Search Results (79,381)

Balance is an essential component in both everyday movement and sports performance. Balance boards are commonly used for training and physical therapy to improve balance. Conventional balance boards primarily rely on the user’s voluntary actions, whereas active/actuated balance boards can provide dynamic motion for both balance and rehabilitation. While this enables more effective training, it also introduces strong user-dependent and time-varying dynamics that are difficult to regulate with conventional controllers. This study addresses this limitation by developing a neuro-adaptive sliding mode controller to handle the strong inter-user variability and nonlinear pressure–force dynamics of pneumatic artificial muscles. The controller combines a learning neural network that updates online with a robust control structure to ensure stable motion in the presence of disturbances. The proposed approach was evaluated against commonly used PID and LQR controllers under sudden changes in operating conditions. Simulation results show that the proposed controller improves stability, reduces control effort, and adapts more effectively to different users and external disturbances. These findings suggest that neuro-adaptive control strategies can improve the reliability and responsiveness of balance training and rehabilitation devices, supporting safer and more personalized therapy. Full article

Background: Cardiovascular risk factors may emerge early in life and track into adulthood. Local data from inland and socioeconomically vulnerable regions remain limited. This study aimed to describe cardiovascular risk indicators in school-aged children from inland Portugal, focusing on body mass index (BMI), blood pressure (BP), and physical activity patterns. Methods: A cross-sectional school-based screening study was conducted in 101 children and adolescents aged 10–15 years. Anthropometric measurements and BP were obtained using standardized procedures. BMI categories were classified according to age- and sex-specific WHO references. BP was classified using European pediatric percentiles. Because measurements were obtained during a single visit, results were interpreted as elevated BP at screening. Associations between variables were explored using chi-square or Fisher’s exact tests and Spearman’s correlation. Results: The prevalence of underweight, normal weight, and overweight/obesity was 25.7%, 67.3%, and 6.9%, respectively. Overall, 24.8% of participants presented elevated BP at screening. The BMI category was significantly associated with BP classification (p = 0.003), and BMI correlated positively with systolic BP (ρ = 0.32; p = 0.001). Most children reported only school-based physical education. Conclusions: This school-based screening suggests a high proportion of elevated BP measurements and an unexpectedly high prevalence of underweight children, indicating the coexistence of different nutritional vulnerabilities. Findings should be interpreted cautiously due to the small, single-school sample and single-occasion BP assessment but support the importance of early cardiovascular risk monitoring in vulnerable settings. Full article

Healthcare systems face increasing pressure to deliver high-quality care while reducing their contribution to environmental harm. Lean quality improvement methods are widely used to reduce waste; however, there is limited understanding of whether and how explicitly integrating environmental sustainability goals into Lean initiatives can generate environmental sustainability outcomes in healthcare. This study addresses this gap by developing program theory to explain how such integration can influence environmental outcomes under specific contextual conditions. A realist review was conducted in accordance with RAMESES publication standards to test and refine seven Initial Program Theories developed in an earlier phase of the inquiry. Environmental sustainability was conceptualized broadly, including reductions in waste, resource use, emissions, and wider system level impacts. Evidence from healthcare and selected non healthcare settings was synthesized to identify recurring patterns of contexts, mechanisms, and outcomes. Four refined program theories were developed: organization-driven, education-driven, individual-driven, and team-driven approaches. Environmental outcomes were more likely when sustainability goals were intentionally embedded within improvement aims and governance structures. Enabling contexts activated mechanisms such as professional motivation and legitimacy, while efficiency-focused Lean initiatives produced limited environmental benefits. The review provides an explanatory framework to guide the integration of environmental sustainability into Lean healthcare improvement practice. Full article

