Search Results (3,754)

This study presents a fiber Bragg grating (FBG) pressure sensor with a spindle-type protective structure, optimized using the NSGA-II algorithm, for monitoring pressure variations at the contact interface between wind turbine foundation rings and concrete. To optimize the sensor sensitivity and measurement range, the NSGA-II algorithm was employed to determine the optimal structural dimensions and material properties of the spindle-type sensor. This approach addresses two critical challenges: firstly, enhancing the survivability of FBG pressure sensors in harsh service environments, and secondly, enabling accurate monitoring of weak pressure signals at the foundation ring–concrete interface. Linearity verification tests demonstrate a sensor sensitivity of 55.01 pm/MPa within a 10 MPa measurement range, accompanied by a linear correlation coefficient of 0.999, confirming high stability of the fabricated sensors. Furthermore, wind turbine foundation model experiments validate the practical service performance of the proposed sensor. Results indicate that the spindle-type FBG pressure sensor not only withstands severe operating conditions but also achieves real-time monitoring of interfacial pressure changes in foundation ring–concrete systems. Full article

Esters are predominant fragrance components in various traditional fermented foods. Hongqu rice wine, a beverage gaining popularity among young consumers in China, largely owes its aromatic profile to esterases derived from Monascus species. However, research on esterification characteristics of Monascus strains remains limited, constraining efforts to improve the quality and flavor of Hongqu rice wine. To better understand their esterification characteristics of commercial Monascus strains from different regions of China and further develop a high-quality esterifying Monascus strain for the liquor industry, we identified five Monascus isolates from red koji samples used in rice wine fermentation. Their esterification activity was evaluated by preparing red koji through solid-state fermentation of wheat bran under conditions simulating industrial production. Among the isolates, M. purpureus M21 exhibited the highest reported esterification activity to date, reaching 88.5 ± 8.6 U. Through atmospheric and room-temperature plasma (ARTP) mutagenesis breeding, the esterification activity of M. purpureus M21 was further enhanced by 41% to 124.8 U. In summary, this study not only figures out the properties of commercial esterifying Monascus from diverse regional sources but also significantly enhances the esterification performance of a potent esterifying Monascus strain without invoking GMO controversies. This high-performance esterifying Monascus strain presents a promising fermentation starter to enhance the flavor profile of Hongqu rice wine and diverse fermented beverages, thereby meeting evolving consumer preferences. Full article

Background: Preoperative education is important in enhancing patients’ preparation and improving outcomes during recovery after surgery. However, there are limited studies in Saudi Arabia concerning levels of satisfaction and the recall of preoperative education among patients undergoing elective surgeries. Aim: The aim of this project was to examine patient satisfaction and recall of preoperative education for elective surgeries. Methodology: An explanatory sequential mixed-method study was carried out at one of the large governmental tertiary hospitals in the Western Region of Saudi Arabia. Data were collected from a total sample of 167 patients. Quantitative data were collected using a structured questionnaire, while interviews were carried out to collect qualitative data. Descriptive, inferential and thematic analyses were utilised for data analysis. Results: The quantitative results revealed high patient satisfaction with preoperative education (60%) and good levels of recall for preoperative education (45%). A moderate positive correlation between patient satisfaction and recall (r = 0.56; p < 0.01) was reported. A regression analysis revealed that age, level of education and surgery specialty predicted both satisfaction and recall. Four major themes (satisfaction with preoperative education, recall of preoperative education, effect of preoperative education on anxiety and preparedness and improvement suggestions) emerged from the qualitative analysis. Conclusions: This study established that patients under elective surgeries were satisfied with their preoperative education and could recall information provided in such educational programs. However, the findings also reinforced the need for follow-up communication after surgery to help improve recall and adherence to postoperative care instructions. Full article

Active bilayer (BL) packaging films were developed by depositing chitosan/fish gelatin blend containing tannic acid (TA) at varying levels (1, 3, and 5%; w/w) onto a polylactic acid layer. Augmenting TA levels enhanced strength (17.27 MPa to 27.57 MPa) but reduced flexibility (85.03% to ~38%) due to enhanced polymer cross-linking induced by TA, as confirmed by FTIR. The films exhibited exceptional UV-blocking capabilities, in which UVB protection reached 98.34% and 100% for films with 1% and 3% TA, respectively. SEM micrographs revealed uniform dispersion of TA with defect-free matrices. The antioxidant activity of the films upsurged with rising TA levels. When baby clam edible portions (BC-EP) were packed in pouches made with BL films, the pouches containing 5% TA most effectively slowed lipid oxidation and inhibited spoilage during 12 days of refrigerated storage. Total viable count, psychrotrophic bacteria count, and counts of specific spoilage organisms were decreased. Reductions in spoilage bacteria including Shewanella and Pseudomonas and dominance of lactic acid bacteria were confirmed using next-generation sequencing analysis. The release kinetics of TA followed Fickian diffusion, enabling sustained antioxidant and antimicrobial action. TA-containing pouches therefore effectively extended the shelf life of BC-EP through synergistic barrier, antioxidant, and antimicrobial mechanisms, offering a sustainable alternative to conventional plastic packaging. Full article

