Search Results (619)

Background: Hospital-acquired influenza remains a persistent threat that amplifies morbidity, mortality, length of stay, and operational strain, particularly among older and immunocompromised inpatients. The COVID-19 era reshaped control norms—normalizing N95 use during surges, ventilation improvements, and routine multiplex PCR—creating an opportunity to strengthen hospital outbreak management. Methods: We conducted a targeted narrative review of WHO/CDC/Infectious Diseases Society of America (IDSA) guidance and peer-reviewed studies (January 2015–August 2025), emphasizing adult inpatient care. This narrative review synthesizes recent evidence and discusses theoretical implications for practice, rather than establishing formal guidelines. Evidence was synthesized into pragmatic practice statements on detection, diagnostics, isolation/cohorting, antivirals, chemoprophylaxis, vaccination, surveillance, and communication. Results: Early recognition and test-based confirmation are pivotal. For inpatients, nucleic-acid amplification tests are preferred; negative antigen tests warrant PCR confirmation, and lower-respiratory specimens improve yield in severe disease. A practical outbreak threshold is ≥2 epidemiologically linked, laboratory-confirmed cases within 72 h on the same ward. Effective control may require immediate isolation or cohorting with dedicated staff, strict droplet/respiratory protection, and daily active surveillance. Early oseltamivir (≤48 h from onset or on admission) reduces mortality and length of stay; short-course post-exposure prophylaxis for exposed patients or staff lowers secondary attack rates. Integrated vaccination efforts for healthcare personnel and high-risk patients reinforce workforce resilience and reduce transmission. Conclusions: A standardized, clinician-led bundle—early molecular testing, do-not-delay antivirals, decisive cohorting and Personal protective equipment (PPE), targeted chemoprophylaxis, vaccination, and disciplined communication— could help curb transmission, protect vulnerable patients and staff, and preserve capacity. Hospitals should codify COVID-era layered controls for seasonal influenza and rehearse unit-level outbreak playbooks to accelerate response and recovery. These recommendations target clinicians and infection-prevention leaders in acute-care hospitals. Full article

This study presents an integrated ex-post evaluation of a municipal window-retrofit program in Goyang, Republic of Korea (heating-dominated, Dwa). Using field surveys and pre- and post-utility bills for 36 dwellings, mainly pre-2000 low-rise reinforced-concrete buildings, we normalize climate with HDD and CDD and prices with CPI-deflated tariffs to isolate the intrinsic effect of window replacement. Area-normalized indicators ($∆e$, $\eta$, DPB, NPV, AC) were computed. Average annual savings were 30.2 kWh per m² per year ($\eta$ ≈ 16 percent), consisting of 10.6 kWh per m² per year of gas and 19.6 kWh per m² per year of electricity (n = 36). The median discounted payback was 7.0 years. Under a 50 percent subsidy, about 80 percent of projects recovered private investment within 15 years and showed positive NPV with a median of about USD 4944. The electricity-tariff multiplier had the largest influence on cash flows and payback. The median abatement cost was about USD 352 per tCO₂-eq. A portfolio view indicates that prioritizing low-cost cases maximizes total abatement, and that higher-cost cases merit design or cost review. Using the first post-retrofit year 2023, portfolio abatement is about 623 tCO₂-eq per year. The framework jointly normalizes climate and price effects and yields policy-relevant estimates for heating-dominated contexts. Full article

State-of-charge (SoC) balancing across multiple battery energy storage systems (BESS) is a central challenge in renewable-rich mini-grids. Heterogeneous battery capacities, differing states of health, stochastic renewable generation, and variable loads create a high-dimensional uncertain control problem. Conventional droop-based SoC balancing strategies are decentralized and computationally light but fundamentally reactive and limited, whereas model predictive control (MPC) is insightful but computationally intensive and prone to modeling errors. This paper proposes a Hierarchical Predictive–Adaptive Control (HPAC) framework for SoC balancing in mini-grids using deep reinforcement learning. The framework consists of two synergistic layers operating on different time scales. A long-horizon Predictive Engine, implemented as a federated Transformer network, provides multi-horizon probabilistic forecasts of net load, enabling multiple mini-grids to collaboratively train a high-capacity model without sharing raw data. A fast-timescale Adaptive Controller, implemented as a Soft Actor-Critic (SAC) agent, uses these forecasts to make real-time charge/discharge decisions for each BESS unit. The forecasts are used both to augment the agent’s state representation and to dynamically shape a multi-objective reward function that balances SoC, economic performance, degradation-aware operation, and voltage stability. The paper formulates SoC balancing as a Markov decision process, details the SAC-based control architecture, and presents a comprehensive evaluation using a MATLAB-(R2025a)-based digital-twin simulation environment. A rigorous benchmarking study compares HPAC against fourteen representative controllers spanning rule-based, MPC, and various DRL paradigms. Sensitivity analysis on reward weight selection and ablation studies isolating the contributions of forecasting and dynamic reward shaping are conducted. Stress-test scenarios, including high-volatility net-load conditions and communication impairments, demonstrate the robustness of the approach. Results show that HPAC achieves near-minimal operating cost with essentially zero SoC variance and the lowest voltage variance among all compared controllers, while maintaining moderate energy throughput that implicitly preserves battery lifetime. Finally, the paper discusses a pathway from simulation to hardware-in-the-loop testing and a cloud-edge deployment architecture for practical, real-time deployment in real-world mini-grids. Full article

