Search Results (2,393)

In this study, we successfully synthesized olivine-type FePO₄ via an in situ oxidation method and further developed two composite cathode materials (o-FePO₄-1/GR-1 and o-FePO₄-1/GR-2) by incorporating graphene. The composites were characterized using scanning electron microscopy (SEM), X-ray diffraction (XRD), and X-ray Photoelectron Spectroscopy (XPS), revealing a three-dimensional porous layered structure with an enhanced surface area and strong interaction between FePO₄ nanoparticles and graphene layers. Electrochemical tests demonstrated that the composite electrodes exhibited significantly improved performance compared to pristine FePO₄, with discharge capacities of 147 mAh g⁻¹ at 1C and 163 mAh g⁻¹ at 0.1C for o-FePO₄-1/GR-2, approaching the level of LiFePO₄. The incorporation of graphene effectively enhanced the electrochemical reaction kinetics, highlighting the innovation of our method in developing high-performance cathode materials for lithium-ion batteries. Full article

Background: Preterm infants and their families face a challenging experience during their stay in the neonatal intensive care unit (NICU). Family-centered care emphasizes the importance of welcoming parents, involving them in their baby’s daily care, and supporting the development of parenting skills. NICU staff should support parents in understanding their baby’s needs and in strengthening the parent–infant bond. Although many tools outline what parents should learn, there is a limited structured framework to monitor their involvement in the infant’s care. Tracking parental participation in daily caregiving activities could support professionals in effectively guiding families, ensuring a smoother transition to discharge. Aims: The aim of this study was to evaluate the adherence to and effectiveness of a structured tool for parental involvement in the NICU. This tool serves several key purposes: to track the progression and timing of parents’ autonomy in caring for their baby, to support parents in building caregiving competencies before discharge, and to standardize the approach of NICU professionals in promoting both infant care and family engagement. Methods: A structured template form for documenting parental involvement (“together TO-CARE template”, TTCT) was integrated into the computerized chart adopted in the NICU of Modena. Nurses were asked to complete the TTCT at each shift. The template included the following assessment items: parental presence; type of contact with the baby (touch; voice; skin-to-skin); parental involvement in care activities (diaper changing; gavage feeding; bottle feeding; breast feeding); and level of autonomy in care (observer; supported by nurse; autonomous). We evaluated TTCT uploaded data for very low birth weight (VLBW) preterm infants admitted in the Modena NICU between 1 January 2023 and 31 December 2024. Staff compliance in filling out the TTCT was assessed. The timing at which parents achieved autonomy in different care tasks was also measured. Results: The TTCT was completed with an average of one entry per day, during the NICU stay. Parents reached full autonomy in diaper changing at a mean of 21.1 ± 15.3 days and in bottle feeding at a mean of 48.0 ± 22.4 days after admission. The mean length of hospitalization was 53 ± 38 days. Conclusions: The adoption of the TTCT in the NICU is feasible and should become a central component of care for preterm infants. It promotes family-centered care by addressing the needs of both the baby and the family. Encouraging early and progressive parental involvement enhances parenting skills, builds confidence, and may help reduce post-discharge complications and readmissions. Furthermore, the use of a standardized template aims to foster consistency among NICU staff, reduce disparities in care delivery, and strengthen the support provided to families of preterm infants. Full article

The significant advances in the surgical and medical treatment of gynecological cancer have led to improved survival outcomes of several subgroups of patients that were until recently opted out of treatment plans. Surgical cytoreduction has evolved through advanced surgical complexity procedures and the need for critical care of gynecological cancer patients has increased. Despite that, however, articles focusing on the need of perioperative monitoring of these patients completely lack from the international literature; hence, recommendations are still lacking. Critical care may be offered in different types of facilities with specific indications. These include the post-anesthesia care unit (PACU), the high dependency unit (HDU) and the intensive care unit (ICU) which have discrete roles and should be used judiciously in order to avoid unnecessary increases in the hospitalization costs. In the present review we focus on the pathophysiological alterations that are expected in gynecological cancer patients undergoing surgical treatment, provide current evidence and discuss indications of hospitalization as well as discharge criteria from intensive care facilities. Full article