Background: Neuraxial anesthesia (NA) is increasingly utilized across various surgical specialties, particularly for abdominal procedures, making it a potential alternative to general anesthesia (GA). Methods: This narrative review was conducted following the PRISMA guidelines for systematic reviews to report on the application of NA worldwide and across various surgical fields. Results: The findings indicate that while NA is gaining popularity, its adoption varies significantly by procedure type and specialty. Evidence supporting its use in major abdominal surgeries remains limited, with most studies focusing on pelvic and minor procedures. The emerging concept of awake surgery under NA shows promising potential, as preliminary data suggest benefits in reducing perioperative morbidity and enhancing recovery. Despite these advancements, gaps in the literature highlight the need for further high-quality trials to establish NA as a safe and routine alternative to GA. Conclusions: NA is increasingly explored across different surgical specialties as a feasible and effective option for abdominal procedures. However, despite this growing interest, solid evidence supporting its use in major abdominal surgery remains limited. Full article

Medical students often begin their studies with preconceived notions about specialties, which may evolve as they gain clinical experience. This study aimed to assess changes in specialty preferences over six years of medical training and to compare two cohorts of first-year students. A repeat cross-sectional design was used, analyzing survey data from the 2019 class during preclinical (first–second year) and clinical (sixth year) stages, and from the 2024 first-year cohort. A total of 367 students participated. Comparing preclinical and clinical students revealed a significant increase in interest in ophthalmology (2.9% vs. 11%, p = 0.012), along with non-significant upward trends in obstetrics and gynecology and family medicine. Declines were observed in psychiatry, oncology, neurosurgery, and surgery. The 2024 cohort included a higher proportion of students with a prior medical background compared with the 2019 cohort (43% vs. 23%, p = 0.002), but no other demographic or specialty preference differences were identified. These findings suggest that specialty preferences among medical students may shift during clinical training, while initial preferences appear relatively consistent across cohorts. Understanding how medical education influences career development may guide curricular strategies to balance specialty distribution and address workforce needs. Full article

The demand for accurate and sensitive trace gas detection in environmental monitoring and industrial diagnostics has driven the development of compact, high-performance Raman-based sensing systems. In this study, a hollow-core anti-resonant fiber (HC-ARF)-enhanced Raman spectroscopy system was developed to improve detection sensitivity. A double-lens signal collection module coupled with a small-core multimode fiber (MMF) was designed to improve Raman signal collection efficiency while mitigating background interference. Together with the CCD row-selective integration strategy, this configuration effectively minimized spatially nonuniform noise and enhanced the overall signal-to-noise ratio of the system. The system performance was systematically evaluated under varying integration times, demonstrating linearity, repeatability, and long-term stability. Under optimized conditions, sub-ppm detection limits were achieved for CO₂ isotopic species (¹²CO₂: 5.13 ppm, ¹³CO₂: 0.82 ppm) and multiple hydrocarbons including CH₄ (2.5 ppm), C₂H₂ (2.7 ppm), C₂H₄ (2.84 ppm), and C₂H₆ (0.57 ppm). These results confirm the performance of the proposed configuration for multi-component gas detection. Overall, this work provides an effective strategy for noise suppression in HC-ARF-based fiber-enhanced Raman systems and demonstrates their potential for real-time, high-precision environmental and industrial gas analysis. Full article

