Search Results (200)

Internet of Vehicles (IoV) security mechanisms often classify isolated messages or assign node-level trust scores, yet these decisions do not explain whether a malicious but authenticated event has distorted the intended evolution of traffic. This paper proposes IntentProv-IoV, a causally grounded provenance framework for traffic-intent preservation in V2X environments. Traffic intent is modeled as the short-horizon collective state expected under non-adversarial conditions, and deviation is measured between predicted and observed traffic states. The framework constructs temporal provenance graphs linking vehicles, roadside units (RSUs), cooperative perception outputs, prediction nodes, and traffic-control decisions. To remove the ambiguity of marginal contribution, node contribution is formalized as an interventional effect in a structural causal model and estimated through Monte Carlo counterfactual edge-weight attenuation, with a linear sensitivity fallback for real-time edge deployment. A calibrated composite score integrates anomaly evidence, traffic-intent deviation, trust risk, and provenance contribution. The evaluation design compares IntentProv-IoV with detection, trust, blockchain trust, graph anomaly, Granger causal, structural causal, and counterfactual GNN baselines and includes predictor sensitivity, adaptive adversaries, prediction noise, packet loss, trajectory-only real-data validation, and edge overhead. Simulation-scale results indicate improved attribution precision, stronger traffic-intent deviation reduction, and edge-suitable latency. By shifting V2X security from message-level detection to causally explainable traffic-intent assurance, IntentProv-IoV provides a more accountable security objective for cooperative vehicular systems. Full article

Background/Objectives: To quantify the adjusted association of obesity with in-hospital outcomes in adult scoliosis hospitalizations involving spine deformity corrective surgery. Methods: A retrospective cohort study was conducted using the National Inpatient Sample (2016–2021), including adult hospitalizations for scoliosis undergoing corrective spine surgery. Obesity was the primary exposure. The primary outcome was a composite of in-hospital complications. Secondary outcomes included individual complications, length of stay, total hospital charges, and discharge disposition. Weighted multivariable regression models adjusted for patient- and hospital-level factors were used. Sensitivity analysis was performed excluding severity adjustment to assess potential overadjustment, as the All Patient Refined Diagnosis Related Group (APR-DRG) severity score may partially reflect in-hospital complications. Results: Among 9323 unweighted hospitalizations (representing a national estimate of 46,610 weighted hospitalizations) included (16.6% obese), obesity was associated with a 22% increase in the odds of total in-hospital complications (Odds Ratio (OR) 1.22; 95% Confidence Interval (CI) 1.04–1.43). Among individual complication categories, obesity was associated with higher odds of renal complications (OR 1.69; 95% CI 1.29–2.21), whereas no significant differences were observed in pulmonary, cardiac, Venous Thromboembolism (VTE), or sepsis complications. Additionally, obesity was associated with increased odds of non-home discharge (OR 1.28; 95% CI 1.12–1.46). In sensitivity analysis, these associations were more pronounced, with additional complication categories reaching statistical significance. Conclusions: Obesity is associated with increased in-hospital morbidity in adult scoliosis surgery, particularly higher odds of renal complications and non-home discharge. These population-level findings help optimize preoperative risk communication and anticipate post-acute discharge resource needs. Full article

Background/Objectives: Fentanyl is widely used in ventilated preterm neonates, but respiratory safety evidence is limited. We assessed the association between fentanyl exposure during mechanical ventilation and respiratory outcomes in preterm neonates <34 weeks and explored a candidate exposure-duration threshold, defined as the duration of continuous fentanyl infusion beyond which the risk of adverse respiratory outcomes rises sharply. Methods: Single-centre retrospective cohort study at Policlinico Umberto I, Sapienza University, Rome (2015–2022). Fentanyl-exposed neonates were 1:2 matched to unexposed neonates on gestational age and birth-weight z-score. Primary outcome: bronchopulmonary dysplasia at 36 weeks postmenstrual age (multivariable logistic regression); secondary outcome: duration of invasive ventilation. A composite outcome (bronchopulmonary dysplasia or invasive ventilation ≥ 7 days) was used for threshold analysis with restricted cubic splines, maximally selected Wald χ², and segmented logistic regression. Results: Of 315 eligible neonates, 50 fentanyl-exposed neonates were matched with 92 unexposed neonates (n = 142). Fentanyl exposure was associated, after adjustment for gestational age and fetal distress, with bronchopulmonary dysplasia (adjusted odds ratio 5.49, 95% CI 1.72–17.54) and longer invasive ventilation (adjusted exp(β) 2.25, 95% CI 1.54–3.29). Three complementary threshold methods were consistent with an exploratory signal around 3 days of continuous infusion, beyond which composite-outcome odds rose, although the breakpoint estimate was imprecise. Conclusions: Fentanyl exposure during mechanical ventilation was associated, after adjustment for gestational age and fetal distress, with bronchopulmonary dysplasia and longer invasive ventilation in preterm neonates <34 weeks. A possible signal around 3 days of continuous infusion is proposed as a hypothesis-generating stewardship prompt, not as a decision rule. Full article

