Search Results (5,170)

Granular modeling has emerged as an interpretable framework for nonlinear system representation by constructing clusters of meaningful data units within the input and output domains. Unlike conventional neuro-fuzzy models that yield crisp outputs, granular models generate fuzzy-set-based outputs, preserving uncertainty information. However, traditional granular architectures rely on linear aggregation mechanisms, limiting their expressive power and structural adaptability. This paper proposes a novel framework termed Logic-Based Fuzzy Granular Networks (LFGNs), in which conventional granular models are enhanced through the incorporation of fuzzy logical neurons implementing AND–OR operations. The proposed logic-based structure enables nonlinear interactions among induced granules while maintaining interpretability. To further improve predictive performance, LFGNs are embedded into a boosting framework, forming a boosted LFGN in which each LFGN acts as a weak learner. Extensive simulation studies on benchmark datasets indicate that the proposed approach outperforms conventional granular models and the existing boosting method in terms of regression accuracy. The integration of logical neurons, boosting, and fuzzy granular models provides a unified and robust granular modeling framework. Full article

Background: Oral progestogens, including megestrol acetate (MA) and medroxyprogesterone acetate (MPA), have largely been superseded by aromatase inhibitors, tamoxifen, and selective oestrogen receptor degraders (SERDs) in oestrogen receptor-positive (ER-positive) metastatic breast cancer. However, they remain an option as late-line therapy after failure of standard treatments. Contemporary data are limited, particularly in patients previously treated with CDK4/6 inhibitors. Methods: We conducted a multi-site retrospective analysis of patients with ER-positive metastatic breast cancer treated with MA or MPA between 2014 and 2024 at four hospital sites across London, United Kingdom. Patients were identified using pharmacy dispensing records. Progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan–Meier method and Cox regression. Subgroup analyses included prior CDK4/6 inhibitor exposure, histology and liver metastases. Results: A total of 116 patients were included. Median PFS was 2.4 months (95% CI 2.2–2.9), and median OS was 3.3 months (95% CI 2.7–4.9). Prior CDK4/6 inhibitor exposure was associated with shorter PFS (1.9 vs. 2.8 months; HR 1.59; 95% CI 1.08–2.35, p = 0.019) and a trend toward shorter OS (3.1 vs. 3.6 months; HR 1.18, 95% CI 0.80–1.75, p = 0.41). Similarly, liver metastases were associated with shorter PFS (2.3 vs. 2.8 months; HR 1.78, 95% CI 1.12–2.85, p = 0.015), with a trend toward worse OS (3.1 vs. 4.9 months; HR 1.45, 95% CI 0.93–2.25, p = 0.103). A subset of patients derived prolonged benefit, with a 6-month PFS rate of 16%. Toxicity was manageable; thromboembolic events and oedema occurred in 9% and 11% of patients respectively. Appetite improvement was reported in 10%. Conclusions: MA and MPA demonstrated modest but clinically relevant late-line activity in heavily pretreated, endocrine-refractory ER-positive metastatic breast cancer. While prior exposure to CDK4/6 inhibitors was associated with shorter PFS, patients without liver metastases appeared to derive the greatest benefit. These findings support a role for oral progestogens in selected patients who have exhausted standard therapeutic options. Full article

Background: Traumatic hemothorax is a common complication of blunt chest trauma and remains associated with significant morbidity and mortality. Although contrast-enhanced computed tomography (CT) is central to diagnosis, the optimal criteria for selecting patients who require invasive management versus conservative treatment remain unclear. This study aimed to evaluate the management strategies and clinical outcomes of traumatic hemothorax and to identify predictors of surgical intervention and postoperative complications. Methods: We conducted a retrospective, single-center cohort study including adult patients admitted to a Level II Emergency Department with hemothorax following blunt chest trauma between January 2019 and December 2024. Primary outcomes were the need for urgent chest drainage or surgery. Secondary outcomes included postoperative complications, length of hospital stay, and intensive care unit admission. Univariable and multivariable regression analyses were performed to identify factors associated with surgical intervention and complications. Results: Seventy-two patients were included (mean age 60.0 ± 20.5 years; 80.6% male). Rib fractures were the most common cause of hemothorax (61.1%). Chest tube placement was required in 70.8% of cases, and 31.9% underwent urgent surgical intervention. Active bleeding on contrast-enhanced CT was identified in 16.7% of patients and was the only independent predictor of urgent surgery (OR 3.85, 95% CI 1.07–13.88; p = 0.039). The initial volume of blood drained after chest tube insertion did not differ between surgically and non-surgically managed patients. Conservative management was successful in 19.4% of cases. Postoperative complications occurred in five patients and were associated with a higher comorbidity burden. Overall mortality was 5.6%. Conclusions: In traumatic hemothorax following blunt chest trauma, active bleeding on contrast-enhanced CT seems to be the strongest predictor of urgent surgical intervention, whereas initial pleural drainage volume alone is not. Conservative management is safe in selected patients, while comorbidities influence postoperative outcomes. Multidisciplinary management and accurate radiological assessment are essential to guide timely and appropriate treatment. Full article

