Search Results (151)

Background: Although extreme heat is associated with adverse cardiovascular outcomes, the relationship between heat-alert-threshold days, acute myocardial infarction (AMI) admissions, and post-AMI mortality remains uncertain. We aimed to evaluate the association between temperature-defined heat-alert-threshold days and (i) daily AMI admissions and (ii) cumulative all-cause mortality after hospitalized AMI in Hungary. Methods: We conducted a nationwide registry-based study using data from the Hungarian Myocardial Infarction Registry (HMR). All AMI admissions between 1 January 2018 and 31 December 2019 were eligible, with mortality follow-up through 16 June 2021. Heat-alert-threshold days were defined using the temperature criterion applied in the Hungarian national heat-health action plan (daily mean temperature ≥25 °C). AMI admissions were analyzed using adjusted quasi-Poisson regression models and cumulative mortality using stratified Cox proportional hazards models. This operational temperature threshold was used as the exposure definition and does not represent linkage to administrative heat-alert declarations. Results: The cohort included 30,883 AMI events from 29,596 unique patients (mean age, 67.2 [SD 12.8] years; 60.3% male). Patients admitted on heat-alert-threshold days had baseline clinical characteristics similar to those admitted on non-alert days (all standardized mean differences <0.10). Heat-alert-threshold days were associated with fewer recorded AMI admissions during summer (adjusted incidence rate ratio [aIRR] 0.93, 95% CI 0.90–0.97). In contrast, no association was observed between heat-alert-threshold exposure and subsequent all-cause mortality after AMI hospitalization (adjusted hazard ratio [aHR] 0.96, 95% CI 0.87–1.05). These findings remained consistent across sensitivity analyses. Conclusions: In this nationwide Hungarian registry-based study, temperature-defined heat-alert-threshold days were associated with fewer recorded AMI admissions during summer but not with differences in post-AMI mortality among hospitalized patients. The observed inverse association should not be interpreted as evidence of a protective effect of heat exposure. Alternative explanations include behavioral adaptation, delayed care-seeking, exposure misclassification, residual confounding, and the possibility of unmeasured out-of-hospital cardiovascular events, which were not captured by the registry. Because administrative heat-alert declarations were not linked to the analytic dataset, the findings should be interpreted as associations with temperature-defined heat-alert-threshold days rather than evaluations of the effectiveness of the Hungarian heat-alert system. Full article

To address the trade-off between stiffness and auxeticity in conventional star-shaped honeycombs (SH), this study introduces a novel star-ellipse honeycomb (SEH) design, incorporating elliptical stiffeners that enhance both load-bearing capacity and energy absorption. The mechanical performance of SEH was comprehensively evaluated using FE simulations, theoretical modeling, and quasi-static tests on 3D-printed multi-cell specimens. An equivalent Cauchy model using the Variational Asymptotic Method (VAM) was established and validated against experiment and finite element results, demonstrating high predictive accuracy in elastic behavior analysis while significantly reducing computational costs. Based on the collapse mechanism of a representative unit cell, a theoretical model was proposed to estimate the plateau stress. Comparative analyses show that the elliptical stiffener mitigates the classic stiffness–auxeticity trade-off by enabling cooperative deformation, which results in a simultaneous increase in elastic modulus and a stronger negative Poisson’s ratio compared to conventional star-shaped honeycombs. Additionally, the SEH exhibited a unique progressive folding mode under compression, delivering enhanced stiffness and energy dissipation, albeit with reduced ductility. The elliptical aspect ratio of 1.3, length ratio of 2.1, thickness ratio of 1.0, and star angle of 45–50° offer the best compromise between stiffness, energy dissipation, and auxetic performance, providing clear guidelines for tailoring SEH structures toward specific lightweight protective applications. Full article