Bacteremia is a life-threatening condition contributing significantly to sepsis-related mortality worldwide. With delayed appropriate antibiotic therapy, mortality increases by 20% regardless of antimicrobial resistance. This study evaluated the perceived clinical utility of Artificial Intelligence (AI)-powered Clinical Decision Support Systems (CDSSs) (OneChoice and OneChoice Fusion) among specialist physicians managing bacteremia cases. A cross-sectional survey was conducted with 65 unique specialist physicians from multiple medical specialties who were presented with clinical vignettes describing patients with bacteremia and 90 corresponding AI-CDSS recommendations. Participants assessed the perceived helpfulness of AI decision-making, the impact of AI recommendations on their own clinical judgment, and the concordance between AI recommendations and their own clinical judgment, as well as the validity of changing therapy based on CDSS recommendations. The study encompassed a diverse range of bacterial pathogens, with Escherichia coli representing 38.7% of the isolates and 30% being extended-spectrum β-lactamase (ESBL) producers. Findings show that 97.8% [(95% CI: 92.2–99.7%)] of physicians reported that AI facilitated decision-making and substantial concordance (87.8% [95% CI: 79.2–93.7%; Cohen’s κ = 0.76]) between AI recommendations and physicians’ therapeutic recommendations. Stratification by pathogen revealed the highest concordance for Escherichia coli bacteremia (96.6%, 28/29 cases). Implementation analysis revealed a meaningful clinical impact, with 68.9% [(95% CI: 58.3–78.2%)] of cases resulting in AI-guided treatment modifications. These findings indicate that AI-powered CDSSs effectively bridge critical gaps in infectious disease expertise and antimicrobial stewardship, providing clinicians with evidence-based therapeutic recommendations that can be integrated into routine practice to optimize antibiotic selection, particularly in settings with limited access to infectious disease specialists. For optimal clinical integration, we recommend that clinicians utilize AI-CDSS recommendations as an adjunct to clinical judgment rather than a replacement, particularly in complex cases involving immunocompromised hosts or polymicrobial infections. Future research should prioritize prospective clinical trials that evaluate direct patient outcomes to establish evidence of broader clinical effectiveness and applicability across diverse healthcare settings. Full article

Background and Objectives: Antimicrobial stewardship plays a key role in the surgical setting by reducing the incidence of healthcare-associated infections and limiting the emergence of antimicrobial resistance. Clinical Decision Support Systems (CDSSs), when integrated into routine practice, are valuable tools for optimizing antimicrobial prescribing. However, evidence regarding their impact on surgical patients, particularly across different specialties, remains limited. Materials and Methods: We conducted a quasi-experimental time series study in surgical patients at a primary-level hospital, evaluating the effect of a CDSS on postoperative antimicrobial therapy. The pre-intervention period included patients admitted from April 2017 to September 2020, and the post-intervention period included those admitted from October 2020 to March 2024. Antimicrobial consumption and expenditures were measured as defined daily doses (DDDs) per 1000 patient-days and euros (€) per 1000 patient-days, respectively. Subgroup analyses were performed by the surgical service. Clinical outcomes included mortality and length of stay (LOS). Results: Following CDSS implementation, overall antimicrobial consumption decreased by 4.4%. Significant reductions were observed in aminoglycosides (−52.0%), macrolides, lincosamides and streptogramins (−40.6%), and fluoroquinolones (−32.3%). Reductions were heterogeneous across surgical services, with significant reductions in Traumatology (−21.3%) and Urology (−14.3%). Expenditures decreased from 3185.4 to 2733.9€/1000 patient-days (−14.2%; p = 0.17). Mortality remained stable, whereas significant reductions in LOS were observed in Urology (5 to 4 days, p = 0.03) and traumatology (16 to 8.5 days, p < 0.01). During the post-intervention period, 476 stewardship recommendations were issued for 330 patients, with an acceptance rate of 76.1%. The most frequent interventions were discontinuation of antimicrobials (25.8%), transition to oral therapy (21.0%), and de-escalation (18.7%). Conclusions: Implementation of a CDSS in the surgical setting was associated with reduced antimicrobial consumption, a downward trend in expenditures, and high acceptance of stewardship recommendations. Mortality remained unchanged, while reductions in LOS in selected services support the safety and potential efficiency of this approach. Full article