Background/Objectives: Poly(ADP-ribose) polymerase 1 (PARP1) is an important therapeutic target in DNA repair-deficient cancers, but discovery of new inhibitors remains constrained by scaffold convergence, tolerability limits, and acquired resistance. This study aimed to develop an interpretable, reliability-stratified cheminformatics workflow for PARP1 potency prioritization and structure-based follow-up. Methods: A curated ChEMBL dataset of 3339 PARP1 inhibitors was encoded using RDKit 2D descriptors and Avalon fingerprints (1143 initial features), then reduced to 132 informative variables by Random Forest-based feature selection. Five regression models were optimized, including a stacked ensemble. Model interpretation was performed using permutation feature importance and SHAP. External near-domain corroboration was assessed using a stringent PubChem similarity expansion (Tanimoto > 0.90) around sub-10 nM seed compounds, followed by comparison with retrievable experimental PARP1 activity values. Top scaffold-diverse candidates were further evaluated by complementary docking against PARP1 (PDB: 4R6E) using AutoDock Vina and cavity-guided docking through the SwissDock platform. Results: The stacked ensemble achieved the best held-out performance (test R² = 0.723; RMSE = 0.610 pIC₅₀ units), with 83.7% of test predictions within ≤0.75 pIC₅₀ units and only 2.7% exceeding 1.5 pIC₅₀ units. PubChem similarity expansion retrieved approximately 32,450 analogs, of which 3349 were predicted to have IC₅₀ ≤ 10 nM. Among 366 compounds with retrievable experimental PARP1 activity values, predicted versus experimental pIC₅₀ showed a positive association (R² = 0.124; Pearson r = 0.479), with RMSE = 0.491 and MAE = 0.330 pIC₅₀ units. Three ligands—CID 168873053, CID 175154210, and CID 172894737—showed the strongest complementary docking support and pocket-consistent poses relative to niraparib. Conclusions: This workflow provides a transparent and practically useful framework for near-domain PARP1 inhibitor prioritization. The combined QSAR, explainability, external corroboration, and docking strategy supports shortlist generation for experimental follow-up. Full article

This work presents a mechanistic modeling approach for simulating methane emissions from triethylene glycol (TEG) dehydrators used in oil & gas (O&G) operations. The model was developed as a modular component of the Mechanistic Air Emissions Simulator (MAES) tool, incorporating species-specific absorption and emission dynamics through two-level, second-order polynomial regression (PR) models trained on ProMax simulation data: (1) species-level regression models that track the transfer rates of individual gas species within the dehydrator unit streams, and (2) outlet flow stream regression models that predict the fraction of inlet gas distributed among the outlet streams of the dehydrator unit. These behaviors were characterized over a range of glycol circulation ratios, wet gas pressures, and temperatures. The model was validated using root mean square error (RMSE) analysis. The species-level PR achieved low root mean square error (RMSE) values (<0.03) for light hydrocarbon species across all dehydrator components, ranging from 0.0009 for methane to 0.029 for normal pentane. Similarly, the outlet-level PR yielded RMSE values below 0.002 for the dry gas fraction, 0.001 for the flash tank fraction, and 0.002 for the still vent fraction, demonstrating strong agreement between predicted and reference ProMax values. When deployed at field facilities, the model significantly improved MAES-simulated dehydrator emissions, revealing that gas-assisted glycol pump emissions are the dominant contributors to both dehydrator-level and site-level methane emissions under uncontrolled conditions. Further analysis of the 154 dehydrator units reported by operators under the AMI 2024 project showed that 54 units (31%) used gas-driven glycol pumps, of which 6 units (11%) operated with uncontrolled flash tanks, and 22 units (40.7%) were identified as potentially oversized. Of the six dehydrator units with uncontrolled gas-assisted pumps, pump emissions accounted for 90.25% of total dehydrator emissions and 63.10% of total site-level emissions. These findings highlight substantial opportunities for emissions mitigation through equipment upgrades. Full article