Measurement While Drilling (MWD) tools are widely employed in deep and ultra-deep well drilling. In the high-temperature and high-pressure (HTHP) environments characteristic of these wells, structural deformation induced by thermal expansion interferes with the bit parameter recorder’s sensor readings, thereby degrading the measurement accuracy of weight on bit (WOB) and working torque (WT). To address this issue, this paper proposes a temperature compensation method based on thermo-mechanical coupling simulation. This method systematically establishes the quantitative relationships between multiple loads—including WT, WOB, temperature, and make-up torque—and the strain at critical locations of the bit parameter recorder through finite element analysis (FEA). Furthermore, surface calibration experiments have verified a strong linear correlation between the strain gauge voltage signals and the simulated strain. Building upon this foundation, an inversion-based compensation algorithm is developed. This algorithm effectively isolates the interference caused by thermally induced deformation and inversely deduces the true WOB and torque values by utilizing downhole-measured sensor voltage and temperature data. The research results demonstrate that the proposed temperature compensation method significantly improves the measurement accuracy of the bit parameter recorder under harsh, high-temperature operating conditions. The relative errors for both WOB and torque measurements are controlled to within 5%, providing a reliable solution for precise parameter measurement in high-temperature deep wells. Full article

Biological cardiovascular vulnerability is defined as an imaging-derived construct integrating myocardial functional impairment, coronary microvascular dysfunction, and modeled hemodynamic burden, including global longitudinal strain, coronary flow reserve, and derived vascular indices. To evaluate whether advanced echocardiographic and coronary Doppler imaging parameters identify biological cardiovascular vulnerability associated with the severity and complications of infective endocarditis beyond conventional structural findings. In this retrospective single-center cohort study, we analyzed consecutive patients with definite infective endocarditis who underwent advanced echocardiographic and coronary Doppler imaging. Comprehensive transthoracic and transesophageal echocardiography assessed vegetation characteristics, left ventricular function, global longitudinal strain (GLS), diastolic indices, right ventricular function, and pulmonary artery systolic pressure. Coronary microvascular function was evaluated noninvasively using transthoracic Doppler-derived coronary flow reserve (CFR) of the left anterior descending artery. Associations with disease severity and perivalvular complications were evaluated using multivariable regression analysis. Reduced coronary flow reserve was independently associated with the composite severe infective endocarditis phenotype, as defined by perivalvular complications, severe valvular dysfunction, or endocarditis team-guided urgent surgical indication. Coronary flow reserve correlated inversely with vegetation size (r = −0.39; p = 0.002) and regurgitation severity (r = −0.36; p = 0.004). Notably, the inverse association between coronary flow reserve and vegetation size showed substantial interindividual variability, particularly among patients with similar vegetation dimensions, suggesting heterogeneity in microvascular vulnerability beyond structural lesion burden. Despite relatively preserved mean arterial pressure across age groups, advanced imaging revealed progressive increases in systemic vascular resistance, declining wall shear stress, impaired microvascular flow, and reduced myocardial reserve. Imaging-derived cardiovascular vulnerability profiles frequently diverged from chronological age, highlighting heterogeneity in cardiovascular reserve despite apparently stable conventional hemodynamic parameters. Advanced echocardiographic and coronary Doppler imaging characterize a spectrum of biological cardiovascular vulnerability that is associated with clinically adjudicated severity in infective endocarditis, rather than serving as independent prognostic predictors. Full article

This study examines the carbonation behavior and CO₂ storage potential of a Ca-rich alkali-activated binder produced entirely from industrial residues-ladle furnace slag (LFS), coal ash (CA), and cement kiln dust (CKD). The system was designed as a one-part alkali-activated material (AAM), with CKD acting as an internal activator, and subjected to ambient curing, water curing, and accelerated CO₂ curing at ambient pressure. Phase evolution, microstructural development, and pore-structure characteristics were investigated using X-ray diffraction, FTIR spectroscopy, DSC–TG analysis, scanning electron microscopy, and X-ray micro-computed tomography, together with measurements of density, water absorption, and compressive strength. Loss-on-ignition measurements combined with chemical analysis were further used to quantify CO₂ uptake and evaluate the degree of carbonation of the binder system. CO₂ curing fundamentally altered the reaction pathway of the binder, shifting it from hydration-dominated to carbonation-controlled phase evolution, leading to the decomposition of calcium-bearing hydrates and complete carbonation of non-hydraulic γ-belite with the formation of vaterite, aragonite, and calcite. These transformations induced pronounced microstructural densification, reflected in a near-doubling of compressive strength (>48 MPa), increased apparent density, reduced water absorption, and simplified pore-network topology. A preliminary carbon footprint assessment indicates that the production of 1 m³ of the developed LFS–CA–CKD concrete generates about 14.36 kg CO₂-eq, while the carbonation process enables significant CO₂ sequestration, resulting in a net negative carbon balance. The results demonstrate that controlled carbonation is an effective post-treatment strategy for waste-derived alkali-activated binders, enabling simultaneous performance enhancement and permanent CO₂ sequestration. Full article

