Search Results (7,631)

Objective: This study aimed to develop a performance evaluation index system for a district-level public hospital in Chongqing, China, based on Diagnosis-Related Groups (DRGs), to provide a benchmark for performance assessment in similar hospitals. The system was constructed using a literature analysis, the Delphi method, and the Analytic Hierarchy Process (AHP) to identify and weight relevant indicators. Results: The evaluation system consists of three primary indicators and eighteen secondary indicators. Key secondary indicators include the Case Mix Index (CMI), cost consumption index, low-risk group mortality rate, the proportion of patients with three- or four-level surgeries at discharge, and the proportion of medical service revenue to medical income. In 2020, significant improvements were observed in several indicators, such as a decrease in the low-risk group mortality rate to 0% and increases in the proportion of patients with three- or four-level surgeries and CMI by nearly 10% and 13%, respectively. Conclusions: This study successfully developed a comprehensive and scientifically sound performance evaluation index system for a district-level public hospital in Chongqing. The system has proven effective in objectively assessing inpatient medical care performance and providing valuable guidance for improving healthcare services in similar settings. Full article

Our study was conducted in the Valle Nuevo National Park and included four habitat classes: tussock grass (Sabapa), pine forest (Pinoc), broadleaf forest (Boslat), and agricultural ecosystem (Ecoag). We had two main objectives: to comparatively describe millipede communities and to determine the relationships between population density/diversity and soil physicochemical variables. The research was cross-sectional and non-manipulative, with a descriptive and correlational scope; sampling followed a stratified systematic design, with eight transects and 32 quadrats of 1 m², covering 21.7 km. We found a sandy loam soil with an extremely acidic pH. The highest population density of millipedes was recorded in Sabapa, and the lowest in Ecoag. The highest alpha diversity was shared between Boslat (Margalef = 1.72) and Pinoc (Shannon = 2.53); Sabapa and Boslat showed the highest Jaccard similarity (0.56). The null hypothesis test using the weighted Shannon index revealed a statistically significant difference in diversity between the Boslat–Sabapa and Pinoc–Sabapa pairs. Two of the species recorded highly significant indicator values (IndVal) for two habitat classes. We found significant correlations (p < 0.05) between various soil physicochemical variables and millipede density and diversity. Full article

Main roads are usually equipped with traffic flow monitoring devices in the road network to record the traffic flow data of the main roads in real time. Three complex scenarios, i.e., Y-junctions, multi-lane merging, and signalized intersections, are considered in this paper by developing a novel modeling system that leverages only historical main-road data to reconstruct branch-road volumes and identify pivotal time points where instantaneous observations enable robust inference of period-aggregate traffic volumes. Four mathematical models (I–IV) are built using the data given in appendix, with performance quantified via error metrics (RMSE, MAE, MAPE) and stability indices (perturbation sensitivity index, structure similarity score). Finally, the significant traffic flow change points are further identified by the PELT algorithm. Full article

Background/Objectives: Although numerous prognostic biomarkers have been proposed for colorectal cancer (CRC), their longitudinal evaluation remains limited. The aim of this study was to investigate longitudinal changes in biomarkers calculated from routinely used laboratory markers and their relationships to common chronic diseases (comorbidities). Methods: A retrospective longitudinal observational study was completed with the inclusion of 817 CRC patients and a total of 4542 measurement points. Pan-immune inflammation value (PIV), prognostic nutritional index (PNI), and systemic immune-inflammation index (SII) were calculated based on complete blood count and albumin measurement data. Results: Longitudinal data analyses confirmed the different values and slopes of the parameters tested at the different endpoints. Survivors had the lowest and most constant PIVs and SII values, and the highest and most slowly decreasing PNI values. Those patients with non-cancerous death had similar values to the previous cohort, but an increase/decrease occurred towards the death event. Patients with CRC-related death had significantly higher PIVs and SII values and significantly lower PNI values (p < 0.0001), and a significant increase/decrease was observed at the early observational periods. The presence of lymph node and/or distant metastases, adjuvant chemotherapy, and hypertension significantly affected PIVs and SII and/or PNI values. The changes in PIVs and SII and PNI values toward pathological values are poor prognostic signs (p < 0.0001). Conclusions: Each of the three calculated markers demonstrates suitability for longitudinal patient follow-up, and their pathological alterations over time serve as valuable prognostic indicators. They may also be useful to detect certain clinicopathological parameters early. Full article

