Search Results (2,487)

Background: Lay counsellor-delivered psychosocial interventions are increasingly used to address workforce shortages in mental health care. While randomised trials commonly report mean improvements, explicit assessment of clinical deterioration is rare. This secondary analysis evaluated whether a lay counsellor intervention for early psychosis was associated with evidence of deterioration compared with usual care. Methods: Patient-level data from a randomised controlled trial in Thailand (n = 255) were analysed. Deterioration was defined as worsening between baseline and the 6-month follow-up across functional, behavioural, and service utilisation domains. Risk differences were estimated using Newcombe confidence intervals, and risk ratios were calculated using standard methods with the Haldane–Anscombe correction applied, where required. Analyses were conducted for the full sample (UC n = 125; LICM n = 130) and stratified by baseline severity (none/borderline: UC n = 103, LICM n = 103; mild-to-severe: UC n = 22, LICM n = 27). Results: In the full sample, deterioration rates were similar across most domains. A statistically significant reduction in deterioration related to disturbing or aggressive behaviour was observed in the LICM arm (risk difference −14.1%; 95% CI −26.8% to −0.6%; risk ratio 0.45; 95% CI 0.26 to 0.79). No statistically significant excess deterioration was observed in other domains. In severity-stratified analyses, no subgroup showed a statistically significant increase in deterioration attributable to the intervention. However, among participants with mild-to-severe baseline illness, although no statistically significant harm signal was detected, the adverse risk differences and risk ratios observed in socially useful activities, self-care, regular outpatient follow-up visits, and medication adherence among participants with greater baseline severity underscore the importance of careful monitoring in higher-risk subgroups. Conclusions: No statistically significant evidence of excess deterioration was observed in either the full sample or subgroup analyses between the intervention and control arms. However, the adverse absolute difference observed in multiple patient-related domains, among participants with mild-to-severe baseline illness, suggests that lay-counsellor interventions may require a stepped-care approach to safely address the mental health needs of patients with higher levels of severity. Psychosocial trials should routinely report deterioration and subgroup analyses alongside mean improvements. Full article

Objective: To determine the publication bias of the reported prevalence of malocclusions in Mexican children and adolescents. Background: Publication bias determination is crucial in a systematic review, helping to ensure the conclusions’ validity and reliability. Nevertheless, without accurate knowledge of disease prevalence and patterns, the health system risks inefficiency, inequity, and failure to meet the population’s needs. On the other hand, malocclusions can impair proper chewing efficiency, contributing to digestive alterations, and nutritional deficiencies among other functional, psychological, and social problems. The data of the prevalence of malocclusion is imperative to implement early interventions in health services that prevent more severe skeletal discrepancies and reduce the need for invasive treatments in adolescence or adulthood. Methods: Studies were collected from five databases, following the PRISMA and Cochrane guidelines for systematic reviews. Eligibility criteria were full-text research in which the prevalence of malocclusions was reported. The risk of bias (Hoy tool), publication bias (the Doi plot and the Luis Furuya-Kanamori (LFK) index), and quality assessments (GRADE tool) were performed. The data were combined using a random-effects meta-analysis. Results: The result of the meta-analysis suggests a high prevalence of malocclusions in mixed dentition was 50.2% (95% confidence interval [CI]: 38.9–61.5%). However, the studies showed a risk of bias and publication bias. Conclusions: In Mexico, there is a high prevalence of malocclusions among children and adolescents. However, these results are not robust enough to draw solid conclusions, due to the low certainty of the evidence. Full article