Background: Assessing aortic dissection (AD) in its early stages is crucial for cardiovascular surgeons to improve patient outcomes and avoid complications associated with surgical intervention for type A aortic dissection. Initial evaluations rely on patient referrals for computed tomography (CT) scans, which involve measuring the maximum aortic diameter. Objective: This study aimed to improve current diagnostic thresholds for type A aortic dissection by using computational fluid dynamics (CFD) modeling to correlate hemodynamic factors related to the wall shear stress with maximum aortic diameter growth rate, offering insights into predicting AD progression and reassessing current diameter-based diagnostic criteria. Methods: The pre- and post-AD scan data, with an average duration of three and a half years for the 15 patients, were converted into 3D geometries. These geometries were analyzed using the transitional-turbulent CFD model. Wall shear stress (WSS), its derivatives, and the pressure gradient from the pre-AD CT scans were compared across 15 patients, grouped according to the aortic diameter growth per year. Results: For patients in group 1 (nine patients with normal diagnosis), pre-AD time-average wall shear stress (TAWSS) was mostly 2–4 Pa, above physiologic levels. Post-AD, values dropped below 1.5 Pa (stagnant, thrombus-prone), with oscillatory shear index (OSI) elevated (0.24–0.32). In group 2 (n = 6, abnormal diagnosis), post-AD TAWSS was <3 Pa (thrombosis risk), with OSI 0.1–0.31 near tear sites. These findings confirm a dual-risk profile: low TAWSS promotes thrombosis, while high TAWSS drives dissection progression. Conclusions: WSS parameters, such as TAWSS and OSI, can be utilized to assess the development of a dilated ascending aorta, especially for extreme maximum aortic diameter. Pre-AD analysis for some patients revealed a strong negative correlation, indicating that high shear stress in the true lumen (TL) results in a drop in diastolic pressure post-AD at the upward-going section of the aorta. Full article

Supply chain (SC) disruption risk assessment and mitigation have attracted significant attention in both academia and practice. However, existing research predominantly focuses on unidirectional disruption propagation, either forward or backward, despite the reality that risks can propagate bi-directionally in complex supply chain networks. Furthermore, conventional assessment tools often concentrate on conceptualizing and quantifying risks, while risk mitigation requires mathematical optimization approaches. To bridge these gaps, this paper proposes a novel pressure wave-based approach inspired by fluid mechanics to assess bi-directional disruption propagation in cluster supply chain networks (CSCNs). The method conceptualizes disruptions as pressure signals that transmit between SC partners and explicitly quantifies disruption severity through wave intensity. By employing mathematical optimization, we develop a framework that assists managers in optimizing risk mitigation strategies, including inventory buffering and cross-chain cooperation. Numerical experiments demonstrate the effectiveness of the proposed method in explaining risk influencing factors, mitigating disruption risks, and achieving dynamic restructuring of SC structures. The results show that our approach reduces the Cluster Propagation Vulnerability Index (CPVI) by up to 40% compared to baseline models without optimization decisions. Full article