Fractional flow reserve (FFR) is a standard physiological index for guiding coronary revascularization, with a threshold of >0.80 typically used to defer intervention. However, due to its distinct anatomical and physiological features, the left anterior descending artery (LAD) often exhibits lower FFR values than non-LAD vessels for lesions of similar angiographic severity. These vessel-specific differences raise concerns about applying a uniform FFR cutoff across all coronary territories. Observational studies indicate that LAD lesions deferred at an FFR of 0.80 may have similar or better outcomes than non-LAD lesions do. LAD lesions also tend to show lower post-percutaneous coronary intervention FFR values, suggesting that vessel specific target thresholds may be more prognostically appropriate. Additionally, some evidence suggests that instantaneous wave-free ratio may offer greater prognostic value than FFR, specifically in LAD lesions, a trend not consistently seen in other arteries. In patients with acute myocardial infarction and multivessel disease, the prognostic relevance of non-culprit lesion FFR may vary by coronary territory, particularly in the LAD. This review outlines the physiological rationale and clinical evidence for vessel-specific interpretation of FFR, with a focus on the LAD, and explores its potential clinical implications and limitations. Full article

The difficulty and manual nature of procuring human evaluators for ranking the quality of images affected by various types of degradations, and of those cleaned up by developed algorithms, has lead to the widespread adoption of automated metrics, like the Peak Signal-to-Noise Ratio (PSNR) and the Structural Similarity Index Metric (SSIM). However, disparities between rankings given by these metrics and those given by human evaluators have encouraged the development of improved image quality assessment (IQA) metrics that are a better fit for this purpose. These methods have been previously used solely for quality assessments and not as objectives in the training of neural networks for high-level vision tasks, despite the potential improvements that may come about by directly optimizing for desired metrics. This paper examines the adequacy of ten recent IQA metrics, compared with standard loss functions, within two trained dehazing neural networks, with observed broad improvement in their performance. Full article

Beech forests in the Italian peninsula are actively managed and they also support a high level of biodiversity. Hence, biodiversity conservation can be synergistic with timber production and carbon sequestration, enhancing the overall economic benefits of forest management. This study aimed to evaluate the effect of forest management regimes on bird communities in the Italian Peninsula during 2022 through audio recordings. We studied the structure, composition, and specialization of the breeding bird community in four managed beech stands (three even-aged beech stands aged 20, 60, and 100 years old, managed by a uniform shelterwood system; one uneven-aged stand, managed by a single-tree selection system) and one uneven-aged, unmanaged beech stand in the northern Apennines (Tuscany region, Italy). Between April and June 2022, data were collected through four 1-hour audio recording sessions per site, analyzing 5 min sequences. The unmanaged stand hosted a richer (a higher number of species, p < 0.001) and more specialized (a higher number of cavity-nesting species, p < 0.001; higher Woodland Bird Community Index (WBCI) values, p < 0.001; and eight characteristic species, including at least four highly specialized ones) bird community, compared to all the managed forests; moreover, the latter were homogeneous (similar to each other). Our study suggests that the unmanaged beech forests should be a priority option for conservation, while in terms of the managed beech forests, greater attention should be paid to defining the thresholds for snags, deadwood, and large trees to be retained to enhance their biodiversity value. Studies in additional sites, conducted over more years and including multi-taxon communities, are recommended for a deeper understanding and generalizable results. Full article

