Search Results (11,691)

Maritime Autonomous Surface Ships (MASSs) raise safety and regulatory challenges that extend beyond technical reliability. This study builds on a published system-theoretic process analysis (STPA) of degraded operations that identified 92 loss scenarios. These scenarios were reformulated into a two-round Delphi survey with 20 experts from academic, industry, seafaring, and regulatory backgrounds. Panelists rated each scenario on severity, likelihood, and detectability. To avoid rank reversal, common in the Risk Priority Number, an adjusted index was applied. Initial concordance was low (Kendall’s W = 0.07), reflecting diverse perspectives. After feedback, Round 2 reached substantial agreement (W = 0.693, χ² = 3265.42, df = 91, p < 0.001) and produced a stable Top 10. High-priority items involved propulsion and machinery, communication links, sensing, integrated control, and human–machine interaction. These risks are further exacerbated by oceanographic conditions, such as strong currents, wave-induced motions, and biofouling, which can impair propulsion efficiency and sensor accuracy. This highlights the importance of environmental resilience in MASS safety. These clusters were translated into five action bundles that addressed fallback procedures, link assurance, sensor fusion, control chain verification, and alarm governance. The findings show that Remote Operator competence and oversight are central to MASS safety. At the same time, MASSs rely on artificial intelligence systems that can fail in degraded states, for example, through reduced explainability in decision making, vulnerabilities in sensor fusion, or adversarial conditions such as fog-obscured cameras. Recognizing these AI-specific challenges highlights the need for both human oversight and resilient algorithmic design. They support explicit inclusion of Remote Operators in the STCW convention, along with watchkeeping and fatigue rules for Remote Operation Centers. This study provides a consensus-based baseline for regulatory debate, while future work should extend these insights through quantitative system modeling. Full article

Most people with obesity who have undergone gastric bypass surgery have dyslipidemia. Because tear film layers play a major role in the pathogenesis of evaporative dry eye, some studies suggest that dry eye syndrome (DES) and dyslipidemia could cooperate in the ocular system. This study aimed to investigate whether tear film conditions are correlated with blood lipid levels. We calculated a sample of 29 patients in this study. We measured the characteristics of the tear film via the Schirmer test and tear break-up time (BUT) test; three measurements were made, and the average value was subsequently recorded. High-density lipoprotein (HDL) correlated positively with BUT (p < 0.05), but cholesterol and triglycerides correlated negatively with Schirmer (p < 0.05 and p < 0.001, respectively). Our findings suggest that HDL levels significantly influence ocular tear film stability and that triglycerides and cholesterol influence the aqueous component of the tear film, which is conducive to the hypothesis that postgastric bypass surgery tear deficiencies could be mainly of evaporative origin and not watery. Bariatric patients may have a high likelihood of suffering dry eye by modifications in the lipid tear layer; however, the development of DES in bariatric patients remains unclear. Thus, high levels of cholesterol and triglycerides could be associated with aqueous-type dry eye (main gland production), and low HDL levels could be associated with evaporative-type dry eye (meibomian gland production). Full article

Positive percentage time series are present in many empirical applications; they take values in the continuous interval (0,1) and are often modeled with linear dynamic models. Risks of biased predictions (outside the admissible range) and problems of heteroskedasticity in the presence of asymmetric distributions are ignored by practitioners. Alternative models are proposed in the statistical literature; the most suitable is the dynamic beta regression which belongs to generalized linear models (GLM) and uses the logit transformation as a link function. However, owing to the Jensen inequality, this approach may also not be optimal in prediction; thus, the aim of the present paper is the in-depth forecasting comparison of linear and beta autoregressions. Simulation experiments and applications to nonstationary time series (the US unemployment rate and BR hydroelectric energy) are carried out. Rolling regression for time-varying parameters is applied to both linear and beta models, and a prediction criterion for the joint selection of model order and sample size is defined. Full article

