Search Results (2,808)

This study presents the coupling-memory-sampled data control (CMSDC) design for the Takagi–Sugeno (T-S) fuzzy system that solves the stabilization issue of a surface-mounted permanent-magnet synchronous generator (PMSG)-based wind energy conversion system (WECS). A fuzzy CMSDC scheme that includes the sampled data control (SDC) and memory-sampled data control (MSDC) is designed by employing a Bernoulli distribution order. Meanwhile, the membership-function-dependent (MFD) $H_{\infty }$ performance index is presented, mitigating the continuous-time fuzzy system’s disturbances. Then, by using the Lyapunov–Krasovskii functional with the MFD $H_{\infty }$ performance index, the data of the sampling pattern, and a constant signal transmission delay, sufficient conditions are derived. These sufficient conditions are linear matrix inequalities (LMIs), ensuring the global asymptotic stability of a PMSG-based WECS under the designed control technique. The proposed method is demonstrated by a numerical simulation implemented on the PMSG-based WECS. Finally, Rossler’s system demonstrates the effectiveness and superiority of the proposed method. Full article

The COVID-19 (C19) pandemic introduced challenges in all areas of the Canadian healthcare system. Along with adaptations to clinical care environments, there was increasing concern about physician burnout during this time. The Canadian Association of Medical Oncologists (CAMO) has examined the effects of the pandemic on the medical oncology (MO) workforce. A series of four multiple choice web-based surveys distributed to MOs who were identified using the Royal College of Physicians and Surgeons directory and CAMO membership in May 2020 (S1), July 2020 (S2), December 2020 (S3), and March 2022 (S4). Descriptive analyses were performed for each survey, and a Chi-square test (α = 0.05) was used to assess factors associated with planned change in practice in S4. The majority of respondents work in a comprehensive cancer center S1/S2/S3/S4 (87%/86%81%/88%) and have been in practice >10 years (56%/61%/50%/64%). The most commonly reported personal challenges were physical (60%) and mental (60%) wellness. In S4, 47% of MOs reported dissatisfaction with their current work–life balance. In total, 83% reported that their workload has increased since the beginning of C19, and 51% of MOs reported their future career plans have been impacted by C19. In total, 56% of respondents are considering retiring or reducing total working hours in the next 5 years. Since the onset of the C19 pandemic, there are concerns identified with wellness, increasing workload, and job dissatisfaction among MOs, associated with experienced staff who have >10 years in practice. As rates of cancer prevalence rise and treatments become more complex, it is crucial to address the concerns raised in these surveys to ensure that we have a stable MO workforce in the future. Full article

Recurrent or metastatic head and neck squamous cell carcinoma (R/M HNSCC) is a challenging disease, requiring personalized management by a multidisciplinary team. The aim of this retrospective multicentric study was to characterize real-world healthcare resource use and patient care for R/M HNSCC in Portugal during the first year after diagnosis. A total of 377 patients ineligible for curative treatment were included, mostly male (92.8%), aged 50–69 years (74.5%), with heavy alcohol (72.7%) or smoking habits (89.3%). Oropharynx (33.2%) and oral cavity (28.7%) were primary tumor locations, with lung metastases being the most common (61.4%). Eligible patients for systemic treatment with palliative intent (80.6%) received up to four treatment lines, with varied regimens. Platinum-based combination chemotherapy dominated first-line treatment (>70%), while single-agent chemotherapy and anti-PD1 immunotherapy were prevalent in later lines. Treatment approaches were uniform across disease stages and primary tumor locations but varied geographically. Treated patients received more multidisciplinary support than those who were ineligible. This study provides the first Portuguese real-world description of R/M HNSCC patient characteristics, treatment patterns, and supportive care during the year after diagnosis, highlighting population heterogeneity and aiming to improve patient management. Full article

In this study, we identified differences in characteristics and circumstances, main presenting problems, and types of referrals received among young people who were in crisis, at imminent risk of homelessness, or currently homeless. This study draws on data from 11,566 young people who contacted the National Runaway Safeline (NRS) through the National Communication System (NCS), a federal program for young people at risk or experiencing homelessness in the U.S. and those who care for them. Frontline staff collect information directly from young people during crisis intervention engagement through the NRS. We used multinomial logistic regression analyses to predict membership in each of the homelessness risk categories and logistic regression analyses to predict the type of service referrals young people received. Results revealed that young people’s circumstances and presenting problems were associated with homelessness risk category membership, which in turn was linked with the types of service referrals young people received. This study illuminates valuable opportunities for targeting prevention opportunities to the specific needs of young people with varying levels of homelessness risk. Full article

