Search Results (173)

Real-time control of web traffic is a critical issue for network operators and service providers. It helps ensure robust service and avoid service interruptions, which has an important financial impact. However, due to the high speed and volume of actual internet traffic, standard multivariate time series models are inadequate for ensuring efficient real-time traffic management. In this paper we introduce a new model for functional time series analysis, developed by combining a local linear smoothing approach with an $L^1$-robust estimator of the quantile’s derivative. It constitutes an alternative, robust estimator for functional modal regression that is adequate to handle the stochastic volatility of high-frequency of web traffic data. The mathematical support of the new model is established under functional dependent case. The asymptotic analysis emphasizes the functional structure of the data, the functional feature of the model, and the stochastic characteristics of the underlying time-varying process. We evaluate the effectiveness of our proposed model using comprehensive simulations and real-data application. The computational results illustrate the superiority of the nonparametric functional model over the existing conventional methods in web traffic modeling. Full article

Pakistan’s fisheries sector is vital for livelihoods, exports, and food security, yet growth has been constrained by weak infrastructure, limited compliance with sanitary standards, and underinvestment. The China–Pakistan Economic Corridor (CPEC) has been promoted as a driver of trade facilitation, but its actual effect on fisheries exports remains unclear. This study analyzes export performance to five leading Asian markets—China, Thailand, Vietnam, Saudi Arabia, and Japan—over 2005–2024 using Interrupted Time Series (ITS) and Difference-in-Differences (DiD) models. Results show that overall fisheries exports averaged 1.25 million metric tons (USD 728.7 million) annually, with Asia absorbing 59% of trade. ITS results show that after 2015, there are considerable structural discontinuities in export paths, mainly for China (coefficient = −1.42, p < 0.001) and Thailand (0.95, p = 0.071). DiD analysis confirmed that CPEC had a statistically significant positive impact: the treatment × post-2015 effect was 0.55 (p = 0.050), showing that exports to China and Thailand grew disproportionately compared with control markets (Malaysia, Indonesia). Importantly, value growth outpaced volume growth, suggesting early evidence of value-chain upgrading. By contrast, Vietnam and Saudi Arabia showed contraction, and Japan remained stable with weak significance (−1.16, p = 0.088). These results provide the first causal evidence that CPEC’s operational phase altered Pakistan’s fisheries export dynamics, though benefits remain uneven. The conclusions indicate the necessity to invest specifically in cold chains, certification, and aquaculture to generate corridor-led benefits in sustainable trade, food security, and long-term sectoral resiliency. Full article

Background: Urinary tract infections (UTIs) are among the most common hospital- and community-acquired infections, creating a substantial healthcare burden due to recurrence, complications, and rising antimicrobial resistance. Accurate diagnosis and timely antimicrobial therapy are essential. This study aimed to identify trends in the etiology, treatment, and resistance patterns of UTIs through a retrospective analysis of urine isolates processed at the Laboratory of Microbiology at University Hospital St. George in Plovdiv, the largest tertiary care and reference microbiology center in Bulgaria, between 2017 and 2022. Materials and Methods: A retrospective single-center study was performed at the hospital’s Microbiology Laboratory. During the study period, 74,417 urine samples from 25,087 hospitalized patients were screened with the HB&L UROQUATTRO system. Positive specimens were cultured on blood agar, Eosin-Methylene Blue, and chromogenic media. Identification was performed using biochemical assays, MALDI-TOF MS, and the Vitek 2 Compact system. Antimicrobial susceptibility testing included disk diffusion, MIC determination, broth microdilution (for colistin), and Vitek 2 Compact, interpreted according to EUCAST standards. Descriptive analysis and temporal resistance trends were evaluated with regression models, and interrupted time-series analysis was applied to assess COVID-19-related effects. Results: Out of 10,177 isolates, Gram-negative bacteria predominated (73%), with Escherichia coli, Klebsiella pneumoniae, and Proteus mirabilis as the leading pathogens. Among Gram-positives, Enterococcus faecalis was the most frequent. In the post-COVID-19 period, ESBL production increased in E. coli (34–38%), K. pneumoniae (66–77%), and P. mirabilis (13.5–24%). Carbapenem resistance rose in K. pneumoniae (to 40.6%) and P. aeruginosa (to 24%), while none was detected in E. coli. Colistin resistance increased in K. pneumoniae but remained absent in E. coli and P. aeruginosa. High-level aminoglycoside resistance in E. faecalis was stable (~70%), and vancomycin resistance in E. faecium rose from 4.6% to 8.9%. Conclusions: Both community- and hospital-acquired UTIs in Southeastern Bulgaria are increasingly linked to multidrug-resistant pathogens, particularly ESBL-producing and carbapenem-resistant Enterobacterales. Findings from the region’s largest referral center highlight the urgent need for continuous surveillance, rational antibiotic use, and novel therapeutic approaches. Full article

