Search Results (14,721)

Wastewater Treatment Plants (WWTPs) rely on automatic control strategies to regulate pollutant concentrations and comply with environmental standards. Among them, Proportional Integral (PI) controllers are widely adopted for their simplicity and robustness, yet their effectiveness is limited by the nonlinear and time-varying dynamics of biological processes. In this work, Long Short-Term Memory (LSTM)-based Artificial Neural Network (ANN) PI controllers are proposed as data-driven replacements for conventional PIs in key WWTP feedback loops. Using the Benchmark Simulation Model No. 1 (BSM1), ANN controllers were trained to replicate the behavior of default nitrate and nitrite nitrogen ($S_{NO,2}$) and dissolved oxygen ($S_{O,5}$) loops, under both time-agnostic and time-aware strategies with three- and four-input configurations. The four-input time-aware model delivered the best results, reproducing PI behavior with high accuracy (coefficient of determination, $R^2\approx 0.99$) and considerably reducing control errors. For instance, under storm influent conditions, the $S_{O,5}$ controller reduced the Integral of Squared Error ($\mathrm{ISE}$) and Integral of Absolute Error ($\mathrm{IAE}$) by 84.7% and 68.4%, respectively, compared with the default PI. Beyond loop-level improvements, a Transfer Learning (TL) extension was explored: the trained $S_{O,5}$ controller was directly applied to additional aerated reactors ($S_{O,3}$ and $S_{O,4}$) without retraining, replacing fixed aeration and demonstrating adaptability while reducing design effort. Plant-wide evaluation with the $S_{NO,2}$ loop and three dissolved oxygen loops ($S_{O,3}$–$S_{O,5}$), all controlled by LSTM-based PI controllers, under storm influent conditions, showed further reductions in the Effluent Quality Index ($\mathrm{EQI}$) and the Overall Cost Index ($\mathrm{OCI}$) by 0.84% and 1.47%, respectively, highlighting simultaneous gains in effluent quality and operational economy. Additionally, the actuator and energy analyses showed that the LSTM-based controllers produced realistic and smooth control signals, maintained consistent energy use, and ensured stable overall operation, confirming the practical feasibility of the proposed approach. Full article

Background/Objectives: High turnover and staff shortages in nursing pose challenges to professional integration and compromised patient safety. Structured onboarding programs are considered key strategies to enhance adaptation, reduce clinical errors, and promote retention. This study aimed to evaluate the impact of a structured onboarding program compared with the standard routine on early professional adaptation, safety culture, and satisfaction among newly hired nurses and nursing assistants. Methods: A prospective quasi-experimental study was conducted between 2022 and 2024 in three private hospitals in Madrid. A total of 200 newly hired health professionals (128 nurses and 72 assistants) were assigned alternately to either the intervention group (structured onboarding program) or the control group (usual routine). The intervention comprised three consecutive days of guided training with mentorship, simulation-based learning, and digital tool instruction. Adaptation was assessed with the validated GAML scale, and satisfaction was measured through a Likert survey one month later. Statistical analyses included Mann–Whitney U, Chi-squared tests, and linear regression. Results: The intervention group achieved significantly higher scores across all competency domains for both nurses and nursing assistants, with overall medians of 25 [22–27] and 22 [20–23.25], respectively, compared with notably lower values in the control groups (p < 0.001). The greatest improvements were observed in digital tool management, clinical protocol knowledge, problem-solving and decision-making, and patient safety practices, demonstrating the strong impact of the structured onboarding program. In terms of satisfaction, participants in the intervention group also reported higher ratings for the clarity and completeness of information, particularly regarding hospital structure, service-specific orientation, and occupational risk prevention. However, global satisfaction differences were more pronounced among nurses than nursing assistants. Conclusions: The structured onboarding program demonstrated substantial benefits in professional adaptation, safety culture, and perceived preparedness of newly hired staff. These findings support integrating standardized onboarding plans as part of hospital quality and safety strategies, requiring sustained leadership and resource investment for long-term success. Full article