The complexity of variation in healthcare, particularly in mental health, remains poorly understood. However, addressing this issue presents an opportunity to opti-mise the allocation of scarce healthcare resources. To explore this, we investigated the variation in psychiatric care measured as the number of psychiatric hospitalisations. We estimated multiple-membership multiple-classification models utilising Danish register data for 64,694 individuals and their healthcare providers, including 2101 general practitioners, 146 community-based care institutions, 46 hospital departments, and 98 municipalities. This approach recognised that data are not strictly hierarchical. We found that, among individuals attending a single healthcare provider, 67.4% of the total variance in the number of hospitalisations corresponds to differences between individuals, 22.6% to differences between healthcare providers’ geographical location, 7.02% to differences between healthcare providers, and 3% to differences between the geographical locations of the individuals. Adding characteristics to the model ex-plained 68.5% of the variance at the healthcare provider geographical level, but almost no explanation of the variation was found on the three other levels despite the nu-merous characteristics considered. This suggests that medical practice may vary un-warrantedly between healthcare providers, indicating potential for optimisation. Streamlining medical practices, such as adhering to clinical guidelines, could lead to more efficient supply of mental health resources. In conclusion, understanding and addressing variation in psychiatric care may impact resource allocation and patient outcomes, ultimately leading to a more effective healthcare system. Full article

Functional dyspepsia is distinguishable from Helicobacter pylori-associated dyspepsia. However, distinguishing H. pylori-associated dyspepsia from functional dyspepsia before H. pylori eradication is difficult. Therefore, in the present study, we aimed to investigate whether serum pepsinogen levels before H. pylori eradication are associated with the amelioration of dyspepsia after successful H. pylori eradication. Additionally, we examined the usefulness of serum pepsinogen levels and other factors in predicting dyspepsia outcomes. H. pylori eradication was effective in 14 patients (Responders) and ineffective in 19 patients (Non-responders). The pepsinogen I/II ratio in Responders (3.4 ± 1.2) and Non-responders (2.3 ± 1.0) differed significantly (p = 0.006). The optimal cut-off pepsinogen I/II value was 2.3. Multivariate logistic regression analysis showed that the adjusted odds ratio for Non-responders was 26.1 (95% confidence interval: 2.0–338.0, p = 0.012) for a pepsinogen I/II ratio ≤ 2.3 and 8.10 (95% confidence interval: 1.1–57.6, p = 0.037) for smoking habits. The pepsinogen I/II ratio and smoking habits were associated with the effects of H. pylori eradication on dyspeptic symptoms. Thus, the pepsinogen I/II ratio cut-off value can be used to identify patients likely to respond to H. pylori eradication after the resolution of dyspeptic symptoms. Full article

Water shortages are serious in northwest China due to the level of social and economic development, engineering, resource shortages, and other factors being restricted, so the conflict between supply and demand for water resources is prominent in different regions and different water use sectors. Therefore, Pingliang City was selected as the research object in this study. The membership function was introduced, and an interactive algorithm to correct model parameters based on the fairness constraint was derived. An uncertain multi-objective fuzzy programming model was also established. The results show that the optimal allocation of water will be 38,051.9~40,740 × 10⁴ m³ and 39,938.4~41,317.5 × 10⁴ m³ under a normal year (p = 50%) and a dry year (p = 75%) in 2025, respectively, and the corresponding water shortage rates will be 4.2% and 6.7%. In 2035, the optimal water allocation will be 45,644.1~49,245.9 × 10⁴ m³ and 46,442.4~50,044.2 × 10⁴ m³ and the water shortage rates will be 7.0% and 7.0%, respectively. The proportion of groundwater supply will decrease by 8.8% and 13.8% in 2025 and 2035 after the optimal allocation, the proportion of surface water supply will increase by 9.6% and 12.2%, and the proportion of reclaimed water will increase by −0.78% and 2.1%, respectively. The results can provide a technical reference for the development and utilization of water resources in other cities and similar areas in semi-arid regions. Full article