The widespread adoption of Location-Based Services (LBSs) has significantly enhanced daily convenience, yet the upload and storage of user trajectory data pose substantial privacy leakage risks. Addressing the limitations of existing privacy protection methods in achieving personalized adaptation and balancing privacy with utility, this paper proposes a personalized privacy protection strategy for location trajectories based on weighted Kullback–Leibler (KL) divergence. The approach first employs a Markov transition matrix to model user movement patterns, utilizes quadtree-based dynamic grid partitioning for adaptive encoding of the state space, and introduces sensitivity scores weighted by dwell duration and visit frequency to identify critical privacy-sensitive points. It then develops an exponential decay perturbation mechanism combining regularization parameters and distortion thresholds to preserve trajectory spatial usability while protecting sensitive transitions. By quantifying privacy leakage through weighted KL divergence and measuring data utility via distortion metrics, a linearly weighted composite index is constructed, enabling personalized parameter optimization via grid search. Experimental results on the real-world Geolife dataset demonstrate that compared to three differential privacy baselines, this method reduces privacy leakage (measured by weighted KL divergence), improves POI Recall rates, and decreases average geographic errors. Paired t-tests confirm that all improvements are statistically significant (p < 0.001) with large effect sizes, validating its effectiveness and superiority in balancing privacy protection and data usability. Full article

With the growing interest in Maritime Autonomous Surface Ships (MASS), numerous risk-assessment models have been proposed for route planning and hazard avoidance during navigation. Existing models, however, generally share two limitations. First, many assess risk from information such as vessel traffic and therefore do not adequately reflect the marine weather and sea state itself. Second, they often consider only one or two factors, such as wave height or wind, and even when several factors are merged into a single value, it is difficult to trace back why the result is dangerous. To overcome these limitations, this study proposes a Meteo-Hydrological Fusion Index (MHFI) that combines five environmental factors—wave height, swell period, current, wind, and visibility—into a single risk value. Each factor is first mapped to a 0–4 risk score, and the three highest scores at a given location are then combined by a weighted sum. This summarizes composite risk in a single value while preserving the ranking of the factors that produced it, so the result remains traceable. Applying the index to the coastal waters of Mokpo, we confirmed that the dominant factor behind a given risk grade varies with time and location, and that a rapid, area-wide rise in risk over a short period can be captured by a single indicator. We further show how risk varies along the main fairway and how the index can be overlaid on a display panel. These results indicate that the MHFI could serve as a decision-support layer in an S-100-based digital navigation environment. Full article

