Search Results (8,275)

Hemorrhagic shock remains a leading cause of preventable death in trauma, yet traditional vital signs may fail to reflect early blood loss before physiological compensatory mechanisms are no longer able to maintain hemodynamic stability. The Compensatory Reserve Measurement (CRM) algorithm offers early detection capability using physiological waveforms but requires testing with emerging wearable sensor technologies for operational deployment. This study tested the Epicore Epidermal Patch for Imperceptible Care (EPIC) wearable healthcare device (WHD) for CRM-based hemodynamic monitoring during progressive central hypovolemia induced by lower-body negative pressure (LBNP) to simulate hemorrhage. Twenty participants underwent progressive LBNP while photoplethysmography (PPG) signals were recorded from EPIC sensors placed at the clavicle and triceps alongside a clinical-grade finger pulse oximeter for reference. Signal quality, heart-rate accuracy, and CRM predictions were evaluated across multiple filtering approaches. The triceps placement achieved signal quality comparable to the pulse oximeter reference when Chebyshev Type II filtering was applied, as well as high heart-rate accuracy. CRM derived from the EPIC sensor placed at the triceps tracked compensatory trends during progressive hypovolemia, but prediction magnitudes were inaccurate compared to calculated CRM values. In contrast, the clavicle placement consistently performed poorly across all measurements, regardless of the signal-processing approach. These findings support the feasibility of soft, flexible wearable sensors for continuous hemorrhage monitoring at the triceps location in operational environments where traditional finger-based pulse oximetry is impractical. Full article

Background/Objectives: Dental caries continues to represent a major oral health concern in children, particularly in uncooperative patients, where effective sealant placement is often compromised. This study evaluated the long-term clinical performance of hydrophilic (UltraSeal XT hydro) and hydrophobic (Helioseal-F) resin-based sealants in uncooperative children aged 6–9 years, assessing retention and caries incidence over 24 months. Methods: In a split-mouth, double-blinded randomized controlled trial, 34 children (104 first permanent molars) were enrolled, with 31 participants (98 teeth) completing the study. Sealants were randomly assigned to hydrophilic or hydrophobic group, with assessments at 3, 6, 12, 18, and 24 months. Results: Complete retention declined progressively in both groups, from 59.2% to 2.0% in the hydrophilic group and from 42.9% to 0% in the hydrophobic group at 24 months, with no significant intergroup differences (p = 0.719). Caries-free rates decreased from 81.6% to 49.0% in the hydrophilic group and from 75.5% to 40.8% in the hydrophobic group (p = 0.293). Children with definitely negative behavior showed significantly lower retention at 6 and 12 months (p = 0.006 and p < 0.001) compared to those with negative behavior, although differences were not significant at 24 months. Conclusions: Overall, both sealants demonstrated comparable retention and cariostatic performance, indicating that material properties alone do not determine long-term success. Further research should focus on long-term follow-up and comparative evaluation of hydrophilic sealants in cooperative and uncooperative populations to better understand how patient behavior affects sealant performance. Full article

Background: Robot-assisted surgery has become increasingly used across multiple specialties; however, its integration into aesthetic plastic surgery remains limited. Individualized patient requirements, such as concealed scar placement, superficial soft tissue dissection, and patient-specific docking angles, are major challenges to its adoption, unlike in other specialties. This review aimed to evaluate the current use of robotic systems in plastic surgery, with a particular focus on aesthetic procedures, operative outcomes, and existing technological limitations. Methods: Multiple databases, including PubMed, Scopus, and Google Scholar, were extensively searched to identify studies published between 2011 and 2026. Data on robotic platforms, operative duration, rehabilitation outcomes, and aesthetic indications were extracted and analyzed. Robotic systems such as da Vinci, Symani, MUSA, and ARTAS demonstrated feasibility across reconstructive subspecialties. However, their clinical application remains limited, as purely aesthetic procedures are rare, highlighting a significant lack of standardized docking methods and dedicated instruments. Results: The data show that robotic platforms offer great advantages, such as precision and minimally invasive access; however, their high costs, bulky instrumentation, and limited docking methods represent barriers to their adoption in aesthetic surgery. Conclusions: Robot-assisted aesthetic plastic surgery remains in the early stage of development. Further research is required to establish reproducible docking standards and expand its clinical indications. Advancements in single-port systems, artificial intelligence integration, and surgeon training will facilitate broader clinical implementation. Full article

