Search Results (839)

Bone fragility represents a significant global health burden, characterized by the deterioration of bone strength, increased brittleness, and heightened fracture susceptibility. Osteoporosis substantially elevates the risk of fragility fractures, the principal clinical manifestation of the disease. Current diagnostic approaches, including biomedical imaging, bone strength assessment, and bone mineral density measurement, are closely linked to identifying bone fragility through various predictive models and tools. Although numerous studies have employed predictors to characterize fragility fractures, few have comprehensively examined the morpho-structural features of bone across multiple hierarchical scales, limiting the ability to fully elucidate the underlying mechanisms of bone fragility. This review summarizes recent advancements in predictive modeling and novel diagnostic tools, focusing on multiscale approaches for assessing bone fragility. We critically evaluate the translational potential of these tools for the early detection of fragility fractures and their clinical application in mitigating fracture risk. Moreover, this study discusses the integration of multiscale predictive methodologies, which promise to enhance early-stage bone fragility detection and potentially prevent severe fractures through timely intervention. Finally, the study reflects on current research limitations, addressing the challenges associated with multiscale predictive modeling of bone fragility, and proposes future directions to refine these tools to improve the accuracy and utility of fragility fracture prediction and prevention strategies. Full article

Background: Sepsis is a common and serious complication in pediatric hematology oncology (PHO) patients. The Endothelial Activation and Stress Index (EASIX) score offers a potentially accessible tool for risk stratification in septic patients. Our objective was to evaluate the association of the EASIX score with adverse clinical outcomes among septic PHO patients. Methods: A retrospective review was conducted for all PHO patients admitted to the intensive care unit (ICU) with sepsis from July 2022 to December 2024. Results: A total of 53 patients with 65 sepsis events were included in this analysis. The median age was 14.9 [IQR 9.9] y and the most common disease was hematologic malignancy. In our cohort, 60% needed vasopressors, 36% required invasive mechanical ventilation, and 22% underwent renal replacement therapy (RRT). Log2-EASIX > 2.5 was associated with higher vasopressor requirements (87% versus 45% in the low log2-EASIX group, p = 0.001) and an increased need for RRT (39% versus 12%, p = 0.024). Septic PHO patients with log2-EASIX > 2.5 were 6.9 times more likely to require vasopressor support [(95% CI 1.7–27.8) p = 0.007]. In addition, PHO patients with log2-EASIX > 2.5 had a longer ICU stay (7 d versus 2 d in the low log2-EASIX group, p = 0.024) and an extended overall hospitalization (33 d versus 25 d, p = 0.029). Conclusions: A higher EASIX score was associated with adverse outcomes in critically ill septic PHO patients. Our findings suggest that the EASIX score can be used as a tool for identifying septic patients at an increased risk of clinical deterioration and poor outcomes. Prospective studies in larger cohorts are warranted to validate and expand upon these findings. Full article

Binary metallic nickel–copper nanocatalysts were anchored onto a polyvinylidene fluoride-co-hexafluoropropylene membrane [NiCu/PVdF–HFP] using the electrospinning technique, followed by the chemical reduction of the relevant precursor salts by introducing sodium borohydride to the synthesis mixture. A series of varied Ni:Cu weight % proportions was developed in order to optimize the electroactivity of this binary nanocomposite towards the investigated oxidation process. A number of physicochemical tools were used to ascertain the morphology and chemical structure of the formed metallic species on polymeric films. Cyclic voltammetric studies revealed a satisfactory performance of altered NiCu/PVdF–HFP membranes in alkaline solution. Ethylene glycol molecules were successfully electro-oxidized at their surfaces, showing the highest current intensity [564.88 μA cm⁻²] at the one with Ni:Cu weight ratios of 5:5. The dependence of these metallic membranes’ behavior on the added alcohol concentration to the reaction electrolyte and the adjusted scan rate during the electrochemical measurement was carefully investigated. One hundred repeated scans did not significantly deteriorate the NiCu/PVdF–HFP nanostructures’ durability. Decay percentages of 76.90–87.95% were monitored at their surfaces, supporting the stabilized performance for prolonged periods. A much-decreased R_ct value was estimated at Ni₅Cu₅/PVdF–HFP [392.6 Ohm cm²] as a consequence of the feasibility of the electron transfer step for the electro-catalyzing oxidation process of alcohol molecules. These enhanced study results will hopefully motivate the interested workers to explore the behavior of many binary and ternary combinations of metallic nanomaterials after their deposition onto convenient polymeric films for vital electrochemical reactions. Full article

