Search Results (59,281)

Against the background of traffic conflicts arising due to the highly concentrated population in high-density cities, this study aims to systematically identify the core transport needs of patients awaiting medical treatment; based on the theory of the Kano model, we construct a measurement system relating to patient transport needs when awaiting medical treatment that encompasses multiple levels. Taking 10 large general hospitals in Guangzhou as samples, this study collected data through questionnaires and auxiliary interviews, using the importance–sensitivity analysis method to accurately measure the degree of patient needs for each influencing factor of the transport environment for medical treatment. The study found that, among the primary needs (core basic needs), the perfection of public transport (which directly affects the convenience of medical care) is the core need with the highest degree of demand. Among the second-level needs (refined categorised demand levels), specifically relating to important attributes (essential needs), priority attention should be given to patient diversion, hospital–city connection, and corridor settings. As concerns the high value-added one-dimensional attributes (desired needs), focus should be placed on controlling health and safety distances and guiding the flow of medical treatment, while for high glamour attributes (glamour needs), primary consideration should be given to crowd distribution, stopping and resting, and direct access to the ground floor. The group difference analysis (grouped by emotional state, transport mode, and group type) showed that the first-level demand sensitivity ranking was highly consistent, and the second-level demand for urban connectivity, convenient transfer, and direct underground access were also common priorities. This study is the first to introduce the Kano model into the analysis of high-density urban healthcare transport systems, providing a clear basis for the grading of demand for the design of the transport environment for patients’ medical care. This is of great practical value for alleviating congestion and improving the resilience of emergency response in mega-cities in relation to medical care. Full article

The lacustrine horizon (thickness of 8.75 cm thick) of the Qin and Han dynasties (221 BC–220 AD) was determined based on AMS-¹⁴C analysis conducted by the Beta Analytic Radiocarbon Dating Laboratory on the Dishaogouwan section (37°43′ N, 108°31′ E) in the Salawusu River Basin, Mu Us Desert, located in the temperate zone of China. The identification results of the ostracod and charophyta fossils from the four samples at this horizon show the following results: 1. All the samples contain 458 ostracod fossil valves, belonging to six genera and eight species. Their quantity (valves) and percentage, in descending order of abundance, are Candoniella albicans (Brady), 255/55.68%, Ilyocypris bradyi Sars, 73/15.94%, Eucypris inflata Sars, 46/10.04%, Cyclocypris serena Koch, 26/5.68%, Candona kirgizica Mandelstam, 18/3.93%, Ilyocypris biplicata (Koch), 17/3.71%, Candoniella mirabilis Schneider14/3.06% and Leucocytherella sinensis Huang, 6/1.31%. 2. All the samples contain 99 fossil charophyte gyrogonites, belonging to one genera and four species. In terms of quantity/percentage, the Chara sp. is the most abundant, with 41 pieces (41.41%), followed by Chara braunii Gemlin, with 26 pieces (26.26%); Chara leptosperma Braun and Chara canescens Loiseleur account for 19 pieces (19.19%) and 13 pieces (13.13%), respectively. Based on the analysis of the ecological environment of the existing species of these ostracods and charophytes, combined with the fossilized Ilyocypris brady, Ilyocypris biplicata, and Gyraulus convexiusculus Hutton found in all the samples—which indicate very warm, even subtropical climates then—it can be concluded that during the Qin and Han Dynasties, the Salawusu River Basin was primarily characterized by a freshwater lake environment under a warm climate, with the average annual temperature and precipitation in this area approximately 2.1 °C and 100 mm higher than they are currently. The prevailing East Asian summer monsoon pushed the warm temperate climate at least 110 km northwestward from this basin. During this period, there were at least four episodes of brief subtropical climate fluctuations, occurring approximately every 110 years. Full article