Background: Effective fluid management is critical for improving outcomes in patients undergoing chronic hemodialysis (HD). Relative blood volume monitoring (RBVM) supports the optimization of ultrafiltration rate adjustments; however, real-world evidence evaluating its impact on hospitalizations in chronic HD is limited. Methods: We conducted a retrospective, propensity score–matched observational cohort study comparing patient outcomes across 165 Fresenius Kidney Care clinics with high RBVM utilization (HI-RBVM; >90% of treatments) matched to 165 clinics not using RBVM (NO-RBVM). Data were collected from July to December 2022. Primary outcomes were patient-level all-cause and fluid-related hospitalizations and hospitalization days over a 6-month follow-up. Multivariable scaled Poisson regression models were used to estimate adjusted incidence rates, rate ratios, and rate differences. Secondary outcomes included patient-level changes in monthly clinical measurements. Results: 24,958 patients were included (11,840 across HI-RBVM clinics; 13,118 across NO-RBVM clinics). Adjusted incidence rates were lower in the HI-RBVM group compared to the NO-RBVM group for all-cause hospitalizations (1.57 vs. 1.70 per person-year [ppy]), fluid-related hospitalizations (0.30 vs. 0.35 ppy), and hospitalization days (9.60 vs. 10.8 ppy), corresponding to 119 fewer hospital days per 100 patient-years (95% CI: –184, −54; p < 0.001). Among patients with dialysis vintage ≤6 months, those treated in HI-RBVM clinics had smaller increases in pre-HD weight (–0.03 kg vs. +0.46 kg; p = 0.008) and ultrafiltration volume (0.11 L vs. 0.21 L; p = 0.004), and underwent more frequent estimated dry weight (EDW) adjustments (mean 7.73 vs. 6.61; p < 0.001). Conclusions: Among HD patients, high RBVM utilization at the clinic level was associated with lower rates of hospitalization. Prospective or quasi-experimental studies are needed to determine causality. Full article

Mobile platforms such as high-speed trains and unmanned aerial vehicles (UAVs) experience quasi-periodic variation in link quality as they move through a cellular base-station lattice, so the service rate of their on-board uplink buffer is itself time-periodic. We model this buffer as a periodic $M/M\left(t\right)/1$ queue whose service rate follows from a signal-to-noise-ratio (SNR)-to-rate map and construct an edge-resident controller that exploits this periodic structure for real-time quality-of-service (QoS) control. From a harmonic-balance (Fourier–Galerkin) solution of the periodic regime, the controller derives backlog and tail-probability indicators and uses them to drive admission, redundancy and handover decisions on the device. The method rests on a stability criterion and a quantitative error bound for the spectral truncation, under stated regularity and stability conditions, and is validated against Monte Carlo simulation along a ∼650 km geo-anchored corridor: on the periodic backbone, the solver matches simulation to within about $1.6\%$, and a coefficient-driven admission rule lowers the 99th-percentile delay by about $28\%$ relative to a reactive baseline at high load. On the full map-derived profile with aperiodic coverage gaps, the proposed proactive controller—spectral backbone admission combined with a radio-map look-ahead—attains the lowest mean and tail delay, about $27\%$ and $21\%$ below the reactive baseline and $54\%$ and $42\%$ below uncontrolled DropTail, with buffer overflow cut from $2.2\%$ to $0.1\%$, at a deliberate admitted-load cost (goodput ≈0.84 vs. $0.94$). An operation-count analysis indicates compatibility with sub-$100$ms control deadlines on a Cortex-A55-class system-on-chip. The controller runs on the device itself, without cloud or GPU, and the architecture is realised in a granted patent; end-to-end hardware benchmarking and an extension to non-Poisson traffic are left for future work. Full article

Background: Children with congenital heart disease (CHD) are highly vulnerable to influenza, yet real-world vaccine effectiveness (VE) data in this post-operative population are lacking, especially in China. This study estimated influenza VE against medically attended influenza-like illness (ILI) in post-operative children with CHD using inverse probability of treatment weighting (IPTW) to address confounding. Methods: We retrospectively enrolled 194 children who underwent CHD surgery in Shanghai (January–July 2023). Vaccination records were obtained from the Shanghai Immunization Information System, and ILI episodes were captured via structured interviews. The primary analysis used doubly robust quasi-Poisson regression on an IPTW pseudo-population. VE = (1 − RR) × 100%. Sensitivity analyses included multivariable Poisson regression, marginal structural models, and stabilized IPTW. Results: Vaccination coverage was 21.6% (42/194). After IPTW, all covariates were well-balanced (SMD < 0.10). The primary VE was 50.9% (95% CI: 11.0–72.9%). Sensitivity estimates ranged from 49.6% to 56.6%. Subgroup analyses showed consistently protective point estimates. Conclusions: Influenza vaccination provided moderate, robust protection (≈51% VE) against ILI in post-operative CHD children, comparable to healthy pediatric populations. Our results reinforce the urgent need to prioritize influenza immunization in this vulnerable group and offer critical baseline data for China. Full article