Purpose: To present the findings of our preliminary experience using daily image-guided radiotherapy (IGRT) supported by implanted fiducial markers (FMs) in the radiotherapy of the vaginal cuff, in a cohort of post-surgery endometrial cancer patients. Methods: Patients with vaginal cuff cancer requiring adjuvant radiation with external beams were enrolled. Five patients underwent radiation therapy targeting the pelvic disease and positive lymph nodes, with doses of 50.4 Gy in twenty-eight fractions and a subsequent stereotactic boost on the vaginal vault at a dose of 5 Gy in a single fraction. One patient was administered 30 Gy in five fractions to the vaginal vault. These patients underwent external beam RT following the implantation of three 0.40 × 10 mm gold fiducial markers (FMs). Our IGRT strategy involved real-time 2D kV image-based monitoring of the fiducial markers during the treatment delivery as a surrogate of the vaginal cuff. To explore the potential role of FMs throughout the treatment process, we analyzed cine movies of the 2D kV-triggered images during delivery, as well as the image registration between pre- and post-treatment CBCT scans and the planning CT (pCT). Each CBCT used to trigger fraction delivery was segmented to define the rectum, bladder, and vaginal cuff. We calculated a standard metric to assess the similarity among the images (Dice index). Results: All the patients completed radiotherapy and experienced good tolerance without any reported acute or long-term toxicity. We did not observe any loss of FMs during or before treatment. A total of twenty CBCTs were analyzed across ten fractions. The observed trend showed a relatively emptier bladder compared to the simulation phase, with the bladder filling during the delivery. This resulted in a final median Dice similarity coefficient (DSC) of 0.90, indicating strong performance. The rectum reproducibility revealed greater variability, negatively affecting the quality of the delivery. Only in two patients, FMs showed intrafractional shift > 5 mm, probably associated with considerable rectal volume changes. Target coverage was preserved due to a safe CTV-to-PTV margin (10 mm). Conclusions: In our preliminary study, CBCT in combination with the use of fiducial markers to guide the delivery proved to be a feasible method for IGRT both before and during the treatment of post-operative gynecological cancer. In particular, this approach seems to be promising in selected patients to facilitate the use of SBRT instead of BRT (brachytherapy), thanks to margin reduction and adaptive strategies to optimize dose delivery while minimizing toxicity. A larger sample of patients is needed to confirm our results. Full article

The ongoing advancement of urbanization has significantly amplified its impacts on the water environment. Understanding the coupling relationships between urbanization and the water environment (UAWE) is crucial for Chinese policymakers aiming to promote sustainable urban development. In this study, a comprehensive UAWE evaluation model was developed to examine the development trajectories in Neijiang City from 2012 to 2022. Methodologically, a comprehensive evaluation approach was applied to assess urbanization and water resource trends over this period, followed by the development of a Coupling Coordination Degree Model (CCDM) to quantify their synergistic relationship. The results showed that the coupling between the comprehensive urbanization index and the water environment system evolved over time, as reflected in the following key findings: (1) Neijiang underwent three distinct stages from 2012 to 2022 in terms of coupling and coordination between urbanization and the water environment: Basic Coordination (2012–2015), Good Coordination (2016–2020), and Excellent Coordination (2020–2022). (2) Urbanization exerted varying impacts on subsystems of the water environment, with the pressure-response subsystems exhibiting marked volatility from 2012 to 2022. The impact intensity followed the order spatial urbanization > economic urbanization > social urbanization > population urbanization. These findings offer valuable theoretical and practical insights for aligning urban sustainability goals with effective water environment protection measures. This study provides essential guidance for policymakers in Neijiang and similar regions, enabling the development of tailored strategies for sustainable urbanization and enhanced water management. Full article

In this paper, we propose a compressionmethod for optical encryption using singular value decomposition (SVD). Double random phase encryption (DRPE), which employs two distinct random phase masks, is adopted as the optical encryption technique. Since the encrypted data in DRPE have the same size as the input data and consists of complex values, a compression technique is required to improve data efficiency. To address this issue, we introduce SVD as a compression method. SVD decomposes any matrix into simpler components, such as a unitary matrix, a rectangular diagonal matrix, and a complex unitary matrix. By leveraging this property, the encrypted data generated by DRPE can be effectively compressed. However, this compression may lead to some loss of information in the decrypted data. To mitigate this loss, we employ volumetric computational reconstruction based on integral imaging. As a result, the proposed method enhances the visual quality, compression ratio, and security of DRPE simultaneously. To validate the effectiveness of the proposed method, we conduct both computer simulations and optical experiments. The performance is evaluated quantitatively using peak signal-to-noise ratio (PSNR), structural similarity index (SSIM), and peak sidelobe ratio (PSR) as evaluation metrics. Full article

