Search Results (2,193)

Background/Objectives: Cancer is a leading cause of death for Aboriginal and Torres Strait Islander people, with remoteness increasing the risk for poorer outcomes. Primary health care (PHC) clinics have an important role in cancer screening, diagnosis, and post-discharge cancer care, particularly in remote communities, so accurate, timely communication between hospitals, specialists and PHC clinics is vital. This paper analyses the perspectives of Northern Territory health care professionals on communication between PHC and hospital services related to providing care for Aboriginal people with cancer and recommends strategies for improving communication between services. Methods: A qualitative study was undertaken in which semi-structured interviews were conducted with fifty staff from 15 health services (8 regional, remote, and very remote PHC clinics; 3 hospitals; one cancer centre and 3 cancer support services) between 2016 and 2019. Transcripts were thematically analysed, with findings categorized into barriers and enablers to communication. Results: Deficiencies in communication impeded patient care and support. A major barrier was fragmented, inefficient information systems; IT systems across health services were unable to interface, resulting in delayed/missing patient information that impacted discharge and follow up. Other barriers included PHC staff with limited knowledge of cancer, high turnover of PHC staff and tertiary hospital staff with limited understanding of remote health care challenges. Individuals used workarounds to overcome system failures and made substantial efforts around individual patients to improve communication. Specific roles and the use of telehealth between services and centralised cancer care services supported better between-service communication. Conclusions: Communication between hospital services and remote PHC clinics is essential to care for Aboriginal cancer patients; our research identified communication as inadequate in terms of consistency and timeliness. Commitment to more timely communication, health care IT systems that facilitate sharing information, designated staff in PHC clinics to support patients with cancer, dedicated Aboriginal cancer roles and additional resourcing to coordinate telehealth appointments could improve communication and sharing of patient information between services. Full article

The fracture behavior of a locking pin used in the penultimate-stage blades of a 600 MW steam turbine in a thermal power plant was investigated through microstructural and microhardness characterization, fracture surface and energy-dispersive spectroscopy (EDS) analysis, as well as finite element load simulation. The microhardness values measured on the cross-section of the service pins ranged from 528 to 541 HV0.1, showing little difference from the unused pins. Scanning electron microscopy analysis revealed that approximately 70% of the fracture surfaces exhibited an intergranular “rock candy” morphology. The results indicate that pin failure was primarily caused by the combined effects of fretting wear and stress corrosion cracking (SCC). Specifically, vibration at the blade root, impeller, and pins due to start–stop cycles and load variations led to fretting wear, forming pits approximately 75 μm in size. Under the combined effects of weakly corrosive wet steam environments and shear stresses, SCC initiated at the high stress concentration points of these pits. Early crack propagation primarily followed original austenite grain boundaries, while later stages mainly extended along martensite plate boundaries. As cracks advanced, the cross-sectional area gradually decreased, causing the effective shear stress to increase until it exceeded the shear strength, ultimately leading to fracture. These findings not only provide a scientific basis for enhancing the reliability of steam turbine locking pins and extending their service life, but also contribute to a broader understanding of the failure mechanisms of key components operating under corrosive and fluctuating load environments. Full article

Underground high-voltage transmission cables, especially high-pressure fluid-filled (HPFF) pipe-type cable systems, are critical components of urban power networks. These systems consist of insulated conductor cables housed within steel pipes filled with pressurized fluids that provide essential insulation and cooling. Despite their reliability, HPFF cables experience faults caused by insulation degradation, thermal expansion, and environmental stressors, which, due to their subtle and gradual nature, complicate incipient fault detection and subsequent fault localization. This study presents a novel, proactive, and retrofit-friendly predictive condition monitoring method. It leverages distributed accelerometer sensors non-intrusively mounted on the HPFF steel pipe within existing manholes to continuously monitor vibration signals in real time. A physics-enhanced convolutional neural network–long short-term memory (CNN–LSTM) deep learning architecture analyzes these signals to detect incipient faults before they evolve into critical failures. The CNN–LSTM model captures temporal dependencies in acoustic data streams, applying time-series analysis techniques tailored for the predictive condition monitoring of HPFF cables. Experimental validation uses vibration data from a scaled-down HPFF laboratory test setup, comparing normal operation to incipient fault events. The model reliably identifies subtle changes in sequential acoustic patterns indicative of incipient faults. Laboratory experimental results demonstrate a high accuracy of the physics-enhanced CNN–LSTM architecture for incipient fault detection with effective data feature extraction. This approach aims to support enhanced operational resilience and faster response times without intrusive infrastructure modifications, facilitating early intervention to mitigate service disruptions. Full article