In the context of increasing interest in healthy and sustainable nutrition, the food industry is challenged to develop innovative products that combine high nutritional quality with consumer acceptance. This study evaluated the potential of pumpkin seed flour (PSF) as a natural ingredient in biscuit formulations. PSF was analyzed for its proximate composition, and biscuits were formulated by replacing rice flour with various concentrations of 10%, 20%, and 30%. The products were analyzed for moisture, protein, fat, fiber, and ash content, subjected to microbiological testing, and evaluated sensorially using a 9-point hedonic scale. Results showed that PSF incorporation in biscuits significantly increased protein content from 6.20% in the control to 9.80% and fiber content from 2.10% to 5.90% in the formulation containing 30% PSF. Lipid content also increased proportionally with PSF addition. All samples complied with microbiological safety standards, and sensory evaluation indicated that biscuits with 10 and 20% PSF achieved the highest acceptability, particularly in terms of taste and texture. Overall, the use of PSF improves the nutritional density of biscuits, enhances their nutritional value, and supports sustainable food production by valorizing underutilized plant resources, in alignment with the United Nations Sustainable Development Goals. Full article

Background: Chronic total occlusion percutaneous coronary intervention (CTO PCI) is a complex revascularization procedure requiring advanced techniques to ensure procedural success and safety. Hybrid strategies combining antegrade dissection/re-entry (ADR) and retrograde approaches have become increasingly adopted in contemporary practice. Objectives: To systematically review and synthesize evidence comparing outcomes of ADR and retrograde CTO PCI techniques, with pooled estimates of success rates and adverse events. Methods: This review followed PRISMA 2020 guidelines. We searched PubMed, Cochrane CENTRAL, and Google Scholar for studies published between January 2015 and June 2025. Eligible studies included randomized controlled trials and observational studies reporting outcomes of ADR and/or retrograde CTO PCI. Data extraction was performed by two independent reviewers. Risk of bias was assessed using the Newcastle–Ottawa Scale and the Cochrane RoB 2.0 tool. A random-effects meta-analysis was conducted for consistently reported outcomes. Results: Twenty studies encompassing over 87,000 CTO PCI procedures were included. Pooled analysis of 16 studies demonstrated a technical success rate of 83.4% and a procedural success rate of 84.6%. The in-hospital major adverse cardiac event (MACE) rate was 3.3%. Hybrid strategies integrating ADR and retrograde approaches yielded the highest success rates (86–91%) with acceptable safety profiles. Use of adjunctive tools such as IVUS, dual arterial access, and re-entry devices was associated with improved outcomes. Discussion: Hybrid CTO PCI techniques are safe, effective, and reproducible across diverse clinical settings. When performed by experienced operators using modern adjuncts, these strategies provide durable benefits and should be considered standard for complex occlusions. Limitations include variation in study quality, heterogeneous procedural definitions, and lack of long-term data in several cohorts. Full article

The Xishan–Yongding River cultural belt is a key component of the three major cultural belts of Beijing and its water heritage; as a representative of the intensive distribution of semi-arid climate, analyzing its spatial and temporal distribution characteristics is crucial for the development of systematic conservation strategies. This study is based on a dataset developed from field surveys and historical documentation and has been spatially analyzed using visual analytical methods and using a Geographic Information System (GIS). In this study, kernel density estimation was used to identify areas of high density, standard elliptic deviation was used to assess the distribution of water heritage sites over time, and the mean nearest neighbor index was used to determine the spatial clustering pattern of these sites. Regarding type and quantity, water heritage in the cultural belt is diverse, with non-water heritage sites, such as temples and inscriptions, being the most prevalent. In terms of temporal distribution, water heritage spans a long period, with the largest number dating to the Qing Dynasty. The centers of distribution across different periods exhibit a trend from south to north and from mountainous regions to plains, exhibiting a gradual concentration. Spatially, water heritage within the cultural belt follows a “multi-core, contiguous distribution” pattern, with three high-density zones, two medium-density zones, and six low-density zones. The distribution of water heritage is influenced by a combination of natural factors, such as river systems, settlements, elevation, and slope, alongside human factors, including historical culture and the political environment. The findings of this research offer a detailed analysis of the regional characteristics and underlying mechanisms of the temporal and spatial distribution of water heritage within the Xishan–Yongding River cultural belt. Full article