Against the background of the acceleration of the integration of the “double carbon” target and transportation energy, the green transformation and business model innovation of highway service areas, as a high-energy-consumption traffic node, are becoming more and more urgent. However, the existing research focuses on a single technology path, and lacks a systematic quantitative evaluation of the “PV–charging–new format” coordination mechanism and its operating efficiency. Therefore, this paper proposes a collaborative framework that integrates photovoltaic power generation, new energy charging piles, and diversified new formats, and introduces a random forest regression algorithm. Based on the actual operation data of the Guangxi expressway service area, the synergistic effect and regional heterogeneity of multiple factors are systematically evaluated. The results show that a photovoltaic system can reduce the unit electricity price by 25–35%, and the investment recovery period is about 7 years. When the penetration rate of charging piles increases to 35%, the annual income can reach CNY 3.285 million, and the return on investment increases to 2.3 times when the utilization rate exceeds 80%. The new business combination can increase the average daily income by 13.3–26.7%. At the same time, the coordinated implementation of the three elements can achieve an annual net income increase of 27–32%, which is better than the linear superposition of the benefits of a single measure. In addition, the analysis of regional heterogeneity shows that the photovoltaic benefit in the western mountainous area is outstanding, the charging benefit in the coastal area is significant, and the comprehensive benefit in the central hub area is the best. This study provides a quantitative basis to support decisions on the differentiated development path of expressway service areas in the background of traffic–energy integration. Full article

Objective: We sought to compare common neonatal and maternal morbidity outcomes amongst operative vaginal delivery (OVD) versus cesarean delivery performed in the setting of failed attempt at labor. We planned to stratify outcomes by type of OVD (vacuum-assisted vaginal delivery (VAVD) and forceps-assisted vaginal delivery (FAVD)). Methods: This was a retrospective cohort study of singleton live births in the United States, using the 2023 National Vital Statistics birth certificate dataset. The primary outcome of interest was the risk of neonatal morbidity, as listed on the birth certificate. The secondary outcome of interest was the risk of maternal morbidity. Neonatal morbidities were planned to be analyzed independently (i.e., risk of NICU admission, need for antibiotics) as well as in aggregate (i.e., the risk of any morbidity occurring). Three groups were planned: FAVD, VAVD, and cesarean in the setting of attempted labor or attempted induction of labor (referent group). Differences in demographic and clinical characteristics were compared and subsequently adjusted for, and odds ratios (aOR) were calculated using multivariable logistic regression. Results: Of the 3,605,081 births from 2023, there were 15,384 FAVDs; 83,134 VAVDs; and 325,310 cesareans after failed labor. Neonatal morbidity was lower in FAVD (aOR 0.71, 95% CI 0.66–0.76) and VAVD (aOR 0.57, 95% CI 0.55–0.59) compared to cesarean delivery, with VAVD showing the lowest rates, in particular, the need for assisted ventilation (aOR 0.52 95% CI 0.48–0.57 with VAVD and aOR 0.74 95% CI 0.68–0.81 with FAVD) and NICU admissions aOR 0.66, 95% CI 0.60–0.71 with FAVD and aOR 0.48, 95% CI 0.46–0.51 with VAVD) were reduced with operative vaginal delivery. Antibiotic usage was only reduced in VAVD, not FAVD. Maternal morbidity was highest FAVD; however, this was driven by perineal lacerations. ICU admission, hysterectomy, and ruptured uterus were all higher in cesarean delivery than FAVD or VAVD. Conclusions: Operative vaginal delivery, particularly VAVD, is associated with reduced neonatal morbidity compared to cesarean delivery in the setting of labor. Full article

Service Level Agreement (SLA) compliance in hospital transport processes is essential in terms of patient safety, service continuity, and resource efficiency. However, transport requests occur as irregular events, limiting the applicability of equally spaced time-series assumptions. The presented study jointly addresses two complementary objectives in an event-based framework: predicting the interarrival time between consecutive transport requests (next-event forecasting) and forecasting the total request count within forward SLA horizons (forward-count forecasting). Machine learning methods such as Ridge Regression, Extra Trees, and Histogram-based Gradient Boosting, as well as deep learning architectures such as Long Short-Term Memory and Gated Recurrent Unit, were compared under different time horizons and adaptive history windows on time-stamped transport request records from the operational system supporting a private hospital in Turkey, including patient, specimen, and material transport requests. Results indicate that deep learning methods yield lower errors in demand count prediction at short time horizons; as the horizon lengthens, machine learning performs similarly and even outperforms in some cases; and as the history window increases, the prediction error for the next request occurrence systematically decreases. The lowest mean absolute error values in request counts were obtained for demand forecasting within a 30 min time window; 2.10 for material transport, 3.88 for patient transport, and 2.84 for specimen transport. Additionally, R² value reached 0.98 for next-event forecasting with a rolling-memory window of 20 events. Overall, the findings suggest that hospital transport demand is substantially predictable and that event-based forecasting can support SLA-oriented staffing, task dispatching, and delay mitigation. Full article