Background and Objectives: Maternal psychological vulnerability during pregnancy is associated with adverse obstetric and neonatal outcomes, but the contribution of candidate genetic markers remains insufficiently defined. This exploratory pilot case–control study examined NRG1 rs35753505, NRG1 rs3924999, and OXT rs2740210 together with validated psychological screening and obstetric–neonatal phenotyping in Romanian primiparous women. Methods: Eighty-two primiparous women were enrolled between February 2024 and February 2025 at a tertiary maternity centre in Timișoara. After genotyping quality control, 79 women with complete data for all three SNPs (50 cases and 29 controls) formed the analytic sample. Fifty women with at least one obstetric complication were compared with 29 women with uncomplicated pregnancies. Participants completed the EPDS, GAD-7, PSS-10, and CD-RISC-25 at 20–28 gestational weeks. Genotyping was performed using TaqMan^® allelic discrimination assays, with Hardy–Weinberg equilibrium assessment and exploratory carrier, allele-dosage, correlation, ANOVA, and logistic-regression analyses. Results: The study lot had higher EPDS, GAD-7, and PSS-10 scores and lower CD-RISC-25 scores than controls (all p < 0.001). The three SNPs were in Hardy–Weinberg equilibrium and did not show statistically significant single-locus case–control differences. NRG1 rs3924999 A-carriers showed the strongest exploratory association pattern, including lower neonatal birth weight and higher psychological vulnerability scores. Across exploratory genetic risk score (GRS) tertiles, birth weight, Apgar-5, perceived stress, and resilience differed significantly; however, the formal multiplicative GRS × PSS-10 model for low birth weight was not significant. Stratified correlations suggested that the PSS-10-birth weight relationship was stronger in the high-GRS tertile. Conclusions: NRG1 rs3924999 and the composite NRG1/OXT score may help define future replication hypotheses, but larger genotype-stratified cohorts are required before clinical risk stratification can be proposed. The composite score is an investigator-weighted, internally derived exploratory index rather than a validated genetic risk model, and the formal gene–environment interaction test was null, so the stratified correlations are descriptive only. The findings should be interpreted as hypothesis-generating. Full article

Sudan faces riverine flooding along the Blue Nile and chronic drought across Darfur–Kordofan, yet no national assessment integrates both hazards with social vulnerability to support sustainable and climate-resilient development. This study develops a Societal Impact Index (SII) for Sudan’s eighteen states using a terrain-based flood-susceptibility surface, a drought-frequency indicator (SPEI-12), and thirteen social-vulnerability indicators. These are combined into four weighted pillars following the Intergovernmental Panel on Climate Change (IPCC) risk architecture and validated against independent humanitarian-needs assessments, with convergent checks based on displacement and malnutrition. An unsupervised machine-learning audit, combining k-means clustering with principal component analysis, tests whether the data’s structure supports the composite ranking. The audit shows that the five High-impact states follow two distinct pathways: hazard-and-exposure dominance in Al Qadarif and Al Jazirah, and sensitivity dominance in the remaining three Darfur states. This distinction enables risk-reduction and infrastructure measures to be tailored to the dominant pathway in each state. The first two principal components correlate only weakly with the SII ($r=0.02$ and $r=0.36$), indicating that the ranking reflects the assigned weights as well as the data structure. Each score is exactly decomposed into pillar contributions, improving transparency, while a prototype scenario tool illustrates practical use. Flood-exposed population increased by 7.4 percent between 2017 and 2020, highlighting the need for continuous updating. The reproducible, open-data framework can support equitable resource allocation, sustainable infrastructure planning, long-term vulnerability reduction, and future disaster-resilience digital twins in data-scarce Sahelian settings. Full article

Background: Gestational tobacco exposure is a major modifiable risk factor for adverse pregnancy outcomes; how smoking-induced redox perturbations transmit across the placental barrier to the fetal compartment, and mediate neonatal outcomes, remains incompletely understood. Methods: In a prospective cohort of 66 maternal-neonatal dyads (24 smokers, 42 non-smokers) from Târgu-Mures, six redox biomarkers (nitrite, nitrate, malondialdehyde, reduced, oxidized glutathione (GSH, GSSG) and GSH/GSSG ratio) were quantified in paired maternal and cord blood and converted to SI units, and pathway-specific composite indices (oxidative and nitrosative stress index–OSI, NSI, global redox index–GRI) were derived via standardized Z-scores of natural-log-transformed concentrations. Associations with preterm birth (PTB) and low birth weight (LBW) were assessed via multivariable regression. Benjamini–Hochberg false discovery rate (FDR) correction was applied within predefined test families. Results: Tobacco exposure was associated with nominally significant depletion of the Neonatal NSI (mean difference = −0.842; 95% CI: −1.567 to −0.117; p = 0.024; FDR-adjusted p = 0.142), while maternal indices showed no significant group differences. Lower Maternal GRI and Neonatal NSI were independently associated with lower birth weight and higher odds of preterm birth (aOR = 0.35 and 0.52, respectively; both p < 0.05). Maternal and neonatal nitrite concentrations were positively correlated (FDR-adjusted p = 0.002) and oxidized glutathione showed an inverse maternal-neonatal correlation (FDR-adjusted p = 0.001), whereas the maternal and neonatal NSI was not significant after FDR-correction (FDR-adjusted p = 0.078) Conclusions: Gestational tobacco exposure was associated with depletion of the neonatal nitrosative stress index. Independently, lower maternal and neonatal composite redox indices were associated with lower birth weight and higher odds of preterm birth. Composite indices may offer an integrated assessment of perinatal redox status, but without external validation warrant confirmation in larger cohorts. Full article

