Search Results (268)

Alcohol Use Disorder (AUD) is common among patients with maxillofacial trauma. Conventional perioperative care recommends complete abstinence. However, abrupt cessation can lead to Alcohol Withdrawal Syndrome (AWS), negatively impacting psychological well-being and compliance. This randomized controlled pilot study evaluated the effectiveness of Monitored Therapeutic Alcohol Administration (MTAA) in reducing perioperative stress and enhancing quality of life without impairing fracture healing. Twenty-four adult male patients with AUD and isolated facial fractures requiring surgery were enrolled. They were assigned to either an intervention group (n = 12) receiving MTAA—oral alcohol at 0.5 g/kg/day for two weeks—or a control group (n = 12) undergoing complete abstinence. Outcomes were assessed over six weeks, including stress (Zung Self-Rating Depression Scale), quality of life (Oral Health Impact Profile-14), soft tissue healing (Landry’s Index), and hard tissue healing (Moed’s Scale, serum osteocalcin). The MTAA group showed significantly reduced stress and improved quality of life (p < 0.001). Healing outcomes were comparable between groups, with no significant differences in soft tissue indices, osteocalcin levels, or radiographic scores. MTAA appears to be a safe and effective strategy to manage AWS-related distress and improve postoperative recovery, offering a practical alternative to strict abstinence in the surgical management of patients with AUD. Full article

Fog computing is increasingly preferred over cloud computing for processing tasks from Internet of Things (IoT) devices with limited resources. However, placing tasks and allocating resources in distributed and dynamic fog environments remains a major challenge, especially when trying to meet strict Quality of Service (QoS) requirements. Deep reinforcement learning (DRL) has emerged as a promising solution to these challenges, offering adaptive, data-driven decision-making in real-time and uncertain conditions. While several surveys have explored DRL in fog computing, most focus on traditional centralized offloading approaches or emphasize reinforcement learning (RL) with limited integration of deep learning. To address this gap, this paper presents a comprehensive and focused survey on the full-scale application of DRL to the task offloading problem in fog computing environments involving multiple user devices and multiple fog nodes. We systematically analyze and classify the literature based on architecture, resource allocation methods, QoS objectives, offloading topology and control, optimization strategies, DRL techniques used, and application scenarios. We also introduce a taxonomy of DRL-based task offloading models and highlight key challenges, open issues, and future research directions. This survey serves as a valuable resource for researchers by identifying unexplored areas and suggesting new directions for advancing DRL-based solutions in fog computing. For practitioners, it provides insights into selecting suitable DRL techniques and system designs to implement scalable, efficient, and QoS-aware fog computing applications in real-world environments. Full article

Concrete bridges, as a vital component of modern transportation infrastructure, have their structural durability directly tied to safety and service life. In recent years, with the aging of bridge structures and increasingly complex environmental conditions, various durability-related deteriorations have become more prominent, significantly affecting structural performance and maintenance costs. This paper presents a systematic analysis of concrete carbonation as a key chemical process and its impact on durability-related pathologies. Particular attention is given to the formation mechanisms and influencing factors of critical deterioration modes such as cracking, reinforcement corrosion, and freeze–thaw damage. A multi-level prevention and mitigation strategy is proposed, encompassing optimized structural material design, strict construction quality control, and effective maintenance and repair techniques. The study concludes that the durability issues of concrete bridge structures exhibit a strong multi-factor coupling effect and proposes a core durability assurance framework. Finally, the paper briefly outlines emerging trends in intelligent monitoring and digital operation and maintenance, offering insights for future durability management of bridges. Full article

Autonomous navigation in dynamic, multi-vessel maritime environments presents a formidable challenge, demanding strict adherence to the International Regulations for Preventing Collisions at Sea (COLREGs). Conventional approaches often struggle with the dual imperatives of global path optimality and local reactive safety, and they frequently rely on simplistic state representations that fail to capture complex spatio-temporal interactions among vessels. We introduce a novel hybrid reinforcement learning framework, D* Lite + Transformer-Enhanced Soft Actor-Critic (TE-SAC), to overcome these limitations. This hierarchical framework synergizes the strengths of global and local planning. An enhanced D* Lite algorithm generates efficient, long-horizon reference paths at the global level. At the local level, the TE-SAC agent performs COLREGs-compliant tactical maneuvering. The core innovation resides in TE-SAC’s synergistic state encoder, which uniquely combines a Graph Neural Network (GNN) to model the instantaneous spatial topology of vessel encounters with a Transformer encoder to capture long-range temporal dependencies and infer vessel intent. Comprehensive simulations demonstrate the framework’s superior performance, validating the strengths of both planning layers. At the local level, our TE-SAC agent exhibits remarkable tactical intelligence, achieving an exceptional 98.7% COLREGs compliance rate and reducing energy consumption by 15–20% through smoother, more decisive maneuvers. This high-quality local control, guided by the efficient global paths from the enhanced D* Lite algorithm, culminates in a 10–32 percentage point improvement in overall task success rates compared to state-of-the-art baselines. This work presents a robust, verifiable, and efficient framework. By demonstrating superior performance and compliance with rules in high-fidelity simulations, it lays a crucial foundation for advancing the practical application of intelligent autonomous navigation systems. Full article