Background: The COVID-19 pandemic exacerbated pre-existing inequities in maternity care, particularly among culturally diverse and migrant women. Although data were collected during the early pandemic phase, revisiting these experiences offers valuable insights for strengthening equity, cultural safety, and system preparedness in maternal healthcare. Methods: A qualitative phenomenological–hermeneutic study was conducted in a tertiary maternity hospital in Spain. Semi-structured interviews were carried out with six women from diverse cultural backgrounds. Data were analysed inductively through thematic analysis, followed by a secondary interpretive review in 2024 to identify enduring implications for culturally safe, equitable, and crisis-resilient maternity care. Results: Four main themes emerged: (1) heightened fear and uncertainty surrounding hospital care; (2) emotional distress linked to restrictions on companionship and support; (3) disruption of culturally embedded postpartum practices, resulting in isolation; and (4) health literacy barriers and dependence on informal information sources. Despite these challenges, participants demonstrated notable adaptability and resilience. Conclusions: COVID-19 amplified structural inequities in maternity care for culturally diverse mothers. The findings highlight the need to reinforce cultural safety, health literacy support, language mediation, family-centred care, and emotional wellbeing. These insights may inform efforts to strengthen resilient and equitable maternal health systems and improve preparedness for future public health emergencies. Full article

Eight species of the medically important scorpion genus Hemiscorpius Peters, 1861 have been reported in Iran, three of which are responsible for most of the severe clinical cases of envenomation. However, morphological similarity complicates species delimitation in this genus, hindering the identification of species implicated in envenomations. The present study integrates morphology, DNA sequences, and ecological niche modeling to clarify the taxonomy and distribution of Hemiscorpius in southern Iran, providing taxonomic insights relevant to public health and biodiversity conservation. Morphometric analyses were performed to evaluate size and shape differences; molecular phylogenetic analyses were conducted on DNA sequences of the mitochondrial Cytochrome c Oxidase Subunit I gene; and species distribution models, based on occurrence records and bioclimatic variables, were developed. Morphometric analyses revealed significant interspecific differences and sexual dimorphism. A new species was identified and described as Hemiscorpius aratta sp. n. Molecular phylogenetic analysis confirmed the distinctiveness of the new species and revealed intraspecific variation in the type species, Hemiscorpius lepturus Peters, 1861, suggesting possible cryptic diversity. Southern Iran, particularly the coastline of the Persian Gulf and the Gulf of Oman, represents a diversity hotspot for Hemiscorpius. Topographical barriers such as the Jebal Barez, Makkoran, and Zagros Mountain ranges promoted isolation and speciation, leading to high levels of endemism in the genus. Ecological niche models revealed that the distributions of Hemiscorpius species are strongly influenced by temperature and precipitation. Coastal species are restricted to thermally stable maritime habitats, whereas semi-arid species occupy regions with higher temperature seasonality. Range-restricted species are habitat specialists, vulnerable to environmental change. This study reinforces the importance of integrating morphological, molecular, and ecological data for resolving taxonomic ambiguity. Full article

