Search Results (11,812)

Background/Objectives: Nutritional support is a key component in the management of chronically ventilated patients, who are at high risk of malnutrition due to prolonged illness and metabolic stress. Enteral nutrition, particularly high-protein formulas (HPFs) and high-density formulas (HDFs), is commonly used to improve clinical outcomes; however, their effects on anthropometric and biochemical parameters remain incompletely understood. Our objective was to evaluate the association of HPFs and HDFs with changes in anthropometric and biochemical parameters in chronically ventilated patients receiving enteral nutrition. Methods: This retrospective study evaluated chronically ventilated patients receiving long-term enteral nutrition. Patients were categorized into four groups based on feeding strategy: continuous HPF, transition to HPF, transition from HPF and transition to HDF. Body weight, serum albumin and total protein were assessed at baseline and follow-up (up to 6 months). Within-group changes were analyzed using paired statistical tests. Results: Within-group analyses demonstrated changes in body weight, body mass index and serum albumin levels over time. Body weight increased significantly across all groups. The greatest increase was observed in patients transitioning to an HPF (70.82–75.35 kg, p = 0.00019), with a significant increase also following HDF administration (59.51–62.57 kg, p = 0.0389). Serum albumin increased significantly only in the transition-to-HPF group. HDF administration showed a non-significant increase in albumin and a near-significant rise in total protein. Conclusions: Enteral nutrition strategies were associated with changes in anthropometric and biochemical parameters in chronically ventilated patients. HPFs and HDFs were associated with improved body weight, with biochemical improvements most evident after HPF initiation and favorable trends observed with HDF administration. Future prospective studies with standardized protocols and objective nutritional markers are warranted. Full article

Ultra-high-voltage direct-current (UHVDC) transmission systems impose stringent requirements on the reliability of insulation materials used in converter transformer bushings. Epoxy resin systems are key insulating materials in resin-impregnated paper (RIP) capacitor bushings, and their processing characteristics, curing behavior, and electrical properties directly affect bushing performance. In this study, two epoxy insulation systems used for resin-impregnated paper (RIP) bushings, namely the imported Araldite LY1564/Aradur 3486 system and the domestic EP-2020/CA-3015 system, were systematically investigated through viscosity, curing, and electrical property tests. The results show that the viscosities of both resins decreased significantly with increasing temperature. At 60 °C, the viscosities of Resin A and Resin B were 151.6 mPa·s and 156.3 mPa·s, respectively. The mixed resin–hardener systems exhibited similar viscosity evolution and comparable pot life characteristics. DSC measurements revealed two-stage curing reactions for both materials, with first exothermic peak temperatures of 65.4 °C and 96.3 °C and second peak temperatures of 269.3 °C and 269.8 °C for Materials A and B, respectively. Electrical testing demonstrated that both materials exhibited similar temperature-dependent dielectric and resistivity behavior, with dielectric loss increasing at elevated temperatures and resistivity decreasing as temperature increased. The volume resistivity trends and dielectric characteristics of the two materials remained highly consistent throughout the investigated temperature range. The results indicate that Material B exhibits processing performance, curing characteristics, and electrical insulation properties comparable to those of Material A. Therefore, Material B demonstrates strong potential for application in UHVDC RIP bushing insulation systems and provides a promising alternative for the localization of key insulating materials. Full article

