Search Results (11,861)

Background: Sustaining measles elimination in the post-elimination era presents increasing challenges due to global resurgence and waning vaccine-induced immunity. We aimed to evaluate epidemiological trends, vaccination strategies, and population immunity associated with achieving and maintaining measles elimination in Taiwan. Methods: We conducted a comprehensive analysis of national surveillance data from 1991 to 2024, including case notifications, viral genotypes, vaccination coverage rates, and surveillance performance indicators. Three population-based seroprevalence surveys conducted between 2002 and 2020 were reviewed to assess age-specific immunity. Descriptive analyses were performed to characterize long-term epidemiological and immunological trends. Results: From 1993 to 2024, the annual number of measles cases remained consistently below 50, except in 2019. Vaccination coverage for both MMR1 and MMR2 has exceeded 95% since 1998, with MMR1 coverage remaining above 97% between 2009 and 2024. Genotyping evidence confirms the interruption of endemic transmission since 2006; furthermore, as of 2024, no continuous chains of transmission lasting longer than 12 months have been recorded. National seroprevalence surveys monitoring measles-specific IgG antibodies revealed declining antibody levels among adolescents and young adults, with seropositivity as low as 36.7% in specific cohorts. Despite this, transmission following importations has remained limited, with minimal secondary spread. Conclusions: Taiwan has successfully sustained measles elimination through high vaccination coverage, robust surveillance, and targeted interventions. Although serological evidence indicates waning immunity, epidemiological data suggest preserved population-level protection, likely mediated by immunological memory. Targeted booster strategies for high-risk groups may be more appropriate than universal additional dosing in post-elimination settings. Full article

Objective: To validate the Oldfry instrumental device for efficiently detecting the risk of falls and frailty in older adults. Design and Methods: An observational, analytical, cross-sectional, multicenter, non-randomized study to validate an instrumental device. It was conducted in several nursing homes for the elderly in the province of Castellón, Comunidad Valenciana, Spain, from February to April 2024. The estimated necessary sample size was 149 people. Specific selection criteria and voluntary acceptance to participate in the study were established. Sociodemographic, anthropometric, and other variables such as fall history in the past year were collected. A descriptive and comparative analysis of the variables was performed. The validity and reliability of the device in its measurements were determined to compare the results of the Timed Up and Go (TUG) test and the Short Physical Performance Battery test (SPPB), with respect to the Oldfry instrumental device. Informed consent was obtained from all participants, and the study was approved by the Bioethics Committee of the University Jaume I. Results: The sample consisted of 151 participants with a median age of 84 years (IQR [78.0–91.0]), comprising 39.10% men and 60.90% women, 65 years of age or older. Oldfry presents a sensitivity of 45.90% and a specificity of 72.7% for the risk of falls with a correlation R: 0.773 and an ICC concordance: 0.821. For frailty assessment, it shows a sensitivity of 91.90% and a specificity of 9.10% with an R: 0.854 and ICC: 0.805. Conclusions: This device has proven to be an effective tool for detecting both the risk of falls and frailty in older adults residing in institutions, showing high levels of reliability, sensitivity, and high concordance and correlation in both measurements. Future studies are anticipated to evaluate the benefits of this application. Full article

Background/Objectives: This study aimed to determine the inguinal hernia recurrence rate after transabdominal preperitoneal (TAPP) repair, particularly considering the effect of simultaneous umbilical hernia repair. The secondary aim was to assess whether closing the 10 mm midline supraumbilical port-site fascia affects the incidence of trocar-site hernia (TSH) following inguinal TAPP. Methods: We reviewed medical records of consecutive patients undergoing inguinal TAPP at the Department of Surgery, University Hospital Centre Zagreb, between 1 January 2014 and 30 June 2022, and supplemented the data with telephone follow-up. Demographic, clinical, and operative variables were compared between patients who did and did not report inguinal hernia recurrence. Patients were also grouped by operating surgeon to compare TSH rates. Surgeon A routinely closed the 10 mm supraumbilical fascial defect with a single suture, while Surgeon B mostly did not, deciding on a case-by-case basis. Results: The analysis included 281 patients with a median follow-up of 60 months. The overall recurrence rate was 10.6%. Baseline demographic and clinical characteristics did not differ significantly between patients who reported recurrence and those who did not. A prior hernia repair was more common in the recurrence group (34.1% vs. 17.2%; p = 0.007). Concomitant umbilical hernia repair was performed in 12.5% of cases. Patient-reported recurrence was higher after combined TAPP and umbilical hernioplasty than after TAPP alone (14.3% vs. 12.2%), but this difference was not statistically significant (p = 0.784). Surgeon A had a lower observed TSH rate than Surgeon B (1.0% vs. 3.6%), although this difference did not reach statistical significance (p = 0.242). Conclusions: Concurrent TAPP and umbilical hernioplasty is not associated with a higher recurrence rate, but further research on a larger cohort is necessary. Routine closure of the 10 mm midline supraumbilical fascial defect could reduce the TSH rate, although the difference was not statistically significant. The side of the hernia does not influence recurrence after TAPP. Full article

