribed bound, thereby limiting gain overestimation and chattering. Third, a dual-mode event-triggering mechanism combines an exponentially decaying threshold with a zero-order hold. A positive lower bound on the inter-event interval is derived from the closed-loop dynamics, which excludes Zeno behaviour. Simulations under matched conditions show that the proposed method reduces the pitch-channel root-mean-square error by 79.4% and the integral squared error by 95.8% relative to the first reproduced baseline. In a separate 15-s communication experiment sampled at 1 kHz, the controller generated 128 transmissions instead of 15,000 periodic updates, corresponding to a 99.15% reduction. These results indicate that the proposed framework can improve fault-tolerant tracking while reducing communication demand under intermittent DoS attacks. Full article

Background: Pharmaceutical waste presents significant economic and environmental challenges, necessitating systemic interventions for sustainable healthcare. Community pharmacists are pivotal in mitigating this waste through optimized dispensing, patient education, and facilitating safe disposal. Methods: A nationwide cross-sectional survey was conducted to evaluate the perceptions, practices and perceived barriers of community pharmacists in Saudi Arabia. Data regarding barriers and mitigation strategies were collected using a five-point Likert scale. Results: A total of 275 pharmacists participated, with an average age of 33.86 ± 7.46 years. Pharmacists showed strong understanding of the economic impact of medication waste, with an average score of 4.41 ± 0.85. The lowest score, 2.80 ± 1.25, reflected poor public awareness about proper disposal practices. The most identified source of waste was the discarding of unopened medication packages, scoring 3.80 ± 1.05. The top barrier was the lack of national guidelines, with a score of 3.82 ± 1.01. Unified patient records and e-prescribing were viewed as the most effective strategies, scoring 4.17 ± 0.94. Practice gaps were clear, as 27.64% of pharmacies did not provide any disposal service. Conclusions: Saudi community pharmacists demonstrate high readiness but are hindered by logistical gaps and fragmented frameworks. Achieving sustainable pharmaceutical stewardship requires standardized national guidelines, formalized take-back pathways, and the expansion of digital tools like Wasfaty to align clinical practice with Saudi Vision 2030 sustainability goals. Full article

Coherent vortices alter flapping-foil energy harvesting, but wake-generated vortex properties and timing are coupled to upstream-body kinematics. We use two-dimensional immersed boundary–lattice Boltzmann simulations of a prescribed heaving–pitching NACA0015 foil at $Re=1100$. An independently prescribed Taylor vortex allows nominal encounter phase, body-fixed offset, diameter, and intensity to be varied at fixed kinematics. Production-grid ${\overline{C}}_P$ is within $0.10\%$ of the fine-grid result; the fine-grid diffusion test gives a maximum full-field velocity $L_2$ error of $0.0690\%$ against the analytical solution over $0\le t^{*}\le 4$. For the reference vortex with a pivot-centered nominal target ($D/c=v_{\theta m}/U_{\infty }=1$), nominal-encounter-aligned mean power coefficients of $0.747$, $0.862$, and $0.987$ occur at ${\psi }_e=0.10$, $0.40$, and $0.60$, respectively, compared with $0.832$ without gusts. These define the power-reducing (PR), near-baseline (NB), and power-enhancing (PE) cases. Within the sampled ranges, diameter is associated mainly with disturbance reach and duration, intensity with loading magnitude, and offset with spatial overlap and interaction timing. Power variations are consistent with the timing of vortex-modified loading relative to prescribed foil motion. In three same-sign, once-per-cycle sequences, the PR–NB–PE ordering persists despite residual-wake interactions, with sustained mean power coefficients of $0.763$, $0.916$, and $0.965$, respectively. Nominal encounter phase and foil placement should be considered jointly for repeatable or predictable vortex passages. Full article

Quantum tunneling is conventionally described by the Schrödinger wave equation with a prescribed static potential barrier, providing accurate transmission probabilities but offering limited insight into the microscopic dynamics of particle–barrier interactions. In this work, we develop a dynamical second-quantization framework in which the barrier is modeled as an ensemble of quantized internal modes rather than as an externally imposed classical potential. The tunneling particle interacts directly with these microscopic barrier excitations through a coupled particle–barrier Hamiltonian, from which the Heisenberg equations of motion are derived. Collective coherent excitations of the barrier modes give rise to an emergent effective barrier that naturally recovers the conventional rectangular barrier and the WKB transmission limit under appropriate conditions. Unlike standard treatments, the present formulation explicitly incorporates microscopic barrier dynamics and provides a unified description of particle–barrier coupling within a second-quantized formalism. The framework further suggests that repeated tunneling events may experience different microscopic interaction histories, motivating a statistical interpretation of tunneling times. Because both the particle and barrier are treated within the same operator formalism, the theory provides a natural foundation for extension to relativistic quantum transport, photonic barriers, cavity quantum electrodynamics, and other structured quantum media. Full article