The steam generator is a core component of nuclear power plants that facilitates heat exchange between the primary and secondary circuits, directly impacting the overall operation of the plant in terms of safety and reliability. During prolonged operation, the heat transfer tubes of the steam generator are subjected to erosion, corrosion, and cracking due to high-temperature, high-pressure fluid impact and vibration. Existing in-service inspection strategies for heat transfer tubes generally employ fixed intervals and coverage, failing to effectively differentiate the actual risk of tubes in various regions, leading to wasted inspection resources or safety hazards. This paper proposes a dynamic inspection and plugging management strategy based on flow-induced vibration (FIV) analysis, specifically utilizing the flow stability ratio (FSR). By calculating the FSR of heat transfer tubes, the strategy categorizes them into high-risk, medium-risk, and low-risk regions, and dynamically adjusts inspection frequency and coverage based on these risk levels. Theoretical analysis and validation with actual data demonstrate that this strategy can improve inspection efficiency and ensure the safety of the steam generator. Full article

In this study, an elastoplastic finite element (FE) contact model was developed to evaluate the plastic deformation of a surface induction-hardened tapered roller bearing used in wind turbines, incorporating depth-dependent material properties and heat treatment-induced residual stress distribution. The validity of this model was confirmed by comparing the calculated plastic deformation with measured profiles from static compression experiments. The results show that the residual stresses generated by induction hardening have a significant influence on the elastoplastic behavior of bearings. Based on this model, a parametric analysis was performed to investigate the effects of surface hardening depth (SHD), contact pressure, and residual stress on surface plastic deformation. Empirical formulas were developed to predict surface plastic deformation and evaluate material yielding for surface-hardened tapered roller bearings, thereby preventing excessive deformation during service. This allows for the rapid estimation of the maximum plastic deformation for different hardening depths and provides an efficient approach for assessing the yielding risk. Full article

Customer churn refers to the termination of a customer’s business relationship with a bank, representing a direct loss of future revenue. Product downsell manifests as a reduction in the number of financial products held or a downgrade in service tier, often signaling early customer disengagement. Accurately identifying customers at risk of these two behaviors has become a cornerstone of profitable growth in the competitive retail banking industry as downsell frequently serves as a precursor to total churn. However, the existing research typically treats these highly correlated behaviors as independent prediction tasks, overlooking their intrinsic link and failing to address the critical challenges of class imbalance and regulatory demands for model interpretability. To tackle these problems, we propose an enhanced multi-task learning network (EMTL-Net), a deep learning framework specifically designed to capture the nuanced interplay between churn and downsell behaviors. EMTL-Net introduces an explicit feature interaction module to enhance the modeling of high-order feature relationships and utilizes a shared representation layer to extract universal customer risk patterns, enabling the joint prediction of churn and downsell. Furthermore, we employ Focal Loss as the training objective to dynamically adjust sample weights, effectively mitigating the class imbalance problem. Critically, to meet financial compliance requirements, we implement a SHAP-based interpretation mechanism that is compatible with multi-task outputs, providing preliminary insights into feature importance. Formal validation of interpretability claims remains an important direction for future research. The experimental results on a publicly available pedagogical bank customer benchmark dataset demonstrate that EMTL-Net achieves excellent performance on both tasks. For churn prediction, the model achieves an AUC of 0.8259, an accuracy of 0.8361, and an F1-score of 0.6235, significantly outperforming the existing baseline models. For downsell prediction (noting that the downsell label is rule-derived from the number of products held), the model achieves an AUC of 0.8932, an accuracy of 0.8571, and an F1-score of 0.7504. Ablation studies confirm the critical contributions of the explicit feature interaction module, Focal Loss, and the residual structure to model performance. Crucially, the interpretability analysis corroborates business intuition by identifying customer age, account balance, and product holdings as dominant churn drivers—a consistency that reinforces the model’s credibility and practical utility in high-stakes financial environments. Full article