The growing demand for lightweight and reliable structures across aerospace, automotive, marine, and civil engineering has driven significant advances in polymer adhesive technology. These materials serve dual roles, functioning as matrices in composites and as structural bonding agents, where they must balance strength, toughness, durability, and sometimes sustainability. Recent review efforts have greatly enriched understanding, yet most approach the topic from specialized angles—whether emphasizing nanoscale toughening, multifunctional formulations, sustainable alternatives, or microscopic failure processes in bonded joints. While such perspectives provide valuable insights, they often remain fragmented, leaving open questions about how nanoscale mechanisms translate into macroscopic reliability, how durability evolves under realistic service conditions, and how mechanical responses interact across different loading modes. To address this, the present review consolidates knowledge on the performance of polymer adhesives under tension, shear, fracture, fatigue, creep, and impact. By integrating experimental findings with computational modeling and emerging data-driven approaches, it situates localized mechanisms within a broader structure–performance framework. This unified perspective not only highlights persistent gaps—such as predictive modeling of complex failure, scalability of nanomodified systems, and long-term durability under coupled environments—but also outlines strategies for developing next-generation adhesives capable of delivering reliable, high-performance bonding solutions for demanding applications. Full article

Nowadays, the online comment process of product after-sales has become a key part of product development. Quality problems, such as the failure of products or services, are more likely to exist or hide in negative comments. Therefore, this paper focuses on detecting abnormal changes in both the time between review T and the emotional score S of negative comments. Due to the complexity of the online review process, the distribution assumption of S and T may be invalid. To solve this problem, this study propose a distribution-free monitoring scheme that combines the exponentially weighted moving average-based Lepage statistics of S and T using a max-type combining function. This scheme is designed for joint monitoring of location and scale parameters in Phase II of an unknown but continuous process. The scheme’s performance is evaluated via Monte Carlo simulation under in-control and out-of-control conditions, using statistical measures such as the mean, standard deviation, median, and selected percentiles of the run length distribution. Simulation results indicate that the scheme is effective in detecting shifts in both location and scale parameters. Furthermore, an application of the proposed scheme for monitoring online reviews is discussed to illustrate its implementation design. Full article

This narrative review synthesizes our current understanding of sepsis and septic shock burden in intensive care units (ICUs) worldwide. Based on a comprehensive but non-systematic literature search from 2000 to 2025, this review synthesizes our current understanding across eight key domains: epidemiology, pathophysiology, diagnostics, management strategies, long-term outcomes, disparities, and future directions. The global burden of sepsis, especially in the developed and developing world, is great: over 48 million cases per year, with mortality rates at the ICU level in the range of 30 to 50%, depending on geography and resources. The pathophysiological progression from an initial hyper-inflammatory state to immune paralysis underlies organ failure and complicates therapeutic targeting. Diagnostic approaches, including clinical scoring systems, biomarkers (e.g., procalcitonin, MR-proADM), and emerging AI tools, offer improved early detection but face challenges in reliability and accessibility. Management in the ICU remains anchored in timely antimicrobial administration, hemodynamic stabilization with balanced fluids and vasopressors, source control, and organ support, including lung-protective ventilation and kidney replacement therapy. Novel adjuncts, such as immunomodulators and extracorporeal therapies, show promise but demand further validation. Importantly, survivors face significant long-term sequelae—post-intensive care syndrome (PICS)—encompassing physical, cognitive, and psychological impairments, which require structured rehabilitation and follow-up. The future of sepsis care lies in integrating precision medicine—through molecular diagnostics, individualized immunotherapy, and AI-supported monitoring—with scalable, equitable implementation strategies that bridge the gap between high- and low-income settings. Addressing disparities and expanding rehabilitation services are essential to improving survival and long-term quality of life in sepsis survivors. Full article

