Search Results (10,037)

Accurate assessment of a crop’s water requirement is essential for optimising irrigation scheduling and increasing the sustainability of water use. The crop coefficient (K_c) is a dimensionless factor that converts reference evapotranspiration (ET₀) into actual crop evapotranspiration (ET_c) and is widely used for irrigation scheduling. The K_c reflects canopy cover, phenology, and crop type/variety, but is difficult to measure directly in heterogeneous perennial systems, such as vineyards. Remote sensing (RS) products, especially open-source satellite imagery, offer a cost-effective solution at moderate spatial and temporal scales, although their application in vineyards has been relatively limited due to the large pixel size (~100 m²) relative to vine canopy size (~2 m²). This study aimed to improve grapevine K_c predictions using vegetation indices derived from harmonised Sentinel-2 imagery in combination with spectral unmixing, with ground data obtained from canopy light interception measurements in three winegrape cultivars (Shiraz, Cabernet Sauvignon, and Chardonnay) in the Barossa and Eden Valleys, South Australia. A linear spectral mixture analysis approach was taken, which required estimation of vine canopy cover through beta regression models to improve the accuracy of vegetation indices that were used to build the K_c prediction models. Unmixing improved the prediction of seasonal K_c values in Shiraz (R² of 0.625, RMSE = 0.078, MAE = 0.063), Cabernet Sauvignon (R² = 0.686, RMSE = 0.072, MAE = 0.055) and Chardonnay (R² = 0.814, RMSE = 0.075, MAE = 0.059) compared to unmixed pixels. Furthermore, unmixing improved predictions during the early and late canopy growth stages when pixel variability was greater. Our findings demonstrate that integrating open-source satellite data with machine learning models and spectral unmixing can accurately reproduce the temporal dynamics of K_c values in vineyards. This approach was also shown to be transferable across cultivars and regions, providing a practical tool for crop monitoring and irrigation management in support of sustainable viticulture. Full article

Background: Maple syrup urine disease (MSUD) is a genetic disorder caused by mutations in the branched-chain α-ketoacid dehydrogenase (BCKDH) complex, leading to toxic buildup of branched-chain amino acids (BCAAs) and their ketoacid derivatives. While newborn screening (NBS) and molecular testing are standard diagnostic tools, they face challenges such as delayed results and false positives. Untargeted metabolomics has emerged as a complementary approach, offering comprehensive metabolic profiling and potential for novel biomarker discovery. We previously applied untargeted metabolomics to neonates with MSUD, identifying distinct metabolic signatures. Objective: This follow-up study investigates metabolic changes and biomarkers in pediatric MSUD patients and explores shared dysregulated metabolites between neonatal and pediatric MSUD. Methods: Dried blood spot (DBS) samples from pediatric MSUD patients (n = 14) and matched healthy controls (n = 14) were analyzed using LC/MS-based untargeted metabolomics. Results: In pediatric MSUD, 3716 metabolites were upregulated and 4038 downregulated relative to controls. Among 1080 dysregulated endogenous metabolites, notable biomarkers included uric acid, hypoxanthine, and bilirubin diglucuronide. Affected pathways included sphingolipid, glycerophospholipid, purine, pyrimidine, nicotinate, and nicotinamide metabolism, and steroid hormone biosynthesis. Seventy-two metabolites overlapped with neonatal MSUD cases, some exhibiting inverse trends between age groups. Conclusion: Untargeted metabolomics reveals that the metabolic profiling of MCUD pediatric patients different from that of their controls. Also, there are valuable age-specific and shared metabolic alterations in MSUD, enhancing the understanding of disease progression in MSUD patients. This supports its utility in improving diagnostic precision and developing personalized treatment strategies across developmental stages. Full article