Objective: This study examined the frequency of entosis in solid tumors of various origins (colorectal cancer, breast cancer, and lung cancer) and its association with clinical and pathological characteristics. It also examined survival and copy number alterations (CNAs) in genes associated with stem cells. The aim was to assess the potential prognostic value of entotic events in tumors. Methods: A total of 238 patients were included: 96 with colorectal cancer (CRC), 45 with lung cancer (LC), and 97 with breast cancer (BC). Entotic cell-in-cell (CIC) structures were evaluated on hematoxylin–eosin–stained slides using Mackay’s criteria. A CIC frequency >0.1 per 20 high-power fields was considered positive. Clinicopathological parameters, overall survival (CRC), metastasis-free survival (LC and BC), and CNA profiles of stemness-related genes were analyzed. Amplifications of MAP1LC3A and other chromosomal loci were assessed. Results: CRC demonstrated the highest entosis rate, more than two-fold higher compared with BC and LC (p < 0.05). Entosis correlated with high tumor grade (G3) in CRC (p = 0.03). In LC, CIC-positive tumors were more frequent in patients with lymph-node metastases (p = 0.02), whereas in BC, the opposite trend was observed (p = 0.02). It was noted that in patients with stage III–IV LC, the frequency of entosis was significantly higher than in patients with stage I–II cancer (p = 0.03). CIC-positive status was associated with poorer overall survival in CRC (p = 0.03) and reduced metastasis-free survival in LC (p = 0.011). In breast cancer, no statistically significant survival differences were observed. Tumors harboring two or more stemness-gene amplifications showed significantly higher entosis frequency regardless of tumor site. A strong association was identified between entosis and MAP1LC3A amplification. Conclusions: Enosis is not a random morphological phenomenon but a process associated with unfavorable tumor characteristics, high malignancy, reduced survival, and amplification of stem cell-related genes. The results of this study confirm the working hypothesis that entosis may contribute to the emergence of aneuploid clones of tumor cells, including those containing amplifications of stem cell-associated genes. This positions entosis as a potential factor in tumor genetic heterogeneity, which is particularly important in the context of therapeutic selection pressure. The observed association between high entosis frequency and the presence of ≥2 stem cell gene amplifications, as well as its association with poor prognosis in colorectal and lung cancer, highlights its potential value as a prognostic indicator. Furthermore, MAP1LC3A amplification data may serve as a molecular marker of entotic activity and a potential therapeutic target. Full article

Slewing bearing is a rotating component with high load-carrying capacity, which is an important part of the crane connecting the upper rotating parts and the lower supporting parts; therefore, it is of great significance to analyze the performance of slewing bearings. This paper establishes a theoretical model and an integrated finite element model for the mechanical performance of slewing bearings, and the results of the two show high consistency. The influences of four bearing parameters (contact angle, raceway curvature radius coefficient, rolling element diameter, and number of rolling elements) and three bolt parameters (number of bolts, bolt preload, and washer thickness) on the mechanical performance of the slewing bearing were studied, aiming to provide a reference basis for the selection and design of crane slewing bearings. Full article