Background: The elderly are vulnerable to chronic diseases and altered lipid metabolism, leading to poor outcomes, including mortality. We investigated the association between Korean Medicine (KM) utilization, blood lipid levels, and health outcomes using the National Health Insurance Service Sample Cohort (NHIS-NSC) database. Methods: This retrospective cohort study included elderly participants who underwent health examinations (2009–2010). Participants were divided into KM and non-KM groups and matched 1:1 using propensity score matching (PSM) for age, sex, income, and comorbidities. Primary outcomes were mortality and disease diagnosis; secondary outcomes included medical spending and utilization. Results: After PSM, 13,044 subjects were analyzed. KM utilization was associated with a significantly lower risk of all-cause mortality (HR 0.93; 95% CI 0.87–1.00; p = 0.048). However, the hypolipidemia subgroup showed no significant differences in all-cause mortality and medical expenses compared to other lipid status subgroups. While the KM group showed a higher incidence of disease diagnosis (HR 1.09; 95% CI 1.04–1.14; p < 0.001), this may reflect increased healthcare engagement and proactive health-seeking behavior. Subgroup analysis revealed that statin users in the KM group had a significantly reduced mortality risk (HR 0.91; 95% CI 0.84–0.99; p = 0.022). Medical expenses and utilization were higher in the KM group. Being underweight or aged over 85 was associated with higher mortality. Conclusions: KM utilization is associated with reduced all-cause mortality after propensity score matching, particularly among statin users. Although KM users had a higher cumulative incidence of disease diagnosis, this potentially reflects increased diagnostic opportunities from prolonged survival. Hypolipidemia, underweight, and late-elderly status remain significant risk factors associated with frailty. KM may support improved survival in the elderly, warranting further prospective studies. Full article

Pin–bushing bearings in heavy-duty construction machinery operating in severe industrial environments are susceptible to accelerated wear, grease degradation, and lubrication failure, yet application-specific guidance for lubricant selection and re-greasing intervals under such conditions remains limited. This study evaluates the combined effects of bushing material (hardened steel, cast bronze, and Cu–Sn alloy), grease type (three commercially used greases with viscosities of 120, 460, and 150 mm²/s at 40 °C), and lubrication interval (8, 12, and 24 h) on grease-condition indicators in a field-operating wheel loader used in slag handling, where surrounding slag temperatures may reach 700–800 °C. A Taguchi L9 orthogonal array was used to define nine experimental configurations, each applied for approximately one week under real operating conditions. Grease samples were characterised using the SKF grease analysis kit based on NLGI consistency grade, base oil release rate, and contamination particle count. All greases showed an increase in NLGI grade from 2 to 3–4 during service, indicating thickening and a possible risk of lubrication channel blockage. Oil release rates decreased by up to 60% in some configurations, indicating reduced base oil mobility during service. When the three grease-condition indicators were evaluated together by Grey Relational Analysis, the combination of steel bushing, type B grease (ISO VG 460, lithium complex with MoS₂), and a 12 h lubrication interval showed the most balanced overall response. These findings provide field-based guidance for grease selection and maintenance scheduling in pin–bushing systems operating under demanding service conditions. Full article

The growing complexity of human systems and the increasing frequency of climate-driven hazards have transformed some disasters from isolated events into cascading phenomena which propagate through critical infrastructure networks, disrupting essential services and amplifying systemic risk. This work examines the impacts of extreme storms and subsequent flooding on critical entities as defined under the new EU Directive (Critical Entities Resilience, CER). This study introduces a structured Critical Entities Disruption Database—Greece (CEDD-GR), as a methodological framework for systematically recording and analysing disruptions to critical entities, and applies it to the case of Storm Daniel (2023), one of the most severe flood events recorded in Greece. The analysis identified direct impacts across eight of the eleven sectors defined in the CER Directive, namely, energy, transport, health, drinking water, wastewater, public administration, digital infrastructure and food production, processing and distribution. A total of 21 different types of critical entities were documented, revealing the mechanisms through which failures affected different subsectors. The results underscore the systemic fragility of critical entities when exposed to extreme storms, compound flooding, and mass wasting processes (landslides, ground subsidence) and highlight the need for integrated resilience planning in line with the CER framework. Full article