Machine learning-based network intrusion detection systems (NIDSs) remain vulnerable to adversarial manipulation, but the robustness literature for tabular NIDS data is still dominated by single-model, single-dataset, and non-adaptive evaluations. In this paper, we reposition the manuscript as a comparative robustness study of a four-component defense pipeline rather than as a claim of a universal defense primitive. We evaluate XGBoost, LightGBM, TabNet, and Residual MLP on RT_IOT2022 and Web_IDS23 under standard attacks, representative constrained/adaptive attacks, component-wise ablations, sample-fraction sensitivity, repeated-run significance tests, per-class F1 analysis, and computational-overhead measurements. The results show strong dataset and architecture dependence. On RT_IOT2022, tree-based models close most of the robustness gap under strong attacks but often only after large clean-accuracy reductions; Residual MLP achieves a more favorable balance, while the full defense stack over-regularizes TabNet. On Web_IDS23, aggregate robustness-gap reduction remains positive, yet simpler baselines such as adversarial-training-only or ensemble-only configurations frequently outperform the full four-stage pipeline in absolute clean/attack accuracy. Across both datasets, median filtering is the most fragile component: larger filter windows substantially degrade both clean and attacked accuracy, whereas contamination rate, anomaly-mixing weight, and ensemble size are comparatively stable. Representative constrained/adaptive evaluations reduce performance only modestly relative to standard FGSM/PGD, but per-class and overhead analyses show that minority-class collapse and training cost remain important deployment limitations. These findings support a more cautious conclusion: adversarial defense for tabular NIDS is validation driven and dataset specific, and the full defense stack should not be treated as a universal default. Full article

Nanoimprint lithography (NIL) plays an increasingly important role in modern nanomanufacturing processes, but its effective application in production conditions requires precise tools for evaluating and optimising technological processes. The aim of the study was to develop and model key performance indicators (KPIs) supporting the optimisation of the quality, stability and efficiency of nanoimprint lithography processes. As part of the selection of indicators, a literature review, surveys and in-depth interviews with industry experts were conducted, which enabled the identification of indicators relevant from a technological practice perspective. The proposed KPI classification was directly linked to the stages of the NIL process, creating a basis for operational performance control and process capability analysis. A novel aspect is the proposal of an integrated KPI model that combines the classification of indicators based on the stages of the NIL process with their direct link to technological parameters and measurable quality effects. These indicators have been linked to critical process parameters for different NIL variants, including Thermal NIL, UV-NIL, Roll-to-Roll NIL and Step-and-Repeat NIL, using a process analysis and multi-criteria optimisation approach. Research indicates that the use of an integrated KPI model improves the accuracy of nanostructure mapping, reduced defect density, and increased process efficiency without compromising technological stability. The proposed approach is a universal tool supporting NIL process control, its scaling to industrial applications, and integration with statistical process control and data-driven optimisation methods. Full article

Background: During the flu season, there is an increase in absenteeism due to illness, a drop in productivity, and a greater risk of the virus spreading among workers. Thus, the Italian Ministry of Health recommends vaccination for essential service workers. The University of Salerno, in collaboration with the local health authority of Salerno, offers free vaccination to its employees. Methods: A public health methodology for seasonal influenza vaccination in the workplace is presented—specifically in the university setting—with the aim of identifying individual, contextual, and organizational elements of the model that have promoted vaccination uptake. An ad hoc questionnaire was used (October–December 2025) to survey 399 academic employees, investigating seasonal influenza vaccination in the following aspects: recent personal experiences, motivations, vaccination experiences at university, sources of information, considerations regarding national and local vaccination campaigns, and level of vaccine confidence (VCI). Results: Seasonal influenza vaccination at the University is appreciated for its compatibility with working hours (66.1%), the availability of a platform that allows flexible booking (56.9%), the perception of safety in the environment (31.6%), the fact that the vaccine is free (17.4%), and the involvement of office/laboratory colleagues (5%). Participants appreciate the model and would apply it to other vaccinations at the University and in other institutional settings. A significant relationship (F = 7.24; df = 1; p < 0.05) exists between confidence in the vaccine and the sense of security experienced when receiving the vaccine in the workplace. Data analysis was performed using the IBM SPSS v.28 software. Conclusions: The model proposed can be applied to other institutional contexts, simplifying and facilitating access to vaccines by implementing vaccination campaigns tailored to specific work environments. Full article