Historic and cultural towns in China are crucial carriers of vernacular heritage, yet many unlisted historic buildings remain highly vulnerable to urbanization and fragmented governance. This study takes Xiangzhu Town in Zhejiang Province as a case study and develops a multidimensional evaluation framework—integrating value, morphology, and risk—to identify conservation priorities and guide adaptive reuse. The results highlight three key findings: (1) a spatial pattern of “core preservation and peripheral renewal,” with historical and artistic values concentrated in the core, scientific value declining outward, and functional diversity emerging at the periphery; (2) a morphological structure characterized by “macro-coherence and micro-diversity,” as revealed by balanced global connectivity and localized hotspots in space syntax analysis; and (3) differentiated building risks, where most assets are low to medium risk, but some high-value ancestral halls show accelerated deterioration requiring urgent action. Based on these insights, a collaborative framework of “graded management–classified guidance–zoned response” is proposed to align systematic restoration with community-driven revitalization. This study demonstrates the effectiveness of the value–morphology–risk approach for small historic towns, offering a replicable tool for differentiated heritage conservation and sustainable urban–rural transition. Full article

Background and objectives: Atopic dermatitis (AD) is a chronic inflammatory skin disease that affects not only physical health but also psychological well-being. While the emotional and social burden of AD is well documented, there is still limited research on how AD affects sexual health. The study aimed to evaluate quality of life (QoL), mental health, and risk factors for impaired sexual life, as well as their relationships. Materials and Methods: A total of 201 participants (96 patients with AD and 105 healthy controls) were enrolled in the study. Socio-demographic and clinical data were obtained using a specifically developed questionnaire. In addition, participants completed validated scales, including the DLQI, HADS, FSFI, IIEF-5, and SRSLQ. AD severity was assessed using the SCORAD questionnaire. Results: Our study found that patients with AD had statistically significantly higher mean anxiety (6.8 ± 3.6 vs. 5.0 ± 3.2; p < 0.001), depression (5.2 ± 3.4 vs. 3.9 ± 2.9, p < 0.01), and skin-related sexual dysfunction scores (15.0 ± 4.5 vs. 4.4 ± 4.7, p < 0.001), as well as QoL scores (12.3 ± 6.1 vs. 1.8 ± 3.1, p < 0.001), than healthy controls. Female AD patients reported higher values of depression and anxiety compared to male patients (5.9 ± 3.1 vs. 4.4 ± 3.5, p = 0.03, 7.6 ± 2.9 vs. 6.0 ± 4.1, p = 0.03, respectively) and lower FSFI scores compared to healthy women (24.8 ± 8.0 vs. 31.3 ± 3.0, p < 0.001). Deterioration in sexual health, assessed by the SRSLQ score, was strongly correlated with QoL impairment (R = 0.5, p < 0.001), anxiety (R = 0.51, p < 0.001), and depression (R = 0.5, p < 0.001). Finally, we found that sex life negatively correlates with AD severity (p=0.001), involvement of a genital area (p = 0.005), intensity of pruritus (r = 0.284, p = 0.005), and insomnia (r = 0.366, p < 0.001). Conclusions: AD significantly affects patients’ quality of life, including their sex life. Many factors associated with the disease also contribute to the deterioration of patients’ sexual health. Routine assessment of sexual life in dermatological practice, using validated tools, could facilitate early identification and support for affected patients. Significance: This study highlights the often-overlooked impact of atopic dermatitis on patients’ sexual health. Our findings demonstrate that sexual function is significantly impaired in individuals with atopic dermatitis—particularly among women—and that such dysfunction is closely associated with disease-related symptoms. These results have important implications for improving the quality of care provided to individuals affected by the condition. Full article