(1) Background: The non-consensual dissemination of intimate images constitutes a severe form of online gender-based violence (OGBV) that inflicts profound harm on victims’ sexual privacy, psychological well-being, and social functioning. Taiwan enacted comprehensive legislative reforms in 2023—commonly referred to as the “Four Acts on Sexual Violence Prevention”—to strengthen criminal responses and expand victim protection mechanisms. However, the extent to which these reforms have translated into effective frontline practice remains insufficiently examined. (2) Methods: This qualitative study employed reflexive thematic analysis to investigate frontline professionals’ experiences with enforcing intimate image offence legislation and delivering victim support services. Semi-structured, in-depth interviews were conducted with 20 practitioners, including social workers, police officers, prosecutors, and lawyers. (3) Results: Three superordinate themes emerged across macro, meso, and micro structural levels. At the macro level, limited public awareness and persistent victim-blaming attitudes undermine prevention, help-seeking, and reporting. At the meso level, legislative fragmentation, challenges in preserving and analysing digital evidence, and inter-agency coordination gaps constrain enforcement capacity. At the micro level, procedural delays, risks of secondary victimization, and perceived inadequacies in compensation and support mechanisms weaken victims’ trust in institutional responses. (4) Conclusions: While Taiwan’s legislative reforms represent a significant institutional advancement, legal reform alone is insufficient to address digital sexual violence effectively. Comprehensive responses require integrated public education initiatives, enhanced inter-agency coordination, strengthened digital investigation capacity, and trauma-informed victim protection practices across all structural levels. In particular, the findings underscore an urgent public health need to establish rapid digital evidence preservation and takedown mechanisms to limit the proliferation of non-consensual sexual images and mitigate the associated mental health harms among victims. Full article

Equitable prioritization of public investments is increasingly critical as municipalities face constrained budgets, heterogeneous neighborhood needs, and demands for transparent decisions. This paper proposes a fairness-aware group multi-criteria decision-making (MCDM) framework for ranking municipal infrastructure investments when budgets are constrained, and neighborhood needs differ. Six alternatives are assessed in the Istanbul case study: flood risk mitigation, inclusive public realm and cooling, smart and energy-efficient municipal assets, walking and cycling infrastructure, healthcare access improvements, and seismic retrofitting of public buildings. The criteria system combines efficiency, implementability, socio-environmental performance, and equity-oriented priorities through five main dimensions and 23 sub-criteria. In addition to cost, feasibility, and service effectiveness, the framework incorporates fairness-related criteria such as baseline need and deficit severity, vulnerability-targeting effectiveness, minimum service guarantee for the worst-off, and priority for low-accessibility centers. Public acceptance and environmental performance are also included. Stakeholder panels provide expert judgments using intuitionistic fuzzy sets, capturing membership, non-membership, and hesitation to reflect uncertainty. Criteria weights are derived with Intuitionistic Fuzzy Step-wise Weight Assessment Ratio Analysis (IF-SWARA), enabling importance elicitation and group aggregation without forcing crisp consensus. Alternatives are then ranked using Intuitionistic Fuzzy Combined Compromise Solution (IF-CoCoSo), which blends additive and multiplicative compromise solutions to balance overall performance with equity objectives. Robustness is assessed through sensitivity analysis by varying the γ parameter within the IF-CoCoSo procedure. A municipal case study demonstrates that healthcare access improvements achieve the highest compromise performance, followed by flood risk mitigation and seismic retrofitting of public buildings, while smart and energy-efficient municipal assets rank last. The findings confirm that explicitly embedding fairness criteria can shift municipal priorities toward alternatives that more directly reduce deprivation, risk, and spatial inequality. The main contribution of this study is not merely empirical application, but the development of a fairness-aware group MCDM framework that operationalizes distributive justice in municipal investment prioritization through a structured set of criteria. Full article