Seafood contamination by heavy metals is a growing public health concern, particularly in regions like Tunisia where seafood is a major dietary component. This study assessed concentrations of cadmium (Cd), copper (Cu), lead (Pb), and zinc (Zn) in the muscle tissue of the red shrimp Parapenaeus longirostris, collected in 2023 from four coastal regions: Bizerte, Monastir, Kerkennah, and Gabes. Metal analysis was conducted using flame atomic absorption spectroscopy. This species was chosen due to its ecological and economic importance. The study sites were chosen based on their differing levels of industrial, urban, and agricultural influence, providing a representative overview of regional contamination patterns. Mean concentrations were 1.04 µg/g for Zn, 0.59 µg/g for Cu, 1.56 µg/g for Pb, and 0.21 µg/g for Cd (dry weight). Pb was the most prevalent metal across sites. Statistically significant variation was observed only for Cu (p = 0.0334). All metal concentrations were below international safety limits set by FAO/WHO and the European Union. Compared to similar studies, the levels reported were similar or slightly lower. Human health risk was evaluated using target hazard quotient (THQ), hazard index (HI), and cancer risk (CR) values. For adults, THQ ranged from 5.44 × 10⁻⁶ to 8.43 × 10⁻⁴, while for children it ranged from 2.40 × 10⁻⁵ to 3.72 × 10⁻³. HI values were also well below 1, indicating negligible non-carcinogenic risk. CR values for Cd and Pb in both adults and children fell within the acceptable risk range (10⁻⁶ to <10⁻⁴), suggesting no significant carcinogenic concern. This study provides the first field-based dataset on metal contamination in P. longirostris from Tunisia, contributing valuable insights for seafood safety monitoring and public health protection. Full article

Research has widely validated three-band spectral index as a simple, valid, and highly accurate method of estimating the copper content of soil. However, selecting the best band combination from hundreds of thousands, even millions of candidate combinations in hyperspectral data, is a very complicated problem. To address this issue, this study collected a total of 170 soil samples from the Aktas copper-gold mining area in Fuyun County, Xinjiang, China. Then, two algorithms including Competitive Weighted Resampling (CARS) and Stepwise Regression Analysis (STE) were applied to pick the bands from the original and first-order derivative spectra, respectively. A three-band index model was developed using the selected feature bands to estimate soil copper content. Results showed the first-order derivative spectrum transforms the spectral curve into a sharper one, with more peaks and valleys, which is beneficial for increasing the correlation between bands and copper content compared with the original spectrum. Moreover, integrating first-order derivative spectroscopy with CARS makes it possible to precisely identify key spectral bands and outperforms the dimensionality-reduction capabilities compared with the integration of STE. This strategy drastically reduces the time spent screening and is proven to have similar model accuracy, as compared to the individual group lifting method. Specifically, it reduces the duration of an 8 h task down to a mere 2 s. An intelligent screening of three-band indices is proposed in this study as a method of rapidly estimating copper content in soil. Full article

Background: Type 2 diabetes (T2D) is a growing public health concern, particularly in low- and middle-income countries. Although prediabetes is a major risk factor for T2D, it remains largely underdiagnosed and untreated. Structured lifestyle interventions have proven effective in preventing diabetes, but their feasibility within the Brazilian public health system remains unclear. Methods: This multicenter pilot randomized controlled trial assessed the feasibility of a culturally adapted lifestyle intervention (PROVEN-DIA) across the five regions of Brazil. A total of 220 adults at high risk for T2D were randomized to an intervention group or a control group (usual care) and followed for three months. Both groups received similar educational content on healthy eating and physical activity, but the intervention group participated in a structured and personalized lifestyle program with regular follow-up sessions. The primary outcome was adherence to dietary recommendations, assessed using the BALANCE Index—a validated dietary score (range: 0–40) based on the Brazilian Cardioprotective Diet that classifies foods into color-coded groups according to nutritional quality—along with engagement in moderate-to-vigorous physical activity (MVPA). Secondary outcomes included diet quality (DQIR), anthropometric and metabolic parameters. Results: Feasibility was demonstrated by a 93.2% retention rate (n = 205). There was no significant difference in the primary outcome (simultaneous improvement in diet and MVPA). However, the PROVEN-DIA group exhibited significantly greater improvements in diet quality, with a 2.8-point increase in the BALANCE Index (vs. 0.5 in the control, p = 0.03), and a significant improvement in the DQIR (p < 0.001). No significant differences between groups were observed in MVPA, HbA1C, glycaemia, or body weight. Conclusions: The PROVEN-DIA intervention proved feasible within the Brazilian public health context, resulting in significant improvements in dietary quality among individuals at high risk for T2D. A larger trial with longer follow-up is warranted to evaluate its effectiveness in preventing the progression to diabetes. However, to enhance physical activity outcomes, specific adaptations and targeted strategies may be required to better support participant engagement in exercise. Full article