Background: Furosemide is one of the most frequently prescribed loop diuretics for cardiovascular conditions, particularly in the management of volume overload and acute elevations in blood pressure. However, detailed real-world data describing its utilization characteristics and documented safety outcomes in primary healthcare settings remain limited, especially in underrepresented health systems. Objective: This study aimed to describe real-world patterns of furosemide utilization, including indications and concomitant treatment patterns, and to document associated adverse drug events and short-term clinical outcomes in routine primary healthcare practice. Methods: A retrospective pharmacoepidemiological observational study was conducted between January and December 2025 in a primary healthcare center. Medical records of 1300 adult patients who received furosemide for cardiovascular indications were reviewed. Indications included arterial hypertension, hypertensive crises, and conditions related to volume overload. Utilization characteristics were operationalized as indication distribution, monotherapy versus combination therapy, and recurrence patterns within the study period. Data collected included demographic characteristics, primary and comorbid diagnoses, blood pressure values recorded before and after administration, furosemide dose and route of administration, concomitant antihypertensive therapy, documented adverse drug events as recorded in routine clinical documentation, recurrent presentations related to hypertensive crises, and the need for hospital referral. Descriptive statistics and paired comparative analyses were performed, with statistical significance set at p < 0.05. Results: The mean patient age was 62.4 ± 11.8 years, with a male predominance (54.1%). Arterial hypertension was the most frequent recorded indication (78.6%), while 32.4% of patients had multiple cardiovascular diagnoses. A statistically significant reduction in systolic blood pressure (from 176.3 ± 18.5 mmHg to 148.7 ± 16.2 mmHg, p < 0.001) and diastolic blood pressure (from 101.2 ± 11.4 mmHg to 89.6 ± 9.8 mmHg, p < 0.001) was observed between measurements recorded before and after administration during the same clinical episode. Recurrent presentations related to hypertensive crises were documented in 27.9% of patients during the study period. Adverse drug events were documented in 9.6% of cases, most commonly dehydration and suspected electrolyte disturbances as noted in routine clinical records. Hospital referral was required in 6.8% of patients. Conclusions: In this real-world primary healthcare cohort, furosemide was commonly used across a heterogeneous mix of cardiovascular indications, predominantly in combination with other antihypertensive agents. Observed temporal reductions in blood pressure and documented adverse events reflect routine clinical practice rather than controlled treatment effects. These findings provide descriptive pharmacoepidemiological evidence from a primary care setting and underscore the importance of careful monitoring, documentation, and rational prescribing in patients receiving loop diuretics. Full article

Rapid urbanisation in arid regions has increased reliance on energy-intensive desalinated water, intensifying environmental and financial pressures on the built environment. Although non-potable water (NPW) reuse is promoted within regional water strategies, empirical validation of decentralised systems at asset scale remains limited. This study applies a greenhouse gas (GHG) intensity metric (kgCO₂e/m³) to multi-year operational data from a large healthcare facility in Abu Dhabi. The analysis integrates calibrated water balance records, onsite pumping energy (Scope 2), embedded desalination emissions (Scope 3), and a 20-year discounted cash flow framework. Three configurations are evaluated: a fully desalinated baseline, the observed mixed-supply system, and an optimised NPW configuration. The baseline exhibits an emission intensity of 19.53 kgCO₂e/m³. The observed configuration reduces desalinated supply but achieves only marginal decarbonisation (0.40 kgCO₂e/m³) due to continued dependence on desalinated make-up water. The optimised configuration reduces outdoor water demand by 36.7% and achieves 10.94 kgCO₂e/m³ net decarbonisation while improving life-cycle cost (LCC) performance. The results show that GHG intensity is primarily driven by water source substitution and system configuration rather than volumetric reuse alone, providing asset-level evidence for evaluating decentralised NPW systems in arid-climate buildings. Full article

Background: Vascular compression syndromes are increasingly recognized as underdiagnosed contributors to morbidity in patients exhibiting dysautonomia. Underlying vascular compression syndromes affecting the head and neck, abdomen, pelvis, and lower extremities may influence venous return, neurohormonal signaling, and autonomic regulation. There is considerable clinical overlap among these syndromes, as well as between hypermobility spectrum disorders (HSD) and dysautonomia, indicating possible shared or interacting pathophysiological mechanisms. Purpose/Aims: This hypothesis-generating narrative review synthesizes current evidence linking vascular compression syndromes with dysautonomia, highlights potential mechanistic pathways, identifies patterns of syndromic overlap, and emphasizes the importance of systematic evaluation in affected patient populations. Key Findings: Evidence from retrospective studies, case series, and clinical observations indicates that vascular compression syndromes may be prevalent among patients with dysautonomia, particularly postural orthostatic tachycardia syndrome (POTS) and HSD, yet are often unrecognized. Proposed mechanisms based on limited data include impaired venous capacitance and preload reserve, increased intracranial pressure, altered renin–aldosterone and cortisol signaling, underlying autoimmune and systemic diseases, and sympathetic ganglion irritation. Several compression syndromes show symptom overlap and frequent co-occurrence, especially in patients with connective tissue disorders. Emerging data suggest that targeted interventions, such as surgical decompression or venous stenting, may improve orthostatic intolerance and quality-of-life measures in selected patients, though high-quality prospective data remain limited. Conclusions: Vascular compression syndromes may be an important yet underappreciated contributor to dysautonomia. Increased clinical awareness and systematic screening may reduce diagnostic delays and morbidity in this underserved population. Prospective studies are needed to clarify prevalence, establish causal relationships, and determine the impact of targeted treatments on autonomic outcomes. Full article