Understanding the spatiotemporal evolution of runoff and its driving mechanisms is of great significance for water resources development, utilization, and sustainable management in mid- to high-latitude river basins under climate change. However, runoff variability is jointly influenced by multiple meteorological factors, and a comprehensive understanding of its multi-scale response characteristics and the relative contributions of different drivers remains limited. In this study, runoff data from three hydrological stations in the Songhua River Basin during 1980–2022 were analyzed. A set of statistical and time-series methods, including the Mann–Kendall test, Pettitt change-point test, Hurst exponent, wavelet analysis, and wavelet coherence, was applied, and a random forest model was used to quantify the influence of key climatic factors such as precipitation, air temperature, and evapotranspiration. The results show that air temperature exhibits significant increasing trends in all four seasons, with the strongest warming occurring in spring (Sen’s slope ≈ 0.06 °C a⁻¹). Precipitation displays pronounced spatial heterogeneity and interannual variability, while evapotranspiration shows an overall increasing trend. Both runoff and major meteorological variables exhibit significant spatial heterogeneity across the basin. Hydro-meteorological variables also show distinct periodic variations among seasons, with temperature, precipitation, and evapotranspiration exhibiting stronger seasonal fluctuations during summer. Wavelet coherence analysis indicates that short-term runoff variability is mainly driven by temperature and precipitation. Temperature exhibits significant coherence with runoff across multiple time scales ranging from approximately 2 to 20 years, whereas precipitation shows stronger coherence at medium- to long-term scales (approximately 10–35 years), with evident seasonal differences. Random forest results indicate that evapotranspiration is the most important contributor to runoff variability at all three stations, accounting for 33.5%, 28.6%, and 26.2% of the total importance at Jiamusi, Fuyu, and Jiangqiao stations, respectively. Temperature and sunshine duration rank second, while precipitation and relative humidity contribute comparatively less. These findings indicate that evapotranspiration plays a key regulatory role in long-term water balance. In addition, runoff exhibits multi-scale variability and a transition from gradual changes to stage-like abrupt shifts. The findings provide a scientific basis for water resources management, flood mitigation, and climate change adaptation in the Songhua River Basin. Full article

Background/Objectives: Standardised institutional patient satisfaction surveys are the primary quality-monitoring tool in Romanian public hospitals, but their ability to capture the full range of patient experiences remains uncertain. This study quantifies the discrepancy between institutional patient satisfaction scores and an independent, unmediated national feedback instrument, the Patient Feedback Mechanism (MFP), at Targoviste County Emergency Hospital (SJUT) over a six-year period (2019–2024), and examines item-level MFP results across eight dimensions of the patient experience, including dimensions not captured by the institutional indicators routinely reported by SMCSP. Methods: A sequential design combined six years of institutional satisfaction data (2019–2024) from SJUT (N = 32,176 questionnaires) with item-level MFP results for the same period, covering eight questions on medical services, cleanliness, out-of-pocket medication costs, staff involvement, communication, recommendation intent, self-reported health outcome, and willingness to report requests for money from staff. Hypotheses were tested using two-proportion z-tests with Wilson confidence intervals, Mann–Kendall trend analysis, and Cohen’s h for effect sizes. Results: Institutional satisfaction remained consistently high (96.88–97.45%), while MFP satisfaction with medical services ranged from 70.7% to 88.9% across the same years, yielding gaps of 7.9 to 26.7 percentage points, significant in every year (p < 0.001; Cohen’s h ranging from 0.32 to 0.82). The gap did not follow a monotonic trend (Mann–Kendall p = 0.469); instead, it widened to a peak in 2021 and narrowed progressively through 2024. A parallel comparison between the Quality and Patient Safety Management Service (SMCSP) overall impression item (exceeding 99%) and the MFP recommendation item (69.9–76.3%) showed even larger gaps, of 23.3 to 29.6 percentage points. The MFP item on willingness to report requests for money from staff, which is not part of SMCSP’s reported institutional indicators, remained in a narrow 4.0–5.5% range between 2019 and 2023 with no significant trend (Mann–Kendall p = 0.82); a higher 2024 value (6.9%) coincides with a national redesign of this item and is not directly comparable to earlier years. Conclusions: Institutional surveys and an independent national feedback instrument offer structurally distinct perspectives on hospital performance, reflecting differences in administration rather than equivalent estimates of patient satisfaction. The discrepancy between sources is significant and persistent, though not monotonic, widening sharply during 2021 before narrowing. One item with no institutional equivalent documents a measurable, non-trivial proportion of patients willing to report informal payment requests every year, although the available data do not establish whether this proportion is rising over time. Systematic use of existing MFP data, already collected nationally, can complement institutional surveys at minimal additional cost, provided the two instruments are interpreted as structurally different rather than as alternative estimates of the same quantity. Full article