Background: Timely recognition of sepsis remains a critical clinical challenge, particularly in cancer patients, who are at higher risk due to immunosuppression. Monocyte distribution width (MDW) has emerged as a biomarker with potential utility in the early detection of sepsis. Methods: This retrospective study analyzed 1167 patients who presented to the emergency department of a cancer specialty hospital in Republic of Korea. Patients were classified according to Sepsis-2 and Sepsis-3 criteria, and the diagnostic performance of MDW was compared with conventional biomarkers, including C-reactive protein (CRP) and procalcitonin (PCT). Subgroup analyses were conducted based on malignancy status, leukopenia, and initial signs of infection. Additionally, turnaround times (TATs) were compared among the biomarkers. Results: MDW demonstrated diagnostic accuracy comparable to or exceeding that of CRP and PCT for identifying sepsis and infection across both Sepsis-2 and Sepsis-3 criteria. In the context of diagnosing sepsis using the Sepsis-3 criteria, MDW yielded the highest area under the curve (0.869), sensitivity (91.0%), and negative predictive value (98%). Notably, in cancer patients, MDW maintained strong diagnostic reliability. It also demonstrated high diagnostic capability in patients with leukopenia or presenting with initial signs of infection. Moreover, the TAT was significantly shorter for MDW (median 59 min) than for CRP (105 min) or PCT (111 min). Conclusions: MDW is a rapid and accessible biomarker with demonstrated value for early sepsis detection in emergency settings. Its balanced diagnostic profile and consistent performance across diverse patient subgroups support its integration into routine clinical workflows, especially as part of multimodal sepsis screening strategies. Full article

Background: Pediatric heart failure (PHF) is a heterogeneous syndrome with high morbidity, but existing classification systems inadequately capture its developmental and pathophysiological complexity due to reliance on adult-centric parameters. Using machine learning, we aimed to identify clinically distinct PHF phenotypes with unique outcomes and therapeutic implications. Methods: In this multicenter retrospective study, we analyzed 2903 consecutive PHF patients (≤18 years) from 30 Chinese tertiary centers from 20 provinces (2013–2022). Unsupervised machine learning (k-means clustering with PCA) evaluated 99 clinical, biomarker, and echocardiographic variables to derive phenotypes, which were compared for mortality, hospitalization, and treatment responses. Results: Three phenotypically distinct clusters emerged. Cluster 1 (Chronic Hypertensive and Cardiorenal Profile, 30.1%) predominantly affected older children (78%) with hypertension (54.4%), renal dysfunction (creatinine 45.8 μmol/L), and ventricular tachycardia (53.8%). This cluster showed the lowest in-hospital mortality (2.5%) but frequent 7–14 day hospitalizations (35.8%) and the highest beta-blocker use (54.5%). Cluster 2 (Preterm and CHD-Associated HF, 43.4%) comprised preterm infants (71.4%) with congenital heart disease (72.2%) and preserved LVEF (67%), demonstrating the highest mortality (5.1%) and prolonged stays (>30 days: 10.6%) with predominant diuretic (40.6%) and antibiotic use (54.3%). Cluster 3 (Fulminant Myocarditis Profile, 26.5%) exhibited cardiogenic shock with severely reduced LVEF (33%) and elevated BNP (3234 pg/mL), showing bimodal outcomes (4.8% LOS < 3 days vs. 32.2% LOS 15–30 days) and the highest IVIG utilization (46.5%) with intermediate mortality (3.8%). The majority of between-group differences were statistically significant (p < 0.001). Conclusions: Machine learning identified three PHF phenotypes with distinct in-hospital risk profiles and therapeutic implications, challenging current classification systems. These findings highlight the potential for phenotype-specific management strategies and provide a rationale for future research into arrhythmia prevention in hypertensive profiles and early immunomodulation in fulminant myocarditis, while highlighting the need for specialized care pathways for preterm/CHD patients. Prospective validation is warranted to translate this framework into clinical practice. Full article

This study proposed a methodology for obtaining a valid database of food retail establishments and characterized the community food environment, understood as the distribution and type of food outlets, in a Brazilian medium-sized municipality after the collapse of a mining tailings dam. An ecological study was conducted with establishments selling food for home consumption (butcher shops, fish markets; fruit and vegetable specialty markets; large- and small-chain supermarkets; bakeries and local markets) and immediate consumption (bars, snack bars, and restaurants). For home-consumption establishments, data were requested from governments and completed with website/app searches, virtual audits (Google Street View), and on-site audits. For immediate-consumption establishments, only on-site audit was used due to the low quality of the secondary databases. Agreement between databases was assessed with the Kappa statistic. Density (d) was calculated by the area (in km²) of the sampling stratum. Public databases presented low validity (23.0%; Kappa −0.388; p = 1.000), even after virtual auditing (31.4%; Kappa 0.37; p < 0.001). 96 establishments for home consumption and 261 for immediate consumption were identified, with predominance of local markets (35.4%), bars (35.2%), and snack bars (29.1%). The region with the highest density of establishments was the “Other Areas” stratum (d = 4.7 for home-consumption establishments and d = 13.2 for immediate-consumption establishments). Audit proved most effective, especially for small establishments. The lack of governmental databases and the identified food environment should inform municipal policies to promote food and nutrition security and reduce inequalities after the disaster. Full article