Parallel, data-intensive applications are now commonly executed on infrastructures that combine Cloud, Fog, and Edge resources. In these environments, execution takes place on devices with markedly different computational power and over networks whose latency and bandwidth can fluctuate over time. Under these conditions, overall performance is influenced not only by processing speed but also by communication delays arising from data dependencies between tasks. This leads to a basic issue: whether scheduling strategies developed under computation-focused assumptions continue to perform well once communication costs are made explicit. This work examines the behavior of simple and widely adopted scheduling heuristics when network effects are modeled directly within the system. No new scheduling algorithms are introduced. Instead, the analysis focuses on how execution time and monetary cost change for deterministic parallel workloads deployed on hierarchical Cloud–Edge infrastructures exposed to stochastic latency and bandwidth variations. For this purpose, we introduce CLOWNSim, a lightweight discrete-event simulation framework that supports large-scale Monte Carlo experiments on fixed task graphs, allowing infrastructural and scheduling effects to be examined independently of workload variability. The experimental analysis covers fully centralized Cloud deployments, intermediate Fog configurations, and resource-constrained IoT scenarios. Scheduling policies based on computational speed, execution cost, or random device selection are evaluated across these settings. In Cloud and Fog environments, communication latency and data transfers represent a substantial portion of the overall makespan, weakening the impact of scheduling decisions driven primarily by computation. In IoT scenarios, limited processing capacity becomes the main limiting factor, while communication overhead remains present but less influential in comparison. The results indicate that performance trends across the Cloud–Edge continuum cannot be attributed to scheduler choice alone. Execution behavior arises from the combined effects of workload structure, placement decisions, and network properties, with different elements becoming dominant depending on the deployment context. The proposed simulation framework offers a practical way to study these interactions and to assess cost–performance trade-offs under communication conditions that reflect realistic operating environments. Full article

Forest structural complexity underpins habitat quality, microclimate buffering, and resilience, yet it remains poorly characterized across the Hindu Kush Himalaya (HKH) where field inventories and airborne LiDAR are difficult to scale across rugged terrain. Conservation planning and protected-area evaluation in the HKH therefore often rely on canopy height or cover proxies that do not directly represent vertical structural organization. Here we develop a repeatable, uncertainty-aware indicator of forest structural complexity from GEDI waveform LiDAR using the Waveform Structural Complexity Index (WSCI) and its prediction intervals. We first define a conservative analysis footprint (“trustable pixels”) by combining a woody-vegetation screen with minimum GEDI sampling support and canopy-stature plausibility, and by excluding the highest-uncertainty tail using a relative prediction-interval criterion. To separate complexity from canopy height, we model the HKH-wide expected WSCI–RH98 relationship and map height-normalized excess complexity (observed minus expected), identifying structural complexity hotspots and coldspots as the upper and lower tails of the excess distribution. Anomaly patterns are strongly organized along elevation and treeline-relevant belts and show coherent departures among ecoregions that persist after stratified adjustment for elevation and mean annual precipitation, indicating additional controls beyond broad environmental gradients. Protected areas exhibit systematically lower hotspot prevalence than surrounding landscapes, and within-elevation comparisons suggest this association is not explained by elevation alone, highlighting the need to interpret protected-area signals in the context of placement and land-use pressure. Overall, the anomaly atlas provides an operational indicator framework to stratify monitoring, prioritize field validation, and support the landscape-scale assessment of structural conditions beyond canopy height across one of the world’s most critical mountain forest systems. Full article