This study evaluates the impact of an educational intervention aimed at improving the management of benign paroxysmal positional vertigo (BPPV) in a clinical setting. Interrupted Time Series (ITS) analysis was used to assess changes in the use of key diagnostic maneuvers—Dix–Hallpike and Supine Roll—as well as the treatment maneuver, Canalith Repositioning Maneuvers (CRM), and the use of CT scans. The intervention aimed to promote evidence-based practices and minimize unnecessary imaging. ITS models accounted for confounders such as history of BPPV and dizziness. The results showed significant improvements in the use of the Supine Roll and CRM maneuvers, with both immediate increases and sustained upward trends following the intervention. For the Dix–Hallpike maneuver, an initial increase was observed after the intervention; however, this effect was no longer statistically significant after adjusting for confounders, suggesting that the observed change may have been influenced by shifts in the patient population rather than the intervention itself. A positive long-term trend persisted. No significant reduction in CT scan usage was found. These findings demonstrate the intervention’s effectiveness in enhancing adherence to recommended diagnostic and treatment practices for BPPV. However, they also suggest that reducing unnecessary imaging may require additional strategies beyond provider education. Full article

Objectives: This study aims to examine the impact of Diagnosis-Related Group (DRG) payment on medical costs, efficiency, and quality of healthcare services in public hospitals, providing policy recommendations for further health insurance payment reforms in China. Methods: Utilizing inpatient medical insurance settlement data from 2020 to 2023 in the selected city, we constructed a regression discontinuity design (RDD) and an interrupted time series (ITS) model to evaluate the causal effects of the DRG reform. The analysis includes 66,533 inpatient settlement records. Results: Following the reform, the average length of stay (LOS) decreased by 2 days (95% CI: −3.43 to −0.70, p < 0.01), total hospitalization expenditures dropped by 13% (95% CI: −0.26 to −0.00, p < 0.05), and expenditures from the medical insurance fund declined by 25% (95% CI: −0.39 to −0.12, p < 0.01). Additionally, examination and consultation fees were reduced by 23% (95% CI: −0.41 to −0.05, p < 0.05), although patients’ out-of-pocket burden increased by 8% (95% CI: 0.05 to 0.10, p < 0.01). In terms of healthcare quality, the 30-day readmission rate decreased by 1% (95% CI: −0.01 to −0.00, p < 0.01), and the mortality rate among low-risk patients declined by 4% (95% CI: −0.04 to −0.03, p < 0.01). We found no evidence of patient selection or denial of admission. Heterogeneity analysis revealed that the reduction in hospital stay was concentrated among enrollees under the Urban and Rural Resident Basic Medical Insurance and those treated in secondary hospitals. The policy’s effects peaked shortly after implementation but gradually attenuated over time. Conclusions: Our study offers hospital-level evidence indicating that the initial stage of DRG implementation achieved its preliminary goals of optimizing medical resource allocation and improving the efficiency of medical insurance fund utilization. However, the reform still faces several challenges. These findings may offer valuable references for developing countries pursuing reforms in primary healthcare and health insurance payment systems. Full article

Background: Nutritional therapy improves prognosis by reducing morbidity and mortality in malnourished hospitalised patients. To determine the occurrence of hospital malnutrition, it is essential to verify healthcare organisations’ ability to identify at-risk patients, considering that malnutrition is often hard to recognise without adequate screening. Methods: The aim of this study is to analyse the temporal evolution in hospitalised patients’ malnutrition, documented as diagnosis discharge letters, over an 11-year period (2014–2024) in four acute care hospitals, with a combined mean of 38,000 inpatients per year. Binomial regression and interrupted time series analysis were used to evaluate temporal evolution in the identification of malnutrition, particularly in relation to the introduction of a nutritional service in 2017. Results: Malnutrition diagnoses increased steadily across hospitals and within internal medicine and surgery departments. Interrupted time series analysis showed a significant rise in diagnostic odds post-intervention, especially in internal medicine. A plateau was observed in the last 3 years, with a mean prevalence of malnutrition of 18.2% for internal medicine (95% CI: 13.6–22.9) and 4.1% for surgery (95% CI: 0.5–7.6). Without the nutritional service, these results likely only would have been reached by 2031 in internal medicine and 2024 in surgery, suggesting an advancement of about eight years in medical wards. Conclusions: The introduction of a nutritional team has probably accelerated and improved the ability to quickly identify and therefore treat malnourished inpatients. Full article

