Search Results (2,181)

The quality of water in households can be affected by plumbing design and materials, water usage patterns, and source water quality characteristics. These factors influence stagnation duration, disinfection residuals, metal release, and microbial activity. In particular, stagnation can degrade water quality and increase lead release from lead service lines. This study employs numerical modeling to assess how combined corrosion control and flushing strategies affect lead levels in household taps with lead service lines under reduced water use. To estimate potential health risks, the U.S. EPA model is used to predict the percentage of children likely to exceed safe blood lead levels. Lead exceedances are assessed based on various regulatory requirements. Results show that exceedances at the kitchen tap range from 3 to 74% of usage time for the 5 µg/L standard, and from 0 to 49% for the 10 µg/L threshold, across different scenarios. Implementing corrosion control treatment in combination with periodic flushing proves effective in lowering lead levels under the studied low-consumption scenarios. Under these conditions, the combined strategy limits lead exceedances above 5 µg/L to only 3% of usage time, with none above 10 µg/L. This demonstrates its value as a practical short-term strategy for households awaiting full pipe replacement. Targeted flushing before peak water use reduces the median time that water remains stagnant in household pipes from 8 to 3 h at the kitchen tap under low-demand conditions. Finally, the risk model indicates that the combined approach can reduce the predicted percentage of children with blood lead levels exceeding 5 μg/dL from 61 to 6% under low water demand. Full article

This study investigates mechanisms that influence how users perceive a technology’s usefulness after adoption as they continue to use the technology. The Expectation Confirmation Model (ECM) has been widely used to examine the key drivers of IT continuance, emphasizing perceived usefulness as a central factor. Although researchers have explored factors, such as ease of use, trust, and site quality, affecting post-adoption perceived usefulness, the mechanisms shaping post-adoption perceived usefulness remain underexplored. This study proposes that post-adoption perceived usefulness is shaped through the actualization of the technology’s affordances. Using a survey focused on fitness app usage (e.g., Fitbit), we examined various affordances users actualize and whether actualization of an affordance shapes their perception of usefulness. Results show that some affordances are actualized widely by most users (e.g., exercise status updating) while others are actualized by fewer users (e.g., reminders to exercise or guiding users how to exercise). Moreover, when an affordance is widely actualized, it significantly influences users’ perceptions of usefulness within the ECM framework. Given that perceived usefulness is a key factor in predicting IT continuance, our findings contribute to the literature by highlighting the influence of actualized affordances on perceptions of usefulness and hence IT continuance. Full article

Introduction: Despite clinical evidence for efficacy, there has been minimal uptake of transcranial direct current stimulation (tDCS) for musculoskeletal conditions. Thus, our objective was to explore the perceptions and experiences of people living with lower-limb musculoskeletal injury as well as healthy physically active populations and relate this to the usage of tDCS and key aspects of tDCS design that would improve the capacity for implementation. Methods: We conducted a qualitative descriptive study of 16 participants (44% women) using semi-structured focus groups to identify the descriptions and experiences of people living with lower-limb musculoskeletal injury and healthy physically active populations. A thematic template was used to create a coding structure. Codes were then grouped, and key themes were derived from the data. Results: Four primary themes were identified from focus groups. These were (i) the impact of musculoskeletal injuries on health and quality of life, (ii) performance and injury recovery as facilitators to using tDCS, (iii) barriers and facilitators to tCDS application and (iv) design and aesthetic factors for a tDCS device. Discussion: Our qualitative descriptive study identified four themes relevant to the successful implementation of tDCS into rehabilitative and performance practice. To increase the likelihood of successful tDCS implementation, these barriers should be addressed and facilitators promoted. This should include innovative approaches to device application and structure that allow for a stylish, user-friendly design. Full article