Background/Objectives: Sarcopenia is common in patients with diabetes mellitus. The use of branched-chain amino acids may influence muscle mass. The aim of this study is to evaluate the effect of a diabetes-specific formula enriched with calcium hydroxy-methyl-butyrate (CaHMB) on muscle mass in patients with diabetes and high risk of malnutrition. Methods: A prospective observational study in 95 patients divided into two cohorts of patients with diabetes, treated with a tailored diet, dietary counseling, and diabetes-specific oral nutritional supplements (ONSs) administered between meals: one enriched with CaHMB (CaHMB Diabetes ONS) 44 (46.32%) patients; and another without CaHMB (Diabetes-Specific ONS) 51 (53.68%) patients. Anthropometric parameters, bioimpedance, artificial intelligence (AI)-assisted ultrasound of the rectus femoris muscle (PIIXMED^TM), and handgrip strength were assessed. Evaluations were conducted at baseline and after 3 months. Results: The mean age was 71.05 (10.67) years; 56.8% were male. After three months, both groups increased their nutritional intake with no differences in dietary protein content between groups. The CaHMB group showed a greater increase in muscle mass as measured by ultrasound, both in muscle area (CaHMB ONS: +5.84 (−3.3 ± 21.58)% vs. Diabetes-Specific ONS: −9.34% (−25.78 ± 12.02)%; p < 0.01) and muscle thickness (CaHMB ONS: +9.17 (−4.40 ± 21.05)% vs. Diabetes-Specific ONS −6.30 (−18.57 ± 12.56)%; p < 0.01). The CaHMB ONS group showed a higher likelihood of increased muscle mass compared to the Diabetes-Specific ONS, with an odds ratio (OR) of 9.31 (95%CI: 2.16–40.13) for thickness and 3.96 (95%CI: 1.11–14.13) for area, adjusted for gender, age, serum albumin, and baseline glycated hemoglobin. Conclusions: Supplementation with Ca-HMB in patients with diabetes and high risk of malnutrition showed significant improvements in muscle mass as assessed by AI-assisted ultrasound. Both groups increased nutritional intake, but only the CaHMB group showed specific benefits in muscle parameters. Full article

Objective: This study evaluated the cost-effectiveness of sacituzumab govitecan (SG) compared with single-agent chemotherapy of the physician’s choice (TPC) from the perspective of Taiwan’s National Health Insurance. Methods: A partitioned survival model was developed to assess outcomes in patients with metastatic triple-negative breast cancer (mTNBC). Clinical data were derived from the ASCENT trial, while direct medical costs were obtained from Taiwan’s National Health Insurance Administration (NHIA). Utility values were taken from published literature. The primary outcome was the incremental cost-effectiveness ratio (ICER), expressed as cost per quality-adjusted life year (QALY) gained. One-way and probabilistic sensitivity analyses were performed to examine parameter uncertainty and test the robustness of the results. Results: In the base-case analysis, SG was associated with an incremental cost of USD 121,836 per QALY gained—exceeding Taiwan’s willingness-to-pay (WTP) threshold of USD 102,120. One-way sensitivity analyses indicated that SG drug cost was the primary driver of ICER variability. Probabilistic sensitivity analysis showed that reducing the price of SG by 50% increased the likelihood of cost-effectiveness. Conclusions: From the NHIA perspective, SG is not cost-effective for patients with advanced or metastatic TNBC at its current price. Substantial price reductions would be required for SG to become cost-effective under the WTP threshold of USD 102,120 per QALY. Full article

This article estimates the impact of a policy change on an event probability in a difference-in-differences hazard model using four estimators. We examine the error distributions of the estimators via a simulation experiment with twelve different scenarios. In four simulation scenarios when all relevant variables are known, three of the four methods yield accurate estimates of the policy impact. In eight simulation scenarios when an individual characteristic is unobservable to the researcher, only one method (nonparametric maximum likelihood) achieves accurate estimates of the policy change. The other three methods (standard Cox, three-step Cox, and linear probability) are severely biased. Full article