Background/Objectives: Patients with incurable cancers enrolled in early phase clinical trials often face uncertainty about prognosis, yet advance care planning (ACP) is frequently delayed. The objective of this study was to assess the documentation of ACP discussions among patients enrolled in early phase oncology trials. Methods: We conducted a retrospective review of electronic medical records for all adults enrolled in early phase clinical trials at a single Australian institution (2012–2021). Data included time from metastatic diagnosis to first ACP discussion, clinical and sociodemographic factors, triggers for discussion, and clinician specialty. Results: Among 170 patients (58% male; median age 65 years), ACP documentation was identified in 109 (64%). ACP was most often initiated within the final year of life (73.8%), with a median interval of 23.5 months from metastatic diagnosis to first documentation. Common triggers were disease progression (39.6%) and hospital admission (37.8%). Discussions were typically led by the treating oncologist or trials specialist (43%) and palliative care physician (37.8%). The most frequently documented topic was the limitations of invasive care such as intubation (60%). Conclusions: ACP documentation was present in two-thirds of patients enrolled in early phase clinical trials, typically late in the disease trajectory. Integrating structured, earlier ACP discussions into oncology pathways would improve alignment of care with patient goals and enhance end-of-life care. Full article

Newborn screening (NBS) for congenital hypothyroidism (CH) facilitates early diagnosis and treatment and prevents permanent intellectual disability. Sadly, 50 years after the first introduction of NBS for CH, only 29.6% of newborns worldwide are screened. Africa and Asia, the continents with the highest birth rates, have very limited screening coverage. Most NBS programs measure TSH in a dried-blood spot taken from a heel-prick on a filter paper after 24 to 72 h of life. Implementing national NBS programs is logistically complex and expensive, requiring parental consent, specialized laboratories, and excellent infrastructure. In limited-resource settings, introducing such a complex program is often impossible. We propose universal decentralized cord blood TSH screening, offered as routine delivery care for all newborns in limited-resource settings. TSH measurement may be performed by local laboratories using widely available, inexpensive radioimmunoassay kits, with the report available within a few hours. Since the TSH report would be available before discharge, suitable clinical decision making would be possible, with a minimal need for recall, thus minimizing the parental, medical, and financial burden and improving developmental outcomes. The most important requirement is to change to a grassroots approach, with the education of obstetricians and pediatricians worldwide to perform routine cord blood TSH and make sure the TSH result is available before the baby is discharged. Full article

Background: The application of large language model (LLM) in surgical decision-making is rapidly expanding, yet its potential in hand and peripheral nerve surgery remains largely unexplored. This study assessed the diagnostic and therapeutic performance of a large language model (ChatGPT-4o) in scenarios characterized by multiple valid management strategies and absent expert consensus. Methods: Three representative cases—thumb carpometacarpal (CMC I) arthritis, scaphoid nonunion, and carpal tunnel syndrome (CTS)—were developed to reflect frequent conditions in hand surgery with competing but accepted treatment options. Each case was submitted to ChatGPT-4o using a standardized prompt. LLM-generated responses were evaluated by 52 participants (34 board-certified hand surgeons and 18 residents) across diagnostic accuracy, clinical relevance, and completeness. Readability indices, including Flesch–Kincaid Grade Level, were analyzed to assess appropriateness for a medical audience. Results: ChatGPT-4o demonstrated coherent but limited diagnostic accuracy (mean 2.9 ± 1.2 SD), moderate clinical relevance (3.5 ± 1.0 SD), and slightly higher completeness (3.4 ± 1.1 SD). Performance was strongest in the standardized scenario (carpal tunnel syndrome, CTS) and weakest in individualized reasoning (CMC I arthritis). No significant differences were observed between experts and residents (p > 0.05). In higher-level reasoning, ChatGPT-4o performed best in CTS and weakest in CMC I arthritis. Readability confirmed professional-level language (mean Flesch–Kincaid Grade Level: 16.4). Conclusions: ChatGPT-4o shows promise as a supportive tool for diagnostic reasoning and surgical education, particularly where standardized frameworks exist. Its limitations in ambiguous scenarios highlight the ongoing need for expert oversight. Future large language model development should emphasize specialty-specific training and context-aware reasoning to enhance their role in surgical decision support. Full article