Cloud computing offers a broad spectrum of services to users, particularly in multi-cloud environments where service-centric features are introduced to support users from multiple endpoints. To improve service availability and optimize the utilization of required services, cloud brokerage has been integrated into multi-cloud systems. The primary objective of a cloud broker is to ensure the quality and outcomes of services offered to customers. However, traditional cloud brokers face limitations in measuring service trust, ensuring validity, and anticipating future enhancements of services across different cloud platforms. To address these challenges, the proposed intelligent cloud broker integrates an intelligence mechanism that enhances decision-making within a multi-cloud environment. This broker performs a comprehensive validation and verification of service trustworthiness by analyzing various trust factors, including service response time, sustainability, suitability, accuracy, transparency, interoperability, availability, reliability, stability, cost, throughput, efficiency, and scalability. Customer feedback is also incorporated to assess these trust factors prior to service recommendation. The proposed model calculates service ranking (SR) values for available cloud services and dynamically includes newly introduced services during the validation process by mapping them with existing entries in the Service Collection Repository (SCR). Performance evaluation using the Google cluster-usage traces dataset demonstrates that the ICB outperforms existing approaches such as the Clustering-Based Trust Degree Computation (CBTDC) algorithm and the Service Context-Aware QoS Prediction and Recommendation (SCAQPR) model. Results confirm that the ICB significantly enhances the effectiveness and reliability of cloud service recommendations for users. Full article

Freezing of gait (FoG) impairs mobility and daily functioning and increases the risk of falls, leading to a reduced quality of life (QoL) in people with Parkinson’s disease (PD). The Cue2walk, a wearable smart cueing device, can detect FoG and hereupon provides rhythmic cues to help people with PD manage FoG in daily life. This study investigated the user experiences and device usage of the Cue2walk, and its impact on health-related QoL, FoG and daily activities. Twenty-five users of the Cue2walk were invited to fill out an online survey, which included a modified version of the EQ-5D-5L, tailored to the use of the Cue2walk, and its scale for health-related QoL, three FoG-related questions, and a question about customer satisfaction. Sixteen users of the Cue2walk completed the survey. Average device usage per day was 9 h (SD 4). Health-related QoL significantly increased from 5.2/10 (SD 1.3) to 6.2/10 (SD 1.3) (p = 0.005), with a large effect size (Cohen’s d = 0.83). A total of 13/16 respondents reported a positive effect on FoG duration, 12/16 on falls, and 10/16 on daily activities and self-confidence. Customer satisfaction was 7.8/10 (SD 1.7). This pilot study showed that Cue2walk usage per day is high and that 15/16 respondents experienced a variety of positive effects since using the device. To validate these findings, future studies should include a larger sample size and a more extensive set of questionnaires and physical measurements monitored over time. Full article

Optimizing passenger train line planning is a complex task that involves balancing operational costs and passenger service quality. This study investigates the adjustment and optimization of train line plans to better align with passenger demand and operational constraints, while minimizing systematic costs. These costs include train operation expenses (e.g., line usage fees and station service fees), passenger travel costs, and hidden costs such as imbalances in station stops. Line usage fees refer to charges for using railway tracks, whereas station service fees cover services provided at train stations. The optimization process employs a Simulated Annealing Algorithm to adjust train compositions, capacity configurations, and stop patterns to better match passenger demand. The results indicate a 13.89% reduction in the objective function value, reflecting improved overall efficiency. Notably, most costs are reduced, including train operating costs and passenger travel costs. However, ticketing service fees—which are calculated as a percentage of passenger fare revenue—increased slightly due to additional backtracking in passenger travel paths, which raised the total fare collected. Overall, the optimization improves the operational performance of the train network, enhancing both efficiency and service quality. Full article

Infrared ship detection plays a vital role in maritime surveillance systems. As a critical remote sensing application, it enables maritime surveillance across diverse geographic scales and operational conditions while offering robust all-weather operation and resilience to environmental interference. However, infrared imagery in complex maritime environments presents significant challenges, including low contrast, background clutter, and difficulties in detecting small-scale or distant targets. To address these issues, we propose an Infrared Ship Detection Network (IRSD-Net), a lightweight and efficient detection network built upon the YOLOv11n framework and specially designed for infrared maritime imagery. IRSD-Net incorporates a Hierarchical Multi-Kernel Convolution Network (HMKCNet), which employs parallel multi-kernel convolutions and channel division to enhance multi-scale feature extraction while reducing redundancy and memory usage. To further improve cross-scale fusion, we design the Dynamic Cross-Scale Feature Pyramid Network (DCSFPN), a bidirectional architecture that combines up- and downsampling to integrate low-level detail with high-level semantics. Additionally, we introduce Wise-PIoU, a novel loss function that improves bounding box regression by enforcing geometric alignment and adaptively weighting gradients based on alignment quality. Experimental results demonstrate that IRSD-Net achieves 92.5% ${\mathrm{mAP}}_{50}$ on the ISDD dataset, outperforming YOLOv6n and YOLOv11n by 3.2% and 1.7%, respectively. With a throughput of 714.3 FPS, IRSD-Net delivers high-accuracy, real-time performance suitable for practical maritime monitoring systems. Full article