Aedes (Stegomyia) albopictus (Skuse), a mosquito vector with increasing capacity to transmit human arboviral infections worldwide, naturally harbors the intracellular bacterium Wolbachia spp. This relationship has been observed in native mosquito populations of Ae. albopictus around the world and, more recently, in Mérida, Yucatán, México (abbreviated hereafter as MID). This study provides additional evidence confirming the presence of Wolbachia A (wAlbA) and B (wAlbB) strains in field-collected Ae. albopictus of Mérida, based on wsp gene DNA sequencing analyses of 14 positive PCR samples. Maximum likelihood (ML) analyses of the wsp gene showed high nucleotide sequence homology between Wolbachia from Merida and the globally reported strains A and B, suggesting that these two Wolbachia strains have remained stable in Ae. albopictus over time, regardless of the geographical area. To the best of our knowledge, this is the first report of Wolbachia gene sequencing in native populations of Ae. albopictus in Yucatán, Mexico. Currently many Aedes mosquitoes (e.g., Ae. aegypti) harboring intracellular Wolbachia B bacteria are being released as part of arbovirus and mosquito control programs in Yucatan and globally. Understanding the presence and stability of Wolbachia strains across different Aedes host backgrounds is crucial to ensuring the long-term effectiveness of biological interventions aimed at controlling mosquito populations and arbovirus transmission in endemic areas. Full article

Increasing the amount of data with complex dynamics requires the constant updating of statistical distributions. This study aimed to introduce a new three-parameter distribution, named the new exponentiated Weibull (NEW) distribution, by applying the logarithmic transformation to the exponentiated Weibull distribution. The exponentiated Weibull distribution is a powerful generalization of the Weibull distribution that includes several classical distributions as special cases—Weibull, exponential, Rayleigh, and exponentiated exponential—which make it capable of capturing diverse forms of hazard functions. By combining the advantages of the logarithmic transformation and exponentiated Weibull, the new distribution offers great flexibility in modeling different forms of hazard functions, including increasing, J-shaped, reverse-J-shaped, and bathtub-shaped functions. Some mathematical properties of the NEW distribution were studied. Moreover, four different methods of estimation—the maximum likelihood (ML), least squares (LS), Cramer–Von Mises (CVM), and percentile (PE) methods—were employed to estimate the distribution parameters. To assess the performance of the estimates, three simulation studies were conducted, showing the benefit of the ML method, followed by the PE method, in estimating the model parameters. Additionally, five datasets were used to evaluate the effectiveness of the new distribution in fitting real data. Compared with some Weibull-type extensions, the results demonstrate the superiority of the new distribution in modeling various forms of real data and provide evidence for the applicability of the new distribution. Full article

Background: The hemoglobin-to-red-cell distribution width ratio has emerged as a novel prognostic marker in various clinical settings. However, its association with total bone mineral density in adolescents remains inadequately explored. Methods: This cross-sectional study was based on data from the 2011–2018 National Health and Nutrition Examination Survey, including adolescents aged 12–19 years with complete data on hemoglobin, red cell distribution width, and total bone mineral density. Weighted multivariable linear regression models and generalized additive models were used to evaluate the association between hemoglobin-to-red-cell distribution width and total bone mineral density. A two-piecewise linear regression model was applied to assess potential threshold effects, with log-likelihood ratio tests used to determine the significance of inflection points. Subgroup and interaction analyses were further conducted to examine whether age, sex, race, and milk product consumption modified this association. Results: A total of 3789 adolescents were included. Participants in the highest hemoglobin-to-red-blood-cell distribution width ratio quartile had significantly higher hemoglobin levels, lower red blood cell distribution width, greater total bone mineral density, higher total calcium and blood urea nitrogen levels, and lower body mass index, high-density lipoprotein cholesterol, and serum 25OHD levels compared to lower quartiles. The hemoglobin-to-red-blood-cell distribution width ratio was positively associated with total bone mineral density (fully adjusted β = 0.078, 95% CI: 0.053, 0.104, p < 0.0001). A two-piecewise linear regression model identified an inflection point at the hemoglobin-to-red-cell distribution width ratio = 1.055; the positive association became stronger above this threshold (β = 0.143 vs. β = 0.039 below the threshold, p = 0.003 for nonlinearity). Subgroup analysis revealed significant gender interactions (p < 0.0001). A higher HRR was significantly associated with greater total BMD in males (β = 0.130, 95% CI: 0.089–0.171, p < 0.0001), whereas no significant association was observed in females (β = −0.009, 95% CI: −0.043–0.025, p = 0.604). Positive associations were also observed among participants aged 12–15 years, non-Hispanic Whites, non-Hispanic Blacks, other Hispanics, Mexican Americans, and frequent milk consumers. Conclusions: Our results indicate that the hemoglobin-to-red-cell distribution width ratio shows a potential association with bone mineral density in male adolescents, which may offer supportive value for bone health assessment but requires further validation. Full article

