Search Results (7,510)

Background: Poor adherence to home exercise programs is a persistent challenge in physical rehabilitation and beyond. Data suggest that follow-up telehealth visits featuring behavior change techniques can improve adherence. However, the optimal frequency of behavioral support for effective self-management of technology-enabled home exercise programs remains unclear. This paper investigates how adherence to home exercise varies with the number of follow-up visits holding the type of exercise constant and measuring adherence objectively. Methods: A secondary analysis of adherence was conducted on participants from the VIGOROUS five-site, single-blind, and randomized controlled trial. Chronic (>6 months) community-resident stroke survivors with mild-to-moderate upper extremity hemiparesis (n = 111) were assigned 15 h of asynchronous video game-based home exercise over 3 weeks. Participants received behavioral support during (a) one single in-person session, (b) four in-person sessions, or (c) four in-person sessions plus six remote teleconsultations. Each consultation incorporated standardized behavior change techniques—contracting, feedback, self-monitoring, action planning, and guided problem solving—to promote increased paretic arm use during daily activities. The primary outcome was adherence (minutes exercising), objectively captured by the gaming system for 87 participants. Results: Six telehealth visits with remote therapeutic monitoring (RTM) increased home exercise completion by 3.3 h [95% CI: 0.008, 6.60]; each remote or in-person consultation was associated with an estimated 34 min of additional asynchronous home exercise. Conclusions: RTM, which does not require travel to a healthcare facility, is a time-efficient modality to enhance therapeutic engagement. Behaviorally focused telehealth visits boost stroke survivors’ adherence to a structured home exercise program. Full article

Vernacular heritage conservation often separates material fabric, environmental adaptation, and social meaning. This study addresses that separation for one settlement. Socio-environmental heritage is defined here as heritage whose significance resides in the documented interdependence of environmental conditions, material practice, social organisation, and customary governance, rather than in fabric or imagery alone. The single purpose of the article is to develop and demonstrate an evidence-based method for interpreting and conserving Thee Ain Heritage Village in Al-Baha, Saudi Arabia, as such a system. A qualitative architectural case-study design combines a structured literature search, regional comparison, the author’s 2014 field observations and photographs, and published digital-heritage, energy-retrofit, and conservation studies; no human-participant data are analysed. Evidence is organised through three analytical layers—climatic material, socio-spatial, and customary governance—and each evidence–interpretation proposition is classified as directly observed, supported architectural inference, or hypothesis requiring measurement; conservation translation is treated as the output of this sequence rather than as a parallel analytical layer. Coded claim units are documented individually so that every interpretation and implication can be traced to its source, strength, and limitation. The analysis links rocky siting, stone and timber assemblies, thick load-bearing madameek walls, limited openings, vertical domestic hierarchy, controlled thresholds, and the agricultural setting to conservation priorities at landscape, construction, spatial, and adaptation scales. These priorities include compatible repair, retention of wall depth and opening logic, protection of privacy gradients and threshold sequences, and service integration without reducing the village to stone-clad imagery. Unlike previous work centred on digital documentation, energy modelling, or policy-level preservation, the contribution is an evidence-structured method linking architectural observation to bounded interpretation, conservation decisions, and explicit future testing requirements. Full article