Background: Molecular syndromic stool panels are increasingly used in paediatric diarrheal syndromes; however, interpretation of Clostridioides difficile (C. difficile) detection remains challenging because colonisation is common in younger children. We aimed to assess the frequency of C. difficile detection using a syndromic gastrointestinal panel in a paediatric tertiary-care centre and to describe the subsequent microbiological work-up and CDI-directed treatment. Methods: We conducted a retrospective single-centre study of all BioFire FilmArray Gastrointestinal (GI) panels performed at San Marco Hospital (University Hospital “G. Rodolico-San Marco”, Catania, Italy) from 1 January 2023 to 31 December 2025. Only the first C. difficile-positive result per patient was included; repeat positives within 30 days were excluded. Index-positive episodes were stratified by age (<1 year, 1 to <2 years, and ≥2 years). Data collected included co-detected pathogens, toxin A/B enzyme immunoassay (EIA) results, GeneXpert PCR findings, and CDI-directed therapy. Results: Among the 714 GI panels performed during the study period, 112 (15.7%) were positive for C. difficile. After exclusion of repeat positives, 91 index-positive episodes were analysed. Median age was 1.0 years (IQR 0.75–4.0), and 48/91 cases (52.7%) occurred in children younger than two years. Toxin A/B EIA was positive in 11/82 tested episodes (13.4%), whereas GeneXpert tcdB was positive in 75/84 episodes (89.3%). Co-detection of at least one additional enteric pathogen occurred in 40/91 cases (44.0%). CDI-directed therapy was administered in 9/91 episodes (9.9%), mainly in children aged ≥2 years. Conclusions: Detection of C. difficile by syndromic molecular panels was relatively frequent in our paediatric cohort but rarely associated with toxin positivity or the need for specific treatment. These findings suggest that many positive Nucleic Acid Amplification Test (NAAT) results may represent colonisation rather than true infection, particularly in younger children. Careful clinical interpretation of syndromic panel results is therefore essential to avoid overdiagnosis and unnecessary antimicrobial therapy. Full article

This study aims to develop a machine learning model that can accurately detect cyberattacks. We compare the performance of Support Vector Machine (SVM), Logistic Regression (LR), and Random Forest (RF) in predicting cyberattacks. Furthermore, we investigate whether using Information Gain Attribute Evaluation (IGAE) for feature selection improves the performance of the algorithms. This work provides a clear comparison of the algorithms and shows the most suitable one for classifying cyberattacks. In addition, this study combines LR and RF using a voting classifier along with IGAE and compares its performance with that of the rest of the algorithms. We investigate whether combining algorithms increases the accuracy of the results. The results show that the most accurate algorithm is RF, followed by LR and SVM. Contrary to initial expectations, the findings further indicate that the application of IGAE marginally reduces algorithm accuracy across the tested classifiers, suggesting that feature selection through information gain is not universally beneficial in cyberattack detection tasks. These findings contribute to the growing body of knowledge on effective machine learning methodologies for cybersecurity applications. Full article

This paper presents a comparative analysis of unconventional roundabouts, commonly referred to as third-generation roundabouts, based on case studies from the United States and Europe, specifically Croatia and Italy. These intersection designs deviate from traditional circular geometries to overcome limitations in safety, capacity, and spatial integration, especially in constrained or high-demand environments. The study focuses on three major typologies: raindrop, turbo, and two-geometry roundabouts (TGRs), examining their geometric characteristics, operational principles, and context-specific implementations. Based on real-world examples and qualitative assessments, each national section investigates design rationale and performance considerations in relation to local traffic dynamics. The paper contributes to the understanding of adaptive and context-sensitive intersection design, offering a conceptual framework for comparing unconventional roundabout typologies across different regulatory environments. The comparative analysis reveals that each typology responds to specific operational and spatial constraints rather than representing a universally optimal solution. In particular, raindrop and dog-bone roundabouts are most effective in interchange contexts, turbo roundabouts enhance safety and capacity in regulated multilane environments, while TGRs provide greater adaptability in constrained and irregular urban settings. These findings highlight the importance of context-dependent design strategies and support the need for flexible and context-sensitive evaluation frameworks. Full article