Background: Historically, lip and oral cavity cancer (LOC) has been more prevalent among men, largely due to higher tobacco use in this group. However, over the past decades, smoking rates among women have risen and, in some regions, are approaching those of men. This shift highlights the urgent need to analyze the burden of LOC specifically in women, as they may respond differently to tobacco control policies. This study assessed whether the World Health Organization Framework Convention on Tobacco Control (WHO-FCTC), launched in 2003, and the implementation of MPOWER measures have influenced LOC trends among women. Methods: A controlled interrupted time series was conducted from 1990 to 2021, with the launch of the WHO-FCTC considered the intervention point. A total of 204 countries and territories were initially categorized into two groups: those without (G1) and with (G2) MPOWER coverage. G2 was further subdivided based on the median MPOWER score from 2007 to 2020 into G2A (equal to or below the median) and G2B (above the median). Analyses were also stratified by Socio-Demographic Index (SDI) levels. Female LOC rates were obtained from the Global Burden of Disease Study 2021. Prais-Winsten segmented regression was applied to estimate annual percent changes (APCs) in LOC rates before and after the WHO-FCTC. Results: Prior to the WHO-FCTC, most trends for G1 and G2A were stable, while all trends for G2B were increasing. After 2003, LOC rates increased across all groups, especially in G2B. In high-SDI settings, rising trends in G2B remained unchanged post-intervention, whereas G1 and G2A shifted from stable to increasing. Among low-SDI groups, slopes were mostly not statistically significant. Conclusions: These findings suggest that the WHO-FCTC has had no measurable impact on reducing LOC burden among women so far. Instead, rates have continued to rise in many regions, signaling a concerning trend for women’s global health. Full article

Background: A point prevalence survey conducted at Singapore General Hospital in 2021 showed 48% of inpatients on antibiotics. We hypothesize that a mobile application, transforming complex antibiotic prescribing information into a succinct and individualized resource, will empower healthcare professionals and improve antibiotic prescriptions. Hence, we developed ABxSG using the behavioral design thinking approach (BDTA) to ensure positive user experience and sustained engagement. We aim to evaluate the impact of ABxSG on the proportion of inpatients on antibiotics, antibiotic appropriateness, and the number of antibiotic-related interventions by pharmacists. Methods: ABxSG was launched in March 2023. An interrupted time series analysis was conducted to evaluate its impact on the above outcomes measured using data collected from October 2021 to September 2024. There were 18 data points pre- and post-ABxSG. Results: Following the ABxSG launch, there was an immediate reduction in the proportion of inpatients on antibiotics by 1.66% (p < 0.01), followed by a sustained reduction of 3.12% at 18 months (p < 0.01). Piperacillin-tazobactam appropriateness increased by 2.76% at 1 month (p = 0.11) and further increased by 7.09% at 18 months (p < 0.05). Similarly, ceftriaxone appropriateness increased by 5.74% (p < 0.05) at 1 month and remained above pre-ABxSG levels. There was a significant increase in the number of pharmacist-led interventions for dosing optimization, with 96 more interventions/month at 18 months (p = 0.14). Conclusion: Antimicrobial stewardship teams must remain agile, embrace innovations, and adopt digital technologies to engage and empower clinicians. ABxSG reduced the proportion of inpatients on antibiotics and improved antibiotic prescriptions. The incorporation of BDTA in ABxSG, strong hospital leader support, and strategic planning to promote adoption led to its success. Full article

In 2024, a significant pertussis surge in Queensland, Australia, strained public health resources. To improve investigation efficiency, the Wide Bay Public Health Unit introduced an online survey for pertussis cases on 1 August 2024, which collected data and provided automated health advice. This retrospective evaluation assessed survey acceptance and staff workload. A controlled interrupted time series (ITS) analysis compared pertussis incidence in the intervention region against a control group of four other de-identified regional hospital and health services in Queensland where the survey was not implemented. Of the 298 eligible cases, 140 responded (47.0%); a total of 67.9% of these required no further staff follow-up, a subgroup for whom time savings were statistically significant (p < 0.01). The ITS analysis for the total population revealed a significant 4.9% weekly reduction in the notification trend compared to the control group (Rate Ratio: 0.95, p = 0.001), with a non-significant immediate level change. The online survey is a practical and effective tool for pertussis investigation in a regional setting. It is associated with significant workload efficiencies and a favourable, statistically significant impact on community disease transmission trends. Full article