Commercial artificial intelligence (AI)-assisted electrocardiography systems require local assessment of the acquisition-to-review pathway before patient-facing use. We conducted a single-site, simulation-based functional assessment of one commercial 12-lead ECG configuration. A physiological signal simulator, ECG acquisition unit, AI-assisted review platform, multiparameter monitor, and central monitoring system were used to examine 13 predefined rhythm and conduction categories, alarm behavior, local export pathways, a representative five-lead signal-display subset, and formative expert feedback. Expected category-level functional agreement was observed in 12 of 13 predefined categories. In the retained record, the discordant asystole scenario was categorized as lead-off/electrode disconnection, identifying a signal-integrity boundary that requires verification of electrodes, leads, cables, waveforms, and context before clinician adjudication. Signal-to-noise ratio and root-mean-square error values from 90 derived windows in five leads were reported descriptively. These findings cannot be generalized to the seven unmeasured diagnostic leads or to complete 12-lead signal fidelity. Local PDF, HL7 v2.x, DICOM, and platform synchronization were demonstrated without independent conformance or semantic-integrity testing. Formative input from six purposively selected experts comprised 30 ordinal ratings (median 5; observed range 4–5) and qualitative comments. These data do not constitute usability or educational-effectiveness validation. The study provides bounded functional evidence for the tested configuration and identifies requirements for prospective technical, human-factors, multivendor, and patient-level validation before clinical deployment. Full article

Objective: This multicenter, prospective, single-arm study evaluated the safety and preliminary clinical performance of a flowable porcine urinary bladder matrix (UBM) particulate for managing tunneling and undermining features in complex wounds. These features are associated with delayed healing, chronic inflammation, and infection risk. Flowable UBM enables targeted delivery into wound tunnels and cavities. Method: Twenty-five subjects from 3 United States (U.S.) sites were enrolled, with 21 meeting protocol criteria for analysis (15 with undermining and 6 with tunneling wounds). Participants received flowable UBM applied directly to tunneling or undermining areas, along with additional UBM particulate or sheet forms applied to the wound surface. The primary endpoint was the percentage reduction in tunneling volume or undermining depth at 12 weeks, with secondary assessment of reduction in overall wound volume. Safety was evaluated through evaluation of device-related adverse events. Results: At 12 weeks, 90.5% of wounds demonstrated positive response, with mean ± standard deviation and median reduction in tunneling or undermining dimensions of 84.6 ± 29.3% and 100.0%, respectively. Complete resolution of these features occurred in 52.4% of wounds (53.3% in undermining and 50.0% in tunneling wounds) with higher closure rates in non-pressure wounds compared to pressure injuries. No device-related adverse events were reported. Conclusions: Overall, flowable UBM was well tolerated and associated with favorable clinical trajectories demonstrated by reduction in tunneling and undermining dimensions; however, comparative effectiveness cannot be inferred from this limited single-arm pilot study. Further controlled studies are needed to confirm comparative effectiveness and optimize clinical use. Full article

Non-invasive radionuclide molecular imaging of epidermal growth factor receptor (EGFR) expression can guide patient stratification for EGFR-targeted therapies. The designed ankyrin repeat protein (DARPin) E01, which binds EGFR ectodomain III with sub-nanomolar affinity, is a promising scaffold for single-photon emission computed tomography (SPECT) imaging probes. In the present study, we compared site-specific radioiodination of DARPin E01 using the bifunctional prosthetic group (4-hydroxyphenyl)ethyl maleimide (HPEM) with site-unspecific radioiodination via [¹²³I]I-para-iodobenzoate (PIB). [¹²³I]I-HPEM was conjugated to the C-terminus of DARPin E01 via Glu-Glu-Glu-Cys ([¹²³I]I-E01-E₃C-HPEM) or Gly-Gly-Gly-Cys ([¹²³I]I-E01-G₃C-HPEM) linkers. Radiolabelling yields were 6 ± 2% and 13 ± 5%, respectively. Size-exclusion purification provided radiochemical purity > 98%. Both HPEM conjugates retained nanomolar EGFR-binding affinity (K_D: 3.2 ± 0.6 and 4.8 ± 0.9 nM) and demonstrated EGFR-specific tumour accumulation in A-431 xenografts. Cellular processing was characterised by rapid binding, slow internalisation, and non-residualising behaviour of all variants. Kidney uptake was lower for the site-specifically labelled variants. However, site-specific labelling evidently elevated hepatobiliary excretion and uptake in Na/I-symporter-expressing organs compared to [¹²³I]I-(HE)₃-E01-PIB, while linker composition (E₃C vs. G₃C) did not significantly alter biodistribution. Site-unspecific radioiodination with [¹²³I]I-PIB remains the preferred approach for clinical SPECT imaging of EGFR expression with DARPin E01. Full article