Management for pheasant shooting is a widespread land use in the UK, with potential implications for forest and hedgerow habitats. This study evaluates whether sites managed for pheasant shooting differ ecologically from similar sites not used for shooting. A systematic evidence evaluation of comparative studies was combined with a spatial analysis using remote sensing data (2010–2024). The literature review identified only 32 studies meeting strict criteria for comparability, revealing inconsistent and often weak evidence, with few studies reporting detailed forest management or statistically robust outcomes. While some studies noted increased or decreased biodiversity associated with pheasant shooting, the evidence base was generally of low quality. Remote sensing assessed forest structural and spectral diversity, intactness, and hedgerow density across 1131 pheasant-managed and 1131 matched control sites. Biodiversity data for birds, plants, and butterflies were sourced from GBIF records. Structural diversity and hedgerow density were significantly higher on pheasant-managed sites, while no significant differences were found in forest spectral diversity, intactness, or biodiversity indicators. Pheasant management may shape certain habitat features but has limited demonstrable effects on overall biodiversity. Further field-based, controlled studies are required to understand causal mechanisms and inform ecologically sustainable shooting practices. Full article

Background/Objectives: Delayed gastric emptying (DGE) is a well-known complication of laparoscopic pylorus-preserving gastrectomy (LPPG). Patients who underwent LPPG in the KLASS-04 trial, which was a multicenter prospective randomized control trial comparing LPPG and laparoscopic distal gastrectomy (LDG), showed an unneglectable incidence of long-term DGE compared to patients who underwent LDG. This study aimed to identify the multifactorial risk factors associated with DGE and to analyze the quality of life (QoL) of patients with DGE following LPPG. Methods: DGE was defined as “nearly normal diet residue” at least once in the endoscopic follow-up at 1, 2, and 3 years after the surgery. Clinicopathological features, surgical outcomes, and QoL were compared between the DGE and non-DGE groups. Results: DGE was observed in 21/124 patients (16.3%) who underwent LPPG. Patients without previous abdominal surgery had a higher incidence of DGE in the univariate (32% vs. 4.8%, p = 0.011) and logistic regression analyses (odds ratio: 0.106, 95% confidence interval: 0.014–0.824, p = 0.032). Patients with DGE reported more symptoms of nausea and vomiting (p = 0.004), constipation (p = 0.04), and a dry mouth (p = 0.005). Conclusions: Despite the strict protocol used to avoid well-known risk factors for DGE, such as damage to the hepatic branch of the vagus nerve, infrapyloric artery and vein, and short antral cuff, the LPPG group of the KLASS-04 trial exhibited a considerable incidence of DGE. No clinicopathological or surgical factors, other than the absence of a previous surgical history, were identified as multifactorial risk factors for DGE. However, DGE had a negative impact on the QoL of patients. Full article

Speaker burn-in is a controversial practice in the audio world, based on the belief that new devices reach optimal performance only after a certain period of use. Supporters claim it improves component flexibility, reduces initial distortion, and enhances sound quality—especially in the low-frequency range. Critics, however, emphasize the lack of scientific evidence for audible changes and point to the placebo effect in subjective listening tests. They argue that modern manufacturing and strict quality control minimize differences between new and “burned-in” devices. This study cites a standard describing a preliminary burn-in procedure, specifying the exact conditions and duration required. Objective tests revealed slight changes in speaker impedance and amplitude response after burn-in, but these differences are inaudible to the average listener. Notably, significant variation was observed between speakers of the same series, attributed to production line tolerances rather than use-related changes. The study also explored aging processes in speaker materials to better understand potential long-term effects. However, subjective listening tests showed that listeners rated the sound consistently across all test cases, regardless of whether the speaker had undergone burn-in. Overall, while minor physical changes may occur, their audible impact is negligible, especially for non-expert users. Full article