Construction project delays remain a persistent challenge in the construction industry, yet existing studies have generally examined delay risk prioritisation and organisational risk management maturity as separate research domains. This study addresses this gap by investigating how organisational risk management maturity influences the evaluation and prioritisation of construction delay risks in the Australian construction context. A structured survey instrument based on the Generic Risk Maturity Model was used to assess maturity across five dimensions: management commitment and leadership, organisational risk culture, risk identification, risk analysis, and standardised risk management processes. Expert judgements were used to derive impact severity, probability of occurrence, and composite criticality scores for 22 construction delay risk factors. Extreme Gradient Boosting (XGBoost) models with SHapley Additive exPlanations (SHAP) were then applied to explain how maturity dimensions influence risk evaluations. The results show that maturity is associated with changes in both the level and pattern of delay risk prioritisation. Owner’s late decisions remained the top-ranked composite risk across all maturity levels, while other risks exhibited maturity-related shifts, with the composite risk weight of poor project cost estimation declining from 0.079 at maturity Level 1 to 0.041 at maturity Levels 3–4, and rainfall and weather conditions becoming more prominent at higher maturity levels. The proposed XGBoost–SHAP framework provides a transparent, data-driven diagnostic tool for linking organisational capability with delay risk prioritisation and supporting more consistent and evidence-based delay risk management. The results further indicate that weaker organisational risk culture and lower process standardisation are associated with greater perceived exposure to planning-, coordination-, and decision-related delay risks. Within the sampled Australian construction organisations, the XGBoost–SHAP framework provides a transparent analytical approach for examining associations between organisational capability and delay risk prioritisation. Full article

Background: Glioblastoma (GBM) carries a median overall survival below 15 months despite aggressive multimodal therapy. Treatment resistance reflects the interplay of genomic instability, dysregulated DNA damage repair (DDR), and an immunosuppressive tumor microenvironment (TME). The shelterin complex maintains telomere integrity, yet its broader role in coordinating DDR, TME remodeling, and clinical outcomes in GBM remains unclear. Methods: We integrated transcriptomic and clinical data from four public cohorts (TCGA, CGGA1, CGGA2, and REMBRANDT, n = 583) and an institutional cohort (CSUXY, n = 65). A composite shelterin score was computed by ssGSEA and correlated with DDR activity, immune infiltration, and checkpoint expression. Ten machine-learning algorithms generated 101 candidate model configurations; the final shelterin-related signature (SRS) was trained in TCGA and evaluated in external public cohorts and the institutional cohort. EFEMP2, the top-weighted gene in the SRS, was further examined using public transcriptomic datasets, an exploratory anti-PD-1 cohort, immunohistochemistry, and in vitro assays. Results: Higher shelterin scores were associated with enhanced DDR pathway activity, greater immune and stromal infiltration, and elevated checkpoint expression. The SRS achieved moderate discrimination, with a mean C-index of 0.60, and stratified patients into prognostically distinct risk groups across cohorts. EFEMP2 was consistently associated with inferior overall survival. High EFEMP2 correlated with an immunosuppressive TME enriched for MDSCs and exhausted T cells alongside reduced enrichment of several DDR pathways. Silencing EFEMP2 suppressed proliferation, migration, and invasion while inducing DNA double-strand break markers. In the small anti-PD-1 cohort, high EFEMP2 showed non-significant trends toward longer OS and PFS, which should be interpreted as hypothesis-generating. Conclusion: This study provides a biologically interpretable prognostic framework that was externally evaluated across multiple independent cohorts and links shelterin-related biology to GBM outcomes. EFEMP2 may connect genomic stress and immune suppression, but its mechanistic and immunotherapy-predictive roles require further validation. Full article