Salt farming has been a hereditary occupation in the coastal communities of Madura Island; however, salt productivity in this area is still relatively low. The government has introduced a new production technology, called a geomembrane, as part of their efforts. The application of the latest technological innovations has been promoted worldwide to increase farm productivity, including in salt farming. This research aims to determine the determinants of adoption decisions for salt production technology and estimate the adoption impact on technical efficiency. The data in this study are cross-sectional from 215 small-scale salt farmers on Madura Island, East Java, Indonesia. The data were analyzed using logistic regression to identify which factors influenced farmers’ decisions to use geomembranes. The influence of adoption on farmers’ technical efficiency was then assessed using propensity score matching (PSM) and data envelopment analysis (DEA). The findings indicate that age and the dummy variables of gender, land ownership, profit-sharing involvement, and membership in the People’s Salt Business Group (KUGAR) all had a significant impact on adoption rates. The findings of controlling matched samples using the PSM process reveal that geomembrane application improves and greatly increases farmers’ technical efficiency. Those who used geomembranes displayed greater technical efficiency than those who did not. These findings imply that salt production technology should be promoted more to increase productivity, especially geomembrane adoption, through outreach and dissemination of information, including for landowners involved in the profit-sharing system. The government should keep supporting salt farmers and motivate them to adopt geomembrane technology to ensure the sustainability of salt production in the coastal communities on Madura Island. Full article

In this paper, a new multidimensional Takagi–Sugeno (T-S) identification technique is proposed for multivariable nonlinear systems. In this technique, multidimensional membership functions are designed using concepts from solid mechanics. The design of membership functions is carried out in multidimensional space, defining the principal axes from the eigenvectors of the inertia matrix, and it has the characteristic of dividing the space into regions with the same inertia. These regions are analyzed to define the center of gravity for each rule. Illustrative examples of multivariable nonlinear systems, such as a thermal mixing process and a binary distillation column, are selected to evaluate the effectiveness of the proposed method. The proposed method is compared with traditional T-S identification that uses one-dimensional membership functions and shows a reduction in the relative identification error and the algorithm execution time. Additionally, the proposed method prevents rules from being positioned outside the system’s range, thereby avoiding the generation of unnecessary rules. Full article

Introduction: Sexually transmitted infections (STIs) continue to occur at high levels. According to the WHO, each year there are an estimated 374 million new infections with syphilis, gonorrhea, chlamydia, and trichomoniasis. STIs are associated with an increased risk of acquiring HIV infection. Migrants are reportedly highly affected by STIs. Objectives: This study aims to characterize factors associated with STIs in a population of HIV-positive migrants living in Portugal. Methodology: This is a cross-sectional observational study of 265 newly diagnosed HIV-1 positive migrants, who were defined as individuals born outside Portugal. This group of people were part of the BESTHOPE study that was developed in 17 Portuguese hospitals between September 2014 and December 2019, and included information collected through sociodemographic and behavioral questionnaires filled in by the migrant patients, clinical questionnaires filled in by the clinicians and HIV-1 genomic sequences generated through resistance testing (Sanger sequencing). A multivariable statistical analysis was used to analyze the association between sociodemographic characteristics, sexual behaviors, HIV testing and sexual infections. Results: Most HIV-1 positive individuals included in the study were men (66.8%) and aged between 25 and 44 years old (59.9%). Men had a higher proportion of STIs when compared to women (40.4% vs. 14.0%) and the majority of men reported homosexual contacts (52.0%). Most men reported having had two or more occasional sexual partners in the previous year (88.8%) and 50.9% reported always using condoms with occasional partners, while 13.2% never used it. For regular partners, only 29.5% of the women reported using condoms, compared to 47.3% of men. Other risk behaviors for acquiring HIV, such as tattooing and performing invasive medical procedures, were more prevalent in men (38.0% and 46.2%, respectively), when compared to women (30.4% and 45.1% respectively) and 4.7% of men reported having already shared injectable materials, with no data for comparison in the case for women. Additionally, 23.9% of women reported having had a blood transfusion while only 10.3% of men reported having had this medical procedure. Meanwhile, 30.9% of the individuals reported having been diagnosed with some type of STI in the last 12 months. In addition, 43.3% of individuals that answered a question about hepatitis reported to be infected with hepatitis B, while 13.0% reported having hepatitis C infection. According to the multivariable analysis, the only transmission route was significantly associated with reports of previous STI infection: men who have sex with men (MSM) were 70% more likely to have been diagnosed with an STI in the past 12 months compared to the heterosexual route. Conclusion: HIV-1 infected men were more likely to report previous STIs than women. On the other hand, most migrant women had a regular sexual partner and never or only sometimes used condoms. This somewhat discrepant findings suggest that gender inequalities may make women unable to negotiate safe sexual practices, resulting in increased susceptibility to infection. However, since migrant women report less STIs, we cannot exclude that these STIs may remain undiagnosed. The implementation of safer sex awareness campaigns for condom use and screening for STIs in women is crucial. On the other hand, health education campaigns for STI knowledge need to be implemented for both MSM and women and their partners. Full article