In the Middle East, RC joist slab systems with wide beams are widely used for residential floors. However, when these beams support planted columns, excessive deflection beyond code limits is often observed, despite adequate flexural and shear design. This paper experimentally assesses, for the first time, the efficacy of using carbon-fiber-reinforced polymer (CFRP) sheets alone versus a novel hybrid system comprising CFRP sheets and CFRP/honeycomb plates in controlling deflection in RC wide beams with planted columns. Four RC wide beam specimens at half-scale, each featuring a planted column, were tested to failure. Two control specimens, the first one was designed to reflect standard construction practices. It was sufficiently designed in flexure and shear, but its deflection exceeded code requirements. The second was designed to satisfy the code deflection requirements. The remaining specimens were strengthened using two different techniques: one with externally bonded CFRP sheets and the other with the hybrid system. The findings demonstrated a marked improvement in the flexural performance of the retrofitted wide beams, with peak load increases of 65–71%, stiffness gains of 63–67%, and reduced deflections meeting serviceability requirements (deflection at peak load was reduced by 45–48%). Furthermore, an analysis procedure was developed to estimate the flexural strength and deflection of these beams. Full article

Corrosion concerns motivate the use of alternatives to conventional steel reinforcement in RC beams. This review evaluates fiber-reinforced polymer (FRP) bars and hybrid steel–FRP composite bars (SFCBs) used for durability-critical applications. We conducted a structured literature search focused on 2010–2025 and included seminal pre-2010 studies for context. Experimental studies and code provisions were screened to synthesize evidence on load–deflection response, cracking, and failure, with brief notes on UHPC systems. FRP-RC offers corrosion resistance but limited ductility and an abrupt post-peak response. Steel is ductile and provides warning before failure. SFCB combines durability with steel-core ductility and yields gradual softening and higher energy absorption. Practice should select reinforcement based on stiffness–ductility–durability trade-offs. Current codes only partially cover hybrids. Key gaps include standardized bond–slip and tension-stiffening models for SFCB and robust data on long-term performance under aggressive exposure. Full article

Carbon Fiber Reinforced Composite (CFRP) is widely used in deep-sea pressure-resistant structures. With the increase in submergence depth demand leading to the increase in the thickness of the CFRP shell plate, there is a significant thickness effect on its compression performance. In order to study the mechanism of the decrease in compression performance of the laminate, uniaxial compression tests, interlaminar shear tests, out-of-plane tensile tests, damage characterization, and FEM analysis were carried out on three thicknesses of laminates. The results showed that the compressive strength, interlaminar shear strength, out-of-plane tensile strength of laminates and FEM compression model decreased by 10.3%, 12.7%, 23.6%, and 13.6% when the thickness of the laminate was increased from 2 mm to 12 mm. Concurrently, the compression failure mechanism is transformed from the overall strength failure to the instability–crush failure mode caused by the initial delamination. The effects of out-of-plane tensile strength and interlaminar shear strength on compressive properties were also considered. It provides support for the regulation of compression performance of large-thickness laminates and the safety of deep-sea pressure-resistant structures in service. Full article