Background: This study aims to thoroughly examine the relationship between weather conditions and reported pulmonary tuberculosis (PTB) cases in Haikou City. The goal is to provide a scientific basis for developing more targeted and timely prevention measures, thereby enhancing local efforts to control PTB. Methods: In this retrospective time-series study from 2010 to 2023, a total of 22,083 PTB cases (15,723 males and 6360 females) were analyzed. Using monthly PTB case counts (overall and stratified by sex and age) and meteorological variables, descriptive analyses along with distributed lag non-linear models (DLNMs) and generalized additive distributed lag models (GADLMs) combined with quasi-Poisson regression model regression were applied. Results: Taking the median of each meteorological factor as the reference, temperature exhibited significant delayed effects. For the overall population, temperatures between 14.30 °C and 24.24 °C posed significant lagged risks, with the effect decreasing as temperature rose. At the minimum monthly average temperature (14.30 °C), the relative risk (RR) peaked at lag 7 months (RR = 1.37, 95% CI: 1.23–1.53). Sex-stratified analysis showed similar patterns for males (14.30–23.94 °C) and females (14.30–23.84 °C), with peak RRs of 1.40 (1.25–1.58) and 1.37 (1.21–1.56), respectively, at 14.30 °C. In the adults group, temperatures between 14.30 °C and 25.45 °C produced significant lagged effects (maximum lag 14 months), with the highest RR of 1.42 (1.27–1.60) at lag 8 under 14.30 °C. The older age group showed a linear association. Average relative humidity exhibited a weak lag-4 correlation with PTB counts in some subgroups, but model testing indicated no statistically significant lagged risk effect in any group. Conclusions: A significant nonlinear lagged exposure–response relationship exists between temperature and PTB incidence in Haikou, with population-specific variations, while relative humidity shows no significant lagged effect. These findings underscore the necessity of incorporating temporal lag effects and population differences into regional PTB early warning and prevention strategies. Full article

Extreme temperatures are an emerging public health concern due to their significant impact on humans, yet the evidence remains limited in tropical countries. This study examined the non-linear relationship between ambient temperature and non-accidental and cause-specific mortality in two northern parts of Peninsular Malaysia, from 2011 to 2019. Daily mortality and meteorological data were analyzed using a quasi-Poisson Generalized Linear Model with a Distributed Lag-Non-Linear model to estimate the relationship between temperature and mortality. A U-shaped and J-shaped relationship was observed for the cumulative effects of 21-day lag periods for Kedah and Penang, respectively. The minimum mortality temperature (MMT) at 27.4 °C in Kedah and 28.2 °C in Penang was observed. Extremely high temperatures were associated with an increased non-accidental mortality, with a 16% increase at cumulative lag days 0–3 in Kedah and a 21% increase at cumulative lag days 0–7 in Penang. Vulnerable groups included individuals with respiratory diseases, the elderly, both genders and those residing in both urban and rural areas. These findings highlight the acute impact of heat on mortality in Malaysia and underscore the need for targeted public health interventions. Strengthening heat-health warning systems, improving healthcare preparedness, and prioritizing vulnerable populations are essential to mitigate the health impacts of rising temperatures in tropical regions. Full article

Background: Antimicrobial resistance (AMR) poses an escalating threat to global health, agriculture, and the environment, demanding urgent multisectoral action under the One Health framework. Despite global awareness efforts, understanding of AMR among the general population remains insufficient, particularly in low- and middle-income countries such as Brazil. This study aimed to evaluate the knowledge, attitudes, and perceptions (KAP) of the Brazilian population regarding AMR. Methods: An online questionnaire was distributed through social media platforms between April and August 2025, resulting in 945 valid responses after data cleaning. Quasi-Poisson models were applied to identify demographic predictors of KAP scores while logistic regression models were used to assess the association between KAP scores and antibiotic use-related practices. Results: Education level was the strongest predictor of higher KAP scores, whereas age and gender showed inconsistent influence. Only 40.3% of respondents correctly identified antibiotics among commonly used medicines, and 25.9% reported proper disposal of antibiotic packaging. More than half (54.2%) were willing to pay more for antibiotic-free products, although only 26.7% had ever noticed such labeling. Network analysis of open-ended responses indicated that concerns about potential health risks and AMR awareness were the primary motivators for purchasing antibiotic-free products. Conclusions: These findings reveal significant gaps in public understanding of antibiotic use and resistance in Brazil, emphasizing the urgent need for targeted educational initiatives, improved public communication, and behavioral interventions to support antimicrobial stewardship and sustainable antibiotic use. Full article