Owing to the poor cold tolerance of Stenotaphrum Trin and the urgent need for shade-tolerant grass species in temperate regions of East China, this study evaluated the cold tolerance of 55 Stenotaphrum accessions, aiming to provide shade-tolerant materials for temperate regions. A fine cold-tolerant turfgrass should have both the advantages of delayed fall dormancy and early spring green-up. However, previous research on the cold resistance of turfgrass has mainly focused on the performance of the spring green-up, with less attention paid to the fall dormancy, which has affected the ornamental and application value of turfgrass. This study first dynamically investigated the leaf colour of each accession during the fall dormancy and the coverage during the spring green-up and evaluated the cold resistance of the accession through membership functions and cluster analysis. Significant differences in the cold resistance were found with the assignment of breeding lines to four categories. The weak correlation (R² = 0.1682) between leaf colour during the fall dormancy and coverage during the spring green-up indicates that using the performance of a single period to represent the cold resistance of accessions is not appropriate. To test whether using the laboratory-based LT50 and stolon regrowth rating analysis can replace the above-improved method, we conducted a related analysis and found that the fit between these two methods is very poor. This phenomenon is attributed to the poor correlation between the laboratory-based parameters and the pot-investigated data. Therefore, this study presents a cold resistance evaluation method for Stenotaphrum that integrates performance in both the fall dormancy and spring green-up periods. This improved evaluation method cannot be simplified by the growth performance of a single period or replaced by using laboratory-based LT50 and stolon regrowth tests. With the help of this improved method, several excellent cold tolerance accessions (ST003, S13, and S12) were identified for temperate regions of East China. Full article

When multiple elements come together, hydraulic concrete develops cracks of varying widths, which huts the dependability of buildings. Therefore, with pertinent tools or procedures, swiftly ascertaining the safety status of hydraulic concrete cracks under diverse service conditions is required by conducting a quantitative and qualitative analysis of the elements influencing the onset of cracks. This paper took the safety status of hydraulic concrete cracks as the main body of research; every step of hydraulic conservation infrastructure from the ground up—design stage, construction process, operation environment, and impoundment operation—was thoroughly examined. After establishing a multi-dimensional and multi-level system for the safety status evaluation of hydraulic concrete cracks, the subjective exponential AHP and objective CRITIC method were employed to determine the weight of each factor. Then, the two weights were processed using an enhanced combination assignment method to produce a more scientifically developed combination weight. Furthermore, fuzziness and randomness were considered in the quantitative analysis thanks to integrating cloud theory and extension matter elements. In order to determine the safety evaluation findings for hydraulic concrete fractures, the maximum membership principle and the cloud picture were employed. The conclusion reached after using this method to evaluate Dianzhan Dam was that the crack had a safety grade of III, meaning that it greatly impacted the reliability of the dam, and called for prompt acceptance or repair measures to improve building efficiency and safety. Full article

Equity and inclusion are requisites of high-quality Physical Education (PE). However, there is a substantial gap in understanding PE Teacher Education’s (PETE) effectiveness in preparing Preservice Teachers (PSTs) to implement equity-driven pedagogies. Moreover, focused on individual retrospective gameplay engagement rates (participation time), current research fails to provide a holistic perspective of the practical manifestations of equity and inclusion in PE. This study fills this void with novel insights offered by a mixed-methods case study examining the following: (i) the process-oriented teaching strategies employed by a PST trained to deliver inclusive pedagogies, alongside student voices on lived experiences; and (ii) the outcome-oriented gameplay patterns across two teaching units (Basketball and Volleyball). Participants included one PST and 26 students. Extensive observations and focus groups mapped the applied teaching strategies and student responses. Video-based social network analysis captured equity and inclusion in students’ gameplay patterns, using metrics such as degree prestige. Findings indicate the PETE impact in inducing PSTs’ inclusive manipulation of learning activities and the fostering of inclusive team membership and positive collaboration. SNA metrics evidenced equitable and inclusive gameplay patterns. Despite pedagogical efforts, content-specific factors may influence students’ gameplay inclusion. Hence, a reflection on the multifaceted and non-linear nature of promoting inclusive participation is prompted. Full article