Third molar extraction is a common oral surgical procedure that can be accompanied by challenges in wound healing and bone regeneration. Materials such as bone substitute materials (BSMs) and platelet-rich fibrin (PRF) are often used to support socket regeneration. This prospective randomized controlled split-mouth clinical trial compared PRF application combined with BSM versus PRF alone in patients requiring bilateral third molar extraction. A total of 15 patients underwent standardized osteotomy procedures, with sockets filled either with PRF alone (control group) or with BSM + PRF on opposite sides (test group) under general anesthesia and with patients blinded to the treatment allocation. Postoperative pain and swelling were measured over 7 days using a visual analog scale and anatomical distance measurements, respectively. Bone regeneration was evaluated using cone beam computed tomography (CBCT) scans after an average healing period of six months, with results showing no significant differences between groups in terms of postoperative pain or swelling (n = 12; 3 patients were lost to randomization). However, CBCT imaging revealed covered socket residuum (CSR)—non-mineralized areas within the socket—in the PRF only group, whereas the BSM + PRF group demonstrated more homogeneous and mineralized bone formation throughout the extraction sites (n = 8; 5 patients were lost to follow-up). These non-mineralized areas represent covered socket residuum within the extraction sockets, which poses a clinical risk of infection and may negatively affect the dental health of the adjacent second molar. Based on the presented findings, we recommend combining BSM with PRF to support bone regeneration and regulate the postoperative pain and swelling following third molar extraction. Nevertheless, further research is required to determine the most suitable BSM type in this regard. Full article

Plastic greenhouses, which account for the majority of protected horticulture facilities in East Asia, are highly susceptible to wind-induced uplift failures that can lead to severe structural and economic damage. To address this issue, this study developed a low-power and low-cost wireless monitoring system applying the concept of structural health monitoring (SHM) to greenhouse foundations. Each sensor node integrates a MEMS-based inertial measurement unit (IMU) for attitude estimation, a LoRa module for long-range alert transmission, and a microSD module for data logging, while a gateway relays anomaly alerts to users through an IP network. Uplift tests were conducted on standard steel-pipe foundations commonly used in plastic greenhouses, and the proposed sensor nodes were evaluated alongside a commercial IMU to validate attitude estimation accuracy and anomaly detection performance. Despite the approximately 30-fold cost difference, comparable attitude estimation results were achieved. The system demonstrated low power consumption, confirming its feasibility for long-term operation using batteries or small solar cells. These results demonstrate the applicability of low-cost IMUs for real-time structural monitoring of lightweight greenhouse foundations. Full article

Percutaneous coronary angiography remains the diagnostic gold standard for coronary artery disease. However, the complex and high-volume nature of the imaging data renders the clinical interpretation of coronary lesions a time-consuming, labor-intensive, and inherently subjective process. This retrospective study collected and preprocessed Coronary artery angiography (CAG) image data from 408 patients with acute myocardial infarction (AMI). An improved YOLOv4 algorithm was developed, validated on standard VOC datasets, and subsequently calibrated via transfer learning on the CAG training set for automated lesion detection and classification. The model-derived lesion characteristics were then statistically correlated with the occurrence of Major Adverse Cardiovascular Events (MACEs) during patient follow-up. The improved model achieved a post-modification mean Average Precision (mAP) of 84.72% (95% CI: 83.44–85.99%) on the VOC dataset. For coronary lesion detection, the model yielded an overall mean Average Precision (mAP) of 55.01%. Importantly, lesion characteristics automatically detected by the model—specifically completely occluded lesions (Log-rank p = 0.003) and multibranching lesions (Log-rank p = 0.033)—demonstrated a significant association with the cumulative incidence of MACEs. The innovative, improved YOLOv4 model exhibits robust performance in effectively and accurately detecting and classifying coronary lesions within AMI patient angiography imagery. This study provides a valuable AI-assisted diagnostic tool and offers preliminary insights for long-term prognostic assessment by seamlessly integrating deep learning-derived anatomical features with MACEs prediction. Full article