Background: High concentrations of coarse particulate matter PM₁₀ from road dust are a major air quality concern in Visby, Sweden. To mitigate these levels, local authorities replaced soft limestone with crushed granite as an anti-slip material starting in the winter of 2023/2024. This is a follow-up study evaluating the impact of this intervention on PM₁₀ concentrations and the associated short-term respiratory health effects. Methods: Daily counts of healthcare visits for respiratory diseases (ICD-10: J00–J99) and daily mean PM₁₀ concentrations were analyzed using a quasi-Poisson regression model. This study compared the limestone period (2015–2019) with the granite period (2023–2025), stratified by season (winter/spring and summer/autumn) and age group (children 0–17 years and adults >17 years). Results: The transition to crushed granite reduced peak PM₁₀ concentrations during the spring. For adults, the relative risks for respiratory visits during winter/spring decreased during the granite period when compared to the limestone period (Wald p < 0.05). However, when considering that there were a majority of non-statistically significant differences when comparing the granite and limestone periods, these results should be interpreted with caution. Among children, more pronounced associations were observed during summer, although no significant differences in risk were detected between the limestone and granite periods. Conclusions: Although the intervention effectively lowered particle mass concentrations, only minor changes were observed in the overall epidemiological pattern. This suggests that public health improvements may be limited by factors beyond total mass reduction, such as particle mineralogy or seasonal exposure dynamics. Full article

Negative Poisson’s ratio materials show great potential in aerospace, automotive engineering, and military protection owing to their unique deformation behavior and superior mechanical properties. Nevertheless, current negative Poisson’s ratio honeycomb structures suffer from an inherent conflict between stiffness and energy absorption, along with poorly understood mechanical regulation mechanisms in complex three-dimensional nested configurations. To address these issues, this paper proposes a novel Cross Re-entrant Hexagon Nested Star-shaped Cell (CRNSC). Through theoretical derivation, finite element simulation, and quasi-static compression experiments, the mechanical properties and energy absorption characteristics of the structure are systematically investigated. A geometric characterization system based on length, angle, and thickness parameters is established. The results show that the cell wall thickness significantly increases the relative density, while the angle θ between the inner inclined strut and the horizontal line induces polarity reversal of the Poisson’s ratio. The outer inclined strut angle α and the inner angle θ exhibit monotonic or nonlinear regulatory effects on the equivalent Poisson’s ratio and the effective Young’s modulus, respectively. The optimal load-bearing configuration (α = 65°, θ = 35°) achieves a peak stress of 1.01 MPa, and the optimal deformation configuration (α = 55°, θ = 25°) reaches an ultimate strain of 4%. Theoretical, simulated, and experimental results are in good agreement with errors below 7%, validating the model’s effectiveness. Full article

This study investigates the elastic anisotropy and thermodynamic properties of the L1₂-type ScAl₃ phase under extreme conditions (0–1500 K and 0–50 GPa) using first-principles calculations. The elastic constants were determined using a precise stress–strain method, with polycrystalline moduli derived via the Voigt–Reuss–Hill (VRH) approximation. A systematic analysis was conducted to characterize the elastic anisotropy of Young’s modulus, shear modulus, and Poisson’s ratio. Results demonstrate that ScAl₃ is mechanically stable and exhibits near-perfect elastic isotropy (A^U = 0.0001). Thermodynamic analysis via the quasi-harmonic Debye–Grüneisen model reveals that the phase maintains its structural integrity and significant heat resistance up to 1500 K, despite thermal softening. These findings provide theoretical insights into the physical nature of ScAl₃ intermetallics and offer quantitative guidance for the design and thermal treatment of Sc-reinforced aluminum alloys in high-temperature aerospace applications due to their superior combination of strength and toughness. Full article

Online reviews are increasingly pivotal in consumer decision-making, with platforms employing mechanisms such as badges to denote reviewer credibility. Although prior research has examined the influence of expert reviewers, it has typically treated badge holders as a homogeneous group, overlooking how variation in tenure within expert tiers shapes the way readers process review content. This article examines how Yelp Elite badge tenure, operationalized as Red (1–4 years), Gold (5–9 years), and Black (10+ years) tiers and treated as a proxy for accumulated platform-recognized expertise, moderates the effects of peripheral cues (Extremity, Length) and central cues (Readability, Subjectivity, and Plutchik’s eight emotions) on perceived helpfulness within an Elaboration Likelihood Model (ELM) framework. The analysis draws on the full population of 324,426 restaurant reviews authored by Yelp Elite badge holders between 2019 and 2021, using a pooled count-model specification with badge tier as a categorical moderator. The primary specification is estimated using Poisson quasi-maximum likelihood with HC1-robust standard errors, and full negative binomial estimation is reported as a robustness check. Wald tests indicate that badge tenure significantly moderates eight of twelve cue–helpfulness relationships (${\chi }^2\left(24\right)=4938$, $p<0.001$). The effect of readability is monotonically positive and increases sharply with tenure, while the effect of joy varies across tenure groups. These findings suggest that reviewer expertise signals are not monolithic, refining theoretical insights on how tenure-based credibility cues moderate cue processing and offering practical implications for review platform management. The findings also indicate that platforms applying uniform ranking or surfacing rules across all Elite reviewers risk misallocating visibility, and that tenure-conditional weighting of textual cues warrants consideration. Full article