In recent decades, humanity has had a significant negative impact on the environment. This problem can be solved only by establishing a rational environmental management policy and ensuring an effective financial policy in the context of balancing emissions and expenditures on environmental protection measures. The purpose of this article is to analyze the efficiency of financing environmental protection measures by determining the dependence of pollutant emissions on environmental protection expenditures in Ukraine and the European Union. The following methods were used for the study: analysis, synthesis, generalization, comparison, specification, and statistical and graphical methods. The statistical information was systematized on the basis of open data from the Open Budget web portal, the State Statistics Service, and Eurostat. This study identified the dynamics of revenues from environmental taxes in Ukraine; taxes on air emissions prevail. Most of the expenditures are made from the state budget. According to the functional classification, environmental expenditures are mainly aimed at preventing and eliminating environmental pollution. The dynamics of capital investments in environmental protection were also studied. To assess the effectiveness of the state policy in the field of environmental protection, we analyzed the dependence of pollutant emissions in Ukraine, Poland, and Romania on the amount of environmental expenditures and investments in this area and revenues from environmental tax. In Ukraine, the amount of pollutants released into the atmosphere depends mostly on investments in this area; in Poland—on revenues from environmental taxes; and in Romania—on expenditures on environmental protection. It has been established that the obtained models are adequate and can be used to build future forecasts of pollutant emissions. Directions for the development of financial and environmental policy are proposed. Post-war restoration of the environmental situation should be carried out on the basis of sustainable development, focusing on the European Green Deal A triple-task approach should be implemented, including environmental restoration, the minimization of negative climate change and balanced use of resources, and the expansion of powers of the relevant ministry with a focus on the strategic goals of the state policy. It is necessary to develop methodological recommendations according to international standards to assess the real state of the environment. Full article

Objective. We aimed to report the real-world use and outcomes over time in immunocompromised individuals receiving tixagevimab/cilgavimab (T/C) pre-exposure prophylaxis (PrEP). Methods. This observational study included participants who received T/C PrEP, categorized into three groups: (i) No COVID-19 (NoC), i.e., participants who never had COVID-19; (ii) Hybrids (H), i.e., participants who had COVID-19 before PrEP; and (iii) Break-through Infections (BTIs), i.e., participants who had COVID-19 after PrEP. The study measured several immune markers at the administration of T/C (T0) at 3 (T1), 6 (T2), and 9 (T3) months afterward. These markers included: anti-receptor-binding domain (RBD) IgG antibodies; BA.5-neutralizing antibodies (nAbs); mucosal IgG; and T cell immunity. The incidence rate ratios for BTIs were analyzed using a Poisson regression model. Results. A total of 231 participants with a median age of 63 years (IQR 54.0–73.0). were included. Among these, 84% had hematological diseases and received a median of three vaccine doses. N = 72 participants belonged to the NoC group, N = 103 to the H group, and n = 56 to the BTI group (24%), with most BTIs being mild/moderate. The incidence rate (IR) of BTIs was 4.2 per 100 patient-months (95% CI 3.2–5.4), with no associated risk factors identified. There was a significant increase in anti-RBD IgG levels 3 months after the T/C administration in all groups, followed by a decline at 6 months, whereas at the same time points, geometric mean titers (GMTs) of anti-BA.5 nAbs were low for all groups and were around or below the detection threshold. No significant changes were observed in IFN-γ levels. The mucosal immune response was observed only 3 months after the PrEP administration. Conclusion. We provided a real-world experience model on the clinical efficacy of T/C PrEP in preventing severe COVID-19 during the Omicron wave through a comprehensive virological and immunological study. While waiting for the arrival of new monoclonal antibodies that can effectively neutralize the most recent variants, T/C PrEP remains the only viable strategy in the available armamentarium today to prevent COVID-19 complications in an extremely fragile population with suboptimal immune responses to COVID-19 vaccines. Full article