This study aimed to identify scientific evidence that addresses women’s experiences in the process of illness and care during tuberculosis treatment. A systematic review of qualitative studies was conducted based on the Joanna Briggs Institute’s Manual for Evidence Synthesis and the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Searches were performed in the Web of Science, MEDLINE, Embase, SciVerse Scopus, and LILACS databases. The following descriptors were used: “Women,” “Tuberculosis,” “Gender Perspective,” and “Qualitative Approach.” Studies reporting the experiences of women with active tuberculosis, published in any language, without time restrictions, were included. Of the 16,029 studies initially identified, 7079 duplicates were removed and 8895 were excluded after title and abstract screening. A total of 55 studies were read in full, of which 41 did not meet the eligibility criteria, resulting in a final inclusion of 14 studies. Most selected studies were conducted in high-tuberculosis-burden, low- and middle-income countries between 2000 and 2024. All studies focused on pulmonary tuberculosis, with one addressing drug-resistant tuberculosis. The results revealed that women’s experiences with tuberculosis are shaped by the following four thematic categories: (1) stigma and social vulnerability of women with tuberculosis; (2) gender factors in access to health services and in the interruption of tuberculosis treatment among women; (3) intersectionality and social determinants of health; and (4) the importance of social, family, and healthcare support in the experience of tuberculosis illness. The experience of illness due to tuberculosis among women is profoundly shaped by vulnerabilities related to gender, stigma, and social class, which intensify social exclusion, hinder access to diagnosis and treatment, and deepen physical and emotional suffering. Stigma reinforces isolation and weakens support networks, while the burden of domestic labor, caregiving responsibilities, and economic dependence makes it difficult for women to prioritize their own health. In this context, family support and gender-sensitive, humanized healthcare are essential. Therefore, the implementation of public policies that address these specificities and confront structural inequalities is urgent to ensure comprehensive care and a dignified, effective recovery for women with tuberculosis. Full article

Reinforced concrete shear wall structures (RCSWs) are commonly used as explosion-resistant chambers for storing hazardous chemical materials and housing high-pressure reaction equipment, serving to isolate blast waves and prevent chain reactions. In this study, full-scale experiments and numerical simulations were conducted to investigate the blast resistance of RC shear wall protective structures subjected to internal explosions. A full-scale RC shear wall structure measuring 9.7 m × 8 m × 6.95 m with a wall thickness of 0.8 m was constructed, and an internal detonation equivalent to 200 kg of TNT was initiated to simulate the extreme loading conditions that may occur in explosion control chambers. Based on experimental data analysis and numerical simulation results, the damage mechanisms and dynamic response characteristics of the structure were clarified. The results indicate that under internal explosions, severe damage first occurs at the wall–joint regions, primarily exhibiting through-thickness shear cracking near the supports. The structural damage process can be divided into two stages: local response and global response. Using validated finite element models, a parametric study was carried out to determine the influence of TNT charge weight and reinforcement configuration on the structural dynamic response. The findings of this research provide theoretical references for the design and strengthening of blast-resistant structures. Full article

The rapid growth of electric vehicles has intensified the spatial mismatch between the layout of charging infrastructure and user demand, resulting in a structural contradiction in which “local oversupply” and “local shortages” coexist. To systematically diagnose and optimize this issue, this study develops an innovative analytical framework for a “residential area–charging infrastructure” collaborative service network and conducts an empirical analysis using Hongshan District in Wuhan as a case study. The framework integrates actual facility utilization data, complex network analysis, and spatial clustering methods. The findings reveal that the collaborative service network in the study area is overall sparse, exhibiting a distinct “core–periphery” structure, with noticeable patterns of resource concentration and isolation. Residential areas can be categorized into three types based on their supply–demand characteristics: efficient-collaborative, transitional-mixed, and low-demand peripheral areas. The predominance of the transitional-mixed type indicates that most areas are currently in an unstable state of supply–demand adjustment. A key systemic mechanism identified in this study is the significant “collaborative reinforcement effect” between facility utilization rates and network centrality. Building on these insights, we propose a hierarchical optimization strategy consisting of “overall network optimization—local cluster coordination—individual facility enhancement.” This ultimately forms a comprehensive decision-support framework for “assessment—diagnosis—optimization,” providing scientific evidence and new solutions for the precise planning and efficient operation of urban charging infrastructure. Full article