Long-term source apportionment of PM_2.5 during high-pollution periods is essential for achieving sustained reductions in both PM_2.5 levels and their health impacts. This study conducted PM_2.5 sampling in Shenzhen from January to March over the years 2021–2024 to investigate the long-term impact of coronavirus disease 2019 and the short-term impact of the Spring Festival on PM_2.5 levels. The measured average PM_2.5 concentration during the research period was 22.5 μg/m³, with organic matter (OM) being the dominant component. Vehicle emissions, secondary sulfate, secondary nitrate, and secondary organic aerosol were identified by receptor model as the primary sources of PM_2.5 during the observational periods. The pandemic led to a decrease of between 30% and 50% in the contributions of most anthropogenic sources in 2022 compared to 2021, followed by a rebound. PM_2.5 levels in January–March 2024 dropped by 1.4 μg/m³ compared to 2021, mainly due to reduced vehicle emissions, secondary sulfate, fugitive dust, biomass burning, and industrial emissions, reflecting Shenzhen’s and nearby cities’ effective control measures. However, secondary nitrate and fireworks-related emissions rose significantly. During the Spring Festival, PM_2.5 concentrations were 23% lower than before the festival, but the contributions of fireworks burning exhibited a marked increase in both 2023 and 2024. Specifically, during intense peak events, fireworks burning triggered sharp, short-term spikes in characteristic metal concentrations, accounting for over 50% of PM_2.5 on those peak days. In the future, strict control over vehicle emissions and enhanced management of fireworks burning during special periods like the Spring Festival are necessary to reduce PM_2.5 concentration and improve air quality. Full article

Background/Objectives: Clostridioides difficile infection (CDI) is a major cause of infectious diarrhea in the inpatient and community setting. Real-world data outside the strict environment of randomized controlled trials (RCTs) are needed to improve the quality of evidence. The aim of this study was to compare different clinical outcomes of CDI patients treated with fidaxomicin with those treated with vancomycin using a representative patient population in the United States of America (USA). Methods: Comprehensive real-world data were analyzed for this retrospective observational study, provided by the TriNetX database, an international research network with electronic health records from multiple USA healthcare providers. This includes in- and outpatients treated with fidaxomicin (FDX) or vancomycin (VAN) for CDI between 01/2013 and 12/2023. The following cohorts were compared: (i) patients treated with fidaxomicin within 10 days following CDI diagnosis (FDX group) vs. (ii) patients treated with vancomycin within 10 days following CDI diagnosis (VAN group). Outcomes analysis between the two cohorts was performed after propensity score matching and included event risk and Kaplan–Meier survival analyses for the following concomitant diseases/events occurring during an observational period of 12 months following CDI diagnosis: death, sepsis, candidiasis, infections caused by vancomycin-resistant enterococci, inflammatory bowel disease, cardiovascular disease, psychological disease, central line-associated blood stream infection, surgical site infection, and ventilator-associated pneumonia. Results: Following propensity score matching, 2170 patients were included in the FDX group and VAN groups, respectively. The event risk analysis demonstrated improved outcomes of patients treated with FDX compared to VAN in 6 out of the 10 events that were analyzed. The highest risk ratio (RR) and odds ratio (OR) were found for sepsis (RR: 3.409; OR: 3.635), candidiasis (RR: 2.347; OR: 2.431), and death (RR: 1.710; OR: 1.811). The Kaplan–Meier survival analysis showed an overall survival rate until the end of the 12-month observational period of 87.06% in the FDX group and 78.49% in the VAN group (log-rank p < 0.001). Conclusions: Our comparative event risk analysis demonstrated improved outcomes for patients treated with FDX compared to VAN in most of the observed events and underlines the results of previously conducted RCTs, highlighting the beneficial role of FDX compared to VAN. Further big data analyses from other industrialized countries are needed for comparison with our observations. Full article