Hypertension is the most common comorbidity in chronic kidney disease (CKD), affecting roughly 80–85% of patients overall and an even higher proportion in nondialysis CKD G3–G5. This narrative review examines whether, and under what clinical conditions, fruits, vegetables, and legumes can be used safely in adults with hypertensive CKD, especially nondialysis CKD G3–G5, as well as moderate to severe loss of kidney function, paying close attention to the gut microbiota, short-chain fatty acids, gut-derived uremic toxins, potassium bioavailability, and modifiable clinical risk factors. The clinical effect of plant foods on serum potassium cannot be predicted from total potassium content alone. The Kidney Disease: Improving Global Outcomes (KDIGO) 2024 guidelines explicitly advise individualized potassium management and emphasize limiting foods rich in bioavailable potassium, especially processed foods, rather than reflexively restricting fruits and vegetables. Across CKD studies, the association between dietary potassium and serum potassium is weak or inconsistent, and the risk of hyperkalemia is modified by kidney function, bowel function, metabolic acidosis, diabetes and hyperglycemia, medications, food processing, and the food matrix itself. Potassium bioavailability varies substantially according to the food matrix, preparation method, portion size, and processing method; some minimally processed plant foods may provide less readily absorbable potassium than potassium-rich processed foods, juices, or potassium additives. Fruits, vegetables, and legumes also provide fiber, resistant starch, and polyphenols that can support saccharolytic fermentation, short-chain fatty acid production, bowel transit, and lower concentrations of some gut-derived uremic toxins. However, blood-pressure and kidney-outcome benefits in CKD are supported more strongly by observational and selected alkali-diet trials than by large microbiome-focused randomized studies. In hypertensive CKD, fruits, vegetables, and legumes should not be universally restricted simply because they contain potassium. A safer and more evidence-aligned strategy is individualized, food-source-aware prescribing that prioritizes minimally processed plant foods, accounts for preparation method and portion size, corrects constipation and acidosis, reviews potassium-raising medications and additives, and monitors serum potassium according to baseline risk. Full article

Rising recognition of attention deficit hyperactivity disorder (ADHD) in adults and children is reshaping how Australian health systems organise diagnosis, prescribing and long-term management. This has coincided with sharp increases in ADHD medicine dispensing, high private assessment costs and prolonged waiting times for psychiatrists and paediatricians. Australian states and territories have commenced reforms that expand the role of general practitioners (GPs) in ADHD diagnosis, prescribing and long-term management. This commentary assesses whether these reforms can expand timely and equitable access while maintaining diagnostic accuracy, medication safety and specialist referral. It uses the New South Wales (NSW) model as a detailed exemplar because it has developed a staged pathway: trained continuation prescribers support previously diagnosed patients who are stable on psychostimulant treatment, while endorsed prescribers receive further accredited training or recognition of prior learning to assess, diagnose, initiate and adjust psychostimulant treatment. The commentary distinguishes professional specialty status from ADHD-specific competency: specialist registration in general practice establishes the professional status of qualified Australian GPs, whereas safe extension of ADHD diagnosis and psychostimulant prescribing requires condition-specific education, competency assessment, prescribing authority, monitoring and defined referral pathways. It reviews Australian reforms, explains the NSW training and governance pathway, compares overseas approaches, and identifies safeguards needed to avoid diagnostic compression, overdiagnosis, stimulant diversion and widening inequity. The central argument is that GP involvement should be framed as trained, governed primary-care capacity. If adequately funded, audited and linked to specialist escalation pathways, the model may reduce access barriers while preserving diagnostic rigour. Full article

A simply supported rectangular isotropic ferromagnetic plate with magnetocaloric properties subjected to convective heating on its upper surface is considered. The governing equations comprise a system of two-dimensional transient equations for the thickness-averaged temperature characteristics of the plate and the two-dimensional bending equations for isotropic plates expressed in terms of generalized displacements within the framework of first-order shear deformation theory. Closed-form solutions to the governing equations are obtained by expanding all thermal and mechanical field quantities in double Fourier sine series satisfying the prescribed boundary conditions, combined with the Laplace transform in time applied to the thermal quantities. A comparative numerical analysis is carried out for the magnetocaloric ferromagnetic plate and a carbon steel plate under ambient temperature rising at a finite rate to a prescribed value. The dependences of all quantities under investigation on the ambient temperature rise rate, time, convective heat transfer coefficient, thermal conductivity of the ferromagnetic material, and geometric parameters of the plate are analyzed and presented graphically. The results obtained provide a quantitative basis for assessing the thermoelastic state and for optimizing the geometry and operating conditions of active magnetic regenerator plate stacks with a view to enhancing their structural reliability. Full article