Selective recovery of gold from cyanide leach liquors is hindered by the co-dissolution of iron minerals that generate ferrocyanide complexes which strongly compete with [Au(CN)₂]⁻ at ion-exchange sorbents. Here, we investigate mixed-bed interpolymer systems (IPS) composed of a strong-acid sulfonated polystyrene–divinylbenzene cation exchanger (TC007, Na⁺ form) and a strong-base quaternary ammonium anion exchanger (AV-17-8, Cl⁻ form) as a charge-selective platform for gold cyanide recovery. IPS compositions spanning cation-to-anion molar ratios from 6:0 to 0:6 were evaluated in batch contact with binary model solutions containing 30 mg L⁻¹ each of [Au(CN)₂]⁻ and [Fe(CN)₆]⁴⁻ at pH 10 and 25 °C. The optimal 1:5 IPS achieved an [Au(CN)₂]⁻ extraction degree of 79.88% and a selectivity coefficient β = D_Au/D_Fe = 4.95 at 48 h, whereas the pure AV-17-8 anion exchanger (0:6) reached only 37.55% Au extraction at 48 h, following an atypical delayed-uptake kinetic profile rather than the rapid, near-quantitative capture expected of an unmodified strong-base resin. Sorption kinetics were best described by a pseudo-second-order model (R² = 0.9992), confirming ion exchange at quaternary ammonium sites as the dominant rate-controlling step, with a ~30-fold increase in k₂ for [Au(CN)₂]⁻ in the 1:5 IPS relative to AV-17-8 alone. FTIR spectroscopy and TGA-DSC revealed the incorporation of metal cyanide complexes into the IPS matrix, with diagnostic C≡N stretching bands at 2108.7 and 2034.1 cm⁻¹ and an additional thermal event at 200–280 °C. These findings establish compositionally tunable IPS based on commercially available resins as a charge-selective sorbent platform demonstrating a capacity to regenerate under single-cycle elution conditions for gold cyanide recovery from ferrocyanide-containing process streams while highlighting the need for further evaluation under industrial Fe:Au ratios. Full article

Unstable rock blocks and cliffs pose a widespread geohazard, and their mechanical state can be tracked through their ambient-vibration resonance frequencies, whose decrease anticipates progressive failure. Such monitoring is usually performed with expensive broadband instrumentation, limiting spatial and temporal coverage. Here we assess whether a low-cost, IoT-enabled node—built around a Raspberry Pi single-board computer, a 24-bit sigma-delta digitiser and a force- balance accelerometer (Geobit FBA-200)—can identify the resonance of an unstable coastal rock block at the celebrated “moving rock” of Kounopetra (Paliki peninsula, Kefalonia, Greece), a site historically renowned for visually perceptible rocking boulders. We stress that the low-amplitude 7.7 Hz structural eigenvibration characterised here is a distinct phenomenon from the historically documented ∼0.3 Hz macroscopic, quasi-rigid rocking of the boulder: the former is the ambient–vibration resonance of the fractured rock mass, the latter a large-amplitude rigid-body oscillation. Two identical nodes recorded ground acceleration simultaneously for nine hours: one on the fractured Kounopetra rock mass and one on stable ground 25 m away, used as a reference. The rock station exhibits a clear, temporally stable fundamental resonance at f₀ = 7.7 Hz (Q ≈ 50, damping ζ ≈ 1%), amplified by up to an order of magnitude relative to the reference and entirely absent from it, whereas a narrow 20.5 Hz line present on both nodes is identified as instrument-related and discarded. A simultaneous two-station analysis further shows that the ambient sources are extremely local (only 0.4% of transient activity is common to the two nodes 25 m apart), quantifying a design constraint for differential schemes. The results demonstrate that a low-cost force-balance node is sufficient to establish a resonance baseline for an unstable rock block, opening the way to dense, affordable early-warning networks; the main limitations are the single vertical component and the short record, which preclude polarisation analysis and long-term tracking of f₀. Full article