The quality of rice, one of the most important food crops in the world, is directly related to people’s dietary experience and nutritional health. With the improvement in living standards, consumer requirements for the taste quality of rice are becoming increasingly strict. Japonica rice occupies an important position in rice production due to its rich genetic diversity and excellent agronomic characteristics. In this study, LJ433, JY653, LJ218, LJ177, LY66, and LX21, which are mainly popularized in northern China and have different taste values, were selected as the experimental subjects, and YJ219, which won the gold award in the third China high-quality rice variety taste quality evaluation, was taken as the control (CK). Low-field nuclear magnetic resonance and spectral analysis were adopted as the main detection techniques. The effects of free water (peak area increased by 13.24–86.68% when p < 0.05), bound water, appearance characteristics (such as chalkiness, which decreased by 18.48–86.48%), and chemical composition (amylose content decreased by 3.76–26.47%) on the taste value of rice were systematically analyzed, and a multi-dimensional “appearance–palatability–nutrition” evaluation system was constructed. The experimental results indicated that increasing the free water content, reducing the chalkiness and chemical component content could significantly improve the taste value of rice (p < 0.05). The results of this research provide a theoretical basis for breeding new high-yield and high-quality rice varieties and have guiding significance for the practice of rice planting and processing. Full article

Benzene, toluene, ethylbenzene, and xylene (BTEX) are widespread volatile organic compounds commonly present in fuels and various industrial materials. Their release into the atmosphere significantly contributes to air pollution, prompting strict regulatory concentration limits in ambient air. In this work, we introduce Multiphoton Electron Extraction Spectroscopy (MEES) as an innovative technique for the sensitive, selective, and online detection and quantitation of BTEX compounds under ambient conditions. MEES employs tunable UV laser pulses to induce the resonant ionization of target molecules under a high electrical field, with subsequent measurement of the generated photocurrent. We now demonstrate the method’s ability to detect BTEX in ambient air, at part-per-trillion (ppt) concentration range, providing distinct spectral signatures for each compound, including individual xylene isomers. The technique represents a significant advancement in BTEX monitoring, with potential applications in environmental sensing and industrial air quality control. Full article

Microbiological safety and quality consistency are critical challenges in the production of traditional Indian fried snacks, particularly in small-scale food enterprises. With growing export demand, maintaining strict quality control measures is essential. This study assessed the microbiological and physicochemical quality of five traditional Indian fried snacks—Kerala Murukku, Kerala Mixture, Banana Chips, Tapioca Chips, and Achappam—produced in a Food Safety Management System (FSMS)-certified facility over a four-year period (2020–2023). Products were evaluated for moisture, pH, salt content, acid value, and Total Plate Count (TPC). The number of ingredients for each product was recorded from standardized product formulation documents. TPC levels remained within acceptable limits (below 50,000 CFU/g) across all products. Among them, Kerala Mixture consistently showed the highest microbial counts (up to 4.61 log CFU/g) and Achappam the lowest, with no detectable variance (1.00 log CFU/g). Statistically significant year-wise differences (p < 0.05) were observed in all quality parameters. Kerala Mixture showed variation in salt and microbial load; Kerala Murukku varied in moisture, pH, and salt; while Tapioca Chips varied in moisture and salt. PCA identified that TPC, salt content, number of ingredients, and pH were key contributors to product variability. Cluster analysis confirmed Kerala Mixture as the most susceptible product to contamination risk. These findings provide valuable insights into the quality trends within an FSMS-certified environment and highlight the importance of strict post-processing controls. Full article