This work quantifies downtime caused by cyberattacks for eight critical urban services in Milan by coupling sectoral Continuous-Time Markov Chains (CTMCs) with an approximately equal-area H3 hexagonal grid of the city. The pipeline ingests OpenStreetMap infrastructure, simulates coupled failure/repair dynamics across sectors (power, telecom, hospitals, ambulance stations, banks, ATMs, surveillance, and government offices), and reports availability, outage burden (area under the infected/down curve, or AUC), and multi-sector distress probabilities. Cross-sector dependencies (e.g., power→telecom) are modeled via a joint CTMC on sector up/down states; uncertainty is quantified with nested bootstraps (inner bands for stochastic variability, and outer bands for parameter uncertainty). Economic impacts use sector-specific cost priors with sensitivity analysis (PRCC). Spatial drivers are probed via hotspot mapping (Getis–Ord $G_i^{*}$, local Moran’s I) and spatial regression on interpretable covariates. In a baseline short decaying attack, healthcare remains the most available tier, while power and banks bear a higher burden; coupling increases P(≥$k\mathrm{sectors}\mathrm{down})$ and per-sector AUC relative to an independent counterfactual, with paired-bootstrap significance at $\alpha =0.05$ for ATMs, banks, hospitals, and ambulance stations. Government offices are borderline, and telecom shows the same direction of effect but is not significant at $\alpha =0.05$. Under a persistent/adaptive attacker, citywide downtime and P(≥2) rise substantially. Costs are dominated by telecom/bank/power under literature-informed penalties, and uncertainty in those unit costs explains most of the variance in total loss. Spatial analysis reveals statistically significant hotspots where exposure and dependency pressure are high, while a diversified local service mix appears protective. All code and plots are fully reproducible with open data. Full article

This study investigates the influence of freeze–thaw (F–T) cycles on the seismic fragility of double-column bridge piers. Mechanical tests were conducted on standard concrete specimens subjected to 0, 25, 50, 75, and 100 F–T cycles using an HC-HDK9/F rapid freeze–thaw testing machine. The experimental results were used to calibrate and validate the applicability of the selected concrete constitutive model. A nonlinear finite element model of a double-column bridge pier was developed in the OpenSees platform, incorporating material degradation parameters corresponding to varying F–T cycles. Incremental dynamic analysis (IDA) was performed to derive seismic demand curves and quantify fragility corresponding to multiple damage states. The results indicate that the failure probability of the piers increases significantly with the number of F–T cycles, particularly for slight and moderate damage levels. In the low to moderate peak ground acceleration (PGA) range, the exceedance probabilities for slight and moderate damage states show a sharp rise, highlighting the sensitivity of early-stage damage to F–T degradation. It is worth noting that under the extreme condition of PGA = 1.0 g and 100 freeze–thaw cycles, the piers still exhibit a certain degree of redundancy against severe and complete damage, which to some extent reflects the certain rationality of the current seismic design in freeze–thaw environments. These findings underscore the robustness of current seismic design provisions in cold regions and provide theoretical and data-driven support for performance assessment, service life prediction, and maintenance planning of bridges exposed to freeze–thaw environments. Full article

This paper presents the results of a comprehensive study of the wear processes of press tools used in the molding of uranium dioxide (UO₂) nuclear fuel pellets. Particular attention is paid to the analysis of the influence of operating conditions on changes in microstructure, geometry and physical and mechanical properties of working surfaces of molds and punches. The studies using scanning electron microscopy (SEM), X-ray fluorescence (XRF) and X-ray phase analysis (XRD) methods, as well as evaluation of microhardness and roughness, allowed to identify the dominant failure mechanisms—abrasive and adhesive wear, microcrack formation and local degradation of coatings. The results of the experiments confirmed the presence of progressive changes on the working surfaces of the tool, affecting the formation of defects of fuel pellets and reducing the service life of the press equipment. This work allows us to not only better understand the wear patterns in the batch production of nuclear fuel, but also to formulate practical recommendations to increase tool life by optimizing pressing modes and using wear-resistant coatings. Full article