Rapid socio-economic development and the impact of human activities have exerted tremendous pressure on the groundwater system of the Dawen River Basin (DRB), the largest tributary in the middle and lower reaches of the Yellow River. Hydrochemical studies on the DRB have largely centered on the upstream Muwen River catchment and downstream Dongping Lake, with some focusing solely on karst groundwater. Basin-wide evaluations suggest good overall groundwater quality, but moderate to severe contamination is confined to the lower Dongping Lake area. The hydrogeologically complex mid-reach, where the Muwen and Chaiwen rivers merge, warrants specific focus. This region, adjacent to populous areas and industrial/agricultural zones, features diverse aquifer systems, necessitating a thorough analysis of its hydrochemistry and origins. This study presents an integrated hydrochemical, isotopic investigation and EWQI evaluation of groundwater quality and formation mechanisms within the multiple groundwater types of the central DRB. Central DRB groundwater has a pH of 7.5–8.2 (avg. 7.8) and TDSs at 450–2420 mg/L (avg. 1075.4 mg/L) and is mainly brackish, with Ca²⁺ as the primary cation (68.3% of total cations) and SO₄²⁻ (33.6%) and NO₃⁻ (28.4%) as key anions. The Piper diagram reveals complex hydrochemical types, primarily HCO₃·SO₄-Ca and SO₄·Cl-Ca. Isotopic analysis (δ²H, δ¹⁸O) confirms atmospheric precipitation as the principal recharge source, with pore water showing evaporative enrichment due to shallow depths. The Gibbs diagram and ion ratios demonstrate that hydrochemistry is primarily controlled by silicate and carbonate weathering (especially calcite dissolution), active cation exchange, and anthropogenic influences. EWQI assessment (avg. 156.2) indicates generally “good” overall quality but significant spatial variability. Pore water exhibits the highest exceedance rates (50% > Class III), driven by nitrate pollution from intensive vegetable cultivation in eastern areas (Xiyangzhuang–Liangzhuang) and sulfate contamination from gypsum mining (Guojialou–Nanxiyao). Karst water (26.7% > Class III) shows localized pollution belts (Huafeng–Dongzhuang) linked to coal mining and industrial discharges. Compared to basin-wide studies suggesting good quality in mid-upper reaches, this intensive mid-reach sampling identifies critical localized pollution zones within an overall low-EWQI background. The findings highlight the necessity for aquifer-specific and land-use-targeted groundwater protection strategies in this hydrogeologically complex region. Full article

The large-scale utilization of hydrogen energy is currently hindered by challenges in low-cost production, storage, and transportation. This study focused on investigating the impact of the diaphragm cavity profile on the movement behavior and stress distribution of a dual-stage diaphragm compressor. Firstly, an experimental platform was established to test the gas mass flowrate and fluid pressures under various preset conditions. Secondly, a simulation path integrating the finite element method simulation, theoretical stress model, and movement model was developed and experimentally validated to analyze the diaphragm stress distribution and deformation characteristics. Finally, comparative optimization analyses were conducted on different types of diaphragm cavity profiles. The results indicated that the driving pressure differences at the top dead center position reached 85.58 kPa for the first-stage diaphragm and 75.49 kPa for the second-stage diaphragm. Under experimental conditions of 1.6 MPa suction pressure, 8 MPa second-stage discharge pressure, and 200 rpm rotational speed, the first-stage and second-stage diaphragms reached the maximum center deflections of 4.14 mm and 2.53 mm, respectively, at the bottom dead center position. Moreover, the cavity profile optimization analysis indicated that the double-arc profile (DAP) achieved better cavity volume and diaphragm stress characteristics. The first-stage diaphragm within the optimized DAP-type cavity exhibited 173.95 MPa maximum principal stress with a swept volume of 0.001129 m³, whereas the second-stage optimized configuration reached 172.57 MPa stress with a swept volume of 0.0003835 m³. This research offers valuable insights for enhancing the reliability and performance of diaphragm compressors. Full article

Background: Diabetes mellitus is a chronic metabolic disorder that increases mortality and morbidity rates. Infections of the hand can easily cause long-term morbidity and dysfunction, but despite their associated high morbidity, diabetic hand infections are more neglected than diabetic foot infections. Objectives: This study was conducted over a one-year follow-up period, considering the total costs of treatment over one year post discharge for patients with diabetic hand infections that required surgery. A Monte Carlo Simulation was used in this study as a sensitivity analysis of all the cost calculations. Materials and Methods: A total of 62 out of 75 patients were diagnosed with Type 2 diabetes; 11 were female, and 64 were male. Out of all the patients, 15 visited outpatient clinics 30 times or more, and due to their recurrent visits, the outpatient treatment costs reached USD 5162.41 ± 3838.55. The total cost incurred over the period from the patients’ first hospitalization to the completion of all treatments and the end of the one-year follow-up was USD 24,602.22 ± 5257.15. Conclusions: The cost of hospitalization was the most important factor affecting the total expenses. Therefore, taking precautions before a diabetic hand infection occurs, or when one does occur, performing treatment without delay is expected to reduce the economic burden. Full article