Background/Objectives: Obstructive sleep apnea (OSA) is a highly prevalent disorder that significantly impacts quality of life and daily functioning. While continuous positive airway pressure (CPAP) therapy is effective, long-term adherence remains a challenge. This single-arm observational study aimed to evaluate clinical outcomes and adherence patterns during telemedicine-supported CPAP therapy and identify distinct phenotypic response clusters in Romanian patients with OSA. Methods: This prospective observational study included 86 adults diagnosed with OSA, treated with ResMed Auto CPAP devices at “Victor Babeș” University Hospital in Timișoara, Romania. All patients were remotely monitored via the AirView™ platform and received monthly telephone interventions to promote adherence when necessary. Clinical outcomes were assessed through objective telemonitoring data. K-means clustering and t-distributed stochastic neighbor embedding (t-SNE) were employed to explore phenotypic response patterns. Results: During telemedicine-supported CPAP therapy, significant clinical improvements were observed. The apnea–hypopnea index (AHI) decreased from 42.0 ± 21.1 to 1.9 ± 1.3 events/hour. CPAP adherence improved from 75.5% to 90.5% over six months. Average daily usage increased from 348.4 ± 85.8 to 384.2 ± 65.2 min. However, post hoc analysis revealed significant concerns about the validity of self-reported psychological improvements. Self-esteem changes showed negligible correlation with objective clinical measures (r < 0.2, all p > 0.1), with only 3.3% of variance being explained by measurable therapeutic factors (R² = 0.033). Clustering analysis identified four distinct adherence and outcome profiles, yet paradoxically, patients with lower adherence showed greater self-esteem improvements, contradicting therapeutic causation. Conclusions: Telemedicine-supported CPAP therapy with structured monthly interventions was associated with substantial clinical improvements, including excellent AHI reduction (22-fold) and high adherence rates (+15% after 6 months). Data-driven phenotyping successfully identified distinct patient response profiles, supporting personalized management approaches. However, the single-arm design prevents definitive attribution of improvements to telemonitoring versus natural adaptation or placebo effects. Self-reported psychological outcomes showed concerning patterns suggesting predominant placebo responses rather than therapeutic benefits. While the overall findings demonstrate the potential value of structured telemonitoring for objective CPAP outcomes, controlled trials are essential to establishing true therapeutic efficacy and distinguishing intervention effects from measurement bias. Full article

Objective: To compare the effect of different bone augmentation procedures, namely, autogenous bone blocks (ABBs) versus guided bone regeneration (GBR), on patient-reported outcomes (PROMs). Methods: This systematic review was conducted according to the PRISMA guidelines. A MEDLINE, Embase, and Web of Science search was conducted by two independent reviewers in combination with a free-hand search in relevant journals until June 2025. Outcomes were PROMs to enhance our understanding of the evolution of these procedures. Results: The electronic search yielded 6291 articles. After title screening, 67 articles were further analyzed for abstract review, which resulted in 14 articles eligible for full-text reading. Six articles were finally included based on the exclusion and inclusion criteria with a total of 295 patients. The overall study quality was low, since only two RCTs could be included. One study demonstrated a high risk of bias. Different PROMs were examined and compared such as pain, edema, neurosensory disturbance, Patient-Reported Predominant Symptom, OHIP-14, postoperative analgesic usage, willingness to repeat, and likelihood to recommend. Meta-analysis was not achievable due to a lack of direct comparisons and heterogeneity in terms of PROMs. Evaluation points varied between pretreatment and up to nearly 10-years of follow-up. Conclusions: Despite significant heterogeneity and reporting, this systematic review concluded that ABB and GBR are well-tolerated procedures. Trends such as transient postoperative pain and swelling with a minor occurring of neurosensory disturbances were reported in a few studies. Overall, a good perception of postoperative recovery was reported for both treatment modalities. Good quality of life was noted related to GBR procedures. Patient-reported outcomes were only analyzed for patients who completed the entire follow-up period. This may introduce bias, as patients who dropped out and were more likely to experience complications were not represented, potentially resulting in a more favorable portrayal of the outcomes. Further well-conducted prospective studies with a long follow-up are needed for an evidence-based evaluation and comparison of PROMs for these procedures. Full article