Postsecondary institutions are seeing an increased prevalence of student mental health concerns and disabilities, highlighting the need for campus-based approaches that support student well-being. While college campuses provide many services to support students, occupational therapists are largely absent from these support systems, despite growing interest in this emerging field of practice. This program description and implementation case study examines preliminary indicators of feasibility for the WILL Thrive program, which delivered occupational therapy (OT) services on a college campus through a Level II fieldwork placement. Feasibility was examined across domains of acceptability, demand and implementation using an integrated approach combining a needs assessment, service development and process evaluation. Data sources included environmental observations, surveys, stakeholder interviews and process evaluation measures, including service delivery tracking, referral patterns, and resource utilization. Referrals and service utilization in this case were most frequently observed among students reporting neurodevelopmental and mental health-related functional challenges, providing preliminary indicators of potential service users, though a small, heterogeneous sample size limits generalizability. Referral patterns and engagement from the wellness center and accessibility staff highlight preliminary strengths of the program, including early indicators of acceptability and demand. In contrast, implementation barriers were also identified, including limited campus-wide understanding of the OT scope and role and constraints in on-campus OT supervision. Findings offer early, exploratory signals of feasibility for integrating OT services through an OT fieldwork II model and suggest that OT may complement existing campus supports by addressing participation-focused, functionally orientated needs. Results should be viewed as preliminary and inform future implementation studies that include systematic outcome measures, comparative analysis with existing services, and broader assessment across diverse higher education contexts. Full article

Accurate needle insertion during epidural anesthesia is challenging due to strong dependence on clinician experience and the limited integration of guidance modalities that simultaneously provide visual feedback and physical motion constraints. Current approaches, including ultrasound guidance and augmented reality visualization, mainly offer passive assistance and do not actively regulate insertion trajectory and depth, which may lead to variability in accuracy and increased risk of complications. This work presents a multimodal human–machine assistance system that combines augmented reality guidance with virtual fixtures to support lumbar epidural needle placement. A Tuohy needle is coupled to a haptic device interacting with a patient-specific L3–L4 lumbar phantom fabricated using 3D printing and ballistic gel. A model-based force profile reproduces the mechanical response of anatomical layers during insertion. Three experimental conditions are evaluated: freehand execution, augmented reality guidance with trajectory and depth visualization, and cooperative guidance using virtual fixtures defined by a cylindrical corridor and a depth-limiting plane. Results show a progressive reduction in mean depth error from 6.82 ± 3.46 mm (freehand) to 4.96 ± 2.41 mm (augmented reality) and 2.21 ± 1.73 mm (virtual fixtures). These findings indicate that the integration of visual and haptic guidance significantly enhances insertion precision and control. The proposed approach highlights the potential of multimodal human–machine cooperation for safer training and assisted interventions. Full article

This paper proposes a new fuzzified multi-objective wireless communication optimization model that maximizes the quantity and placement of Reconfigurable Intelligent Surfaces (RISs). In order to meet realistic deployment constraints like non-overlapping and acceptable location, the model aims to decrease the number of deployed RISs while raising the achievable rate. The Modified Pied Kingfisher Optimization Algorithm (MPKOA) is suggested as a solution to this intricate optimization issue. MPKOA features many significant improvements over the traditional Pied Kingfisher Optimization Algorithm (PKOA), such as energy-based motion control, adaptive subgrouping, flock cooperation, and memory-driven re-perching. These techniques speed up convergence, improve solution precision, reduce computation time, and balance exploration and exploitation. MPKOA performs better than standard PKOA, Enhanced version of PKOA (EPKO), Differential Evolution (DE), Grey Wolf Optimizer (GWO), and other existing algorithms, according to extensive comparisons. MPKOA can achieve up to 20% higher optimization values and 30% faster convergence, according to simulation data. In addition, the proposed MPKOA reduces computational complexity and runtime by about 50% when compared to standard PKOA-based approaches since it only requires single fitness evaluation per iteration. This enables the deployment of fewer RISs while still achieving higher communication rates. In multiuser wireless systems, MPKOA offers a robust and effective approach to RIS placement optimization, which helps to boost capacity and provide more energy-efficient 6G communication networks. Full article