Background: Acute necrotising encephalopathy (ANE) is a rare and severe type of encephalopathy with bilateral symmetrical brain lesions, often following a viral prodrome. ANE type 1 (ANE1) is a disease subtype with a predisposing mutation in the gene encoding RAN binding protein 2 (RANBP2). Methods: We report a case of a 3-year-old girl with clinical symptoms of ANE and brain MRI findings suggesting ANE1, which was subsequently confirmed by genetic analysis. Results: MRI of the brain demonstrated symmetrical high T2/FLAIR signal changes in the lateral geniculate bodies, claustrum, ventromedial thalami, subthalamic nuclei, mamillary bodies, and brainstem, with partly corresponding diffusion restriction, as well as additional haemorrhagic changes in the lateral geniculate bodies on susceptibility weighted imaging. Genetic analysis revealed a heterozygous pathogenic variant of the RANBP2 gene. With immunosuppressive and supportive treatment, the patient fully recovered and was discharged after 10 days in the hospital with no residual symptoms. Conclusions: Recognition of the characteristic MRI findings in ANE1 can facilitate a timely diagnosis and enhance the clinical management of the patient and their relatives, especially given the high risk of disease recurrence. Full article

Background/Objectives: Atrial fibrillation (AF) is the most significant modifying risk factor for the development of cardioembolic stroke, which is associated with worse outcomes and higher intrahospital mortality compared to other types of ischemic stroke. Antithrombotic medications are administered as prophylactic treatment in patients with a risk of stroke. The aim of this study was to determine outcome measures in patients with first-ever ischemic stroke and AF regarding prior antithrombotic therapy. Methods: We collected data on stroke risk factors, CHADS₂ score, and international normalized ratio (INR) value in the context of warfarin therapy, as well as data related to localization, stroke severity, and functional outcome at discharge. Results: A total of 754 subjects with first-ever ischemic stroke and AF were included in this cross-sectional study (122 on warfarin, 210 on acetylsalicylic acid, and 422 without prior antithrombotic therapy). The diagnosis of AF was previously unknown in 31% of the subjects. Stroke risk factors (arterial hypertension, hyperlipidemia, diabetes mellitus, and cardiomyopathy) were significantly lower in the group without prior antithrombotic therapy. The anticoagulant group was significantly younger (p = 0.001). Overall, 45.4% of subjects with a previously known AF event and a high risk of developing stroke received anticoagulant therapy. Participants on warfarin had a significantly better functional outcome than those on antiplatelet therapy or without prior antithrombotic therapy (median mRS 4 vs. 5 vs. 5; p = 0.025) and lower NIHSS scores, although the difference was not statistically significant (median 10 vs. 12 vs. 12; p = 0.09). There was no difference between stroke localization among groups (p = 0.116). Conclusions: Our study showed that, in our cohort, first-ever ischemic stroke due to AF was more common in women. Subjects on prior anticoagulant therapy had more favorable outcomes at discharge. Full article

The uterine microbiota plays a crucial role in maintaining postpartum reproductive health in dairy cows, and its dysregulation is closely associated with uterine diseases. Vaginal discharge characteristics serve as important clinical indicators for assessing uterine status and guiding clinical decision-making. This study employed 16S rRNA gene sequencing to analyze uterine microbial diversity in cows with different discharge types. Results revealed significant microbial shifts associated with discharge severity. Notably, Caviibacter was highly enriched (up to 60.25%) in cows with mildly purulent discharge (<50%), suggesting its potential role in early-stage endometritis. In contrast, Fusobacterium and Helcococcus dominated when purulent discharge exceeded 50%, while Bacteroides, Porphyromonas, and Peptostreptococcus prevailed in cows with malodorous or discolored secretions, indicating severe inflammation. This study extends previous findings by uncovering stage-specific microbial transitions and proposing Caviibacter as a potential early biomarker of endometritis. These insights support early diagnosis and targeted interventions, contributing to improved reproductive management and sustainable dairy farming. Full article