Background/Purpose: Rectal neuroendocrine tumors (NETs) with distant metastases are uncommon, and evidence supporting the effectiveness of peptide receptor radionuclide therapy (PRRT) in this population remains limited, particularly in Asian cohorts. This study aimed to evaluate the clinical role and real-world outcomes of PRRT in Japanese patients with somatostatin receptor-positive metastatic rectal NETs. Methods: We retrospectively analyzed 20 patients with metastatic rectal NETs who underwent PRRT at the University Hospital Basel (Switzerland) and Yokohama City University Hospital (Japan) between April 2015 and May 2023. The primary endpoint was progression-free survival (PFS), and secondary endpoints included disease control rate (DCR), overall response rate (ORR), overall survival (OS), and adverse events (AEs). Exploratory subgroup analyses were performed according to clinical characteristics, including changes in serum neuron-specific enolase (NSE). Results: The median PFS was 18.9 months (95% CI, 13.5–24.3), and the median OS was 30.3 months (95% CI, 18.9–41.7). The DCR was 80.0%, and the ORR was 15.0%. Treatment responses included partial response in 3 patients, stable disease in 13, progressive disease in 3, and not evaluable in 1. The most common AEs were lymphopenia and anemia, and no secondary malignancies were observed. No clinical factors were significantly associated with PFS; however, higher baseline NSE levels showed a trend toward shorter PFS. Patients with post-treatment declines in NSE showed more favorable treatment responses. Conclusions: PRRT may provide durable disease control with a favorable safety profile in Japanese patients with metastatic rectal NETs. However, these findings should be interpreted with caution given the small sample size and heterogeneous patient population. Baseline NSE elevation and early post-treatment declines may serve as potential prognostic indicators. These results are hypothesis-generating and warrant validation in larger, multicenter studies. Full article

Wastewater heat recovery has emerged as a vital strategy for building energy conservation, due to its significant potential and the inherent thermal stability of sewage as a heat source. Enhancing synergy between such waste heat and other clean energy sources is a key research focus. This study developed a solar-assisted sewage-source coupled heating system for a Chinese university dormitory and established a multiobjective optimization framework integrating economic, environmental, and energy efficiency indicators via a combined weighting approach of the Analytic Hierarchy Process and Entropy Weight Method. Optimization was conducted using the Hooke–Jeeves algorithm, Particle Swarm Optimization algorithm, and the Hooke–Jeeves–Particle Swarm Optimization hybrid algorithm (shorten as HJ–PSO), with subsequent comparative performance analysis. The HJ–PSO hybrid performed best: 24% lower operating costs, a 4.8-year shorter dynamic payback period, 26.35% fewer carbon dioxide emissions, 38.65% lower overall energy consumption, and an 11.18% higher system coefficient of performance. Supported by relevant policies, the system is low-carbon and economically viable, enabling grid peak shaving. This research provides theoretical and engineering references for renewable energy heating systems. Full article

Classrooms in severe cold regions face the dual challenge of ensuring high-quality daylighting while minimizing heating energy consumption. To address this challenge, this study develops a data-driven workflow that integrates building performance simulation, multi-objective optimization and a classification-based surrogate model, aiming to explore integrated improvements in daylighting and heating energy consumption in university classrooms. The results show that: (1) multi-objective optimization significantly enhances overall performance. Daylighting performance improves, with Spatial Daylight Autonomy (sDA) and Useful Daylight Illuminance (UDI) increasing by 0.15 and 10.67%, respectively, and Daylight Glare Probability (DGP) decreasing by 16.35%. Meanwhile, Heating Energy Consumption (E_h) is reduced by 6.20 kWh/m²; (2) SHAP analysis further identifies classroom depth, height, and glazing option as key design parameters influencing integrated daylight–thermal performance; (3) the MLP classification model achieves stable predictive accuracy, with accuracy, recall, and F1-score exceeding 0.95, demonstrating strong generalization ability. This study provides quantitative insights into the relationship between spatial parameters and daylight–thermal performance, offering researchers a method for rapidly evaluating design schemes at the early design stage. Full article

Robotic colorectal surgery has revolutionized minimally invasive techniques worldwide, offering a more stable operative platform, superior 3D visualization, and wristed instrumentation for challenging pelvic dissections. This narrative review describes the global evolution of robotic colorectal surgery, from the use of multi-port to single-port systems, modular platforms and endoluminal robotic devices. Using Hong Kong’s role as an innovation and research hub, this review demonstrates how integrated innovation, structured training, workflow efficiencies and digital policy frameworks can overcome barriers and inform international implementation of robotic colorectal surgery. Since 2005, The Chinese University of Hong Kong has been pioneering the use of robotic platforms in colorectal surgery, performing first-in-human trials of the da Vinci SP system, the locally developed Sentire C1000 and the EndoMaster EASE for robotic ESD. There is increasing evidence supporting the use of the robotic platform over laparoscopic colorectal surgery, with benefits including reduced open conversions, fewer intraoperative complications, shorter hospital stay, better long-term functional outcomes and improved oncologic outcomes. However, several challenges remain before robotics can be implemented widely on a global scale, such as higher initial capital costs, limited training access, surgeon credentialing and governance for AI-driven data analytics. Full article