The safety profile for bio-derived phenols post-oxidation and their related antioxidant/redox potential remain largely under-explored. Oxidation by fungi, in terms of environmental impacts via fungal oxidation by enzymes, remains an attractive strategy under milder conditions, since it is one route by which many naturally occurring lignocellulosic phenols are modified; thus, an immediate need still exists for characterizing the effects that these modified phenolic compounds may have. Methodology: We examined four different biomass-derived phenolics—vanillin, ferulic acid, syringaldehyde and guaiacol—that were oxidized with fungal laccase and characterized their effects on normal human lung fibroblasts and levels of cellular oxidative stress. Laccase activity was evaluated via the ABTS method and through simple observation and UV-Vis spectroscopic scanning of the phenolics in question, and compared with the untreated version of each phenolic. In addition to assessing the cytotoxic effect and oxidative stress generated by the phenols alone, an ELISA-based measurement assay was used to investigate the relative abundance of malondialdehyde (MDA), superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPx) and reduced glutathione (GSH) in the human normal lung fibroblast cell line under varying treatment regimes, complemented by phase-contrast microscopy. Scores integrating the biomarkers were analyzed via clustering, PCA, radar and Pearson correlation analyses, to discern distinct trends in antioxidant potential after laccase conversion. Observations: Each of the four tested phenolics demonstrated the presence of laccase activity, leading to substantial differences in visible appearance compared with the control and characteristic absorbance shifts at differing wavelengths from the original molecule. Cell viability dropped dramatically as phenol concentration was increased and the untreated phenolics resulted in diminished confluence and induced greater levels of oxidative damage, from guaiacol and syringaldehyde. Laccase treatment resulted in higher MTT reduction activity and improved cellular morphology compared with the corresponding untreated phenolic compounds. Untreated phenols induced the highest levels of MDA, while decreasing SOD, CAT, GPx and GSH levels. Post-oxidation with laccase, there were lower amounts of lipid peroxidation, along with improved levels of antioxidant activity compared with the control phenol. Multi-technique analyses show clear distinctness between the untreated and laccase-converted phenolic groups. Clustering with multivariate techniques separated all cell groups in line with control samples, grouping the laccase-converted treatments towards the middle and displaying an inverse relationship between MDA and the antioxidant markers. Conclusions: Laccase conversion markedly decreases the adverse effects that bio-derived phenols have on normal cell viability and induces fewer detrimental effects on the cellular redox balance. This is a critical discovery in terms of finding greener methods by which to upgrade bio-derived substances as we research these lignocellulosic phenols. By employing ELISA-based measurements along with multiple analysis techniques, we present a suitable paradigm for studying biological effects in all bio-based goods intended for pharmaceuticals, packaging materials, nutraceuticals or a host of different applications. Full article

In this study, the microstructural changes and coarsening behavior of Ag₃Sn in Sn-6.4Sb-3.9Ag-0.25Ni-0.003Ge (mass%) during high-temperature aging were investigated. Additionally, low-cycle fatigue tests were conducted to compare the fatigue behavior of Sn-6.4Sb-3.9Ag-0.25Ni-0.003Ge with that of Sn-3.0Ag-0.5Cu. At room temperature, SbSn phases are dispersed in the β-Sn matrix. As the temperature rises, Sb atoms dissolve in the β-Sn phase; thus, the SbSn phases disappear, and some of the atoms aggregate. The activation energy was 45 kJ/mol for the coarsening of Ag₃Sn in Sn-6.4Sb-3.9Ag-0.25Ni-0.003Ge due to aging. Ag₃Sn coarsening was estimated to be controlled by the lattice diffusion of Ag atoms in the β-Sn phase. Furthermore, it was confirmed that the solid solution of Sb atoms in the β-Sn phase reduces the solubility limit of Ag atoms in the β-Sn phase, which delays the coarsening of Ag₃Sn. Regarding fatigue properties, while both alloys exhibited comparable low-cycle fatigue behavior at room temperature, the fatigue ductility exponent’s increase was confirmed to be suppressed for the Sn-6.4Sb-3.9Ag-0.25Ni-0.003Ge alloy at 175 °C. This trend suggests that the delayed coarsening of Ag₃Sn maintains the cyclic strain-hardening exponent, thereby influencing high-temperature fatigue behavior. Full article