Objectives: Transcatheter aortic valve implantation (TAVI) has become the standard of care for severe aortic stenosis across all surgical risk categories. Continuous innovation in prosthesis technology necessitates a comprehensive and clinically oriented analysis of contemporary TAVI systems to guide device selection and understand evolving trends. This review aims to provide a practical, device-specific decision-making framework for TAVI prosthesis selection, synthesizing the latest evidence (2023–2025) to address the challenge of individualized choice in an era of device proliferation. We conducted a detailed review of current TAVI models from leading manufacturers (Medtronic, Abbott, Boston Scientific, Biotronik, etc.), examining their technical specifications, design innovations, and data from recent international clinical trials and registries. A comparative analysis was performed based on key parameters: delivery profile, resheathability/repositionability, sealing mechanisms, hemodynamic performance, and complication rates. Modern TAVI prostheses demonstrate significant advancements. Self-expanding nitinol frames offer superior adaptability and lower profiles (as low as 14 Fr). Innovations in sealing technology have drastically reduced the incidence of moderate-to-severe paravalvular leak (PVL) to below 2–3%. Supra-annular leaflet designs provide superior hemodynamics. Clinical outcomes show excellent 30-day mortality rates (1.1–2.0%) and durability estimates of 10–15 years. Variation exists between devices in rates of permanent pacemaker implantation and coronary access. The current generation of TAVI prostheses represents a mature technology offering high safety and efficacy. The key development vectors are focused on further device miniaturization, enhancing long-term durability, and expanding indications. This analysis provides a novel, clinically oriented comparison that moves beyond technical specifications to guide optimal device selection based on specific patient anatomy and clinical characteristics. Full article

Drought is a major climatic hazard affecting water resources, agriculture, and livelihoods in semi-arid regions, with increasing severity under climate change. This study assessed long-term drought in Dura City, Palestine, from 2000 to 2023 using the Standardized Precipitation Index (SPI) at 3-, 6-, and 12-month timescales. Monthly precipitation and temperature data were obtained from local meteorological stations, with mean annual precipitation of 408 mm and average summer and winter temperatures of 28 °C and 12 °C, respectively. Trends were analyzed using the Mann–Kendall test and Sen’s slope estimator. SPI-3 values ranged from −3.13 to 3.87, including 67 moderates to severe drought months and 12 extreme wet months. SPI-6 ranged from −2.97 to 2.53, showing 34 drought months and 40 wet months, while SPI-12 ranged from −1.94 to 2.32, reflecting generally stable long-term precipitation. Annual rainfall exhibited no significant trend (Sen’s slope = −1.34 mm/year, p = 0.785), whereas yearly average temperature increased significantly by 0.054 °C/year (p = 0.02), raising evapotranspiration and drought risk. Results indicate high short- and medium-term drought variability despite stable annual precipitation, underscoring the need for integrated water management strategies, including rainwater harvesting, groundwater protection, and efficient irrigation, to improve resilience under evolving climate conditions. Full article