Background: Gastrointestinal (GI) bleeding is a recognised complication of long-term antithrombotic therapy. Whereas the overall bleeding risk associated with direct oral anticoagulants (DOACs) and low-dose aspirin has been extensively characterised, the anatomical distribution of bleeding lesions between these two pharmacological classes remains incompletely defined. Methods: We retrospectively analysed all consecutive adult patients admitted to the Emergency Department of San Carlo di Nancy Hospital (Rome, Italy) between January 2022 and March 2025 with a clinical diagnosis of acute GI bleeding. Patients were categorised as DOAC monotherapy or aspirin (ASA) monotherapy at presentation. The primary endpoint was the site of bleeding (upper vs. lower GI tract) by drug group. Secondary endpoints included site of bleeding by specific DOAC molecule and indicators of clinical severity (haemoglobin at admission, transfusion requirement, melena, hematochezia). Logistic and linear regression models were adjusted for age and sex. Because the number of transfused units is count data with a right-skewed distribution, the corresponding linear-regression estimate is reported as an exploratory approximation and interpreted with caution. As adjustment was limited to age and sex, all adjusted estimates are associative rather than causal and do not represent an independent effect of drug class. Results: The merged cohort comprised 316 patients; the head-to-head analysis included 179 patients on monotherapy (DOAC n = 100, ASA n = 79). Upper GI bleeding (UGIB) was equally distributed between groups (55% vs. 54%; OR 1.02, 95% CI 0.57–1.85; p = 1.00), whereas identified lower GI bleeding (LGIB) was numerically less frequent in DOAC monotherapy (34% vs. 49%; OR 0.53, 95% CI 0.29–0.97; p = 0.047), an association that was attenuated and no longer significant after adjustment for age and sex (p = 0.076). Restricting to patients who underwent oesophagogastroduodenoscopy (EGDS), the diagnostic yield was substantially lower in DOAC monotherapy (72% vs. 91%; adjusted OR 0.25, 95% CI 0.08–0.79; p = 0.018). DOAC-treated patients presented with lower haemoglobin (7.9 ± 2.4 vs. 9.3 ± 2.9 g/dL; adjusted β = −1.32 g/dL, p = 0.002) and required transfusion more frequently (68% vs. 49%; adjusted OR 2.50, 95% CI 1.29–4.83; p = 0.007). No statistically significant differences were detected among the four DOAC molecules for site of bleeding or specific lesion, although this analysis was substantially underpowered. Conclusions: In a real-world emergency cohort, DOAC and ASA monotherapy were associated with a comparable proportion of upper GI bleeding, while identified LGIB was numerically less frequent in DOAC users. DOAC users presented with lower haemoglobin and more frequently required transfusion, despite a lower diagnostic yield at EGDS. Among the four DOAC molecules, no significant differences emerged. In sensitivity analyses, the lower identified-LGIB frequency and the higher transfusion burden in DOAC users were attenuated and no longer statistically significant when the analysis was restricted to fully evaluated patients or when count-based and comorbidity-adjusted models were applied. Further studies are warranted to clarify the anatomical distribution of bleeding sources in DOAC users with negative initial endoscopy. Full article