The Qinghai–Tibet Plateau is characterized by highly complex terrain, and civil aviation serves as a primary mode of transportation for regional mobility. A comprehensive understanding of wind field characteristics within the terminal areas of plateau mountain airports, as well as the formation mechanisms of wind shear during different flight phases, is of considerable importance for flight risk assessment, improvement of transport efficiency, and refined meteorological support services. However, studies focusing on wind field structures within the terminal areas of plateau mountain airports remain limited. In this study, dry-season observations from Coherent Doppler Wind Lidars at two critical locations in the terminal area of Lhasa Airport are analyzed. A comparative analysis is conducted on the vertical structure, diurnal variation, and the characteristics of turbulence and wind shear under different terrain conditions. The results show that above the valley height, both sites are dominated by stable westerly winds. Below the valley height, the wind field is strongly influenced by terrain complexity. At the Lhasa Airport site (LS), the valley is regular in shape and has a stable orientation. The prevailing wind direction is aligned with the valley, and easterly winds dominate the entire valley, especially in the middle and lower layers. In contrast, the Qushui site (QS) is located at the confluence of two valleys, where the terrain is more open and complex. The prevailing wind shifts clockwise with height, from northeasterly in the lower layers to easterly aloft. The wind direction is less concentrated than at LS. In terms of diurnal variation, a stable easterly layer forms within the valley at LS in the morning. A transition layer of about 200–300 m exists between this layer and the westerlies aloft. Within the transition layer, wind speed is relatively weak and wind direction stability is low. At QS, morning winds are weaker and more variable within the valley. Wind direction stability increases with height. In the afternoon, both sites are influenced by the downward transport of westerly momentum. However, the effect is more pronounced at QS, where low-level wind speed is higher and wind direction is more stable. Turbulence at both sites peaks between 14:00 and 17:00 and is mainly driven by thermally induced updrafts. Turbulence intensity at QS is stronger, with a vertical extent exceeding 1500 m, indicating a stronger response to thermal forcing. Wind shear at both sites mainly occurs between 12:00 and 18:00, with peak frequency from 13:00 to 17:00. This period is consistent with peak turbulence activity. Wind shear at LS occurs more frequently and lasts longer. At QS, momentum transport from above 1500 m enhances wind shear occurrence at 800–1000 m. The causes of wind shear differ under different prevailing wind conditions. Under prevailing westerlies, wind shear is mainly caused by rapid changes in wind direction with height. Under prevailing easterlies, it is primarily associated with an enhanced vertical gradient of wind speed. These results reveal the significant influence of complex terrain on low-level wind structures and causes of wind shear. The findings provide a scientific basis for operational decision-making at plateau mountain airports. Full article

Managed Service Providers (MSPs) have increasingly become prime targets for cyberattacks due to their privileged access across multiple client environments. Utilizing a qualitative thematic synthesis and an Open-Source Intelligence (OSINT) methodology, this study examines a purposive sample of major MSP-targeted cyber incidents from 2020 to 2025 to identify common attack patterns, exploited vulnerabilities, and operational impacts on downstream clients, particularly small and medium-sized businesses. Analysis of publicly reported incidents reveals a clear trend toward attacks leveraging centralized management platforms, remote access tools, and multi-tenant architectures, resulting in cascading disruptions from limited initial compromise. The synthesis highlights extortion-driven ransomware, supply chain compromises, and the exploitation of unpatched edge devices as dominant threats. To counter these systemic risks, this study outlines contextualized mitigation strategies such as zero trust principles, strict identity controls, tenant isolation, and continuous monitoring tailored to balance security requirements with MSP operational constraints. While these strategies are evidence-informed and grounded in observed trends, they remain proposed solutions that require further empirical validation. The findings emphasize the critical need for proactive, collaborative security practices among MSPs, clients, and regulators to manage evolving cyber threats effectively. Full article