Background: Acute lung injury (ALI) and its severe form, acute respiratory distress syndrome (ARDS), remain major causes of morbidity and mortality, yet no targeted pharmacological therapy is available. Excessive neutrophil and macrophage infiltration drives reactive oxygen species (ROS) production and cytokine release, leading to alveolar–capillary barrier disruption and fatal respiratory failure. Methods: We applied an integrative multi-omics strategy combining single-cell transcriptomics, peripheral blood proteomics, and lung tissue proteomics in a lipopolysaccharide (LPS, 10 mg/kg)-induced mouse ALI model to identify key signaling pathways. Harpagide, an iridoid glycoside identified from our natural compound screen, was evaluated in vivo (40 and 80 mg/kg) and in vitro (0.1–1 mg/mL). Histopathology, oxidative stress markers (SOD, GSH, and MDA), cytokine levels (IL-6 and IL-1β), and signaling proteins (HIF-1α, p-PI3K, p-AKT, Nrf2, and HO-1) were quantitatively assessed. Direct target engagement was probed using surface plasmon resonance (SPR), the cellular thermal shift assay (CETSA), and 100 ns molecular dynamics (MD) simulations. Results: Multi-omics profiling revealed robust activation of HIF-1, PI3K/AKT, and glutathione-metabolism pathways following the LPS challenge, with HIF-1α, VEGFA, and AKT as core regulators. Harpagide treatment significantly reduced lung injury scores by ~45% (p < 0.01), collagen deposition by ~50%, and ROS accumulation by >60% relative to LPS (n = 6). The pro-inflammatory cytokines IL-6 and IL-1β were reduced by 55–70% at the protein level (p < 0.01). Harpagide dose-dependently suppressed HIF-1α and p-AKT expression while enhancing Nrf2 and HO-1 levels (p < 0.05). SPR confirmed direct binding of Harpagide to HIF-1α (KD = 8.73 µM), and the CETSA demonstrated enhanced thermal stability of HIF-1α. MD simulations revealed a stable binding conformation within the inhibitory/C-TAD region after 50 ns. Conclusions: This study reveals convergent immune–microenvironmental regulatory mechanisms across cellular and tissue levels in ALI and demonstrates the protective effects of Harpagide through multi-pathway modulation. These findings offer new insights into the pathogenesis of ALI and support the development of “one-drug, multilayer co-regulation” strategies for systemic inflammatory diseases. Full article

The rapid growth of urban populations intensifies congestion, air pollution, and energy demand. Green mobility is central to sustainable smart cities, and the Internet of Things (IoT) offers a means to monitor, coordinate, and optimize transport systems in real time. This paper presents an Internet of Things (IoT)-based architecture integrating heterogeneous sensing with edge–cloud orchestration and AI-driven control for green routing and coordinated Electric Vehicle (EV) charging. The framework supports adaptive traffic management, energy-aware charging, and multimodal integration through standards-aware interfaces and auditable Key Performance Indicators (KPIs). We hypothesize that, relative to a static shortest-path baseline, the integrated green routing and EV-charging coordination reduce (H1) mean travel time per trip by ≥7%, (H2) CO₂ intensity (g/km) by ≥6%, and (H3) station peak load by ≥20% under moderate-to-high demand conditions. These hypotheses are tested in Simulation of Urban MObility (SUMO) with Handbook Emission Factors for Road Transport (HBEFA) emission classes, using 10 independent random seeds and reporting means with 95% confidence intervals and formal significance testing. The results confirm the hypotheses: average travel time decreases by approximately 9.8%, CO₂ intensity by approximately 8%, and peak load by approximately 25% under demand multipliers ≥1.2 and EV shares ≥20%. Gains are attenuated under light demand, where congestion effects are weaker. We further discuss scalability, interoperability, privacy/security, and the simulation-to-deployment gap, and outline priorities for reproducible field pilots. In summary, a pragmatic edge–cloud IoT stack has the potential to lower congestion, reduce per-kilometer emissions, and smooth charging demand, provided it is supported by reliable data integration, resilient edge services, and standards-compliant interoperability, thereby contributing to sustainable urban mobility in line with the objectives of SDG 11 (Sustainable Cities and Communities). Full article