Introduction: Plantar fasciosis is a common degenerative condition characterized by structural alterations of the plantar aponeurosis, including increased thickness and loss of its normal fibrillar pattern. Ultrasound imaging is widely used to assess these changes; however, the validity of plantar aponeurosis thickness as a marker of tissue recovery remains controversial. Dextrose prolotherapy has been proposed as an effective treatment for this condition, although its effects are not yet fully established. In particular, different injection approaches have been described, such as perifascial and intrafascial techniques, whose comparative effectiveness remains unclear. Therefore, the aim of this study was to evaluate longitudinal changes in plantar aponeurosis thickness and fibrillar pattern following treatment with these two prolotherapy approaches. Methods: A total of 56 patients with plantar fasciosis were prospectively evaluated over a one-year period following treatment with 20% dextrose prolotherapy. Ultrasound assessments were performed at multiple time points to measure plantar aponeurosis thickness and to qualitatively evaluate the fibrillar pattern (recovered vs. non-recovered). Longitudinal changes in thickness were analyzed using repeated-measures generalized linear models (GLMs), while differences in fibrillar pattern recovery according to injection technique (intrafascial vs. perifascial) were assessed using the chi-square test and Fisher’s exact test. Results: No significant changes in plantar aponeurosis thickness were observed over the follow-up period (p = 0.260), despite a slight decreasing trend. In contrast, recovery of the fibrillar pattern was observed in 92.9% of patients (52/56) at one year. The recovery rate was significantly higher in the perifascial group (100%) compared to the intrafascial group (80%) (Fisher’s exact test, p = 0.013). Qualitative fibrillar pattern assessment was independently re-evaluated by a blinded second examiner, demonstrating almost perfect inter-rater agreement (Cohen’s κ = 0.83). Conclusions: Dextrose prolotherapy was associated with ultrasonographic evidence of structural tissue remodeling of the plantar aponeurosis, as evidenced by recovery of the fibrillar pattern, without inducing significant changes in thickness. These findings suggest that assessment of the fibrillar pattern may offer additional information regarding structural remodeling following 20% dextrose prolotherapy, whereas plantar aponeurosis thickness remained relatively stable throughout follow-up. Full article

Cities face the need to implement urban planning solutions that support sustainable development; however, this is not fully possible due to inadequate legal regulations. This development can be understood as increasing the environmental and economic resilience of urban areas and improving the quality of life for city residents. A noticeable trend in urban development plans is the implementation of the “15 min city”, “20 min city”, or similar concepts, which aim to enhance walkability by ensuring access to basic urban services and functions within walking distance. The aim of this article is to evaluate accessibility to green areas and selected educational services in cities (named in the article as MSAS–Municipal Standards for Accessibility of Social Infrastructure), and then to compare the results with proposed legal regulations in Poland that set minimum distances between social infrastructure zones and residential areas. The study will be conducted using selected urban centers: in Poland as a case study and in Belgium as verification. The use of spatial analysis methods (GIS) and a method transferability test enables the assessment of accessibility zones, as well as the identification of potential discrepancies between legal standards and actual accessibility conditions. In this context, this article addresses the question of whether accessibility standards for elementary schools and public green spaces can affect the future directions of residential development and urban spatial policy. The conclusions indicate that, although MSAS are not perfect solutions for a variety of reasons, they represent a step toward sustainable development. Full article

Predicting landslide displacement is important for geological-hazard early warning. In reservoir areas, displacement evolution is affected by rainfall, reservoir water level, vegetation variation, and the intrinsic non-stationarity of the displacement sequence, which makes accurate prediction difficult for conventional single-sequence models. To address this problem, this study proposes a residual-increment-oriented landslide displacement prediction framework that fuses multi-source monitoring variables. The displacement sequence is first processed into trend and periodic-related fluctuation representations, and the residual increment is used as the prediction target. Rainfall, reservoir water level, and the normalized difference vegetation index (NDVI) are incorporated as external monitoring variables. A cross-branch attention mechanism models interactions among heterogeneous feature branches, and a sparse MoE-based fusion module is introduced to adaptively adjust branch contributions under different deformation conditions. The model predicts the displacement residual increment, from which the final displacement is reconstructed. A case study using the Baishui River (Baishuihe) landslide monitoring dataset was conducted, together with additional validation on the related Bazimen Z110 landslide monitoring dataset and comparisons against conventional recurrent, convolutional, statistical, and Transformer-based baselines. The results show that the proposed model achieves lower RMSE and MAE than the compared methods on the tested datasets. These findings suggest that residual-increment modeling, multi-source monitoring variables, and condition-dependent branch fusion can improve short-term displacement prediction for the tested reservoir-area landslide cases. Full article