In the development of carbonate reservoirs via water flooding huff-n-puff, the osmotic pressure effect is frequently overlooked, and existing models inadequately quantify the matrix imbibition and oil expulsion driven by salinity gradients. To address this issue, this study establishes a coupled oil–water two-phase huff-n-puff flow model for carbonate reservoirs that incorporates the interplay between salt concentration and osmotic pressure, which, for the first time, fully couples the van ’t Hoff osmotic pressure equation with solute transport equations for fractured-vuggy carbonate huff-n-puff, filling the gap that prior tight/shale reservoir low-salinity flow models fail to adapt to cyclic injection-soaking production regimes of carbonates. Based on the IMPES (implicit pressure–explicit saturation) numerical simulation method, an equivalent single-nucleus model is adopted to characterize the fractured-vuggy reservoir architecture. The model integrates the osmotic pressure formula, solute transport equation, and two-phase seepage governing equations, enabling a systematic analysis of the mechanisms by which osmotic pressure affects the multi-stage seepage process and the influence of key parameters on development performance. Quantitative simulation reveals three core laws controlled by salinity-induced osmosis: first, osmotic pressure drives water molecules to spontaneously migrate from the high-permeability fracture inner core toward the tight matrix pores, thereby modifying the water saturation distribution, expanding the water sweep region, and smoothing the saturation gradient between the inner and outer cores, which effectively mitigates water channeling in fractured reservoirs. Under the base case (injected water salinity = 1000 mg/L, inner-core permeability = 1000 mD, shut-in time = 80 d), the oil recovery factor with osmotic pressure considered reaches 13.46%, representing a 3.50% increment over the case without osmotic pressure. The recovery factor decreases monotonically with increasing injected water salinity, while it increases with longer shut-in time and higher inner-core permeability, both exhibiting pronounced diminishing marginal returns; the optimal shut-in time is approximately 80 d under the simulated conditions. This work delivers a fully coupled numerical tool and quantitative evaluation standard for osmotic imbibition mechanisms in fractured-vuggy carbonates. The quantified recovery increment and optimal soaking window established herein can directly guide field parameter optimization of injection water salinity, shut-in cycle and fracture reconstruction scale, balancing oil increment revenue and water treatment/well shutdown operation costs for on-site low-salinity huff-n-puff design. Full article

Historic gardens are among the cultural heritage assets most vulnerable to climate change because their significance depends on the continuous interaction between living ecological systems, designed landscapes and cultural values. Although international policies increasingly advocate the integration of climate adaptation into heritage management, operational methodologies capable of systematically incorporating climate risk into the conservation planning of historic gardens remain limited. This paper develops the Historic Garden Climate Risk Management Framework (HG-CRMF), a multi-scale, heritage-centered methodological framework designed to integrate climate risk management within existing Conservation Management Plans (CMPs). The framework was developed through the synthesis of international heritage conservation principles, climate adaptation policies, environmental risk assessment methodologies and adaptive governance approaches. Its principal innovation lies in combining strategic conservation planning at the scale of the historic garden with operational implementation through Garden Conservation Units (GCUs), spatially coherent heritage entities that enable site-specific assessment of heritage values, climate hazards, exposure, vulnerability, adaptation measures and monitoring indicators. The HG-CRMF provides a structured workflow linking heritage significance, climate risk assessment, adaptation planning, monitoring and adaptive governance within a single decision-support methodology. Rather than constituting a stand-alone adaptation strategy, the framework strengthens existing conservation planning by embedding climate-informed decision-making into routine management processes. Full article