Background/Objectives: Carbapenem-resistant Klebsiella pneumoniae (CRKP) threatens Intensive Care Units (ICU), particularly in settings where serine (KPC) and metallo-β-lactamases (NDM) co-circulate. The aim of this study was to assess CRKP susceptibility especially to novel β-lactam/β-lactamase inhibitor combinations, characterize the genetic determinants of resistance, and contribute to the understanding of local epidemiology in the ICU of our hospital. Methods: We studied 32 non-duplicate CRKP isolates (30 ICU, 2 wards) collected at Hippokration General Hospital, Thessaloniki (May–Oct 2023). Bacterial identification and Antimicrobial susceptibility testing (AST) were performed by VITEK-2; Minimum inhibitory concentrations (MICs) for ceftazidime/avibactam (CAZ/AVI), meropenem/vaborbactam (MER/VAB), and imipenem/relebactam (IMI/REL) were determined by E-tests. Colistin MICs were performed by broth microdilution. Carbapenemases were screened phenotypically and by immunochromatography and confirmed by multiplex PCR. One bronchial isolate co-harboring bla_NDM and bla_KPC genes underwent WGS. Results: All isolates were carbapenem-resistant and showed extensive resistance to β-lactams and fluoroquinolones. By PCR, 8/32 (25%) carried bla_KPC alone, 8/32 (25.0%) bla_NDM alone, and 16/32 (50%) co-harbored bla_KPC and bla_NDM. KPC-only isolates were generally susceptible in vitro to CAZ/AVI, MER/VAB, and IMI/REL, whereas dual KPC-NDM producers were resistant to all three combinations. Tigecycline showed the highest retained activity; colistin remained active in a minority. WGS of one ST512 (CG258) isolate revealed co-harboring bla_NDM-1 and bla_KPC-3 with additional resistance determinants and plasmid replicons, consistent with high-risk spread. Conclusions: Half of CRKP isolates in this ICU-predominant series co-produced KPC and NDM, severely limiting β-lactam/β-lactamase inhibitor options. These data support routine screening for carbapenemases, strict infection prevention, antimicrobial stewardship, and access to agents active against MBLs. Full article

Background: The aim of this study was to describe the clinical and laboratory characteristics of hospitalized pediatric influenza cases during the 2024–2025 season in Northwestern Greece, with a focus on influenza-associated benign acute childhood myositis (BACM). Methods: We conducted a retrospective observational study of children aged 0–16 years hospitalized with laboratory-confirmed influenza between October 2024 and May 2025 at two pediatric departments. BACM was diagnosed based on calf pain, difficulty walking, elevated creatine kinase (CK), and symptom resolution without other causes. Results: A total of 113 children (mean age 7.0 ± 4.2 years; 50.4% male) were included; 61.1% had influenza A and 38.9% influenza B. None had received influenza vaccination. BACM was identified in 37 children (32.7%), who were significantly older than patients without myositis (9.3 ± 2.7 vs. 6.0 ± 4.5 years, p < 0.001). Influenza B was strongly associated with BACM (70.3% vs. 29.7%, χ²(1) = 22.7, p < 0.001, Cramer’s V = 0.448). Median CK in BACM cases was 2637 IU/L (range: 189–129,390 IU/L); all had preserved renal function. One patient with congenital myopathy developed rhabdomyolysis (peak CK 130,000 IU/L) but had a full recovery. All patients received oseltamivir and supportive care; no intensive care admissions or deaths occurred. Conclusions: In our hospitalized cohort, BACM was observed relatively frequently (32.7%), particularly in children with influenza B; however, this proportion reflects hospitalized cases and does not indicate the true incidence in the general pediatric population. Despite high CK levels, outcomes were favorable with supportive care. These findings underscore the importance of clinician awareness to avoid unnecessary investigations and hospitalizations. Full article