Urbanization poses growing threats to archaeological heritage sites embedded within cities, necessitating innovative monitoring and documentation strategies. This study investigates the use of Unmanned Aerial Vehicle (UAV) photogrammetry for mapping and 3D modelling of urban archaeological landscapes, focusing on the Byzantine-era Didymoteicho Fortress in northern Greece. High-resolution aerial imagery was captured and processed into an orthophoto mosaic and a detailed 3D model of the site’s monuments and their urban surroundings. The UAV-based survey provided comprehensive, up-to-date spatial data that traditional ground methods could not easily achieve in dense urban settings. The results illustrate how UAV mapping can document complex heritage structures, detect risks (such as structural deterioration or encroachment by development), and inform preservation efforts. The discussion situates these findings within global heritage management practices, highlighting UAV technology as a cost-effective, accurate, and non-invasive tool for safeguarding cultural heritage in urban areas. The suggested methodology enhances heritage documentation and risk assessment, demonstrating strong potential for policy integration and proactive conservation planning in historic cities. Full article

The rehabilitation of mining environments poses significant challenges due to the contamination risks associated with hazardous materials, such as arsenic and other chemical products. This research study presents the development of a Digital Twin for the Lavrion Technological and Cultural Park (LTCP), a former mining and metalworking site that is currently undergoing environmental restoration. The Digital Twin integrates advanced technologies, including real-time sensor monitoring, geophysical methods, and 3D modeling, to provide a comprehensive tool for assessing and managing the environmental conditions of the site. Key elements of the project include the monitoring of hazardous-waste storage, the evaluation of contaminated soils, and the assessment of the Park’s infrastructure, which includes both deteriorating buildings and successfully restored structures. Real-time sensor data are collected to track critical parameters such as conductivity, temperature, salinity, and levels of pollutants, enabling proactive environmental management and mitigation of potential risks. The integration of these technologies enables continuous monitoring, historical data analysis, and improved decision making in the ongoing efforts to preserve the site’s ecological integrity. This study demonstrates the potential of using Digital Twins as an innovative solution for the sustainable management and valorization of mining heritage sites, offering insights into both technological applications and environmental conservation practices. Full article

Bridges play an increasingly indispensable role in endorsing the economic and social development of societies by linking highways and facilitating the mobility of people and goods. Concurrently, they are susceptible to high traffic volumes and an intricate service environment over their lifespans, resulting in undergoing a progressive deterioration process. Hence, efficient measures of maintenance, repair, and rehabilitation planning are critical to boost the performance condition, safety, and structural integrity of bridges while evading less costly interventions. To this end, this research paper furnishes a mixed review method, comprising systematic literature and scientometric reviews, for the meticulous examination and analysis of the existing research work in relation with maintenance fund allocation models of bridges (BriMai_all). With that in mind, Scopus and Web of Science databases are harnessed collectively to retrieve peer-reviewed journal articles on the subject, culminating in 380 indexed journal articles over the study period (1990–2025). In this respect, VOSviewer and Bibliometrix R package are utilized to create a visualization network of the literature database, covering keyword co-occurrence analysis, country co-authorship analysis, institution co-authorship analysis, journal co-citation analysis, journal co-citation, core journal analysis, and temporal trends. Subsequently, a rigorous systematic literature review is rendered to synthesize the adopted tools and prominent trends of the relevant state of the art. Particularly, the conducted multi-dimensional review examines the six dominant methodical paradigms of bridge maintenance management: (1) multi-criteria decision making, (2) life cycle assessment, (3) digital twins, (4) inspection planning, (5) artificial intelligence, and (6) optimization. It can be argued that this research paper could assist asset managers with a practical guide and a protocol to plan maintenance expenditures and implement sustainable practices for bridges under deterioration. Full article

Background: Preventing nutritional decline during hospitalisation is imperative in reducing the development of complications such as malnutrition and pressure injuries. However, existing malnutrition screening and assessment tools employ a reactive rather than proactive approach, using predictors to identify inpatients who are already malnourished instead of those at risk of developing hospital-acquired malnutrition. Therefore, this review aimed to identify key contextual and individual factors contributing to nutritional deterioration and their interrelatedness, and to inform strategies for preventing hospital-acquired malnutrition. Methods: A scoping review of five databases (Medline, CINAHL, Embase, All EBM Reviews and PsycINFO) up to June 2024 was conducted to include English-language studies that reported statistically significant risk factors for changes in nutritional status during hospitalisation. A directed acyclic graphing method was used to visualise the interlinkage between contextual and individual risk factors identified. PRISMA Extension for Scoping Reviews was followed in reporting. Results: Of 8215 retrieved abstracts, 51 studies were included. Four contextual (ward type; food service satisfaction; medical-related mealtime interruption; nutrition care collaboration) and four individual factors (nutritional status prior admission; hospital length of stay; multimorbidity; disease acuity) were found to significantly predict nutritional decline during hospitalisation and were closely interrelated. Conclusions: More contextual risk factors are modifiable, suggesting a need for organisational strategies to optimise collaborative nutrition care and improve patient satisfaction with hospital food services to promote early nutritional intervention, particularly within the first three days of admission and for inpatients with multimorbidity, high disease acuity, or pre-existing malnourishment. Full article