Background/Objectives: Forensic DNA analysis is a key investigative resource in sexual-violence casework, but its recorded use depends on how cases move through clinical, custody, judicial, and laboratory pathways. In Italy, this transition is organizationally heterogeneous and poorly documented through linkable procedural data. This study aimed to describe archive-based trends in archived cases, documented judicial seizures, and recorded forensic DNA analyses within a Milan-based clinical-forensic custody pathway from 2016 to 2024. Methods: A retrospective, archive-based observational study was conducted using records from the institutional UNIMI forensic custody observatory linked to the SVSeD pathway. The primary dataset included annual counts of archived sexual-violence-related cases, cases with documented judicial seizure of biological evidence, and cases with recorded forensic DNA analysis. For contextual interpretation, aggregate centre-level indicators, namely total sexual-violence cases and ex officio reports, were also reviewed as non-linkable background data. Only descriptive analyses were performed, and no causal inference was attempted. Results: Over the study period, the archive recorded 2311 cases, 102 cases with documented judicial seizure of biological evidence, and 142 cases with recorded forensic DNA analysis. The temporal series showed marked variability, including a decline in 2020, followed by recovery in subsequent years. Most recorded forensic DNA analyses were documented as being performed by the Polizia Scientifica and Carabinieri (RIS/RaCIS), whereas smaller proportions involved the university laboratory and other external laboratories. Contextual indicators showed a progressive increase in total sexual-violence cases over time, while ex officio reports did not rise proportionally. Conclusions: The findings document pathway-level attrition between archived cases, documented seizure, and recorded forensic DNA analysis, but they do not identify the exact procedural stage at which attrition occurs. The absence of standardized case-level procedural variables precludes causal attribution for non-seizure or non-analysis of biological evidence. Future evaluation of forensic DNA utilization in sexual-violence casework will require standardized tracking across clinical, custody, judicial, and laboratory stages. Full article

Background and Objectives: Placental vascular lesions are significant histopathological findings that indicate disruptions in uteroplacental and fetoplacental circulations and are associated with adverse pregnancy outcomes such as preeclampsia, intrauterine growth restriction (IUGR), and perinatal morbidity. This study aimed to re-examine the frequency and distribution of placental vascular lesions in placentas submitted for histopathological analysis at our center, based on criteria established by the Amsterdam Placental Workshop Group Consensus Statement. Materials and Methods: In this retrospective study, placental samples examined in the Department of Pathology at Akdeniz University Faculty of Medicine from 2016 to 2019 were analyzed. A total of 571 cases with at least one placental vascular lesion identified on histopathology were included. Hematoxylin–eosin-stained sections from all cases were re-evaluated, and maternal vascular malperfusion (MVM), fetal vascular malperfusion (FVM), and other placental vascular pathologies were assessed according to the Amsterdam consensus criteria. Statistical analyses were performed using IBM SPSS Statistics for Windows, Version 25 (IBM Corp., Armonk, NY, USA). Categorical variables were compared using the chi-square or Fisher’s exact test, while continuous variables were analyzed with the Mann–Whitney U test. Results: MVM and FVM were considered the primary outcomes of the study. MVM was identified in 95.1% of cases, whereas FVM was present in 1.9%. Among individual lesions, chorangiosis (97.2%) and villous/perivillous fibrinoid deposition (88.3%) were the most frequent findings, followed by mucinous cystic degeneration of the umbilical cord (61.5%) and dystrophic calcification (58.1%). Retroplacental hematoma was observed in 38.4% of cases. Although no significant association was found between MVM and placental weight or size, umbilical cord length was significantly shorter in MVM-positive cases (p = 0.032). In contrast, FVM showed significant associations with chorangiosis (p = 0.035) and placentomegaly (p = 0.003). The high frequency of chorangiosis may reflect a compensatory angiogenic response to chronic intrauterine hypoxia, potentially mediated by vascular growth factors, with variable effectiveness depending on the severity of the underlying condition. Conclusions: These findings suggest that placental vascular lesions are not only markers of obstetric complications but also serve as morphological indicators of fetoplacental adaptive responses. Full article