This study aimed to test the reliability of seven functional performance tests in amateur trail runners, including ankle mobility, balance, hopping, and countermovement jump (CMJ) tests. The sample consisted of 35 runners who were evaluated in two sessions separated by 7 to 14 days, which varied due to participants’ scheduling constraints. Relative reliability was assessed using the Intraclass Correlation Coefficient (ICC, which indicates consistency between repeated measures), the Standard Error of Measurement (SEM, which reflects measurement precision), and the Minimal Detectable Change (MDC, which represents the smallest real change beyond measurement error). The results show high reliability in almost all tests. The Lunge Test obtained an ICC of 0.990 and 0.983 for distance, and 0.941 and 0.958 for angular measurements in both legs. The Hop Tests showed moderate reliability with ICC above 0.7 In contrast, the Y Balance Test demonstrated lower reliability, with ICC values ranging from 0.554 to 0.732. The CMJ test showed good reliability, with an ICC ranging from 0.753 to 0.894, an SEM between 5.79% and 11.3%, and an MDC ranging from 15.54% to 31.44%, making it useful for assessing lower limb explosive strength. Both tests presented comparatively higher error values, which should be considered when interpreting individual changes. These findings support the use of these tests as valid and reliable tools for evaluating ankle dorsiflexion, balance, functional symmetry, and lower limb explosive strength in amateur trail runners, prior to training programs or injury prevention strategies, provided that standardized protocols and validated measuring instruments are used. Full article

Background/Objectives: Acute-on-chronic liver failure (ACLF) is a life-threatening complication of cirrhosis, characterized by organ failures and high short-term mortality. Alcohol-related cirrhosis is one of the most frequent underlying etiologies of ACLF in Europe. Infections, particularly those leading to sepsis are recognized triggers; however, their relative contribution, clinical features, and prognostic impact in critically ill patients with alcohol-related cirrhosis remain incompletely defined. This study aimed to systematically identify and characterize precipitating events of ACLF in this population and to compare outcomes between sepsis- and non-sepsis-related cases. Methods: We conducted a retrospective cohort study including 188 ICU patients with alcohol-related cirrhosis who were treated for ACLF at a tertiary university medical center. ACLF was defined and graded according to the European Association for the Study of the Liver—Chronic Liver Failure Consortium (EASL-CLIF) criteria, and sepsis was diagnosed according to Sepsis-3 definitions. Clinical data, precipitating events, microbiological evidence, organ support requirements, and in-hospital outcomes were systematically analyzed. Results: Sepsis was the most frequent precipitating event, identified in 118 patients (62.8%), while 70 patients (37.2%) developed ACLF due to non-septic triggers such as gastrointestinal bleeding. Patients with sepsis-associated ACLF presented with more advanced disease (ACLF grade 2–3 in 80.5% vs. 57.1%, p = 0.004), higher Chronic Liver Failure Consortium—Acute-on-Chronic Liver Failure Score (CLIF-C ACLF) scores (median 55 vs. 50, p = 0.04), longer ICU stays (median 11 vs. 4.5 days, p < 0.001), and markedly higher in-hospital mortality (60.2% vs. 20.0%, p < 0.001) compared to patients without sepsis. Pneumonia (48.3%), urinary infections (17.8%) and spontaneous bacterial peritonitis (16.1%) were the leading infectious foci triggering sepsis. Microbiological evidence was obtained in 82.2% of sepsis cases, with frequent polymicrobial infections and opportunistic pathogens including Enterococcus faecium and Candida albicans. Conclusions: In critically ill patients with alcohol-related cirrhosis, infections leading to sepsis are the predominant precipitating event of ACLF and the strongest determinant of short-term prognosis. Compared with non-sepsis triggers, sepsis-associated ACLF is characterized by more severe disease, greater need for organ support, longer ICU stays, and substantially higher mortality. These findings highlight the urgent need for early recognition, rapid diagnostic strategies, and optimized infection management to improve outcomes in this high-risk population. Full article