Background/Objectives: Solar elastosis, a key histopathological alteration in skin photodamage, results from chronic UV exposure and photoaging. Clinically, it manifests as deep wrinkles, laxity, and a dull complexion. The growing demand for effective treatments has spurred the development of numerous therapeutic strategies. This systematic review aims to synthesize and critically evaluate the scientific evidence regarding interventions for treating the clinical and histological manifestations of solar elastosis, to provide an updated overview and guide future clinical practice. Methods: PubMed, Scopus, ProQuest, and Web of Science databases were searched for articles published in the last ten years. Clinical studies on adults with signs of solar elastosis and photoaging, evaluating therapeutic interventions, were included. Primary outcomes were clinical and histopathological improvements, while secondary outcomes included skin elasticity, safety, and patient satisfaction. This review was registered in the PROSPERO database under registration number CRD420251086680. Results: Twenty-two studies, totaling 608 participants, were included. The analyzed therapies comprised a wide range of strategies, including energy-based devices (laser, radiofrequency), stem cell derivatives, bioactive topical compounds, and growth factor-rich plasma. Device-assisted and biologically augmented interventions consistently improved visible photoaging outcomes and skin elasticity, with selective histologic remodeling, heterogeneous effects on barrier function, and an overall acceptable safety profile, with mild and transient adverse events. Patient satisfaction was consistently high. Conclusions: Therapeutic strategies in solar elastosis and photoaging, particularly those combining energy-based devices with regenerative agents, have proven effective in improving the structural and functional aspects of photodamaged skin. Although the results are promising, the current literature is limited by methodological heterogeneity and small sample sizes. High-quality randomized controlled trials with long-term follow-up are needed to establish standardized, evidence-based protocols. Full article

Acid-base analysis is a high-load diagnostic skill that many medical students struggle to master when taught using traditional text-based flowcharts. This multi-institution mixed-methods study evaluated a novel visual mnemonic algorithm that integrated Medimon characters, symbolic imagery, and pop-culture references into the standard acid-base diagnostic framework. First-year medical students (n = 273) at six distributed WWAMI campuses attended an identical lecture on acid-base physiology. Students at five control campuses received the original text-based algorithm, while students at one experimental campus received the Medimon algorithm in addition. Achievement was measured with a unit exam (nine focal items, day 7) and a final exam (four focal items, day 11). A Differences-in-Differences approach compared performance on focal items versus baseline items across sites. Students at the experimental campus showed no significant advantage on the unit exam (DiD = +1.2%, g = 0.12) but demonstrated a larger, but still non-significant, medium-to-large effect on the final exam (DiD = +11.0%, g = 0.85). At the experimental site, 39 students completed the Situational Interest Survey for Multimedia (SIS-M), revealing significantly higher triggered, maintained-feeling, maintained-value, and overall situational interest scores for the Medimon algorithm (all p < 0.001). Thematic analysis of open-ended responses identified four themes: enhanced clarity, improved memorability, increased engagement, and barriers to interpretation. Collectively, the findings suggest that embedding visual mnemonics and serious-game characters into diagnostic algorithms can enhance learner interest and may improve long-term retention in preclinical medical education. Full article

Background/Objectives: The marginal adaptation of CAD/CAM restorations remains a key determinant of long-term clinical success, particularly in minimally invasive preparations. This in vitro study evaluated and compared the marginal gap of three CAD/CAM restorative materials—Cerasmart, G-CAM, and IPS Empress CAD—using standardized preparation and SEM measurement protocols. Methods: A total of 18 crowns were fabricated, of which 9 presented margins sufficiently interpretable under SEM and were included in the pooled quantitative analysis (n = 362 measurement points). Marginal gaps were recorded at 45×, 100× and 450× magnification using a Jeol JSM 25S scanning electron microscope. Normality and variance homogeneity were verified prior to parametric testing. Results: When pooled per material group, the mean ± SD marginal gap values were 18.53 ± 14.15 µm for Cerasmart, 21.60 ± 14.89 µm for G-CAM, and 47.09 ± 16.93 µm for IPS Empress CAD. All values fell below the contemporary clinical threshold of <70 µm for adhesive cementation. Pairwise comparison showed a large difference between IPS Empress CAD and the two resin-based materials, whereas the difference between Cerasmart and G-CAM was small. Conclusions: Hybrid and resin nano-ceramic CAD/CAM materials demonstrated narrower marginal gaps compared with the glass ceramic tested, likely due to their lower elastic modulus and greater seating accommodation during cementation. Within the limits of this in vitro design, all materials exhibited marginal adaptation consistent with current clinical acceptability criteria. Full article