Background: Intravascular lithotripsy (IVL) has emerged as a novel vessel preparation device for patients with peripheral artery disease undergoing angioplasty. The IVL catheter includes an integrated balloon, which emits high pressure and transient sonic waves. The release of shockwaves results in cracking of intimal and medial calcium within the vessel wall improving lumen patency. Objectives: The aim of this prospective observational cohort study is to evaluate the morphological and imaging changes in atherosclerotic plaque in patients with PAD undergoing IVL as a vessel preparation technique, followed by angioplasty with drug-coated balloon (DCB) or stent placement if required. Secondary endpoint is to evaluate the efficacy of IVL in the perfusion of the lower extremities, by calculating the ankle–brachial index (ABI) and toe–brachial index (TBI) post-angioplasty, as well as adverse events within 30 days. Methods: Consecutive adult (≥18 years of age) patients with symptomatic femoropopliteal artery disease selected to undergo IVL will be included in the study. Computed tomography angiography (CTA) of the lower limbs will be performed pre- and postoperatively. Intraoperatively, an intravascular ultrasound (IVUS) will be used before and immediately post-angioplasty, for real-time evaluation of the morphological and quantitative changes in the atherosclerotic plaque. All participants will be clinically re-evaluated in 30 days postoperatively and a color Duplex ultrasound of the lower extremity arteries will be performed. The perfusion of the peripheral arteries will be assessed using ABI and TBI post-procedurally. Outcomes: The primary outcome is the quantitative assessment of changes in plaque morphology and volume within the index target lesion, based on pre- and post-procedural computed tomography angiography using TeraRecon™ (Durham, NC, USA) plaque analysis module, reflecting plaque modification and redistribution, in the context of IVL-based vessel preparation. Secondary outcomes include improvement of peripheral arterial perfusion and freedom from clinically driven target lesion revascularization (CD-TLR) and major adverse events. Full article

Equitable access to rehabilitation services is essential for individuals living with a disability, yet geographic disparities in outpatient rehabilitation care remain understudied. This study examined spatial accessibility to outpatient physical and occupational therapy services across Texas to identify regional inequities and inform workforce and policy planning. A descriptive cross-sectional geospatial analysis was conducted using outpatient clinic location data from the Texas Health and Human Services database (2022) and population data from the 2020 U.S. Census. Clinic addresses were verified and geocoded. Accessibility was measured using an origin–destination cost matrix to estimate the travel time to the nearest clinic, and the two-step floating catchment area (2SFCA) method to calculate an accessibility index. Spatial clustering of access was assessed using the Getis-Ord Gi* statistic to identify hot and cold spots. The analysis included 2255 outpatient rehabilitation clinics across 6896 census tracts. Travel times varied substantially, with rural areas experiencing the longest travel burdens. The 2SFCA analysis revealed pronounced disparities, with low-accessibility clusters concentrated in rural and border regions and high-accessibility clusters in urban metropolitan areas. These findings demonstrate persistent geographic disparities in outpatient rehabilitation access across Texas, suggesting the need for targeted workforce placement, transportation investment, and policy interventions to improve equitable access. Full article