Background: The rising prevalence of neurodegenerative conditions such as dementia underscores the impact of population aging. Consequently, long-term care needs have increased and are often met by family members through informal caregiving, thereby supporting formal care systems by reducing associated costs. These caregivers face physical and mental health challenges, raising concerns about their psychological well-being and prompting interest in both clinical and psychosocial research. Ryff’s eudaimonic model offers a robust framework for the assessment of psychological well-being; yet, in Romania, data on this population segment remain limited. Objective: This study aimed to compare the psychological well-being of Romanian dementia family caregivers with a reference population from the Romanian adaptation of the 54-item Ryff Psychological Well-Being Scale, and to explore how sociodemographic characteristics relate to relevant differences across well-being dimensions. Methods: A cross-sectional study was conducted among 70 Romanian family caregivers recruited from a single clinical hospital in Bucharest, Romania. Caregivers completed the 54-item Ryff Scale (Romanian adaptation), and scores were compared to reference values using one-sample t-tests with bootstrap confidence intervals. The most relevant dimension (purpose in life) was dichotomized and further examined in relation to sociodemographic and caregiving variables using Chi-squared and Fisher’s exact tests. Results: Caregivers reported significantly lower scores compared to the reference population in purpose in life (p < 0.001, d = −1.01), personal growth (p < 0.001, d = −0.91), and positive relations (p = 0.01, d = −0.30). The most pronounced deficit was observed in purpose in life, with 85.7% of caregivers scoring below the reference mean. This dimension was further examined in relation to caregiver characteristics. Retirement status showed a statistically significant association with Purpose in Life, with retired caregivers more likely to report lower scores (χ² (1) = 4.04, p = 0.04), supported by the likelihood ratio test (p = 0.01) and a linear trend (p = 0.05). Additional marginal associations were found for household income (p = 0.14) and whether the patient slept in a separate room (p = 0.15), suggesting possible links between caregiver well-being and economic or environmental conditions. Conclusions: The study findings highlight notable psychological vulnerabilities among Romanian dementia caregivers, particularly in purpose in life and personal growth. Associations with structural and contextual factors such as retirement status, income, and caregiving environment suggest that caregiver well-being is shaped by broader socioeconomic conditions. While the magnitude of these deficits may be underestimated due to elevated stress levels in the reference group, the findings underscore the need for targeted clinical, social, and policy-level interventions aimed at strengthening existential meaning and personal development in culturally specific settings. Full article

Background: Although surgical antibiotic prophylaxis (SAP) is considered a standard of care for preventing surgical site infections, the rising incidence of antimicrobial resistance (AMR) increases the likelihood of infections caused by multidrug-resistant organisms (MDROs), which may be associated with worse surgical outcomes. Methods: A multidisciplinary working group was convened by the Italian Multidisciplinary Society for the Prevention of Healthcare-Associated Infections (SIMPIOS) to define key measures for optimizing SAP in the era of AMR. Selecting the most appropriate SAP in patients colonized with MDROs is a complex decision that cannot be generalized, as it depends on both host factors and the specific surgical procedure. At present, there is limited evidence of SAP in these patients. Results: This position paper aims to provide practical guidance for optimizing SAP in the context of an AMR era. It is structured in three sections: (1) core principles of surgical antibiotic prophylaxis; (2) the role of screening, decolonization, and targeted prophylaxis for MDROs; and (3) barriers to changing surgeons’ prescribing behaviours. Conclusions: The working group developed 15 recommendation statements based on scientific evidence. Full article

Background/Objective: This study examined whether a brief measure combining subjective cognitive concerns and financial interference, termed Subjective Cognitive Decline-Financial (SCD-F), is associated with excess spending behavior in older adults. Methods: Community-dwelling older adults, some with early memory loss and some with no cognitive complaints (N = 150, M age = 72.6), provided 12 months of checking account statements and participated in interviews to clarify aspects of their personal financial behaviors. SCD-F was defined by asking if memory decline was interfering with financial decision-making or transactions. A 3-point SCD-F measure was created. Excess spending was determined by checking whether account expenditures exceeded all sources of income. Nonparametric tests (Kruskal–Wallis and Mann–Whitney U) and multiple regression models assessed group differences and predictors. Results: Group differences in excess spending were pronounced (H(2) = 15.75, p < 0.001). Those in the high SCD-F group had a significantly greater likelihood of excess spending (Z = −4.11; r = 0.43) and higher excess spending percentages (Z = −4.11; r = 0.43) compared to those with no memory loss. Regression analyses indicated that SCD-F was the strongest predictor of excessive spending (β = 0.40, t = 5.43, p < 0.001), even after controlling for age, gender, race, and education (R² = 0.235, F(5,144) = 8.86, p < 0.001). Conclusions: A brief self-report measure, SCD-F, effectively identifies older adults at risk of financial mismanagement, even absent formal cognitive impairment. Monitoring subjective cognitive concerns together with financial interference could enable early intervention. This brief measure may be useful in clinical settings as a screening tool, and in large national surveys. Full article