Background/Objectives: Platelet-rich plasma (PRP)–based regimens are widely used in non-scarring alopecia, yet objective response is variable and clinic-ready predictors are lacking. We evaluated short-term trichoscopic outcomes in routine practice and tested whether baseline complete blood count–derived inflammatory status, quantified by the neutrophil-to-lymphocyte ratio (NLR), can stratify response under PRP-based therapy. Methods: We performed an ambispective observational cohort study (October 2024–October 2025) in an outpatient dermatology practice. The final analytic cohort included 129 patients allocated to four treatment groups: PRP alone (n = 54), PRP combined with microneedling-assisted Purasomes Hair & Scalp Complex (HCS50+, Dermoaroma; exosome-containing) (n = 33), PRP combined with microneedling-assisted Mesoaroma Hair Cocktail (scalp formulation; nutrient complex) (n = 24), and a nutrient complex alone (n = 18). Trichoscopy (FotoFinder ATBM; FotoFinder Systems GmbH, Bad Birnbach, Germany) was obtained at baseline (T1) and first follow-up (T2). Density response was defined as a ≥10% increase in total hair density and hair-cycle response as an anagen fraction increase ≥5 percentage points. Predictive analyses were prespecified and restricted to PRP-containing regimens, using logistic regression and a multilayer perceptron with repeated cross-validation for internal validation. Results: Across the full cohort (n = 129), total hair density and hair-cycle parameters improved from T1 to T2. In the PRP-containing subgroup (n = 111), baseline NLR strongly discriminated density responders (AUC 0.85, bootstrap 95% CI 0.77–0.91). In multivariable models, NLR remained independently associated with density response (OR 0.31 per 1-unit increase, 95% CI 0.20–0.48). Conclusions: In this cohort, baseline NLR was associated with discrimination of early trichoscopic response in PRP-based treatment of non-scarring alopecia. Using the Youden-derived cut-off (NLR = 2.202), patients with NLR > 2.202 had a higher risk of density non-response (72.1% vs. 4.7%), corresponding to a 15.49-fold increased failure risk in this cohort. These findings are exploratory and hypothesis-generating, and external validation and calibration are required before any routine clinical or decision-support use. Full article

This study examines the firm-specific factors associated with the level and quality of compliance with the International Integrated Reporting Framework (IIRF) among companies in the United Arab Emirates (UAE), an emerging economy characterized by a growing sustainability-oriented institutional context. Although the Securities and Commodities Authority (SCA) mandates listed companies to publish an integrated report, it does not prescribe a specific reporting framework. As a result, alignment with the IIRF and the depth of disclosure remain largely discretionary. Using a sample of 89 non-financial firms listed on the Dubai Financial Market (DFM) and Abu Dhabi Securities Exchange (ADX), an Integrated Reporting Disclosure Score (IRDS) was constructed through content analysis based on 43 criteria derived from the IIRF. Regression and dominance analyses were employed to examine the relationship between firm characteristics and the level of IIRF compliance. The results indicate that firm size, profitability, board size, and gender diversity are positively associated with higher levels of IIRF alignment and disclosure quality, while financial leverage and board independence are not significantly associated with disclosure levels. The dominance analysis further shows that firm size, board size, gender diversity, and profitability account for the majority of the model’s explanatory power. Overall, the findings contribute to the literature by providing empirical evidence on voluntary compliance with international integrated reporting standards beyond mandatory reporting requirements in an emerging market context. Full article