Dysregulation contributes to Alzheimer’s disease (AD) pathophysiology. Zinc therapy promotes enterocyte copper sequestration, potentially reducing systemic copper. Individual biological responses may vary. Methods: ZINCAiD was a 24-week, randomized, double-blind, placebo-controlled phase II trial assessing zinc therapy in individuals with mild cognitive impairment (MCI) due to AD (EudraCT No.: 2019-000604-15; registered on 26 March 2020). Participants were randomized 2:1 to receive elemental zinc (135 mg/day for 12 weeks, then 65 mg/day) or placebo. Ceruloplasmin was measured at predefined intervals for safety monitoring, blinded to the investigators. Post hoc, “Zinc Responders” were defined by ≥20% reduction in ceruloplasmin at week 12. The primary cognitive endpoint was the Cognitive Composite 2 scale (CC2); secondary endpoints included MMSE and CDR-Sob. Findings: Of the 48 participants randomized, 9 discontinued, primarily due to unrelated clinical deterioration; 39 had complete ceruloplasmin data. Two serious adverse events occurred in the Placebo group. Mild gastrointestinal symptoms occurred in eight participants, with only four leading to dropout. In the primary zinc vs. placebo analysis, no significant differences emerged in cognitive outcomes. A post hoc exploratory analysis stratified participants by pharmacodynamic response: 12 individuals with MCI due to AD (31%) met the criteria for “Zinc Responder,” defined by ≥20% reduction in serum ceruloplasmin at week 12. Only Zinc Responders maintained cognitive stability over 24 weeks, whereas the combined group of Zinc Non-Responders and placebo-treated participants showed a significant decline. For the composite cognitive score (CC2), the interaction between visit and response group was significant (p = 0.030), with deterioration observed only in the Non-Responder + Placebo group (Δ = –2.72, p < 0.0001 vs. –0.71, p = 0.35 in Responders). Similar patterns were observed for CDR-Sob (interaction p = 0.017) and MMSE (trend p = 0.09). Interpretation: Zinc therapy stabilized cognition in a pharmacodynamically defined MCI subgroup. These exploratory findings suggest serum ceruloplasmin as a feasible biomarker of target engagement. Larger trials are needed for confirmation. Full article

Epoxy resins used in reactors are prone to cracking and failure due to mechanical vibration, thermal stress, and ultraviolet radiation. Improving their resistance to damage is important to extend the service life of reactors. This investigation develops a self-healing imidazole-cured epoxy resin for reactors using epoxy microcapsules and amine microcapsules prepared by electrospraying-interfacial polymerization (ES-IP) microencapsulation technique. Firstly, this investigation studies the feasibility of using double nozzles for simultaneous spraying to improve the preparation of small-sized microcapsules. After successful synthesis, the healing performance of self-healing imidazole-cured epoxy based on the microencapsulated epoxy-amine chemistry was studied, focusing on the influence of the ratio, concentration, and size of the two microcapsules on the healing efficiency, and further exploring the thermal stability of the self-healing performance. The addition of microcapsules to the mechanical properties was also investigated. Results show that the double-nozzle technique can prepare microcapsules with controllable sizes (20~200 μm). The self-healing imidazole-cured epoxy exhibits high self-healing performance, reaching 100% at the optimal ratio with 10.0 wt% 50~100 μm microcapsules. Although the added microcapsules reduce the tensile strength of the material, they improve its high-temperature aging resistance. The above investigation is significant for developing self-healing fiber-reinforced epoxy-based composite materials for reactors. Full article

Limited evidence exists on how teachers contribute to student learning gains in early childhood education. This study draws on the Dynamic Model of Educational Effectiveness (DMEE) and investigates the impact of teacher factors on pre-primary students’ mathematics achievement. It also examines whether the five proposed dimensions—frequency, quality, focus, stage, and differentiation—can clarify the conditions under which these factors influence learning. Using a stage sampling procedure, 463 students and 27 teachers from Greek pre-primary schools were selected. Mathematics achievement was assessed at the beginning and end of the school year, while external observations measured the DMEE factors. Analysis of observation data using multi-trait multilevel models provided support for the construct validity of the measurement framework. Teacher factors explained variation in student achievement gains in mathematics. The added value of using a multidimensional approach to measure the functioning of the teacher factor was identified. Implications of the findings are drawn. Full article

Background and Objectives: Diagnosing the underlying cause of ascites remains complex, especially when cytology results are inconclusive. Measuring biomarkers directly in ascitic fluid may offer better diagnostic insight than serum testing alone. This review evaluated the clinical utility of tumor and inflammatory markers in ascitic fluid. Materials and Methods: A systematic search was conducted in PubMed and Scopus for studies published from January 2014 to December 2024, with the final search carried out in May 2025. The included studies were observational, comparative or biomarker validation studies evaluating ascitic fluid markers for diagnosing malignant and inflammatory ascites. The extracted outcomes included diagnostic accuracy metrics such as area under the curve (AUC), sensitivity and specificity. Risk of bias was evaluated using the ROBINS-I tool. Studies were excluded if they were case reports, animal studies, cytology-only analyses, or if they lacked biomarker data in ascitic or peritoneal fluid. Results: Forty-two studies met the inclusion criteria. CEA showed high diagnostic performance when measured in ascitic fluid. Combining markers or using ascitic-to-serum ratios improved diagnostic reliability. Inflammatory markers in ascitic fluid, such as CRP, IL-6 and VEGF added diagnostic value when cytology was inconclusive. Discussion and Conclusions: Evaluating biomarkers in ascitic fluid improved diagnostic accuracy. However, the included studies showed considerable methodological heterogeneity and moderate risk of bias. Full article