Introduction: Traumatic brain injury (TBI) is a leading cause of morbidity worldwide, with the Glasgow Coma Scale (GCS) serving as a tool to measure injury severity. This study aimed to investigate the relationship between GCS admission scores and various socio-demographic, clinical, injury-related, and hospital-related variables in patients with TBI across two tertiary care centers in Eastern Europe, a region that remains underrepresented in the literature. Methods: A retrospective observational study was conducted using data from 119 TBI patients admitted between March 2020 and June 2023 at Cluj County Emergency Hospital (Romania) and Saint Vincent Hospital (Poland). GCS scores were analyzed as both categorical and continuous variables. Statistical analyses included Wilcoxon and Kruskal–Wallis tests for group comparisons and Spearman correlations for continuous variables. Results: Most patients included suffered a mild TBI (GCS score between 13 and 15). There were significant associations between GCS scores and post-traumatic amnesia (p < 0.05), discharge status (p < 0.01), discharge destination (p < 0.01), and education level (p < 0.01). GCS scores at admission were linked to survival, absence of post-traumatic amnesia, higher education levels, and home discharge. No significant differences observed across sex, residence, employment status, injury type, cause, or mechanism of injury. A weak but significant negative correlation was observed between GCS and length of hospital stay (rho = −0.229, p > 0.05), while age showed a non-significant correlation. Conclusions: The GCS score at admission is significantly associated with various clinical and socio-demographic outcomes in TBI patients, supporting the utility of the GCS score as a prognostic tool. The predominance of mild cases and the absence of radiological data, such as cerebral contusions or epidural or subdural hematomas, limit the generalizability of the findings. Further studies with larger samples and comprehensive imaging data are necessary to validate these findings. Full article

Objective: To explore the experiences and self-efficacy of parent-caregivers providing care for a child with a tracheostomy tube. Study Design: Parent-caregivers completed surveys and participated in semi-structured interviews about their experiences learning to care for their child with a tracheostomy tube. Survey data were analyzed using descriptive statistics. Interviews were transcribed verbatim and analyzed thematically through coding. Results: Fifteen parent-caregivers participated in the survey, 13 of whom completed an interview. After receiving a tracheostomy, children were hospitalized a median of 6 months prior to discharge home. At the time of our study, children had been home for a median of 3.5 years. Parent-caregivers felt more prepared to perform routine daily care compared to triaging a change in medical status. Parent-caregiver self-efficacy in performing tracheostomy care skills improved with experience at home. Four themes were identified from interviews: new identity formation, enduring education, child and family biopsychosocial support, and establishing normalcy. Parent-caregivers shared that education was more than just acquiring skills; it also involved discovering diverse ways of learning and building confidence in one’s own abilities to fulfill the many types of roles they serve to successfully care for and keep their child safe while supporting their social and emotional needs as parent-caregivers. Conclusions: Parent-caregivers’ reflections on their experiences provide critical insight into their psychosocial needs and challenges in providing care to children with tracheostomies. Further investigation of lived experiences is vital to shaping a community that can support families of medically complex children. Full article

Plasma electrolytic oxidation (PEO) is an advanced electrochemical surface treatment technology. It can effectively improve the corrosion resistance of magnesium and its alloys. This paper aims to form protective PEO coatings on an AZ31 substrate with different electrolytes, while monitoring the micro-discharge evolution by noise intensity and morphology analysis. By setting the PEO parameters and monitoring process characteristics, such as current density, spark appearance, and noise intensity, it was deduced that the PEO process consists of the following three stages: anodic oxidation, spark discharge, and micro-arc discharge. The PEO oxide coating formed on the AZ31 alloy exhibits various irregular volcano-like structures. Oxygen species are uniformly distributed along the coating cross-section. Phosphorus species tend to be enriched inwards to the coating/magnesium substrate interface, while aluminum piles up towards the surface region. Surface roughness of the PEO coating formed in the silicate-based electrolyte was the lowest in an arithmetic average height (Sa) of 0.76 μm. Electrochemical analysis indicated that the corrosion current density of the PEO coating decreased by about two orders of magnitude compared to that of untreated blank AZ31 substrate, while, at the same time, the open-circuit potential shifted significantly to the positive direction. The corrosion current density of the 10 min/400 V coating was 1.415 × 10⁻⁶ A/cm², approximately 17% lower than that of the 2 min/400 V coating (1.738 × 10⁻⁶ A/cm²). For a fixed 10 min treatment, the longer the PEO duration time, the lower the corrosion current density. Finally, the tested potentiodynamic polarization curve reveals the impact of different types of PEO electrolytes and different durations of PEO treatment on the corrosion resistance of the oxide coating surface. Full article