Background: Implant-based breast reconstruction (IBBR) is the most widely used reconstructive strategy after mastectomy, but postoperative infection remains a major complication because it may require reoperation, implant explantation, and reconstructive failure. This study evaluated the incidence, determinants, and clinical burden of infection in a large single-center cohort. Materials and Methods: This retrospective observational study included 1537 reconstructed breasts undergoing post-mastectomy implant-based breast reconstruction. The unit of analysis was the reconstructed breast. Infection was defined clinically by erythema, pain, swelling, or secretion requiring antibiotic treatment, without requiring microbiological confirmation or formal surgical-site-infection criteria; this pragmatic definition reflects the retrospective nature of the study and should be considered when comparing results across studies. Univariate analyses were performed using chi-square, Fisher’s exact, or Mann–Whitney U tests, as appropriate. Independent predictors were assessed by multivariate binomial logistic regression. Results: Postoperative infection occurred in 66 of 1525 reconstructed breasts (4.3%). Among infected breasts, 54 cases (81.8%) required surgery, whereas 12 (18.2%) were managed conservatively. Implant explantation was performed in 82 of 1525 reconstructions (5.4%), and infection accounted for 39 of 74 explantations with available indication data (52.7%). In multivariate analysis, longer operative time remained independently associated with infection (OR 1.005 per minute, 95% CI 1.001–1.010; p = 0.010; corresponding to OR 1.38, 95% CI 1.08–1.77, per 60 min increment). Prepectoral reconstruction was also associated with a higher risk of infection compared with retropectoral reconstruction (OR 2.31, 95% CI 1.03–5.16; p = 0.042). Additional analyses showed that prepectoral reconstruction was more frequently associated with bilateral procedures, nipple-sparing mastectomy, and longer operative time. In unilateral reconstructions, the association between prepectoral reconstruction and infection persisted. Conclusions: Infection after implant-based breast reconstruction remains a clinically relevant source of morbidity and frequently requires further surgery. Longer operative time emerged as the most consistent independent factor associated with infection in the overall cohort. Prepectoral reconstruction was also associated with infection, although this finding should be interpreted cautiously in light of reconstructive context and case selection. Full article

Background/Objectives: High-grade serous ovarian cancer (HGSOC) represents the most aggressive subtype of epithelial ovarian cancer and is frequently diagnosed at advanced stages. Increasing evidence suggests that systemic inflammation plays an important role in tumor progression and clinical outcomes. This study aimed to evaluate the association between preoperative systemic inflammatory indices and tumor burden, perioperative outcomes, and recurrence risk in patients with HGSOC undergoing primary debulking surgery. Methods: We conducted a retrospective study including 125 patients with histopathologically confirmed HGSOC who underwent primary debulking surgery between January 2020 and December 2025. Preoperative hematological parameters obtained within 24 h before surgery were used to calculate inflammatory indices including the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), and aggregate index of systemic inflammation (AISI). Associations between inflammatory markers, clinicopathological characteristics, perioperative outcomes, and recurrence were analyzed using non-parametric tests and logistic regression models. Results: The mean patient age was 53.66 ± 9.14 years, and most patients presented with advanced disease (FIGO III–IV: 70.4%). Patients with T3 tumors showed significantly higher monocyte (0.66 vs. 0.50 × 10⁹/L, p = 0.003), neutrophil (5.43 vs. 4.99 × 10⁹/L, p = 0.042), and platelet counts (325 vs. 280 × 10⁹/L, p = 0.006) and lower lymphocyte counts (1.79 vs. 1.96 × 10⁹/L, p = 0.009). Composite inflammatory indices were also increased in advanced disease, including PLR (177 vs. 153, p = 0.009), AISI (492 vs. 341, p = 0.002), and SIRI (1.65 vs. 1.18, p = 0.018). Patients requiring postoperative blood transfusion had higher neutrophil counts (7.65 vs. 4.97 × 10⁹/L, p < 0.001) and elevated SIRI (2.56 vs. 1.55, p < 0.001). Patients with recurrence had significantly higher platelet counts (339 vs. 293 × 10⁹/L, p = 0.001) and SII values (2849 vs. 2586, p = 0.012). In multivariate analysis, SII remained independently associated with recurrence (OR 1.022 per 100-unit increase; 95% CI 1.002–1.043; p = 0.033) together with advanced FIGO stages (OR 2.863; 95% CI 1.011–8.104; p = 0.048). Conclusions: Preoperative systemic inflammatory markers are significantly associated with tumor burden, surgical outcomes, and recurrence risk in HGSOC. An elevated SII appears to be an independent predictor of recurrence and may represent a practical biomarker for improving preoperative risk stratification and postoperative surveillance. Full article