The performance of reinforced concrete (RC) frame structures will gradually decrease over time, posing a threat to the safety of buildings. Although the performance of some buildings may still meet the safety requirements, they cannot meet new usage requirements. Therefore, this paper proposes a new-type joint to promote the development of research on the reinforcement and renovation of RC frame structures in response to this situation. The RC beams and columns of the joints are connected by embedded horizontal steel plate (a single plate with dimension of 150 mm × 200 mm × 5 mm), and the beams and columns are individually wrapped in steel. Through conducting low cyclic loading tests, this paper analyzes the influence of carrying out wrapped steel treatment and the thickness of wrapped steel of the beam and connector on mechanical performance indicators such as hysteresis curve, skeleton curve, stiffness, ductility, and energy dissipation. The experimental results indicate that the reinforcement using steel plate can significantly improve the dynamic performance of the joint. The effect of changing the thickness of the connector on the dynamic performance of the specimen is not significant, while increasing the thickness of wrapped steel of beam can effectively improve the overall strength of joint. The research results of this paper will help promote the application of reinforcement and renovation technology for existing buildings, and improve the quality of human living. Full article

NetworkX is a free Python library for graphs and networks and is used in many applications and projects to find the shortest path in path planning scenarios. For dense graphs, the library provides the Floyd–Warshall algorithm for shortest paths and the A* (“A-Star”) algorithm for shortest paths and path lengths. However, several extensions have been proposed to improve the A*, but they are not included in the library. In this context, this paper presents a set of implementations improving the A*, such as the IDA*, D* Lite, SMA*, Bidirectional A* and RTA*. The goal or challenge is to address the limitations of the A* in specific scenarios, such as searching for an optimal path repeatedly or when confronted with memory limitations, as exemplified by the NetworkX library. To do this, we first review the literature of the usage and general application of NetworkX in different domains of applicability and then explore their usage in a shortest path context. By reviewing and validating the usage of A* and extensions in Python using the NetworkX framework, the implementations were submitted to the network environment validation and passed the tests. We have also done the benchmarking of the A*, comparing it with the new ones, and concluded the better efficiency of the A* extensions in tri-objective scenario parameters (length, cost and toll). Despite the extensive utilisation of A* and its notable efficacy in identifying optimal paths, its performance is suboptimal in specific scenarios, such as when confronted with memory constraints and dynamic environments. Almost every algorithm outperformed or matched the A* in the fields that were developed to have an advantage, demonstrating the quality and robustness of the implemented algorithms. As a contribution and to foster further research in this shortest path specific context field, the dataset and Python code of the algorithms are available in a GitHub opensource repository. Full article

This study investigates the impact of teacher decisions and other contextual factors on indoor air quality (IAQ) in mechanically ventilated elementary school classrooms using low-cost air quality sensors. Four classrooms at a K–8 school in San Jose, California, were monitored for airborne particulate matter (PM), carbon dioxide (CO₂), temperature, and humidity over seven weeks. Each classroom was equipped with an HVAC system and a portable air cleaner (PAC), with teachers having full autonomy over PAC usage and ventilation practices. Results revealed that teacher behaviors, such as the frequency of door/window opening and PAC operation, significantly influenced both PM and CO₂ levels. Classrooms with more active ventilation had lower CO₂ but occasionally higher PM_2.5 due to outdoor air exchange, while classrooms with minimal ventilation showed the opposite pattern. An analysis of PAC filter material and PM morphology indicated distinct differences between indoor and outdoor particle sources, with indoor air showing higher fiber content from clothing and carpets. This study highlights the critical role of teacher behavior in shaping IAQ, even in mechanically ventilated environments, and underscores the potential of low-cost sensors to support informed decision-making for healthier classroom environments. Full article