Background: HIV/AIDS remains a major global public health challenge, with persistent regional disparities in burden and progress toward the UNAIDS 95–95–95 targets. This study assessed temporal trends in the HIV/AIDS burden in Kazakhstan, compared them with Central Asia and global patterns, and projected trends through 2030. Methods: We conducted a population-level analysis using Global Burden of Disease 2023 data, examining age-standardized rates (per 100,000) of incidence, prevalence, mortality, disability-adjusted life years (DALYs), years of life lost (YLLs), and years lived with disability (YLDs) from 2010 to 2023. Trends were quantified using percent change and average annual percentage change, with projections based on log-linear models. Results: Between 2010 and 2023, prevalence in Kazakhstan increased by 332.1% and incidence by 111.0%, contrasting with the decline in global incidence (−24.7%). Mortality decreased (−32.7%), along with DALYs (−28.8%) and YLLs (−37.1%), while YLDs increased by 135.5%, indicating a shift toward a chronic disease burden. In 2023, Kazakhstan had a lower overall burden than global estimates but showed steeper increases in incidence and prevalence. Age-specific analyses indicated the largest increases among adults aged 30–69 years. Under current trend assumptions, projections suggest continued growth in prevalence and incidence, with modest mortality declines through 2030, though these trajectories do not account for future changes in prevention coverage, treatment access, or policy. Conclusions: Kazakhstan is undergoing a transition toward a chronic HIV epidemic, underscoring the need to strengthen prevention, expand PrEP and testing coverage, and address structural barriers to achieve epidemic control. Full article

Background: Tests for a trend in location are appropriate when there is an ordered alternative such as, for example, when it is assumed that the effect does not decrease with increasing doses of a drug or fertilizer. Classical trend tests for normally distributed data as well as the nonparametric Jonckheere trend test can have inflated type I error rates when variances differ between groups. Here, different approaches suggested to handle heterogeneous variances are investigated in combination with the Williams trend test. Methods: A simulation study was performed to compare the Jonckheere trend test with competing tests. The different tests were investigated for normal and non-normal data and also applied to a data set on sizes of walnuts opened by birds in various stages of a winter. Results: With one exception, all investigated trend tests can have an inflated type I error rate when variances differ. Only a nonparametric multiple contrast test based on relative effects showed an acceptable type I error rate in all scenarios considered in the simulation. Conclusions: The Williams trend test in combination with the nonparametric multiple contrast test based on relative effects can be suggested for routine use. With this procedure, an increase in variance cannot cause a significant result in the test for trend. Full article

Bipolar vessel sealing systems are widely used in surgery, yet their effectiveness varies depending on the histological composition of the target vessel. In particular, the influence of elastin on seal stability is not well understood. Porcine carotid arteries, which show a pronounced proximal–distal elastin gradient, provide an ideal model for systematic analysis. In this study, fresh porcine carotid arteries were divided into three segments based on vessel diameter (<5 mm, 5–7 mm, >7 mm). Histological EvG staining was used to quantify elastin and collagen content. All vessels (n = 8 per group) were sealed using a bipolar marSeal^® 5 plus device, followed by burst pressure testing and peel force measurements. Elastin content increased significantly from peripheral to central segments (9% → 25% → 42%; p < 0.001), while collagen content remained constant (22 ± 2%). In parallel, seal stability decreased markedly: burst pressures dropped from 723 mmHg to 240 mmHg and to 31.5 mmHg (p < 0.001). Peel forces showed the same trend (1.75 ± 0.07 N → 0.65 ± 0.03 N → 0.26 ± 0.11 N; p < 0.001). Wall thickness showed no proportional relationship to seal quality. Interestingly, the sealing performance of bipolar systems seems to be greatly influenced by the histological structure of the vessel wall. A high elastin content—rising from 9% to 42% along the carotid artery—was associated with a reduction in burst pressure and peel strength. These findings highlight the need to consider tissue composition when selecting sealing methods and support the development of adaptive energy delivery technologies. Full article