Background/Objectives: Ulipristal acetate (UPA) is a selective progesterone receptor modulator approved for the treatment of uterine fibroids, but concerns have arisen regarding its potential for severe hepatotoxicity, particularly following regulatory warnings in Europe and Korea. The real-world risk of UPA-induced liver injury in Korean women remains largely unknown. To evaluate the hepatic safety of UPA among Korean women with uterine fibroids using large-scale, population-based healthcare claims and health screening data. Methods: A retrospective, propensity score-matched cohort study was conducted using the Korean National Health Insurance Service database. Women diagnosed with uterine fibroids who received UPA between 2013 and 2016 (n = 12,166) were compared to matched controls (n = 36,498) who did not receive UPA. Primary outcomes included changes in liver enzymes (AST, ALT, γ-GTP) and Fatty Liver Index (FLI) before and after UPA use. Results: UPA users showed small but statistically significant increases in ALT, γ-GTP, and FLI compared to pre-treatment values, though all values remained within normal reference ranges. Odds of elevated FLI (≥60) and γ-GTP (≥40 IU/L) were modestly increased in the UPA group, but no cases of severe hepatotoxicity or liver failure occurred. Conclusions: UPA use in Korean women was associated with mild, subclinical elevations in liver enzymes and fatty liver index, but not with clinically significant hepatotoxicity. These findings support vigilant hepatic monitoring during UPA therapy, while contextualizing its risk as low in this population. Full article

Urban water distribution systems, as integral parts of underground pipeline networks, face challenges from aging infrastructure, operational demands, and transient pressure surges that can compromise structural integrity and service reliability. This work introduces a cost-oriented multi-objective design framework that explicitly accounts for both the likelihood of fire flow failure and the risks posed by transient pressures. The approach links a probabilistic reliability model with a transient pressure evaluation module, and couples both within a non-dominated sorting genetic algorithm to generate Pareto-optimal design solutions. Design solutions are constrained to maintain transient pressures within permissible limits, ensuring enhanced pipeline safety while optimizing capital costs. Case studies show that adopting a minimum 150 mm distribution main improves fire flow capacity and reduces transient-induced failure risks. The proposed method provides a predictive, computational tool that can be integrated into digital twin environments, supporting sustainable infrastructure planning, long-term monitoring, and proactive maintenance for resilient urban water supply systems. Full article

Conventional strengthening measures for existing structures are usually not effective for the self-weight, which accounts for around 70% of the total load in reinforced concrete structures. Therefore, their effect on the overall load-bearing capacity is low. A self-weight-effective alternative for flexural strengthening is the thermal prestressing of additional reinforcement installed on the structure. In this method, reinforcing bars are slotted into the tensile zone, embedded in filler material, and tempered from the outside. They are thermally stretched, and once cooling starts, the bond with the hardened filler prevents re-deformation. The induced prestressing force counteracts dead loads and relieves the tensile zone, making the additional bars effective for the self-weight. In this paper, the effectiveness of the strengthening method is experimentally investigated in the serviceability and the ultimate limit states. Experiments involve strengthening a reinforced concrete beam under load by a thermally prestressed additional bar. Moreover, two reference tests are made to evaluate the method. An unstrengthened beam characterizes the lower capacity limit. Another beam with the same reinforcement amount as the strengthened one, but completely installed at casting, serves as the upper benchmark. All beams are loaded until bending failure. The strengthening method is assessed by means of the load-bearing behavior, deflection, crack development, and the strains in the initial as well as the added reinforcement. The results demonstrate the effectiveness of the strengthening method. The thermally prestressed bar achieves an effective pre-strain of approximately. 0.4‰ by heating at about 70 °C. The induced prestressing force and associated compression reduce tensile cracks by approx. 45% and increase stiffness. The strengthened beam reaches the maximum load of the upper benchmark, but with about 33% less deflection. The filler, which also expands thermally, generates an additional prestressing force that is effective up to about 20% of the load capacity. Beyond this, the filler begins to crack and its effect decreases, but the pre-strain in the reinforcing bar remains until maximum load. Full article