Expanding the capacity of Matrix-Assisted Laser Desorption Ionization Time of Flight Mass Spectrometry (MALDI-TOF MS) beyond species identification to strain typing becomes a new challenge in clinical microbiology. This study demonstrated a specific identification of Streptococcus agalactiae sequence type 1 (ST1) by a manual decision tree and automatically ranking from the newly added MTPPs library, which has not been previously reported. The mass spectra of 25 STs (277 isolates) were generated. The presence and absence of specific peaks were combined to create a decision tree for manual identification. Three peaks at 3127, 5914, and 6252 in combination with m/z 3368 and 6281 were used for primary identification of ST1. However, to differentiate ST1 and ST314, five additional peaks were required. For the automatic system, the MTPP of all isolates was divided into three training–testing ratios of 40:60, 50:50, and 60:40. All categories revealed excellent accuracy rates of above 90% for ST1 identification. The 60:40 group showed the highest overall performance, in which sensitivity was observed at 83.9 to 96.8%, and specificity reached up to 100.0% for both the top two and the top three matches. In conclusion, we propose that the MTPP from MALDI-TOF is a potential model for speedy bacterial typing, crucial in epidemiology, prevention, and patient management. Full article

The self-starting capability of straight-bladed H-type Darrieus Vertical Axis Wind Turbines (VAWTs) remains a major constraint for deployment, particularly in urban, low speed, and turbulent environments. We conducted a systematic review of technological strategies to improve self-starting, grouped into five categories: (1) aerodynamic airfoil design, (2) rotor configuration, (3) passive flow control, (4) active flow control, and (5) incident flow augmentation. Searches in Scopus and IEEE Xplore (last search 20 August 2025) covered the period from 2019 to 2026 and included peer-reviewed journal articles in English reporting experimental or numerical interventions on H-type Darrieus VAWTs with at least one start-up metric. From 1212 records, 53 studies met the eligibility after title/abstract screening and full-text assessment. Data were synthesized qualitatively using a comparative thematic approach, highlighting design parameters, operating conditions, and performance metrics (torque and power coefficients) during start-up. Quantitatively, studies reported typical start-up torque gains of 20–30% for airfoil optimization and passive devices, about 25% for incident-flow augmentation, and larger but less certain improvements (around 30%) for active control. Among the strategies, airfoil optimization and passive devices consistently improved start-up torque at low TSR with minimal added systems; rotor-configuration tuning and incident-flow devices further reduced start-up time where structural or siting constraints allowed; and active control showed the largest laboratory gains but with uncertain regarding energy and durability. However, limitations included heterogeneity in designs and metrics, predominance of 2D-Computational Fluid Dynamics (CFDs), and limited 3D/field validation restricted quantitative pooling. Risk of bias was assessed using an ad hoc matrix; overall certainty was rated as low to moderate due to limited validation and inconsistent uncertainty reporting. In conclusions, no single solution is universally optimal; hybrid strategies, combining optimized airfoils with targeted passive or active control, appear most promising. Future work should standardize start-up metrics, adopt validated 3D Fluid–Structure Interaction (FSI) models, and expand wind-tunnel/field trials. Full article