This article analyzes the unequal distribution of perceived work flexibility in Chile, drawing on data from the 2023 National Time Use Survey (ENUT). Using multilevel multinomial logistic regression models, this study explores how individual and contextual variables shape the likelihood of perceiving jobs as fully flexible, partially flexible, or non-flexible. The findings reveal that flexibility is a stratified experience: women are more likely to access partial—but not full—flexibility; workers with higher educational attainment report lower perceptions of flexibility, and longer working hours are associated with diminished flexibility. Among the contextual factors, occupation stands out as the strongest predictor, explaining a substantial share of variance across the models. Employers are more likely to report full flexibility, while dependent workers tend to experience only limited forms of autonomy. These results challenge the notion of flexibility as a universally empowering feature of modern labor markets, underscoring the need for policies and organizational practices that address the structural inequalities embedded in flexible work arrangements. Full article

Objective: This study conducted a comprehensive analysis of molecular transmission networks and pretreatment drug resistance (PDR) in newly diagnosed HIV-1 infections in Taizhou, China. Methods: From 2021 to 2023, we collected 1126 plasma samples from newly diagnosed HIV patients in Taizhou. The HIV pol gene was amplified, and the obtained sequence was used to construct a maximum likelihood (ML) phylogenetic tree and molecular transmission network. PDR-related mutations were analyzed based on the Stanford University HIV Resistance Database. We conducted genotyping analysis and analysis of factors related to the larger clusters (≥10). Results: We successfully amplified and sequenced the pol region from 937 (83.2%, 937/1126) treatment-naïve HIV-1 patients, each with comprehensive epidemiological documentation. Phylogenetic characterization revealed significant subtype heterogeneity, with CRF07_BC (42.1%, 395/937), CRF01_AE (27.6%, 259/937) and CRF08_BC (22.1%, 209/937) being the most prevalent. Notably, 11.4% of the sequenced population (107/937) presented detectable PDR mutations. Univariate analysis revealed that larger clusters (≥10) are more inclined to be aged ≥60, divorced or widowed, have high or technical secondary school education, and have sexual contact with homosexuality. Multivariate analysis revealed that age ≥60 years and not having a PDR mutation (p < 0.05) were factors associated with larger clusters (≥10). Conclusions: Molecular transmission networks suggest that CRF08_BC is spreading rapidly among the older male population. Consequently, targeted interventions aimed at this population are crucial for halting the ongoing rapid dissemination of this subtype. Full article

This study intends to identify and quantify the individual, perceptual, and contextual factors associated with odor-related perception and to assess the perception of odor sources according to meteorological conditions. Two face-to-face seasonal community surveys were conducted using stratified random sampling with proportional allocation, yielding representative samples of residents in a southern Brazilian city, where mild constant temperatures throughout the year and shifting prevailing wind directions expose residents to different odor sources. Chi-Square tests were applied to assess associations between odor perception and qualitative variables, while logistic regression was used to identify predictors of higher annoyance. Results showed that prevailing wind direction influenced source attribution, with steel industry and sewage-related sites most frequently cited. Proximity to the steel plant increased both source recognition and annoyance levels. Reported impacts included closing windows and reducing outdoor activities. Self-reported respiratory problems consistently predicted higher annoyance levels in both surveys. The statistical methods were effective in analyzing the likelihood of odor-related perception and its relationship with explanatory variables. These findings highlight the value of a data-driven approach—specifically, integrating wind direction, source proximity, and community-based perception—to support urban environmental management and guide odor mitigation strategies. Full article