Adult mental disorders (aMD), including borderline personality disorder (BPD), major depressive disorder (MDD), and social anxiety disorder (SAD), share adverse childhood experiences (ACEs) as an environmental risk factor. Epigenetic mechanisms, including DNA methylation (DNAm), may mediate the biological link between early adversity and psychiatric risk. SIAH3, implicated in stress-related and mitochondrial pathways, has been previously associated with both ACE and aMD. This study examined SIAH3 DNAm in adults with BPD, MDD, or SAD, relative to healthy control participants (HC), testing effects of diagnosis, ACE exposure, and their interaction across the pooled sample and within each diagnostic group. Both aMD diagnosis and high ACE exposure showed trends toward SIAH3 hypomethylation, and a significant diagnosis × ACE interaction emerged, with inconclusive post-hoc tests. Disorder-specific analyses revealed heterogeneous patterns: in BPD, high ACE showed a trend toward hypermethylation in unadjusted models; in MDD, interaction effects were marginal and not robust to covariate adjustment; in SAD, significant main effects and a diagnosis × ACE interaction were observed, with high ACE associated with lower DNAm exclusively in HC. These findings suggest disorder-specific epigenetic responses to ACE, positioning SIAH3 as a potential molecular link between early life stress, mitochondrial function, and aMD. Full article

Background/Objectives: Wearable technology is increasingly used to provide biofeedback in physical rehabilitation; however, there is no consensus on which biofeedback parameter is most appropriate for clinical use, as most studies evaluate only one arbitrarily selected parameter. This study presents a wearable multimodal biofeedback system integrating multiple parameters selected based on the prior literature and evaluates its feasibility, usability, and implementation within a rehabilitation context through a longitudinal post-stroke case study. Methods: The system integrates inertial and electromyographic sensors to monitor centre of mass (CoM-B), joint angle (ANG-B), and muscle activity (EMG-B), delivering real-time sensory cues based on the monitored parameters. Feasibility was assessed in a post-stroke participant (male, 32 years, 29 months post-stroke, left hemiparesis, Fugl-Meyer Lower Extremity Score = 27) across 15 sessions involving stand-to-sit, split-stance weight shifting, and walking tasks. Each task was practiced with all three biofeedback parameters, with five sessions per parameter. Results: The motor performance varied across biofeedback parameters and tasks. CoM-B was associated with favourable trends in motor performance during stand-to-sit, showing improvements in medio-lateral displacement (0.03/session); ANG-B during walking, showing increased ankle dorsiflexion (1 deg/session); and EMG-B during split-stance weight shifting, showing increased tibialis anterior activation (5 µV/session). Conclusions: The findings generate the hypothesis that the ability of biofeedback to elicit favourable motor performance is task-dependent, suggesting that the choice of biofeedback parameters may need to be adapted to task demands. The system demonstrated high usability and feasibility, supporting its potential for post-stroke rehabilitation. Further studies are needed to test the generated hypothesis and evaluate the system efficacy. Full article

Under global warming, understanding regional drought evolution is essential for drought early warning, food security, climate adaptation, and sustainable water-resource management. This study analyzed meteorological drought in Jiangxi Province during 1961–2022 using SPI-12, SPEI-12, and EDDI-12 from the CHM_Drought high-resolution multi-index dataset. The Mann–Kendall (MK) test, Theil–Sen slope estimator, three-threshold run theory, Morlet wavelet analysis, wavelet coherence (WTC), and cross-wavelet transform (XWT) were used to examine drought trends, event characteristics, periodicity, and inter-index relationships. Results showed a widespread drying tendency. EDDI-12 exhibited a highly significant increase in 99.86% of valid resampled raster pixels, indicating enhanced atmospheric evaporative demand, while SPEI-12 and SPI-12 showed significant decreasing trends in 97.96% and 93.24% of valid pixels, respectively. Stronger drying signals were mainly distributed in central and northern Jiangxi. Run-theory analysis indicated longer-duration cumulative droughts in southern mountainous areas and frequent short-duration drought events in the Poyang Lake Plain and central-northern Jiangxi. Wavelet analysis identified a dominant interdecadal periodicity of approximately 20–21 years. WTC and XWT revealed strong in-phase coherence between SPI and SPEI, whereas SPI/SPEI and EDDI mainly showed anti-phase statistical phase relationships. From a sustainability perspective, these findings provide scientific support for multi-index drought monitoring, adaptive agricultural water allocation, drought early warning, and climate-resilient water-resource management in humid monsoon regions. Full article