Large language models (LLMs), built upon Transformer architectures, have demonstrated remarkable performance in a wide range of natural language processing tasks. However, their practical deployment—especially in long-context scenarios—is often hindered by the computational and memory costs associated with managing the key–value (KV) cache during inference. Optimizing this process is therefore crucial for improving LLM efficiency and scalability. In this study, we propose a novel entropy-guided KV caching strategy that leverages the distribution characteristics of attention scores within each Transformer layer. Specifically, we compute the entropy of attention weights for each head and use the average entropy of all heads within a layer to assess the layer’s contextual importance. Higher-entropy layers—those exhibiting broader attention dispersion—are allocated larger KV cache budgets, while lower-entropy (sink-like) layers are assigned smaller budgets. Instead of selecting different key–value tokens per head, our method selects a common set of important tokens per layer, based on aggregated attention scores, and caches them uniformly across all heads within the same layer. This design preserves the structural integrity of multi-head attention while enabling efficient token selection during the prefilling phase. The experimental results demonstrate that our approach improves cache utilization and inference speed without compromising generation quality. For example, on the Qwen3 4B model, our method reduces memory usage by 4.18% while preserving ROUGE score, and on Mistral 0.1v 7B, it reduces decoding time by 46.6%, highlighting entropy-guided layer analysis as a principled mechanism for scalable long-context language modeling. Full article

Background/Objectives: Knee osteoarthritis is one of the most significant diseases globally and in Portugal. Despite the availability of international guidelines, there is a lack of tailored, evidence-based recommendations specifically for Portuguese physiotherapists to manage their knee osteoarthritis patients with non-pharmacological and non-surgical interventions. This study aimed to develop a clinical practice guideline that integrates the latest international evidence with local clinical practice data to enhance patient outcomes. Methods: To achieve the objective, a comprehensive search was conducted in November 2024 across major health-related databases, to identify robust and recent evidence regarding the efficacy of non-pharmacological and non-surgical interventions, as well as their usage in the national context. Two key sources were identified: An umbrella and a mixed-methods study. Data from both sources were independently reviewed and integrated through a comparative analysis to identify interventions with robust scientific support and high local acceptability. Recommendations were then formulated and categorized into gold (strong), silver (moderate), and bronze (weak) levels based on evidence quality and clinical relevance. A decision-making flowchart was developed to support guideline implementation and clinical usage. Results: The integrated analysis identified three gold-level interventions, namely Nutrition/Weight Loss, Resistance Exercise, and Self-care/Education. Five silver-level recommendations were Aerobic Exercise, Balneology/Spa, Extracorporeal Shockwave Therapy, Electrical Stimulation, and Manual Therapy. Similarly, five bronze-level recommendations comprised Kinesio Taping, Stretching, Ultrasound Therapy, Thermal Agents, and Walking Aids. Conclusions: This clinical practice guideline provides a context-specific, evidence-based framework for Portuguese physiotherapists managing knee osteoarthritis. By bridging international evidence with local clinical practice, the guideline aims to facilitate optimal patient care and inform future research and guideline updates. Full article

The confluence of financial constraints, climate change mitigation efforts, and evolving user expectations has significantly transformed the concept of facility management (FM). Traditional FM has now evolved to enhance sustainability in the built environment. Sustainable facility management (SFM) can add value to companies, organizations, and governments by balancing the financial, environmental, and social outcomes of the FM processes. The systematic literature review revealed a limited number of studies developing a performance measurement framework for SFM in office buildings and/or other building types in the literature. Given that the lack of this theoretical basis inhibits the effective deployment of SFM practices, this study aims to fill this gap by developing a performance measurement framework for SFM in office buildings. Accordingly, an in-depth literature review was initially conducted to synthesize sustainable performance measurement factors. Next, a series of focus group discussion (FGD) sessions were organized to refine and verify the factors and develop a novel performance measurement framework for SFM. Lastly, consistency analysis, the Bayesian best worst method (BBWM), and sensitivity analysis were implemented to determine the priorities of the factors. What the proposed framework introduces is the combined use of two performance measurement mechanisms, such as continuous performance measurement and comprehensive performance measurement. The continuous performance measurement is conducted using high-priority factors. On the other hand, the comprehensive performance measurement is conducted with all the factors proposed in this study. Also, the BBWM results showed that “Energy-efficient material usage”, “Percentage of energy generated from renewable energy resources to total energy consumption”, and “Promoting hybrid or remote work conditions” are the top three factors, with scores of 0.0741, 0.0598, and 0.0555, respectively. Moreover, experts should also pay the utmost attention to factors related to waste management, indoor air quality, thermal comfort, and H&S measures. In addition to its theoretical contributions, the paper makes practical contributions by enabling decision makers to measure the SFM performance of office buildings and test the outcomes of their managerial processes in terms of performance. Full article