Background/Objectives: Low fruit and vegetable consumption and unhealthy salt-related behaviours are important modifiable risk factors for non-communicable diseases. Nationally representative data on these dietary patterns in Kazakhstan remain limited. We aimed to assess fruit, vegetable, and salt-related behaviours among adults aged 18–69 years and examine the socio-demographic and geographic factors associated with inadequate fruit and vegetable consumption and unfavourable salt-related knowledge, attitudes, and behaviours. Methods: We conducted a nationally representative cross-sectional survey of 6720 adults across all 17 administrative units of Kazakhstan in 2021–2022 using multistage stratified cluster sampling and the WHO STEPS questionnaire. Fruit and vegetable consumption, as well as salt-related knowledge, attitudes, and behaviours, were assessed by interview. Associations were examined using weighted logistic regression. Results: Mean fruit and vegetable consumption was 3.0 (SD 2.3) servings/day, and only 15.7% of respondents met the WHO recommendation of ≥5 servings/day. Women were more likely than men to meet the WHO recommendation (17.9% vs. 13.4%), and men had lower adjusted odds of adequate fruit and vegetable consumption (aOR 0.72, 95% CI 0.62–0.84). Adequate fruit and vegetable consumption was most common in southern regions and least common in northern and urban areas. Although 80.6% of participants were aware of the health risks of high salt consumption, only 41.7% considered salt reduction very important, while 64.6% reported adding salt during cooking and 39.6% at the table, and 29.2% frequently consumed salty processed foods. Less favourable salt-related patterns were more common among men, younger adults, less educated respondents, smokers, and residents of several administrative units. Conclusions: Adults in Kazakhstan show insufficient fruit and vegetable consumption and suboptimal salt-related behaviours. Targeted, geographically adapted, multisectoral measures are needed to support healthier dietary practices. Full article

Mobile health units (MHUs) can reach populations facing barriers to traditional primary care, but information about factors associated with their utilization is limited. The objective of this ecological study was to evaluate whether MHU encounter density is increased in census tracts designated as Primary Care Health Professional Shortage Areas (HPSAs) and explore whether associations varied by socioeconomic vulnerability. We analyzed Wayne State University/Wayne Health MHU encounters with adult patients from July 2021 to September 2025. Negative binomial regression models with a log link and log(population) offset tested the a priori hypothesis that encounter density was increased in designated versus undesignated HPSA census tracts. Sensitivity analyses assessed variation by social vulnerability index score quartiles established by the US Centers for Disease Control and Prevention. One quarter of the five-county metropolitan Detroit, Michigan, catchment area census tracts were designated healthcare shortage areas. Overall, 13,852 encounters with 10,924 unique patients occurred across 924 of 1305 census tracts. Encounter rate per adult population was significantly increased by severalfold comparing designated versus undesignated shortage areas, with stronger associations at lower socioeconomic vulnerability index score quartiles (interaction p = 0.0006). These findings support continued efforts to scale and evaluate MHUs to address projected healthcare shortages, particularly in socioeconomically vulnerable areas. Full article

Greenhouse gas emissions reductions are urgently necessary to mitigate the effects of climate change. Several protocols and agreements are in place to reduce emissions, but global emissions continue to rise nonetheless. This is in part due to emissions offshoring: the shift of manufacturing from countries with developed economies to countries with developing economies. While many countries have achieved reductions through technological advancements, offshoring remains an issue, demonstrated by a global emissions increase despite developed economies reducing their emissions. Trends of atmospheric emission of nitrogen oxides (NO_X), which can be used as a surrogate for gauging sustainability with respect to fossil fuel combustion, confirm this issue. Canada has a developed economy and purports to have reduced emissions in recent decades. Countries accounting for 90% of the dollar value of manufactured goods imported to Canada from 1990 to 2022 were analyzed. Canada shows a decrease in NO_X emissions attributed to manufacturing alongside an increase in imports of manufactured products. Human Development Index (HDI), a United Nations metric for the development level of a country, was plotted against relative manufacturing NO_X emissions on a country basis. There are distinct trends over the time period among low, medium, high, and very high HDI categories for the top countries importing to Canada. Piecewise linear regressions were run for each country, allowing the number of breaks to be equivalent to the number of HDI category changes spanned over the time period. As the HDI category increased, the number of countries with an inverse relationship between HDI and NO_X emissions grew. Countries with very high HDI almost all showed that the HDI increase corresponded to lower emissions of NO_X, while countries with lower HDI categories showed a reduction in this trend. The results support the theory that Canada has offshored manufacturing emissions rather than decreasing the emissions they are responsible for in terms of their manufactured goods. Full article