Government-invested Engineering, Procurement, and Construction (EPC) projects often encounter challenges, such as ambiguous value-added pathways and undefined key driving mechanisms, which impede efficiency improvements during implementation. To systematically elucidate the value-added pathways and core driving mechanisms in these projects, this study identified and distilled 20 critical influencing factors across four dimensions—contract cost, organization, technology, and environment—through a combination of a literature review, case analysis, and a questionnaire survey yielding 68 valid responses. Employing a DEMATEL–TAISM–MICMAC hybrid model, the research conducted an in-depth analysis: the DEMATEL method quantified the interdependencies among factors and identified key causal elements; a TAISM-directed topological hierarchy diagram was constructed to clearly delineate the hierarchical transmission pathways; and the MICMAC model was utilized for driver–dependency analysis, classifying factor roles and providing cross-validation from three analytical perspectives. The results indicate that S₁₂ (collaborative participation in early planning and design phases) exhibits the highest causal influence and serves as the core driving factor, while S₁ (detailed and explicit contractual clauses) and S₁₂ are positioned at the root level of the hierarchical model, functioning as foundational independent factors that regulate the entire system. The value-added pathways are characterized by a hierarchical transmission logic of “root level → transitional level → direct level”. Based on these findings, the study proposes a system optimization strategy of “strengthening the root level, optimizing the transitional level, and safeguarding the direct level”, thereby offering both theoretical insights and practical guidance for enhancing the value-added efficiency of government-invested EPC projects. Full article

Alzheimer’s disease (AD) is characterized by amyloid-beta (Aβ) plaque accumulation and neurodegeneration. This study identified gyrophoric acid, a lichen-derived phenolic metabolite, as a dual-action Aβ42 inhibitor preventing aggregation and disassembling of mature Aβ42 fibrils. Integrated in silico studies revealed that gyrophoric acid was a strong thermodynamic stabilizer of Aβ42 (MM–GBSA: −27.3 kcal/mol) via entropically driven hydrophobic interactions and disruption of aggregation-prone conformations (100 ns MD simulations). Through biochemical analysis of the fluorescent dye thioflavin T (ThT), gyrophoric acid induced rapid Aβ42 fibril disassembly within 5 h, with time-lapse confocal microscopy quantitatively confirming the near-complete dissolution of large aggregates by 24 h. ADMET profiling revealed favorable pharmacokinetics (moderate oral absorption: 48.5%–57.3%; low toxicity) and Lipinski’s rule compliance. These results establish gyrophoric acid as a promising natural bioactive compound for anti-AD therapeutics with a unique hydrophobic-stabilization mechanism. Full article

Background/Objectives: The intranasal (IN) route of administration is a promising non-invasive approach for brain targeting, bypassing the blood–brain barrier and enhancing bioavailability. Citalopram hydrobromide (CT), a widely prescribed sparingly water-soluble selective serotonin reuptake inhibitor (SSRI), faces challenges with oral and intravenous administration, including delayed onset, adverse effects, and patient compliance issues. Methods: This study aimed to develop a novel thermoresponsive polymeric micelle (PM) system based on Pluronic^® copolymers (Pluronic F127 and Poloxamer 188) improving CT’s solubility, stability, and nasal permeability for enhanced antidepressant efficacy. A preliminary study was conducted to select the optimized formulation. The preparation process involved using the thin-film hydration method, followed by freeze-drying. Comprehensive evaluations of optimized formulation characteristics included Z-average, polydispersity index (PdI), thermal behavior (lower critical solution temperature, LCST), encapsulation efficiency, X-ray powder diffraction (XRPD), thermodynamic solubility, and biological stability. Additionally, in vitro CT release and CT permeability in nasal conditions were studied. Stability under storage was also evaluated. Results: The optimized CT-PM formulation showed nanoscale micelle size (Z-average of 31.41 ± 0.99 nm), narrow size distribution (polydispersity index = 0.241), and a suitable thermal behavior for intranasal delivery (lower critical solution temperature (LCST) ~31 °C). Encapsulation efficiency reached approximately 90%, with an amorphous structure confirmed via XRPD, leading to a 95-fold increase in CT solubility. The formulation demonstrated appropriate biological and physical stability. In vitro studies showed a 25-fold faster CT release from optimized formulation compared to the initial CT, while CT-PM permeability in nasal conditions increased four-fold. Conclusions: This novel nanoscale thermosensitive formulation is a value-added strategy for nasal drug delivery systems, offering enhanced drug solubility, rapid drug release, stability, and improved permeability. This smart nanosystem represents a promising platform to overcome the limitations of conventional CT administration, improving therapeutic outcomes and patient compliance in depression management. Full article