Background/Objectives: Whether ketogenic diets provide greater weight-loss benefits than higher-carbohydrate diets when prescribed energy intake or targeted energy deficit are comparable remains uncertain. This systematic review and meta-analysis evaluated their effects on body weight change in adults with overweight or obesity. Methods: Following PRISMA 2020, PubMed, Scopus, and Web of Science were searched for randomized controlled trials comparing ketogenic diets with higher-carbohydrate diets under matched energy prescriptions. Ketogenic diets were defined as providing ≤50 g carbohydrate/day or ≤10% of total energy from carbohydrate. A random-effects meta-analysis used restricted maximum likelihood estimation and the Hartung–Knapp adjustment. Risk of bias and certainty of evidence were assessed using RoB 2 and GRADE, respectively. Results: Eight reports representing seven studies were included in the systematic review; six studies comprising 259 participants contributed to the meta-analysis. Ketogenic diets were associated with slightly greater weight loss than higher-carbohydrate diets (MD = −1.49 kg; 95% CI: −2.41 to −0.58; p = 0.008; I² = 0%). Estimates remained similar after alternative imputations of change-score standard deviations, exclusion of the trial at high risk of bias, and leave-one-out analyses. In three trials meeting the prescribed protein-matching criterion, the effect remained directionally consistent but was imprecise and compatible with no difference. Certainty of evidence was low because of risk of bias and imprecision. Conclusions: Under comparable prescribed energy conditions, ketogenic diets may produce a small additional reduction in body weight. However, predominantly short-term evidence, uncertainty regarding achieved energy and protein intakes, the absence of a synthesis of body composition, and low certainty of evidence limit confidence in the magnitude, durability, and clinical significance of this advantage. Full article

This paper presents a validation framework for automated aircraft mass and balance operations, combining statistical process control with integrated risk scoring and addressing the critical gap between traditional centralised load control and emerging automated operations. A dual-validation system integrates univariate control limits, a weighted multivariate T²-type statistic, and composite scoring with operational risk assessment; risk scoring quantifies centre of gravity proximity and maximum mass margins. The framework was validated using 48 flights operated by Airbus A350-900/1000 aircraft. The framework was evaluated using a two-phase design—flights 1–30 for calibration (Phase I) and flights 31–48 for prospective evaluation (Phase II). Across all 48 flights it yields an 81.25% automation-eligibility rate (39 GREEN), with 4.17% YELLOW (non-blocking supervisor notification within a defined service window) and 14.58% RED (mandatory review). RED cases result from cargo offloads, dangerous goods changes, or significant baggage/ZFW variations, while cargo operations show exceptional stability (the exclusively cargo-loaded Compartment 2 has σ = 9 kg, versus 219 kg for total cargo). The framework enables transition from centralised load controller roles to exception-based supervision, with risk scoring outputs driving targeted, proportional safety measures. To the best of the authors’ knowledge, it provides the first systematic method for determining when automated load control can be trusted without human intervention—a critical requirement as the industry transitions towards full automation. Full article