The accuracy of static computer-aided implant surgery (s-CAIS) is fundamental for predictable clinical outcomes. The objective of this study was to evaluate the influence of different guide-support modalities on the linear and angular accuracy of implant placement. In this retrospective clinical investigation conducted at a single specialty hospital, a total of 180 implants were analyzed, divided into three equal groups (n = 60) based on the guide support type: tooth-supported, bone-supported, and mucosa-supported. Accuracy was assessed by superimposing preoperative virtual plans with postoperative cone-beam computed tomography (CBCT) scans, measuring linear deviations at the neck and apex of the implant, as well as angular discrepancies. The type of guide support was found to be a significant factor associated with surgical accuracy (p < 0.001). Tooth-supported guides demonstrated the highest level of accuracy, with a mean angular deviation of 1.81° ± 0.45° and linear deviations at the neck and apex of 0.59 ± 0.18 mm and 0.73 ± 0.19 mm, respectively. These were followed by bone-supported guides (2.14° ± 0.48°; 1.04 ± 0.26 mm; 1.61 ± 0.31 mm), while mucosa-supported guides exhibited the greatest deviations (2.95° ± 0.60°; 1.47 ± 0.29 mm; 1.87 ± 0.37 mm). Significant intergroup differences and large effect sizes were observed, particularly regarding angular and horizontal discrepancies. These findings demonstrate a distinct gradient of accuracy based on guide support, establishing tooth-supported guides as the most accurate, followed by bone-supported and, lastly, mucosa-supported guides. While all modalities are clinically applicable, the use of mucosa-supported guides necessitates increased safety margins to account for the increased risk of linear and angular discrepancies inherent to mucosal tissue displacement. Full article

Background: Conventional Herbst appliances are effective for the correction of skeletal Class II malocclusion, but they are frequently associated with dentoalveolar side effects, particularly lower incisor proclination. Skeletal anchorage systems may improve orthopedic outcomes; however, submucosal miniplates require invasive surgical procedures that may reduce patient acceptance. This pilot clinical study evaluated the feasibility, safety, and skeletal effects of a minimally invasive digitally guided protocol using supragingival miniplates for bone-supported Herbst therapy in late adolescents. Methods: Eleven late-adolescent patients (14–17 years; cervical vertebral maturation stages CS4–CS5) with skeletal Class II malocclusion due to mandibular retrusion were prospectively treated using a bone-supported Herbst appliance anchored to digitally planned supragingival stainless-steel miniplates fixed with bicortical miniscrews. Miniscrew placement was planned by merging CBCT and intraoral scan data and performed using 3D-printed surgical guides. Cephalometric variables, including SNA, SNB, Wits appraisal, mandibular plane angle, and incisor inclinations, were assessed before treatment and after a 10-month Herbst phase. Mandibular advancement was additionally explored using a complementary linear measurement (SeMndb-line). Results: All patients completed treatment without anchorage loss, appliance failure, or surgical complications. Significant skeletal improvements were observed, including an increase in SNB (+3.36°, p < 0.001) and a reduction in Wits appraisal (−2.65 mm, p < 0.001). The SeMndb-line increased by +3.49 mm (p < 0.001), supporting effective mandibular advancement. Lower incisor inclination remained stable (Δ = −0.18°, p = 0.909), indicating effective dentoalveolar control. No clinically relevant changes in vertical skeletal pattern were observed. Conclusions: Digitally guided supragingival miniplates for bone-supported Herbst therapy appear to be a feasible and minimally invasive approach for the treatment of skeletal Class II malocclusion in late adolescents. This protocol achieved clinically meaningful mandibular advancement while minimizing dentoalveolar side effects. Given the pilot design, small sample size, and lack of a control group, further controlled studies with larger samples and long-term follow-up are required. Full article

The study presents an engineering solution for maintaining traffic flow during road and utility operations, such as trench excavation. The analysis of existing organizational and technical approaches, along with global experience in temporary bridge use, showed that most foreign analogs were developed for military purposes and are not fully suitable for urban conditions in Kazakhstan and CIS countries. As an alternative solution, the development of a mobile overpass adapted for operation in dense urban environments is proposed. The present study continues earlier research focused on optimizing the placement of mobile overpass supports while accounting for the nonlinear deformation behavior of the soil foundation. At the previous stage, a rational distance between the supports and the trench edge was substantiated, and horizontal soil deformations were reduced. In the current study, the primary focus is on the design of the undercarriage, which determines the mobility, stability, and operational feasibility of the structure. A morphological analysis and synthesis method is applied to select a rational configuration of the undercarriage. A 3D model and a 1:4 scale test bench were developed, followed by load tests of 50–200 kg. The maximum deflection of −1.19 mm at 200 kg demonstrated an almost linear deformation pattern. The constructed regression model ($R^2=0.97$) confirmed the accuracy and reliability of the design. The developed mobile overpass is versatile, cost-effective, and practical, improving the resilience of urban transport infrastructure, reducing traffic congestion during roadworks, and creating a foundation for serial production in Kazakhstan and CIS countries. Full article