A major challenge for modern transit systems relying on traditional fixed-route designs is providing broad accessibility to users. Flex-route transit can enhance accessibility in low-density areas, since it combines the directness of fixed-route transit with the coverage of on-demand mobility. Although deviating for optional pickups can increase ridership and transit accessibility, it also deteriorates the service performance for fixed-route riders. To balance this inherent trade-off, this paper proposes a reinforcement learning approach for deviation decisions. The proposed model is used in a case study of a proposed flex-route service in the city of Boston. The performance on competing objectives is evaluated for reward configurations that adapt to peak and off-peak scenarios. The analysis shows a significant improvement of our method compared to a heuristic derived from industry practice as a baseline. To evaluate robustness, we assess performance across scenarios with varying demand compositions (fixed and requested riders). The results show that the method achieves greater improvements than the baseline in scenarios with increased request ridership, i.e., where decision-making is more complex. Our approach improves service performance under dynamic demand conditions and varying priorities, offering a valuable tool for smart cities to operate flex-route services. Full article

This study develops a computational framework for the simultaneous quantification of seismic resilience and economic losses in corrosion-affected coastal continuous girder bridges. The proposed model integrates adjustment factors to reflect delays in post-earthquake repairs and cost increments caused by progressive material degradation. Finite element methods and nonlinear dynamic time-history simulations were conducted on an existing coastal continuous girder bridge to validate the proposed model. The key innovation lies in a probability-weighted resilience index incorporating damage state occurrence probabilities, which overcomes the computational inefficiency of traditional recovery function approaches. Key findings demonstrate that chloride exposure duration exhibits a statistically significant positive association with earthquake-induced structural failure probabilities. Sensitivity analysis reveals two critical patterns: (1) a 0.3 g PGA increase causes a 11.4–18.2% reduction in the resilience index (RI), and (2) every ten-year extension of corrosion exposure decreases RI by 2.7–6.2%, confirming seismic intensity’s predominant role compared to material deterioration. The refined assessment approach reduces computational deviation to ±2.4%, relative to conventional recovery function methods. Economic analysis indicates that chloride-induced aging generates incremental indirect losses ranging from $58,000 to $108,000 per decade, illustrating compounding post-disaster socioeconomic consequences. This work systematically bridges corrosion-dependent structural vulnerabilities with long-term fiscal implications, providing decision-support tools for coastal continuous girder bridges’ maintenance planning. Full article

Microfluidic device prototyping demands rapid, cost-effective, and high-precision mould fabrication, yet ultrashort pulsed laser structuring of polymer inserts remains underexplored. This study presents a novel method for fabricating microfluidic mould inserts using femtosecond (fs) laser ablation of polyimide (PI) films, achieving high precision from design to prototype. PI films (250 µm) were structured using a 355 nm fs laser (300 fs, 500 kHz, 0.95 J/cm²) in a photochemically dominated ablation regime and bonded to reusable steel plates. Injection moulding trials with cyclic olefin copolymer (COC) and polymethyl methacrylate (PMMA) were conducted with diverse designs, including concentration gradient generators (CGG), organ-on-chip (OOC) with 20 µm bridges, and double emulsion droplet generators (DEDG) with 100–500 µm channels, ensuring robustness across complex geometries. The method achieved near 1:1 replication (errors < 2%, microchannel height tolerances < 1%, Sa = 0.02 µm in channels, 0.26 µm in laser-structured areas), machining times under 2 h, and mould durability over 100 cycles without significant deterioration. The PI’s heat-retarding effect mimicked variothermal moulding, ensuring complete micro-penetration without specialised equipment. By reducing material costs using PI films and reusable steel plates, enabling rapid iterations within hours, and supporting industry-compatible prototyping, this approach lowers barriers for small-scale labs. It enables rapid prototyping of diagnostic lab-on-chip devices and supports decentralised manufacturing for biomedical, chemical, and environmental applications, offering a versatile, cost-effective tool for early-stage development. Full article