Timely and accurate diagnosis of gastrointestinal diseases (GIDs) remains a critical bottleneck in clinical endoscopy, particularly due to the limited contrast and sensitivity of conventional white light imaging (WLI) in detecting early-stage mucosal abnormalities. To overcome this, this research presents Spectrum Aided Vision Enhancer (SAVE), an innovative, software-driven framework that transforms standard WLI into high-fidelity hyperspectral imaging (HSI) and simulated narrow-band imaging (NBI) without any hardware modification. SAVE leverages advanced spectral reconstruction techniques, including Macbeth Color Checker-based calibration, principal component analysis (PCA), and multivariate polynomial regression, achieving a root mean square error (RMSE) of 0.056 and structural similarity index (SSIM) exceeding 90%. Trained and validated on the Kvasir v2 dataset (n = 6490) using deep learning models like ResNet-50, ResNet-101, EfficientNet-B2, both EfficientNet-B5 and EfficientNetV2-B0 were used to assess diagnostic performance across six key GI conditions. Results demonstrated that SAVE enhanced imagery and consistently outperformed raw WLI across precision, recall, and F1-score metrics, with EfficientNet-B2 and EfficientNetV2-B0 achieving the highest classification accuracy. Notably, this performance gain was achieved without the need for specialized imaging hardware. These findings highlight SAVE as a transformative solution for augmenting GI diagnostics, with the potential to significantly improve early detection, streamline clinical workflows, and broaden access to advanced imaging especially in resource constrained settings. Full article

Background/Objectives: The SARS-CoV-2 and influenza A (H1N1)pdm09 pandemics have resulted in high numbers of ICU admissions, with high mortality. Identifying risk factors for ICU mortality at the time of admission can help optimize clinical decision making. However, the risk factors identified may differ, depending on the type of analysis used. Our aim is to compare the risk factors and performance of a linear model (multivariable logistic regression, GLM) with a non-linear model (random forest, RF) in a large national cohort. Methods: A retrospective analysis was performed on a multicenter database including 8902 critically ill patients with influenza A (H1N1)pdm09 or COVID-19 admitted to 184 Spanish ICUs. Demographic, clinical, laboratory, and microbiological data from the first 24 h were used. Prediction models were built using GLM and RF. The performance of the GLM was evaluated by area under the ROC curve (AUC), precision, sensitivity, and specificity, while the RF by out-of-bag (OOB) error and accuracy. In addition, in the RF, the im-portance of the variables in terms of accuracy reduction (AR) and Gini index reduction (GI) was determined. Results: Overall mortality in the ICU was 25.8%. Model performance was similar, with AUC = 76% for GLM, and AUC = 75.6% for RF. GLM identified 17 independent risk factors, while RF identified 19 for AR and 23 for GI. Thirteen variables were found to be important in both models. Laboratory variables such as procalcitonin, white blood cells, lactate, or D-dimer levels were not significant in GLM but were significant in RF. On the contrary, acute kidney injury and the presence of Acinetobacter spp. were important variables in the GLM but not in the RF. Conclusions: Although the performance of linear and non-linear models was similar, different risk factors were determined, depending on the model used. This alerts clinicians to the limitations and usefulness of studies limited to a single type of model. Full article