Background/Objectives: Type 2 diabetes mellitus (T2DM) and arterial hypertension (AH) frequently coexist and are major risk factors for cardiovascular disease (CVD) and chronic kidney disease. Although the Mediterranean diet (MeDi) is widely recommended in cardiometabolic management, longitudinal real-world evidence regarding dietary adherence, body composition, and the role of continuous dietitian-led follow-up remains limited. Methods: This three-year prospective observational study included 158 adults with T2DM and AH treated at the Outpatient Clinic for Clinical Nutrition, University Hospital Centre Split, Croatia. Body composition was assessed using multi-frequency bioelectrical impedance analysis, dietary adherence using the Mediterranean Diet Serving Score (MDSS), and renal and metabolic parameters using standard laboratory methods. Participants were stratified according to attendance at scheduled dietitian-led follow-up visits. Results: Significant reductions were observed in body weight, body mass index (BMI), waist circumference, muscle mass, skeletal muscle index, and phase angle (PhA) during follow-up (all p < 0.001). Lipid profile improved, with reductions in total cholesterol and low-density lipoprotein levels and an increase in high-density lipoprotein concentrations. In contrast, renal function declined, as evidenced by increased creatinine and urea levels and decreased estimated glomerular filtration rate (eGFR). CVD incidence increased significantly during follow-up (p < 0.001). Although overall adherence to the MeDi improved, only 17.8% of participants achieved high adherence. Participants attending regular dietitian-led follow-up demonstrated significantly higher MDSS scores, greater adherence to the MeDi, and higher phase angle values compared with participants without regular follow-up. Conclusions: Adults with T2DM and AH demonstrated partial enhancement of MeDi adherence over three years; although the lipid profile also improved, this could not be attributed to diet and may largely reflect pharmacological treatment. These changes were accompanied by progressive muscle mass loss, declining renal function, and increased cardiovascular burden. Continuous dietitian-led follow-up was associated with superior dietary quality and better nutritional status, supporting the importance of individualized, multidisciplinary approaches integrating sustained nutritional counselling, lean mass preservation, and structured physical activity in long-term cardiometabolic care. Full article

Food loss and waste (FLW) constitutes a structural challenge for agri-food systems. However, current analytical tools for assessing management and valorisation options remain fragmented across disciplines. Existing frameworks rarely capture within a single structure the environmental, social, and economic–institutional feasibility dimensions needed to compare alternative recovery pathways. This study introduces the ESG-FLW Index, a multidimensional composite index designed to support comparative evaluation of FLW valorisation strategies, with particular attention to recovery for human consumption. The index draws on a comparative analysis of eight established frameworks. It integrates Life Cycle Assessment for the environmental pillar; Techno-Economic Assessment together with compliance, data-quality, scalability, and replicability indicators for the governance pillar; and Social Return on Investment for the social pillar. These components are aggregated through Multi-Criteria Decision Analysis, following methodological guidance for robust composite indicators. The framework aligns explicitly with the Food Waste Hierarchy and SDG Target 12.3. It also includes hurdle criteria to limit the risk that high aggregate scores obscure critical shortcomings. As a proof of concept, the index was applied to the CiboAmico redistribution programme. Redistribution scored substantially higher than composting (85.1 versus 30.7). The ranking remained stable under ±20% weight variations and Monte Carlo simulations (n = 1000). The ESG-FLW Index offers a transparent and replicable decision-support tool. It is best suited to relative comparison among options and to making sustainability trade-offs explicit. Full article

Background/Objectives: Adolescent pregnancy is associated with an increased risk of adverse neonatal outcomes, including low birth weight, preterm birth, and impaired neonatal adaptation. While maternal age is a well-established determinant, the independent role of parity in this population remains uncertain. This study aimed to assess the association between parity and neonatal outcomes in adolescent mothers. Methods: We conducted a retrospective cohort study including 751 singleton live-birth deliveries to adolescent mothers aged <18 years at a Romanian secondary-care hospital. The unit of analysis was the delivery episode recorded in the institutional birth registry. Mothers were classified according to parity at the time of the index delivery as primiparous or multiparous. Neonatal outcomes included low birth weight (<2500 g), preterm birth (<37 weeks), Apgar score < 7 at 5 min, and a composite adverse neonatal outcome. Multivariable logistic regression models were used to evaluate the association between parity and neonatal outcomes, adjusting for maternal age (<15 vs. ≥15 years), gestational age, and mode of delivery, as appropriate. Results: A total of 751 singleton live-birth delivery episodes were included; 609 (81.1%) occurred in primiparous adolescents and 142 (18.9%) in multiparous adolescents. Parity was not significantly associated with preterm birth (aOR 0.86, 95% CI 0.48–1.56, p = 0.622), Apgar score < 7 at 5 min, or the composite adverse neonatal outcome. Maternal age < 15 years and gestational age were independently associated with Apgar score < 7 at 5 min. Multiparity was associated with lower odds of low birth weight (aOR 0.40, 95% CI 0.17–0.92, p = 0.031). Conclusions: Parity was not independently associated with most neonatal outcomes in adolescent pregnancies. Multiparity was associated with lower odds of low birth weight, but this finding should be interpreted cautiously because residual confounding cannot be excluded. Full article