Background/Objectives: Hospital water and wastewater environments are potential reservoirs for antimicrobial resistance genes (ARGs), particularly in high-risk clinical units. This study examined site-specific ARG DNA detection patterns in wet and waste-associated sites of a haematology ward and an intensive care unit (ICU) to identify environmental hotspots that may inform targeted infection prevention and control (IPC) interventions. Methods: A descriptive point-prevalence environmental study was conducted in May 2025 in a tertiary acute-care hospital. Samples were collected after routine cleaning and during usual clinical activity. Real-time PCR assays were used to detect bla_TEM, bla_SHV, bla_CTX-M, bla_OXA-48-like, bla_VIM, bla_NDM, bla_IMP, bla_KPC, and mcr-1. Analytical summaries included samples meeting predefined quality-control criteria. Ct signals were categorised descriptively; Ct values ≤ 40 were considered positive, with Ct values 36–40 classified as very low molecular signals, whereas Ct values > 40 were considered negative. Results: The analytical dataset comprised 60 samples: 31 from haematology and 29 from ICU. At least one included ARG signal was detected in 40/60 samples (66.7%), including 23/31 haematology samples (74.2%) and 17/29 ICU samples (58.6%), bla_TEM (51.7%) and bla_SHV (43.3%) were most frequent. Sink drains showed the broadest multi-gene profiles, especially combinations of ESBL- and carbapenemase-associated genes. Haematology showed broader carbapenemase-associated diversity, whereas ICU detections clustered in patient-room sink drains and sluice-room wastewater infrastructure. Conclusions: ARG DNA signals were unevenly distributed, with sink drains representing most frequently positive sampling sites for multi-gene detection. This molecular, single-timepoint environmental study does not demonstrate viable organisms, colonisation, or transmission; however, point-prevalence environmental assessments may identify wet and wastewater-associated hotspots that can inform targeted IPC interventions against the spread of multidrug-resistant microorganisms. Full article

Background: This single-site qualitative interview study sought the opinions of 15 stakeholders from a nursing home based in the United Kingdom (UK) about identification and management of comorbidities in residents with dementia. Methods: Stakeholders were recruited through one of the nursing home owners, who acted as the gatekeeper. No residents with dementia were interviewed. Semi structured interviews were conducted online via Microsoft Teams in 2024. Data was analyzed using thematic analysis. Results: Stakeholders comprised four care assistants; three well-being companions; two nurses; a general practitioner (GP); two informal caregivers; a chaplain; the manager; and the owner of the nursing home. Stakeholders perceived that the identification and management of comorbidities in residents with dementia were shaped by interacting factors across four domains: the wider healthcare context, nursing home organization, staff capability and care practices, and resident-related challenges. Perceived healthcare under-resourcing increased complexity, while coordinated teamwork, continuous improvement, staff well-being, geriatric expertise, and person-centred, inclusive care were viewed as key facilitators. Conclusions: Overall, the perspectives of stakeholders interviewed in this single-site case study suggest that improving the identification and management of comorbidities in residents with dementia requires multilevel interventions that strengthen staff capability, organizational practices, and integration between nursing homes and the wider healthcare system. Full article

Lanthanide-doped Ca₂Nb₂O₇ offers versatile and tunable luminescence properties. Previous studies have shown that Pr³⁺-doped and Pr³⁺/Er³⁺ co-doped Ca₂Nb₂O₇ ceramics exhibit non-destructive mechanoluminescence, up- and down-conversion luminescence, and thermoluminescence, with potential for optical temperature sensing. However, to date, niobate glass–ceramics (GCs) remain largely unexplored, although they would offer excellent temperature resistance, high chemical durability, controllable crystallization, and the possibility to combine functional properties. This study investigates Pr³⁺ single doping and Pr³⁺/Er³⁺ co-doping in glass–ceramics prepared from niobium-containing calcium aluminosilicate glasses with the composition 55CaO-(35-x)Al₂O₃-10SiO₂-xNb₂O₅ (mol%, where x = 0, 10). The aim is to obtain glass–ceramics containing Ca₂Nb₂O₇ crystals with a layered perovskite structure and to evaluate their suitability as hosts for rare-earth ions. The luminescence properties of both parent glasses and GCs were investigated, and it is shown that the glasses show intrinsic luminescence which, when doped, enables sensitization of rare-earth elements via charge transfer. Furthermore, several interesting photoluminescence mechanisms were observed in the doped GCs, including (i) Er³⁺ up-conversion from the NIR to the visible, (ii) variations in the relative intensities of Er³⁺ hypersensitive transitions, reflecting changes in site symmetry, and (iii) a charge transfer process to the activator ions under UV excitation. These phenomena extend the accessible excitation range for rare-earth emission. Overall, the developed Ca₂Nb₂O₇ GCs demonstrate efficient dopant integration, confirming their suitability as lanthanide hosts for advanced photonic, sensing and energy conversion applications. Full article