Background: Pancreaticoduodenectomy (PD) with portal–superior mesenteric vein (PV-SMV) resection is increasingly performed in borderline-resectable periampullary cancer. While conventional PD is the reference standard, robotic PD (RPD) may improve operative ergonomics and recovery; its performance and learning curve in PV-SMV resection remain unclear. Materials and Methods: We retrospectively reviewed consecutive patients undergoing PD with PV-SMV resection at a single tertiary center by a single surgeon (July 2016–September 2022). Twenty-seven patients met the inclusion criteria and were grouped as conventional PD (n = 14) or RPD (n = 13). To assess the learning curve, RPD cases were stratified as early (cases 1–3) versus late (cases 4–13). Primary outcomes were operative time and blood loss; secondary outcomes included 90-day morbidity/mortality, R0 margin, lymph node yield, length of stay, readmission, and overall survival. Results: Baseline characteristics were comparable between conventional PD and RPD. Median operative time was longer with RPD vs. conventional PD (624.0 [IQR 579.0–794.0] vs. 529.5 [456.5–636.5] mins; p = 0.024). Median blood loss trended lower with RPD (350.0 [200.0–1950.0] vs. 1455.0 [630.0–2940.0] mL; p = 0.254). Rates of clinically relevant complications (including POPF, DGE, and hemorrhage), R0 resection (69% vs. 64%), lymph node retrieval, length of stay, 90-day readmission, 90-day mortality, and overall survival were similar between conventional PD and RPD. Within RPD, operative time and blood loss improved from the early to late phases (794.0 → 601.5 min; 1950.0 → 275.0 mL), consistent with a learning-curve effect, though not statistically significant in this small cohort. Conclusions: In selected patients, RPD with PV-SMV resection is feasible and achieves oncologic and short-term clinical outcomes comparable to conventional PD, with evidence of efficiency gains as experience accrues. These findings support structured training and case accumulation for the safe adoption of complex robotic pancreatic surgery. Full article

Age-related macular degeneration (AMD) is a leading cause of irreversible blindness, yet current tools for forecasting treatment outcomes remain limited by either the opacity of deep learning or the rigidity of rule-based systems. To address this gap, we propose a hybrid neuro-symbolic and large language model (LLM) framework that combines mechanistic disease knowledge with multimodal ophthalmic data for explainable AMD treatment prognosis. In a pilot cohort of ten surgically managed AMD patients (six men, four women; mean age 67.8 ± 6.3 years), we collected 30 structured clinical documents and 100 paired imaging series (optical coherence tomography, fundus fluorescein angiography, scanning laser ophthalmoscopy, and ocular/superficial B-scan ultrasonography). Texts were semantically annotated and mapped to standardized ontologies, while images underwent rigorous DICOM-based quality control, lesion segmentation, and quantitative biomarker extraction. A domain-specific ophthalmic knowledge graph encoded causal disease and treatment relationships, enabling neuro-symbolic reasoning to constrain and guide neural feature learning. An LLM fine-tuned on ophthalmology literature and electronic health records ingested structured biomarkers and longitudinal clinical narratives through multimodal clinical-profile prompts, producing natural-language risk explanations with explicit evidence citations. On an independent test set, the hybrid model achieved AUROC 0.94 ± 0.03, AUPRC 0.92 ± 0.04, and a Brier score of 0.07, significantly outperforming purely neural and classical Cox regression baselines (p ≤ 0.01). Explainability metrics showed that >85% of predictions were supported by high-confidence knowledge-graph rules, and >90% of generated narratives accurately cited key biomarkers. A detailed case study demonstrated real-time, individualized risk stratification—for example, predicting an >70% probability of requiring three or more anti-VEGF injections within 12 months and a ~45% risk of chronic macular edema if therapy lapsed—with predictions matching the observed clinical course. These results highlight the framework’s ability to integrate multimodal evidence, provide transparent causal reasoning, and support personalized treatment planning. While limited by single-center scope and short-term follow-up, this work establishes a scalable, privacy-aware, and regulator-ready template for explainable, next-generation decision support in AMD management, with potential for expansion to larger, device-diverse cohorts and other complex retinal diseases. Full article