This study investigates the resilience dynamics of the Maldives’ tourism sector through a longitudinal analysis of tourist arrivals from six global regions (2008–2024), focusing on spatiotemporal behavioral shifts induced by external shocks such as the COVID-19 pandemic. Using ANOVA and time-series data, the findings reveal divergent recovery trajectories across regions, highlighting resilience as a differentiated and adaptive process. European markets exhibited a rapid, V-shaped rebound, surpassing pre-pandemic levels by 2022, reflecting the “One Island, One Resort” model’s alignment with post-crisis preferences for safety, isolation, and controlled environments. Conversely, Asian markets experienced a more gradual, L-shaped recovery due to extended mobility restrictions and slower border reopening. The analysis further demonstrates that tourism seasonality has been structurally reconfigured, with European arrivals still driven by climatic “push” factors (winter-sun demand). In contrast, Middle Eastern travel is anchored in cultural and religious “pull” factors, such as halal tourism and school vacations. These findings emphasize that tourism resilience is spatially, temporally, and behaviorally contingent, rather than uniform. Accordingly, policymakers should move beyond one-size-fits-all recovery models and implement spatially targeted, adaptive strategies, including customized marketing, diversified tourism offerings, and crisis-ready governance frameworks, to mitigate seasonality and reinforce the Maldives’ long-term capacity to withstand future shocks. Full article

Background/Objectives: COVID-19 and long COVID remain prevalent, with household transmission being an important mode of spread. To quantify household transmission of subclinical SARS-COV-2 infection and identify sociodemographic risk factors that may explain disparities in transmission, we conducted a case-ascertained antibody surveillance study of households in Cincinnati, Ohio. Methods: A partnership was formed between the Cincinnati Health Department and Cincinnati Children’s Hospital Medical Center. The Health Department identified cases of COVID-19. Infected individuals, along with their household contacts (n = 245), completed multiple questionnaires about symptoms, demographics, psychosocial (Adverse Childhood Experiences Scale and Everyday Discrimination Scale) and social risk factors, and conditions before and during the pandemic. In addition, they completed a non-fasting blood draw for IgG, IgM, IgA, and nucleocapsid protein serology testing. Results: Household contacts experienced few symptoms of COVID-19. However, according to the presence of the nucleocapsid protein, nearly 50% contracted the SARS-CoV-2 virus. This rate was similar by vaccination status but it was higher for household contacts who experienced high levels of early life adversity compared with those with lower levels. Conclusions: Our results confirm the high transmission of subclinical disease among household contacts, which may vary due to psychosocial factors. This reinforces the importance of isolating cases to prevent transmission, regardless of vaccination status. Full article

Designing laboratory experiences that support both skill development and conceptual understanding is a persistent challenge in introductory chemistry education—especially within accelerated or compressed course formats. To address this need, we developed and implemented a systems-thinking-based laboratory module on error analysis for a large introductory chemistry course at Brown University, composed primarily of first-year students (approximately 150–200 students in the spring semesters). Unlike traditional labs that isolate single techniques or concepts, this module integrates calorimetry, precipitation reactions, vacuum filtration, and quantitative uncertainty analysis into a unified experiment. Students explore how procedural variables interact to affect experimental outcomes, promoting a holistic understanding of accuracy, precision, and uncertainty. The module is supported by multimedia pre-lab materials, including faculty-recorded lectures and interactive videos developed through Brown’s Undergraduate Teaching and Research Awards (UTRA) program. These resources prepare students for hands-on work while reinforcing key theoretical concepts. A mixed-methods assessment across four semesters (n > 600) demonstrated significant learning gains, particularly in students’ ability to analyze uncertainty and distinguish between accuracy and precision. Although confidence in applying significant figures slightly declined post-lab, this may reflect increased awareness of complexity rather than decreased understanding. This study highlights the educational value of integrating systems thinking into early-semester laboratory instruction. The module is accessible, cost-effective, and adaptable for a variety of institutional settings. Its design advances chemistry education by aligning foundational skill development with interdisciplinary thinking and real-world application. Full article

In-plane shear is the dominant deformation mode during thermoforming of fiber-reinforced composites, and accurate characterization of shear behavior is essential for reliable forming simulations. The present work investigates the shear response of a unidirectional cross-ply UHMWPE material system (DSM Dyneema^® HB210) using the picture-frame test, with emphasis on sample configuration, normalization methods, and shear rate effects. Three cruciform sample sizes were tested at 120 °C, along with a configuration in which cross-arm material was removed to isolate the gage region. Finite element analyses using LS-DYNA^® were performed to evaluate the shear rate distribution during forming and to validate the experimental characterization. To maintain a constant shear rate during testing, a decreasing crosshead speed profile was implemented in the test software. Results showed that normalizing by the full specimen area yielded consistent shear stiffness curves across sample sizes, indicating that the arm region contributes equally to the load. Samples with cross-arm material removed exhibited greater scatter than those specimens without cross-arm material removed, confirming that preparation of cross-arm removal complicates repeatability. Rate dependence was observed at room temperature but not at elevated processing temperatures, suggesting that rate-dependent shear models are unnecessary for forming simulations of this material system. These findings provide a practical methodology for shear characterization of UHMWPE cross-ply laminates suitable for thermoforming analyses. Full article