Background: Airborne transmission of bacteria, viruses, and fungal spores poses a major threat in enclosed settings, particularly nursing homes where residents are highly vulnerable. Compressive Heating Air Sterilization Technology (CHAST) applies compressive heating to inactivate microorganisms without reliance on filtration or chemicals. Methods: CHAST efficacy was evaluated in laboratory and deployed for a feasibility and performance validation study of air sterilization in a nursing home environment. Laboratory studies tested prototypes (300–5000 CFM; 220–247 °C) against aerosolized surrogates including Bacillus globigii (Bg), B. stearothermophilus (Bst), B. thuringiensis (Bt), Escherichia coli, and MS2 bacteriophage. Viral inactivation thresholds were further assessed by exposing MS2 to progressively lower treatment temperatures (64.5–143 °C). Feasibility and performance validation evaluation involved continuous operation of two CHAST units in a nursing home, with pre- and post-treatment air samples analyzed for bacterial and fungal burden. Results: Laboratory testing demonstrated consistent microbial inactivation, with most prototypes achieving > 6-log (99.9999%) reductions across bacterial spores, vegetative bacteria, and viruses. A 5000 CFM prototype achieved > 7-log (99.99999%) elimination of B. globigii. MS2 was completely inactivated at 240 °C, with modeling suggesting a threshold for total viral elimination near 170 °C. In the feasibility study, baseline sampling revealed bacterial (35 CFU/m³) and fungal (17 CFU/m³) contamination, dominated by Bacillus, Staphylococcus, Cladosporium, and Penicillium. After 72 h of CHAST operation, discharge air contained no detectable viable organisms, and fungal spore counts showed a 93% reduction relative to baseline return air. Units maintained stable operation (464 °F ± 2 °F; 329–335 CFM) throughout deployment. Conclusion: CHAST reproducibly and scalably inactivated airborne bacteria, viruses, and fungi under laboratory and feasibility field studies, supporting its potential as a chemical-free strategy to improve infection control and indoor air quality in healthcare facilities. Full article

By employing thin section analysis, scanning electron microscopy (SEM), homogenization temperatures of fluid inclusions, and carbon–oxygen isotope analysis of carbonate cements, this study conducted a temporal-quantitative investigation into the porosity evolution of relatively high-quality reservoirs in the Second Member of the Xujiahe Formation (Xu-2 Member) in the Xinchang area of western Sichuan. The analysis focused on quantifying porosity loss due to compaction, cementation, and porosity enhancement from dissolution. Results indicate that compaction exerted the most significant impact on reservoir quality in the Xu-2 Member, causing over 70% of total porosity loss. Cementation processes, including carbonate cements, silica cements, and authigenic chlorite, further degraded reservoir properties. Authigenic chlorite precipitated earliest at burial depths of 600–800 m, while authigenic quartz and carbonate cements persistently affected the reservoir at depths of 2000–5000 m, reducing porosity by at least 10% (up to 21%). Dissolution processes initiated at approximately 3500 m burial depth, generating secondary porosity of ≥2%, with a maximum increase of 16%. Integrating these findings with the natural gas accumulation history, the coupling relationship between pore evolution and gas accumulation was elucidated. The study reveals that reservoir tightness in the Xu-2 Member developed at burial depths of 4050–5300 m, with large-scale gas accumulation predominantly occurring prior to reservoir densification. The findings provide critical guidance for identifying high-quality tight sandstone reservoirs and optimizing exploration targets in the Xu-2 Member of the Xinchang area, Western Sichuan Basin, thereby supporting efficient development of regional tight gas resources. Full article