Post-acute sequelae of COVID-19 have been associated with an elevated risk of thromboembolism and adverse cardiovascular events (CVEs). We aim to evaluate whether alterations in poorly studied hemostatic and endothelial proteins are associated with CVEs in patients previously admitted to the ICU and evaluated one year post-discharge. We carried out a cross-sectional study involving 63 COVID-19 patients previously admitted to the ICU one year post-discharge. Plasma levels of factor IX (coagulation factor), protein C, protein S (natural anticoagulant), and von Willebrand factor (VWF, an endothelial marker) were measured using a Luminex 200™ analyzer. Generalized linear models (GLMs) were used to assess the association of these coagulation proteins with CVEs and N-terminal pro-B-type natriuretic peptide (NT-proBNP). We found that lower levels of factor IX (p = 0.011), protein C (p = 0.028), and protein S (p = 0.008) were associated with CVEs one year after ICU discharge. Additionally, at the one-year follow-up, we found lower levels of factor IX (p = 0.002) and higher levels of VWF (p = 0.006) associated with higher levels of NT-proBNP, underscoring the involvement of both hemostatic imbalance and persistent endothelial dysfunction. Our findings revealed a gender-specific pattern of associations with NT-proBNP levels. These findings highlight the significant role of persistent hemostatic imbalance and endothelial dysfunction in the development of cardiovascular abnormalities among COVID-19 survivors discharged from the ICU. Full article

Sulfate as a potential pollution source in the water environment of the basin, identifying sulfate sources and migration mechanisms is essential for protecting the water environment and ensuring sustainable water management. Liuyang River is a primary tributary of the Xiangjiang River. It has experienced progressively intensifying anthropogenic influences in recent decades, manifested by sustained sulfate concentration increases. However, the sulfate sources and their contributions were not clear. This study used hydrochemistry and multi-isotopes methods combined with Simmr model to study the hydrochemical characteristics, sulfate sources, and migration–transformation processes of surface water and groundwater. The results showed that the hydrochemical types of surface water were HCO₃-Ca and HCO₃·SO₄-Ca·Mg, and groundwater were HCO₃-Ca, HCO₃-Ca·Mg, and HCO₃·SO₄-Ca. Ions in the water primarily originated from carbonate and silicate rocks dissolution and sulfide oxidation, augmented by mining operations, sewage discharge, and chemical production. The analyses of hydrochemistry, isotopes, and Simmr model revealed that surface water sulfate originated from soil sulfate (35.70%), sulfide oxidation (26.56%), sewage (16.58%), and atmospheric precipitation (12.45%). Groundwater sulfate was derived predominantly from sewage (34.96%), followed by soil sulfate (28.09%), atmospheric precipitation (17.35%), and sulfide oxidation (12.25%). Sulfate migration and transformation were controlled by the natural environment and anthropogenic impacts. When unaffected by human activities, sulfate mainly originated from soil and atmospheric precipitation, relating to topography, geological conditions, agricultural activities, and precipitation intensity. However, in regions with intense human activities, contributions from sewage and sulfide oxidation significantly increased due to the influences of mining and industrial activities. Full article

Botulism is a severe muscle paralysis disease mediated by the botulinum toxin. Here, we reported a foodborne botulism case caused by Clostridium botulinum subtype A5(b3) from self-packaged vacuum spicy rabbit heads. Treatment for this case was delayed due to misdiagnosis and insufficient diagnostic capacity in three hospitals, which resulted in progressive clinical deterioration, and eventually, the patient was transferred to Shandong Public Health Clinical Center for specialized therapy. The case was suspected as foodborne botulism by the Qilu Medical-Prevention Innovation Integration pathway and multi-disciplinary consultation. An epidemiological investigation and laboratory confirmation revealed that the botulinum neurotoxin originated from vacuum-packaged spicy rabbit heads distributed via interprovincial cold chain logistics. After treatment with botulism antiserum, the patient’s condition significantly improved, and they were discharged after recovery. We revealed that this foodborne botulism outbreak was caused by the Clostridium botulinum A5(b3) subtype from food by whole-genome sequencing and SNP typing. All the strains belonged to Group I carrying the botulinum neurotoxin gene classified as the ha cluster. Toxin A was confirmed by MBA and other methods, while toxin B was non-functional due to the truncated bont/B gene. Other virulence genes and antibiotic resistance genes were also detected. Our findings indicate that self-packaged vacuum meat products represent an emerging risk factor for botulism transmission when stored improperly. Importantly, the recurrent misdiagnosis in this case underscored the urgent need to enhance the training of healthcare professionals in medical institutions to improve the diagnostic accuracy and clinical management of botulism. Full article