Background: During the flu season, there is an increase in absenteeism due to illness, a drop in productivity, and a greater risk of the virus spreading among workers. Thus, the Italian Ministry of Health recommends vaccination for essential service workers. The University of Salerno, in collaboration with the local health authority of Salerno, offers free vaccination to its employees. Methods: A public health methodology for seasonal influenza vaccination in the workplace is presented—specifically in the university setting—with the aim of identifying individual, contextual, and organizational elements of the model that have promoted vaccination uptake. An ad hoc questionnaire was used (October–December 2025) to survey 399 academic employees, investigating seasonal influenza vaccination in the following aspects: recent personal experiences, motivations, vaccination experiences at university, sources of information, considerations regarding national and local vaccination campaigns, and level of vaccine confidence (VCI). Results: Seasonal influenza vaccination at the University is appreciated for its compatibility with working hours (66.1%), the availability of a platform that allows flexible booking (56.9%), the perception of safety in the environment (31.6%), the fact that the vaccine is free (17.4%), and the involvement of office/laboratory colleagues (5%). Participants appreciate the model and would apply it to other vaccinations at the University and in other institutional settings. A significant relationship (F = 7.24; df = 1; p < 0.05) exists between confidence in the vaccine and the sense of security experienced when receiving the vaccine in the workplace. Data analysis was performed using the IBM SPSS v.28 software. Conclusions: The model proposed can be applied to other institutional contexts, simplifying and facilitating access to vaccines by implementing vaccination campaigns tailored to specific work environments. Full article

Slaughterhouse detection of lesions compatible with bovine tuberculosis represents a key passive surveillance component in Santa Catarina, Brazil, yet subsequent trace-back investigations often fail to identify infected farms. This study developed a quantitative framework to prioritize epidemiological investigations by estimating the probability of infection associated with each farm connected to PCR-confirmed cases. Using official movement records and historical diagnostic data, we reconstructed the lifetime contact networks of slaughtered cattle presenting confirmed Mycobacterium bovis lesions (n = 502). For each sentinel animal–farm interaction (n = 1452), infection probability was estimated through a non-homogeneous Poisson process incorporating exposure duration and the time-weighted average herd size as determinants of infectious pressure. After evaluating stochastic variability through Monte Carlo simulation, a deterministic model using the mean infectious-pressure parameter was applied to classify farms into high-, medium-, and low-risk categories. Model performance was assessed using validated field diagnostic outcomes within a three-year temporal window. High-risk farms represented most validated contacts (58%) and demonstrated a relative risk of 3.48 compared with lower-risk category. These findings indicate that a standardized risk-based classification can substantially improve the prioritization of trace-back investigations, offering a practical decision-support tool to enhance bovine tuberculosis surveillance and contribute to eradication strategies in Santa Catarina. Full article

In the context of digital tourism development, artificial intelligence has become one of the major techniques for tourists’ information acquisition and interaction in the field of intangible cultural heritage (ICH) tourism. However, whether AI with anthropomorphism elements attracts tourists to visit cultural heritage sites and how AI anthropomorphism design affects visitors’ visit intentions remains unclear. Therefore, based on the stimulus–organism–response (S–O–R) theory, this study proposes an “AI anthropomorphism–AI trust–visit intention” model and investigates the role of AI anthropomorphism in visit intention. In particular, this study tests the effects of perceived intelligence and perceived risk on AI anthropomorphism, as well as the role of AI trust and perceived cultural sustainability on the relationship between AI anthropomorphism and visit intention. With a sample of 478 Chinese respondents who are intangible cultural heritage (ICH) tourists, the hypothesized relationships are tested by employing structural equation modeling. The results show that perceived intelligence exerts a positive effect on AI anthropomorphism, while perceived risk exerts a negative effect on AI anthropomorphism. Moreover, AI anthropomorphism exerts an effect on AI trust, which in turn yields a great influence on visit intention. In addition, further analysis shows that AI type intensifies the effect of anthropomorphism on AI trust, and the relationship between AI trust and visit intention is regulated by perceived cultural sustainability. This study reveals how AI anthropomorphism functions in ICH tourism, and the findings provide practical guidance for advancing intelligent services and giving cultural sustainability top priority in order to support the sustainable growth of ICH tourism. Full article