The evolution toward sixth-generation (6G) networks envisions humans as active nodes within a fully interconnected digital ecosystem, supported by data collected from in-body and on-body sensors. Since many of these devices are not equipped to connect directly to 6G networks, Wireless Body Area Networks (WBANs) serve as an essential intermediate layer. However, conventional radio-frequency technologies face limitations in terms of energy efficiency, security, and data integrity, motivating the adoption of lightweight security mechanisms. Physical Layer Security (PLS), and in particular Physical Key Extraction (PKE), offers a promising solution by enabling legitimate devices to derive shared cryptographic keys from the reciprocal properties of the communication channel. Galvanic coupling (GC) communication has recently emerged as an on-body transmission technology alternative to radio-frequency (RF), which exploits low-power electrical signals propagating through biological tissue. Building on prior feasibility studies, this work proposes a PKE framework tailored to GC channels, integrating a lightweight key reconciliation method, based on Hamming (7,4) error-correction codes, and evaluating system performance through dedicated reliability and security Key Performance Indicators (KPIs). Results reveal a trade-off shaped by electrode placement and channel quantization parameters. Among the ones tested, the optimal configuration is achieved with a 3 cm transverse inter-electrode spacing at both transmitter and receiver, and a 3 cm longitudinal separation between transmitter and receiver, by quantizing the channel impulse response with two quantization bits. While this work focuses on validating the method in controlled conditions in order to establish a reliable study framework, future developments will focus on enhanced reconciliation, privacy amplification, and analysis of the GC channel considering physiological and environmental variations. Full article

This paper addresses the optimal management of photovoltaic (PV) systems and distribution static synchronous compensators (D-STATCOMs) in modern electrical distribution networks. A mixed-integer nonlinear programming (MINLP) model is formulated which co-optimizes device placement, sizing, and multi-period dispatch to minimize the total annualized system costs while satisfying AC power flow and operational constraints. To solve this challenging problem, a decomposition methodology is proposed, wherein the binary location decisions for the PVs and D-STATCOMs are treated as predefined inputs, upon the basis of site selections commonly reported in the literature. With the integer variables fixed, the problem is reduced to a continuous nonlinear programming (NLP) subproblem for optimal capacity sizing and operational scheduling, which is solved using the interior point optimizer (IPOPT) via the Julia/JuMP environment. The core contribution of this work lies in its comprehensive demonstration of the economic superiority of variable reactive power injection over conventional fixed compensation schemes. Through numerical validation on standard 33- and 69-bus test systems, it is shown that a variable D-STATCOM operation yields substantial and consistent economic gains. Compared to optimized fixed-injection solutions, variable injection provides additional annual savings averaging USD 120,516 (33-bus feeder) and USD 125,620 (69-bus grid), corresponding to a further 3.4% reduction in total costs. These benefits prove robust across different device location sets identified by various metaheuristic algorithms, and they scale effectively to larger network topologies. The results demonstrate that transitioning to variable power injection is not merely an incremental improvement but a fundamental advancement for achieving techno-economic optimality in distribution system planning. The proposed methodology provides utilities with a computationally efficient framework for determining near-optimal PV and D-STATCOM management strategies by first fixing deployment locations based on established planning insights and then rigorously optimizing sizing and dispatch, in order to maximize economic returns while ensuring reliable network operation. Full article