Background: Clostridioides difficile infection (CDI) is a major concern in hospital-acquired infections. C. difficile spores can survive on surfaces for months and require sporicidal disinfection for elimination. The use of disinfectants should be based on laboratory-confirmed sporicidal activity, tested according to current standards in suspension and carrier tests. Further evaluation of disinfectant efficacy should occur in clinical settings by analyzing reductions in CDI incidence. This study aims to conduct a retrospective analysis of the impact of a new disinfection protocol and concurrent changes in antibiotic consumption on the incidence of healthcare-acquired CDI (HA-CDI). Methods: This retrospective, single-center study assessed the impact of a chlorine dioxide-based disinfection protocol on HA-CDI across three periods: pre-intervention, intervention, and post-intervention. An interrupted time series analysis (ITS) with a Poisson distribution was used to evaluate the incidence of HA-CDI, while antibiotic consumption data were analyzed to identify any correlation with CDI infection rates. Results: Incidence Rate Ratio (IRR) before the intervention is 1.00, serving as the reference value. During the intervention period, the IRR is 0.79 (95% CI: 0.42–1.36; p = 0.43), indicating a decrease in the incidence of infections compared to the pre-intervention period, although this result is not statistically significant. After the intervention, the IRR is 0.53 (95% CI: 0.26–0.97; p = 0.057), suggesting a further reduction in the incidence of CDI; this result is on the borderline of statistical significance (p = 0.057), indicating a potential effect of the intervention, albeit without full statistical certainty. Conclusions: The absence of a CDI surge despite increased antibiotic consumption highlights the synergistic relationship between antibiotic stewardship and rigorous infection control practices. The combination of the improved disinfection protocol and comprehensive staff training proved remarkably effective in mitigating CDI risk. Cleaning and disinfection in healthcare facilities is crucial for the prevention of healthcare-associated infections. Full article

Pet ownership is the most common form of human–animal interaction (HAI), is prevalent worldwide and confers benefits for the health and wellbeing of humans. Here, we examined a large set of anonymised data from the Royal Society for the Prevention of Cruelty to Animals (RSPCA) to identify trends in the intake, adoption and relinquishment of companion animals in England and Wales before and during times of uncertainty, namely, the COVID-19 pandemic and the cost-of-living crisis (COLC). We employed an interrupted time series (ITS) design which controls for pre-existing trends by comparing observed outcomes post-intervention with those expected if the intervention had not occurred. Nearly 200,000 animals were taken in by the RSPCA and over 140,000 animals were adopted or released over the four-year period from 2018 to 2022. When controlling for the brief closure of RSPCA sites, fewer dogs and cats were taken in and adopted during the pandemic compared to pre-pandemic, and the intake and adoption of animals were lower during the COLC than before. A downward trend in the return of animals was observed, and the principal reasons for return were problem behaviours, owner unpreparedness and a change in circumstances. Our ITS analysis also permitted forecast predictions to be made which could prove helpful to the RSPCA. Full article

In forestry data management and analysis, data integrity and analytical accuracy are of critical importance. However, existing techniques face a dual challenge: first, sensor failures, data transmission interruptions, and human errors lead to the prevalence of missing data in forestry datasets; second, the multidimensional heterogeneity and environmental complexity of forestry systems not only increase the difficulty of missing value estimation, but also significantly affect the accuracy of resolving the potential correlations among data. In order to solve the above problems, we proposed the $L^2$ model using the aspen woodland as the experimental object. The $L^2$ model consists of a complementary model and a predictive model. The $L^2$ complementary model integrates low tensor tensor kernel norm minimisation (LRTC-TNN) to capture global consistency and local trends, and combines long and short-term memory and convolutional neural network (LSTM-CNN) to extract temporal and spatial features, which is effective in accurately reconstructing the missing values in forestry time-series data. We also optimised the LRTC-TNN model to handle multi-class data and incorporated a self-attention mechanism into the LSTM-CNN framework to improve performance in the case of complex missing data. The $L^2$ prediction model adopts a dual attention mechanism (temporal attention mechanism and feature attention mechanism) based on LSTM to construct a stem diameter prediction model, which achieves high-precision prediction of stem diameter variation. Then we further analyzed the effects of various factors on stem diameter using SHAP (Shapley Additive Explanations). Experimental results demonstrate that our $L^2$ significantly improves data completion accuracy while preserving the original structure and key characteristics of the data. Moreover, it enables a more precise analysis of the factors affecting stem diameter, providing a robust foundation for advanced forestry data analysis and informed decision making. Full article