In China, a majority of the proven crude oil reserves are found in clastic rock reservoirs, which typically exhibit low natural energy levels. Water injection has become the most widely adopted technique for maintaining reservoir pressure and enhancing oil recovery in such formations. However, conventional water injection strategies heavily rely on empirical knowledge, often failing to accurately characterize the dynamic inter-well connectivity between injection and production wells. This limitation hinders the effective management of fluid injection and production processes. To address this challenge, we propose an intelligent optimization method for water allocation in high-water cut, low-permeability reservoirs. Our approach employs a Bidirectional Long Short-Term Memory (BiLSTM) neural network to learn the complex patterns from historical injection data in a data-driven manner. Furthermore, we design a well distance and time joint attention mechanism, which is integrated after the dual BiLSTM layers to enhance the model’s ability to capture the critical dynamic relationships among wells. This mechanism decouples temporal pattern recognition and the spatial physical constraints, laying the foundation for interpretable injection strategy optimization. We name this architecture “AttBiLSTM”, which is designed for optimizing injection strategies for individual layers in separate-layer water injection wells (The layer refers to the basic geological unit or flow unit within a vertically heterogeneous reservoir that is delineated and requires independent water injection regulation). Using field data from the Xinjiang Oilfield, we validate the proposed method and compare its performance against traditional water injection schemes and mainstream data-driven models. The experimental results demonstrate that the AttBiLSTM model effectively establishes a nonlinear mapping between the injection volumes and oil production rates, showing strong performance in both production prediction and injection optimization. An independent numerical reservoir simulation verification confirms that the optimized scheme increases well group oil production by over 3.6%, with no premature water breakthrough risk in a 5-year development cycle. This study provides a novel and practical technical framework for efficiently developing low-porosity, low-permeability, and highly heterogeneous reservoirs. Full article

Background: Antimicrobial resistance (AMR) is a global healthcare threat. Traditional largely non-selective antibiotics produce side effects due to the natural host microbiome being modified creating a loss in homeostasis. In women, AMR is a cause of acute generational impact. For example, bacterial vaginosis (BV), the most common gynecological infection in reproductive-age women, is a serious public health concern due to its high rates of recurrence, secondary infections, and reproductive issues; and two currently prescribed antibiotics for BV do not fully resolve the symptoms. Objective: The strong need for innovative, potent, safe, and selective therapeutics has prompted a search for such bioactive molecules in milk. Resulting from 200 million years of evolutionary pressure, mammalian lactation not only nourishes infants, but it has also been under relentless Darwinian selective pressure to provide protection from a variety of infections. Methods: Computationally designed human-milk-inspired peptides (AMPs) were tested in standard microbicidal assays for activity against BV pathogens, and evaluated for stability and safety. Results: Several AMPs are bactericidal towards Gardnerella vaginalis, a major BV-associated pathogen, and other BV-associated pathogens. Some novel AMPs do not impact the viability of key lactobacilli linked to a healthy vaginal microbiome. These stable, membrane-acting cationic AMPs reduce inflammation during an infection assay and are safe in EpiVag organoid tissues. Conclusions: AMPs can address concerns like non-selectivity and antibiotic resistance—thereby addressing AMR. Lead AMPs from this study offer a promising solution for the development of novel therapeutics for the treatment of BV, which may reduce the burden of AMR. Full article