Smart grid operators face escalating cyber threats and tight resource constraints, demanding the transparent, defensible prioritization of security controls. This paper asks how to select cybersecurity controls for smart grids while retaining picture fuzzy evidence throughout and supporting policy-sensitive “what-if” analyses. We propose a hybrid Picture Fuzzy Stepwise Weight Assessment Ratio Analysis (SWARA) and Combinative Distance-based Assessment (CODAS) framework that carries picture fuzzy evidence end-to-end over a domain-specific cost/benefit criteria system and a relative-assessment matrix, complemented by multi-scenario sensitivity analysis. Applied to ten prominent solutions across twenty-nine sub-criteria in four dimensions, the model highlights Performance as the most influential main criterion; at the sub-criterion level, the decisive factors are updating against new threats, threat-detection capability, and policy-customization flexibility; and Zero Trust Architecture emerges as the best overall alternative, with rankings stable under varied weighting scenarios. A managerial takeaway is that foundation controls (e.g., OT-integrated monitoring and ICS-aware detection) consistently remain near the top, while purely deceptive or access-centric options rank lower in this context. The framework contributes an end-to-end picture fuzzy risk-assessment model for smart grid cybersecurity and suggests future work on larger expert panels, cross-utility datasets, and dynamic, periodically refreshed assessments. Full article

Fibre-reinforced composites are facing new challenges in the context particular in sustainability and recyclability. Vitrimers could be useful as new matrices to support the increase in sustainability. Due to their high strength, which is comparable to that of thermosets often used in composites, and their covalent adaptive networks, which make them reshapeable for scaled-up manufacturing and recycling purposes, they are very useful. Orthogonal cutting is used for precise reshaping and functional integration into carbon fibre reinforced plastics. Vitrimers could improve processing results at the cutting edge as well as surface quality thanks to their self-healing properties compared to brittle matrices, as well as enabling the recycling of formed chips and scrap. This study showcases the manufacturing of a carbon fibre-reinforced vitrimer using 4-aminophenyl disulfide as a hardener, with vacuum-assisted resin infusion. The temperature of chip formation and the cutting parameters are then shown for different fibre orientations, cutting widths and speeds. The observed cutting forces are lower (less than 140 N) and more irregular for fibre orientations 45°/135°, increasing with cutting depth, and fluctuating periodically during machining. Despite varying cutting speeds, the forces remain relatively constant in range between 85 N and 175 N for 0°/90° fibre orientation and 50 N and 120 N for 45°/135° fibre orientation, with no significant tool wear observed and lower-damage depth and overhanging fibres observed for 0°/90° fibre orientation. Damage observation of the cutting tool shows promising results, with lower abrasion observed compared to thermoset matrices. Microscopic images of the broached surface also show good quality, which could be improved by self-healing of the matrix at higher temperatures. Temperature measurements of chip formation using a high-speed camera show a high temperature gradient as cutting speeds increase, but the temperature only ever exceeds 180 °C at cutting speeds of 150 m/min, ensuring reprocessability since this is below the degradation temperature. Therefore, orthogonal cutting of vitrimers can impact sustainable composite processing. Full article

Ionic rare earths are extracted from primary sources by the in situ chemical leaching method, where the type and concentration of leaching agents significantly affect the mechanical properties and microstructure of the ore body. In this study, MgSO₄ and Al₂(SO₄)₃ solutions of varying concentrations were used as leaching agents to investigate the evolution of shear strength, the characteristics of Duncan–Chang hyperbolic model parameters, and the changes in microstructural pore characteristics of rare earth samples under different leaching conditions. The results show that the stress–strain curves of all samples consistently exhibit strain-hardening behavior under all leaching conditions, and shear strength is jointly influenced by confining pressure and the chemical interaction between the leaching solution and the soil. The samples leached with MgSO₄ exhibited higher shear strength than those treated with water. The samples leached with 3% and 6% Al₂(SO₄)₃ showed increased strength, while 9% Al₂(SO₄)₃ caused a slight decrease. With increasing leaching agent concentration, the cohesion of the samples significantly declined, whereas the internal friction angle remained relatively stable. The Duncan–Chang model accurately described the nonlinear deformation behavior of the rare earth samples, with the model parameter b markedly decreasing as confining pressure increased, indicating that confining stress plays a dominant role in governing the nonlinear response. Under the coupled effects of chemical leaching and mechanical stress, the number and size distribution of pores of the rare earth samples underwent a complex multiscale co-evolution. These results provide theoretical support for the green, efficient, and safe exploitation of ionic rare earth ores. Full article