Neck of femur (NOF) fractures are a critical orthopaedic emergency with a high morbidity and mortality prevalence, particularly in people living with Human Immunodeficiency Virus (PLWHIV). A combination of HIV infection, combined antiretroviral therapy (cART), and compromised bone health further increases the risk of fragility fractures. Additionally, HIV-related immune dysfunction, cART-induced osteoporosis, and perioperative infection risks further pose challenges in ongoing surgical management. Despite the rising global prevalence of PLWHIV, no specific guidelines exist for the perioperative and post-operative care of PLWHIV undergoing NOF fracture surgery. This narrative review synthesises the current literature on the surgical management of NOF fractures in PLWHIV, focusing on pre-operative considerations, intraoperative strategies, post-operative complications, and long-term outcomes. It also explores infection control, fracture healing dynamics, and ART’s impact on surgical outcomes while identifying key research gaps. A systematic database search (PubMed, Embase, Cochrane Library) identified relevant studies published up to February 2025. Inclusion criteria encompassed studies on incidence, risk factors, ART impact, and NOF fracture outcomes in PLWHIV. Data were analysed to summarise findings and highlight knowledge gaps. Pre-operative care: Optimisation involves assessing immune status (namely, CD4 counts and HIV-1 viral loads), bone health, and cART to minimise surgical risk. Immunodeficiency increases surgical site and periprosthetic infection risks, necessitating potential enhanced antibiotic prophylaxis and close monitoring of potential start/switch/stopping of such therapies. Surgical management of neck of femur (NOF) fractures in PLWHIV should be individualised based on fracture type (intracapsular or extracapsular), age, immune status, bone quality, and functional status. Extracapsular fractures are generally managed with internal fixation using dynamic hip screws or intramedullary nails. For intracapsular fractures, internal fixation may be appropriate for younger patients with good bone quality, though there is an increased risk of non-union in this group. Hemiarthroplasty is typically favoured in older or frailer individuals, offering reduced surgical stress and lower operative time. Total hip arthroplasty (THA) is considered for active patients or those with pre-existing hip joint disease but carries a higher infection risk in immunocompromised individuals. Multidisciplinary evaluation is critical in guiding the most suitable surgical approach for PLWHIV. Importantly, post-operative care carries the risk of higher infection rates, requiring prolonged antibiotic use and wound surveillance. Antiretroviral therapy (ART) contributes to bone demineralisation and chronic inflammation, increasing delayed union healing and non-union risk. HIV-related frailty, neurocognitive impairment, and socioeconomic barriers hinder rehabilitation, affecting recovery. The management of NOF fractures in PLWHIV requires a multidisciplinary, patient-centred approach ideally comprising a team of Orthopaedic surgeon, HIV Physician, Orthogeriatric care, Physiotherapy, Occupational Health, Dietitian, Pharmacist, Psychologist, and related Social Care. Optimising cART, tailoring surgical strategies, and enforcing strict infection control can improve outcomes. Further high-quality studies and randomised controlled trials (RCTs) are essential to develop evidence-based guidelines. Full article

Background/Objectives: Celiac disease (CD) is an immune-mediated condition triggered by gluten ingestion in genetically predisposed individuals, requiring lifelong adherence to a strict gluten-free diet (GFD). Despite dietary compliance, many patients with CD experience impaired health-related quality of life (HRQoL). Emerging evidence suggests that dietary quality may influence HRQoL. Although the Mediterranean diet (MD) is linked to multiple health benefits, its role in CD management remains underexplored. This study aimed to investigate the relationship between MD adherence and HRQoL in adults with CD. Methods: In this cross-sectional study, adherence to the MD was assessed using the MedDiet Score. HRQoL was evaluated using the Short Form-12 (SF-12), measuring the Physical Component Summary (PCS) and Mental Component Summary (MCS) scores. Results: The study enrolled 100 individuals with CD and 100 age- and sex-matched healthy controls. The mean MedDiet Score (MDS) was 30.4 ± 3.9 for patients and 30.7 ± 5.0 for controls (p = 0.709), with moderate adherence in most participants. The patients had significantly lower PCS scores (43.80 ± 4.99) compared to controls (45.45 ± 4.76; p = 0.015), while the MCS scores did not differ significantly (42.12 ± 8.05 vs. 42.79 ± 6.56; p = 0.738). In individuals with CD, the MedDiet Score was positively correlated with MCS12 (ρ = 0.302, p = 0.002), but not with PCS12 (ρ = 0.059, p = 0.562). Conclusions: Adherence to the MD is associated with better mental health outcomes in individuals with CD. Promoting a Mediterranean-style GFD may offer a holistic approach to enhancing well-being in this population. Full article

Women have a lower age-matched cardiovascular risk than men, largely due to estrogen’s protective role in endothelial function. While exercise improves vascular health, acute vascular responses are influenced by factors such as age, fitness level, metabolic status, and exercise modality. In premenopausal women, fluctuations in estrogen levels during the menstrual cycle may further affect vascular reactivity. Here, we review current evidence on acute exercise-induced vascular responses in women, emphasizing menstrual phase influences and key biomarkers such as flow-mediated dilation (FMD), along with others including vascular conductance and pulse wave velocity (PWV). Despite limited and heterogeneous evidence, shear-induced vascular responses, (including FMD) following acute exercise, appear to be relatively stable across menstrual cycle phase, suggesting that strict phasic control may not always be necessary. However, future high-quality studies are needed to further clarify this response. In contrast, other vascular assessments that rely more heavily on neural components—such as vascular conductance and PWV—show greater estrogen sensitivity. Nonetheless, the inconsistencies between studies again underscore the need for future research with hormonal verification. Morever, adequate sample sizes, and standardized exercise protocols will improve both consistency and help develop and promote the inclusion of women in vascular research. Full article