Background/Objectives: Our study aimed to assess longitudinal trends in blood culture contamination in a regional secondary care teaching hospital before and after the COVID-19 pandemic and to evaluate differences in the interpretation of trends using two distinct quasi-experimental statistical methods, including interrupted time-series analysis. Methods: We analyzed data from a 10-year period spanning from 2015 to 2024, encompassing 147,733 admissions and 634,158 patient-days, as well as a total of 25,068 blood cultures. The (i) blood culture contamination rate, (ii) contaminant proportion, (iii) single blood culture rate, and (iv) first-to-second bottle contamination ratio were calculated. Results: The observed usage rate of blood cultures per 1000 patient-days was 38.9. The contamination rate of blood cultures increased from 0.9% to 1.5% (p = 0.001) in the post-COVID-19 period, accompanied by a rise in the proportion of contaminant bacteria from 9.8% to 14.2% (p = 0.016). Additionally, the proportion of single blood culture collections increased from 23.1% to 33.6% (p < 0.001). Finally, the overall first-to-second bottle contamination ratio was 1.54, while the ratio in the post-COVID-19 period was 1.92. Conclusions: In a low-COVID-19-burden secondary care teaching hospital setting, blood culture contamination rates have progressively increased over the past decade, irrespective of the pandemic. These findings underscore the importance of sustained vigilance in infection prevention and control practices, strict adherence to blood culture collection protocols, and the ongoing need for staff training. Full article

Background: The COVID-19 pandemic had significant impacts on healthcare systems, including the disruption of essential services such as childhood immunization. Containment measures, such as social distancing, contributed to reduced adherence to vaccination programs, increasing the risk of re-emerging vaccine-preventable diseases. We aim to assess the evolution of childhood vaccination coverage in Brazil from 2010 to 2024, identifying trends before, during, and after the COVID-19 pandemic. Methods: An interrupted time series (ITS) study was conducted using publicly available aggregated data on vaccination coverage for children under one year of age. Prais–Winsten regression models were applied to estimate trend changes and evaluate the impact of the pandemic on immunization levels. Results: The findings indicate a progressive decline in vaccination coverage between 2010 and 2019, which was intensified in 2020 by the pandemic. The BCG vaccine showed the greatest decline (−24.88%, p < 0.001), while pentavalent and hepatitis B vaccines decreased annually by −3.72% and −2.21%, respectively. From 2021 onwards, a gradual recovery in coverage was observed, with significant increases for BCG (+7.48% per year, p < 0.001), hepatitis B (+7.45%, p = 0.014), and MMR (+6.73%, p = 0.017) vaccines. Discussion: The results highlight a concerning decline in childhood immunization, exacerbated by the pandemic but showing recent signs of recovery. This scenario underscores structural challenges within the National Immunization Program, requiring coordinated efforts to reverse vaccination losses and ensure system resilience in the face of future crises. Full article

The Mae Kha Canal in Chiang Mai, Thailand, has long suffered from severe water quality deterioration due to rapid urbanization, population growth, and inadequate waste management practices. This article describes an integrated water resource management approach, started in February 2018, with the goal of guaranteeing sustainable urban living conditions and improving the water quality of the canal. This study was a quasi-experimental study, with key interventions including garbage net installation, coconut-fiber mattress weir installation, and Free Water Surface Wetland treatment using vetiver grass. An interrupted time-series analysis of the monthly biochemical oxygen demand (BOD) and dissolved oxygen (DO) levels were applied to examine the trends and changes after the full implementation of wastewater management in March 2021. The results demonstrated significant improvements in water quality, indicated by reduced BOD levels (from 17.00–38.70 to 9.00–12.67 mg/L) and increased DO levels (from 0.00–2.40 to 0.80–6.00 mg/L). However, the decreases in BOD and increases in DO levels were not stable during the year. The post-intervention trend of BOD level decreased after the wastewater management implementation at SriDonChai Road (coefficient of trend: = −0.75 [95% confidence interval: −1.44 to −0.06]). This project highlights the effectiveness of integrated management strategies in addressing urban water quality issues and emphasizes the importance of community involvement in sustainable environmental management. The findings underscore the necessity for integrated approaches to wastewater management in urban environments to address both ecological health and public welfare. Full article