Background/Objectives: As survival improves in congenital heart defects (CHD), psychosocial support—particularly during crises—has become increasingly important. We examined how concerns of CHD patients and their relatives evolved during the Coronavirus Disease 2019 (COVID-19) pandemic, focusing on the influence of role (patient vs. relative), gender, and CHD complexity. Methods: The German National Register for Congenital Heart Defects (NRCHD) conducted two nationwide online surveys in April 2020 (Survey 1) and April 2021 (Survey 2). Free-text responses were analyzed using Mayring’s summarizing content analysis. Categories were coded per respondent (present/absent) for exploratory comparisons by year, role, sex, and CHD complexity. Analyses were cross-sectional and descriptive (p-values unadjusted). Results: In survey 1, 15.9%, and in survey 2, 19.3% of respondents provided qualitative information. In 2020, dominant themes included general COVID-19 information (37.3%), lack of CHD-specific information (30.4%), worry (24.1%), fear (23.2%), isolation (21.4%), and uncertainty (21.2%). By 2021, concerns shifted toward vaccination (24.1%) and vaccination prioritization (23.4%), while information gaps (21.8%) and fear (21.0%) persisted. Significant year-to-year changes included decreases in general information needs, concern, isolation, and uncertainty, and increases in prioritization (all p < 0.01). Relatives consistently reported higher psychological burden than patients (p ≤ 0.01). Conclusions: Concerns moved from early fear/uncertainty to vaccination and prioritization one year later, with persistent information needs across subgroups. Clear CHD-specific communication, caregiver-inclusive psychosocial support, and crisis-resilient care pathways (including telemedicine) are essential for this vulnerable population. Full article

Background: Immunization coverage has increased substantially in the Western Pacific Region, saving millions of lives and supporting disease elimination efforts. However, gaps in coverage and inequitable vaccine access persist, leaving millions unvaccinated. Wealth-based inequalities remain a critical barrier to achieving equitable immunization coverage and maximizing the health benefits of vaccination programs. Methods: We analyzed full immunization coverage among 1-year-olds in 10 middle-income countries of the Western Pacific Region using data from the WHO Health Inequalities Data Repository. National and wealth quintile-specific coverage rates and within-country inequalities were assessed using absolute and relative measures (difference, ratio, slope index of inequality, and relative index of inequality). Trends over time were examined in countries with longitudinal data (n = 5), identifying pro-rich or pro-poor changes based on shifts in quintile-specific coverage. We also calculated the population attributable risk (PAR) and fraction (PAF) to estimate the potential increase in national coverage if wealth-based inequalities were eliminated. Findings: Substantial gaps in immunization coverage persist across all countries studied (n = 10), but with substantial between- and within-country disparities. Coverage was higher among the richest quintiles in half of the countries, with the rest showing no significant disparities. Trends in inequalities were mixed: Cambodia, Mongolia, and Viet Nam experienced pro-poor improvements over time; the Philippines saw widening pro-rich inequalities; and Lao PDR showed little change. Population attributable risks (PAR) showed that eliminating wealth-based inequalities could increase national coverage significantly in five countries (Fiji, Lao PDR, Papua New Guinea, Samoa, and Tonga), with relative gains that could increase national coverage by up to 50% while achieving equity gains. Conclusions: Addressing wealth-based inequalities in immunization could drive substantial gains in national coverage across the Western Pacific Region. Sustained, equity-oriented approaches are essential to achieving universal vaccine access and ensuring no population is left behind. Inequality patterns can guide equity-focused policies to reach underserved and disadvantaged populations. Full article