Disamenity and amenity facilities pull property values in opposite directions, yet prior studies have treated disamenities as a homogeneous category and have been constrained by data scattered across agencies and by mismatched spatial scales. This study integrates multi-source spatial data, comprising 3426 sub-districts (eup-myeon-dong) nationwide, a 500 m population grid of 376,668 cells, and the actual point locations of individual facilities, into a single spatial framework and applies a multi-method design that combines a spatial Durbin model (SDM), explainable machine learning (XGBoost–SHAP), an environmental-justice analysis, and a micro-siting analysis. Four findings emerge. First, not all disamenities are associated with lower prices: only pollution-emitting facilities with a clear emission signature, namely, sewage treatment plants and incinerators, capitalize robustly as cross-sectional associations, into both housing prices and officially assessed land values, with the effect extending into neighboring sub-districts rather than staying purely local. The other disamenities show no robust total effect on either price; their estimates are small or unstable across specifications. Second, capitalization of pollution-emitting facilities is pronounced in the urban sample and disappears in the rural one, and the coefficient structure differs overall between urban and rural areas (global Chow test, p < 10⁻²¹). Third, micro-siting analysis shows that where a facility is placed (siting) and what it leaves behind in prices (capitalization) are distinct layers, and that capitalization tracks the population a facility keeps nearby rather than its nuisance type: pollution-emitting facilities retain enough nearby housing for their burden to register, whereas funerary facilities sited far from people do not. Fourth, the environmental inequity of pollution exposure runs along income rather than age and concentrates in cities rather than in rural areas: the exposure rate among residents of low-income urban sub-districts (49%) is 2.5 times that of the urban population as a whole (19%), while the greater Seoul metropolitan area remains comparatively insulated. These layered findings were possible only once the dispersed spatial data had been integrated and standardized, and the study demonstrates that fusing and efficiently managing spatial data is a precondition for evidence-based land-use and environmental policy. Full article

Riverine plastic waste is difficult to detect and map accurately because debris ranges from small items to large floating clusters, and tropical rivers present challenging conditions, such as murky water, floating vegetation, and variable lighting. This study develops and benchmarks a deep learning method for pixel-level, multi-scale mapping of riverine waste from five-band UAV multispectral imagery. We deployed a drone equipped with a five-band multispectral sensor over the Brantas River in Surabaya, East Java, Indonesia, and introduce the Multi-Scale Hierarchical Attention Ensemble (MHAE), which combines three backbone networks across three image resolutions through learned scale- and backbone-attention weighting. MHAE was evaluated against 12 CNN-, transformer-, state-space-, and traditional-machine-learning-based baselines (including Random Forest, U-Net, UNet++, and DeepLabV3+) on the accompanying BrantasRiverWaste-UAV dataset (882 image tiles from a single-site, single-season orthomosaic covering approximately 0.54 km² of river surface, labelled as water, land, organic waste, or inorganic waste), with pairwise comparisons assessed using Wilcoxon signed-rank tests with Bonferroni correction. MHAE achieved the highest pixel-level waste detection rate among the 12 evaluated models (86.76%), with a mean intersection-over-union of 78.33% (third-highest, behind UNet++ and U-Net). This work provides an initial, single-site benchmark and reference architecture for near-real-time riverine waste monitoring, and introduces the BrantasRiverWaste-UAV as, to our knowledge, one of the first five-band multispectral UAV datasets for tropical riverine waste mapping. Balanced sampling and multi-scale attention fusion can substantially improve waste-pixel detection under severe class imbalance; because the benchmark derives from a single site and season, future work should extend evaluation across additional seasons and river systems before the approach is generalised operationally. Full article