Single Point Incremental Forming (SPIF) has emerged as a flexible and cost-effective technique for producing complex sheet metal parts. However, its industrial application is often limited by issues related to surface quality. This study examines the impact of tool geometry on the surface integrity of the AA6061-T6 aluminum alloy. The research novelty lies in the innovative eccentric tool with a variable radius (ETVR), which we compare to two conventional hemispherical tools with radii of 5 mm and 10 mm. Truncated cones were formed under the same process conditions, and their quality was assessed by measuring surface roughness and microhardness along the cone’s generatrix in both the rolling direction and the transverse direction. Additionally, microchip analysis and visual inspections were conducted. The results reveal distinct differences in the surface morphology, evolution of roughness, and distribution of microhardness among the three tools. The SS5 tool produced the highest level of hardening but also resulted in significant surface deterioration. In contrast, the SS10 tool generated smoother surfaces with moderate hardening, while the ETVR tool struck a balance between surface uniformity and enhanced hardness. Statistical analyses, using t-tests, confirmed the significance of these findings. This study offers new insights into tool design for SPIF, highlighting the trade-offs between surface quality and material strengthening. Full article

Background and Objectives: Urinary tract infections (UTIs) are a major cause of emergency department (ED) visits and hospital admissions among older adults. Although most seniors present hemodynamically stable, a sizeable fraction deteriorate during hospitalization, and no ED-specific tool exists to identify those at greatest risk. We sought to determine risk factors for in-hospital mortality in this population and to develop a predictive model. Materials and Methods: We analyzed the MIMIC-IV-ED database (2011–2019) and enrolled culture-confirmed UTI patients aged ≥ 65 years who were hemodynamically stable—defined as a systolic blood pressure ≥ 100 mm Hg without vasopressor support. Demographics, comorbidities, triage vital signs, and initial laboratory tests were extracted. Least Absolute Shrinkage and Selection Operator (LASSO) regression with 10-fold cross-validation was performed for variable selection. Discrimination was quantified with the C-statistic, calibration with the Hosmer–Lemeshow test, and clinical utility with decision curve analysis. Internal validation was assessed via 1000-sample bootstrap resampling. Results: Among 1571 eligible encounters (median age 79 years, 33% male), in-hospital mortality was 4.5%. LASSO selected eight variables; six remained significant in multivariable analysis: age, systolic blood pressure, oxygen saturation, white blood cell count, red cell distribution width, and blood urea nitrogen. The predictive nomogram demonstrated a C-statistic of 0.73 (95% CI 0.66–0.79) and outperformed traditional early warning scores. Conclusions: A six-variable nomogram may stratify mortality risk in hemodynamically stable older adults with UTI. Because the model was developed in a single U.S. tertiary-care ED, it remains hypothesis-generating until validated in external, multicenter cohorts to confirm generalizability. Full article

Healthcare systems worldwide face growing challenges related to staff shortages, excessive workload, and deteriorating working conditions, which compromise both staff well-being and care quality. Despite these issues, there is a lack of validated tools that capture healthcare professionals’ subjective perceptions of resource adequacy. This study presents the development and initial validation of the Staff Resource Adequacy Questionnaire for Healthcare Professionals (SRAQ-HP), a multidimensional tool designed to assess staffing adequacy and workload, quality of care, and working conditions and support. The development process followed a mixed-methods design, incorporating theoretical foundations from Kanter’s empowerment theory, role enactment models, and professional competence frameworks. The initial item pool of 32 statements was reduced to 26 through expert reviews, focus groups, and pilot testing (n = 35). Content validity index (CVI = 0.931) and face validity index (FVI = 0.976) demonstrated high content relevance and clarity. Cronbach’s alpha for the full scale was 0.841, confirming internal consistency. Expert re-review confirmed strong content (S-CVI/Ave = 0.931) and face validity (FVI = 0.976) for the final 26-item version. Three core dimensions were retained: Staffing Adequacy and Workload, Quality of Care, and Working Conditions and Support. The SRAQ-HP provides a novel, evidence-based approach to systematically assess workforce sufficiency and support structures in clinical settings. It can guide decision-making in healthcare institutions and inform national workforce policies. Further research with larger and more diverse samples is needed to confirm its factorial validity and practical applicability. Full article