The performance of synchrotron beamlines critically depends on the optimal coupling between the undulator and the monochromator. This work presents the implementation and quantitative characterization of a synchronized scanning system for the elliptically polarizing undulator (EPU) and the variable-line-spacing plane-grating monochromator at the BL07U beamline of the Shanghai Synchrotron Radiation Facility (SSRF). The system ensures that the monochromator’s narrow bandwidth dynamically tracks the brilliant central cone of the undulator radiation. A linear correlation between the monochromator energy and the undulator gap, justified theoretically for small scan ranges and reinforced by a robust real-time calibration procedure, forms the control basis. The automation is built upon a standard software stack comprising EPICS for device control, the Bluesky Suite for experimental orchestration, and Phoebus for the human–machine interface. Through comparative X-ray absorption spectroscopy (XAS) measurements at the Fe L_2,3-edges, the synchronized mode is shown to enhance beam brilliance by 37% and stabilize the incident flux, reducing its variation from 4.2% to 1.8%. This directly results in absorption spectra with superior lineshape fidelity, a 40% reduction in noise, and the elimination of pre- and post-edge artifacts, unequivocally isolating the synchronization effect. This advancement provides a stable, high-brilliance photon source essential for high-quality XAS and X-ray magnetic circular/linear dichroism (XMCD/XMLD) studies. Full article

Background: Pathogenic variants in the TRIP12 gene are associated with Clark-Baraitser syndrome, a condition characterized by neurodevelopmental disorders, including intellectual disability, autism spectrum disorder (ASD), and speech delay. Phenotypic expression is variable, and facial features are not consistently present. Familial inheritance is rare. Methods: Whole-exome sequencing (WES) was performed on a proband with speech disorder and ASD, as well as on her parents. Clinical assessment included developmental, cognitive, and physical evaluations. Results: A heterozygous missense variant c.3404A>T (p. Asp1135Val) in the TRIP12 gene was identified in both the proband and her father. Both presented with speech disorder and ASD without facial features or severe intellectual disability. Conclusions: In line with recent genotype–phenotype studies, missense TRIP12 variants tend to be associated with milder neurodevelopmental presentations, typically characterized by mild to moderate intellectual impairment, variable autistic traits, limited or absent facial features, and a low incidence of epilepsy. This familial case further presents the phenotypic spectrum of TRIP12 missense variants and highlights that ASD and speech disorder may occur as isolated neurodevelopmental findings without syndromic features. The report reinforces the relevance of TRIP12 analysis in the differential diagnosis of ASD and language disorders, even in individuals lacking physical traits, supporting more accurate genetic counseling and broader awareness of inherited TRIP12-related conditions. Full article

Carbapenem-resistant Gram-negative (CR-GN) pathogens pose a critical threat to patient outcomes in high-dependency and intensive care environments. This study aimed to delineate species prevalence, antimicrobial resistance phenotypes, carbapenemase genotypes, and clinical–environmental transmission dynamics across critical-care units. Cross-sectional surveillance was conducted in six ICUs and HDUs of a tertiary-care hospital in Karachi, Pakistan. We identified predominant species, quantified resistance patterns, and detected carbapenemase genes using PCR, exclusively on meropenem-resistant isolates. Network analysis highlighted high-centrality contamination hubs across ICUs and HDUs. Acinetobacter baumannii (36.7%) and Klebsiella pneumoniae (33.9%) were predominant, with 58% originating from environmental reservoirs. Meropenem non-susceptibility was 55% (60/109), and colistin non-susceptibility was 68.6% (35/51), based on standardized CLSI testing. ICU isolates exhibited significantly higher meropenem resistance than HDU isolates. Among carbapenem-resistant isolates, blaOXA-48-like (52.8%) and blaNDM (25%) were most prevalent. Network topology revealed ICU1 and HDU2 as high-centrality transmission nodes. These findings highlight pervasive environmental colonization and heightened antimicrobial pressure in ICUs, necessitating reinforced decontamination protocols, antimicrobial stewardship, and continuous molecular surveillance. This study provides the first integrated clinical–environmental surveillance of MDR Gram-negative bacteria in Pakistan, revealing that over half of isolates originated from surfaces and that network-based mapping can pinpoint contamination hubs driving hospital transmission. Full article