Count outcomes are commonly analyzed using Poisson regression, but empirical data often exhibit overdispersion, excess ties, heaping, or other departures from the Poisson distribution. This paper evaluates a rank-Poisson transformation, denoted poisrank, designed to map observed counts onto Poisson quantiles before fitting a Poisson regression model. Our goal is to test whether a rank-Poisson transformation offers a useful general-purpose strategy when count data do not satisfy Poisson assumptions. Using an empirical example and a Monte Carlo simulation study with Poisson, overdispersed, rounded, and gapped count distributions, we compared Poisson regression on raw counts, Poisson regression after the poisrank transformation, quasi-Poisson regression, and additional comparison approaches. Although the transformation made the marginal distribution more similar to a Poisson distribution, it generally did not outperform standard alternatives for inference. In particular, quasi-Poisson regression more consistently maintained appropriate rejection rates with overdispersion whereas poisrank tended to be conservative and often reduced power. These findings suggest that the rank-Poisson transformation is better understood as an exploratory robustness device than as a preferred replacement for established count-data methods. Full article

Wastewater-based epidemiology has emerged as a valuable complementary tool for population-level monitoring. This study evaluated the early warning value of wastewater surveillance for monitoring SARS-CoV-2 and its correlation with COVID-19 infection trends. From May 2024 to December 2025, 526 wastewater samples were collected from five treatment plants. Spearman correlation and a quasi-Poisson generalized additive model (adjusting for wastewater temperature) were used to assess relationships between SARS-CoV-2 RNA concentration, the number of reported cases, and lag associations. Wastewater viral loads (copies/mL) significantly correlated with reported cases. Wastewater temperature was positively correlated with both viral concentrations and case numbers. A significant lagged association was observed for the N gene, with relative risk peaking at a 10-day lag. Although the ORF1ab gene was not significant for most lag periods, its temporal trend was consistent with that of the N gene. Wastewater surveillance of SARS-CoV-2, particularly targeting the N gene, can effectively predict COVID-19 infection dynamics with a 10-day lead time, thereby supporting wastewater surveillance as an early warning tool for public health monitoring. Full article

Background/Objectives: Seasonal influenza vaccination is pivotal for protecting high-risk populations, including those with chronic health conditions (CHCs), from severe complications and outcomes. This study aims to describe the sociodemographic characteristics of unvaccinated children (6 months–17 years old) with CHCs, the reasons why vaccine hesitant parents chose not to vaccinate their children, and the factors associated with seasonal influenza non-vaccination among these children. Methods: This cross-sectional analysis used a sub-sample from the 2023 Childhood COVID-19 Immunization Coverage Survey, which captured data between April and July 2023. Parent and child characteristics were explored, using frequencies and proportions. Weighted unadjusted, partially adjusted (with child age and sex at birth), and fully adjusted multivariable quasi-Poisson models were designed to identify socio-demographic factors associated with seasonal influenza non-vaccination. Results: A total of 649/1187 (55%) children with CHCs were unvaccinated against influenza during the 2022–2023 influenza season. Vaccine hesitant parents with unvaccinated children expressed concerns with vaccine effectiveness (39.1%) and safety (27.5%), as did parents who refused vaccination for their child (56.1% and 35.8%, respectively). Unvaccinated parents (RR: 4.549, 99% CI: 4.480, 4.619) and parents with low household income (RR: 1.428, 99% CI: 1.400, 1.456) were more likely to have unvaccinated children, whereas children who received an annual influenza vaccine (RR: 0.097, 99% CI: 0.094, 0.100) and did not have a disability (RR: 0.913, 99% CI: 0.904, 0.922) had a lower likelihood of non-vaccination. Conclusions: These findings highlight the need for renewed messaging and educational resources targeting vaccine hesitancy and misinformation prevalent among parents with vulnerable youth. Full article