Intravenous push (IVP) administration of controlled substances in hospital settings presents operational challenges related to medication waste, documentation, and diversion risk. This multi-site observational study aimed to quantify the pharmacy workforce time and associated costs linked to IVP waste management across a 16-hospital health system in Southwest Florida. Data were collected from over 4400 controlled substance transactions involving fentanyl, midazolam, hydromorphone, morphine, ketamine, and lorazepam. Methods included automated transaction analysis, manual chart reviews, and software-based compliance case evaluations. Results indicated patterns of partial dose waste, particularly for midazolam (85.2%) and hydromorphone (78.8%), and identified opportunities where documentation efforts could be further optimized through automation. Manual review of 333 incidents required an average of 6 min and 43 s per case, extrapolating to over 496 h of quarterly pharmacy labor or nearly 1985 h annually. Software-based case reviews added another 32 h per quarter or 130 h annually. Additionally, waste receptacle systems incurred over USD 1.1 million in capital costs and USD 322,500 in annual maintenance, with technician labor contributing further operational burden. These findings underscore the resource demands of IVP waste management and support the need for standardized dosing, enhanced documentation workflows, and pharmacy-led interventions to improve efficiency and reduce diversion risk. Full article

Pharmaceutical formulations, in addition to the medicinal substance(s), contain added excipients that make it possible to create a pharmaceutical product that exhibits required properties in terms of mechanical, physical, chemical, and microbiological stability. Additionally, these substances can act as release modifiers or improve bioavailability parameters. Literature data indicate that excipients, especially polymeric ones, can also affect the polymorphism of the active substance, resulting in drug bioavailability enhancement or reduction. This influence can be evaluated using thermal and spectroscopic methods. In the study, differential scanning calorimetry (DSC), vibrational spectroscopic studies (Fourier transform infrared spectroscopy, FTIR), Raman spectroscopy, and X-ray diffraction (XRD) assay of ibuprofen, naproxen, and naproxen sodium standards and pharmaceutical preparations containing these medicinal substances in their compositions were carried out. DSC results indicated that a sharp melting peak was observed on the DSC curves of the standards, confirming their crystalline form. DSC results obtained for pharmaceutical formulations also indicated that the enthalpy of melting is sometimes lower than calculated from the percentage of active ingredients in the formulations. In addition, the melting peak is often broadened and shifted toward lower temperatures, suggesting the influence of excipients on the polymorphism of drug substances. The FTIR and Raman spectra of pharmaceutical formulations contained all characteristics of the active substances. XRD analysis was also performed. Therefore, possible chemical interactions between the components of the preparations have been excluded. At the same time, FTIR and Raman spectroscopy results as well as XRD assay showed a reduction in the height of signals corresponding to the crystalline API form, confirming the possibility of reducing API crystallinity in pharmaceutical formulations. Full article

This study explored the feasibility of applying XGBoost and random forest algorithms to predict the risk of sudden death from coronary heart disease. From the perspective of symmetry, the human body’s physiological and pathological states can be considered to have a certain dynamic balance, akin to a form of biological symmetry. Sudden death from coronary heart disease disrupts this inherent balance, representing extreme asymmetry in the body’s state. Our study aims to restore a degree of symmetry in the decision-making process for medical professionals by providing accurate prediction models. By adding the fuzzy comprehensive evaluation method for data preprocessing, the prediction models for sudden death from coronary heart disease based on XGBoost and random forests were optimized and constructed. The results indicated that XGBoost and random forest algorithms could be effectively applied to predict the risk of sudden death from coronary heart disease. The promotion and application of these models could serve as an auxiliary tool to provide additional insights that may assist physicians in their decision-making, especially for those with relatively less clinical experience in grassroots units, enable early intervention for high-risk patients, and thereby reduce the occurrence and mortality risk of sudden death from coronary heart disease. Full article

Fire retardancy and thermal management improvements in epoxy resins can critically impact their use in electronics for IoT and 5G devices. This study proposes a facile method to improve the fire retardancy and thermal properties of epoxy resins (EPs) by incorporating boron nitride nanoparticles (BNNPs) with boron polyol complex (BPC) to form an ionanofluid and explores the synergistic effect of polyelectrolytes with BN. The modified multifunctional additive BPC–BNNPs were then used for the functional modification of epoxy resin. Our detailed tests and analyses on these materials confirm that by adding 0.2 wt% of BNNPs in the EP–BPC–BN complex achieved a V-0 rating in the UL-94 vertical burning test. The resultant composite demonstrated that the modification of BN with the polyol complex imparted a low smoke and char formation in the modified epoxy composites. The current study shows that EP–BPC–BN complex has great potential as a thermal interface material for the thermal management of electronics or similar applications. The presented EP–BPC–BN composite can also be utilised as a fire-retardant coating, adhesive, and binding agent in the aerospace, transportation, and building industries. Full article