Search Results (425)

Background/Objectives: Hartmann’s procedure is commonly employed to manage complications of acute sigmoid diverticulitis, such as perforation or abscess formation. However, determining the optimal timing for colostomy reversal remains a topic of debate. This study aims to evaluate the effect of early versus delayed colostomy reversal on postoperative outcomes, focusing on complications, hospital stay duration, and readmission rates. Methods: A retrospective cohort study was conducted on 148 patients who underwent Hartmann’s procedure for acute sigmoid diverticulitis at a single tertiary care center between 2014 and 2023. Participants were grouped based on the timing of colostomy reversal: early (45–120 days), intermediate (121–180 days), and late (>180 days). Data on complications, hospital stay length, and readmissions were analyzed. Results: Early reversal was associated with fewer postoperative complications, shorter hospital stays, and reduced readmissions compared to delayed reversal. The late reversal group had higher rates of complications, longer hospital stays, and a higher need for reintervention. Advanced age and comorbidities, such as cardiovascular disease and diabetes, were significant predictors of poor outcomes, contributing to delayed reversal. Logistic regression analysis indicated that late reversal was independently associated with higher complication rates. Conclusions: Early colostomy reversal within 45–120 days following Hartmann’s procedure is associated with improved postoperative outcomes, including fewer complications and a shorter hospital stay. The timing of colostomy reversal should be individualized based on patient health status, with early reversal preferred for those without significant comorbidities. Further prospective research is needed to confirm these findings and refine guidelines for optimal reversal timing. Full article

Polyethylene terephthalate (PET) is widely used in the food and beverage packaging sector due to its chemical and mechanical properties. Although PET is a fossil-based polymer, its recyclability significantly contributes to reducing the environmental impacts caused by excessive plastic consumption. However, the growing demand for post-consumer recycled PET (PET-PCR) food packaging has raised concerns about the efficiency of decontamination processes involved in recycling this material. This review initially addresses PET synthesis processes, highlighting injection stretch blow molding as the predominant technique for packaging production. It then discusses reverse logistics as a strategy to promote sustainability through the recovery of post-consumer packaging, such as plastic bottles. This review examines mechanical and chemical recycling methods used in PET-PCR production, food safety requirements including positive lists of permitted substances, contaminant migration limits, non-intentionally added substances (NIASs), and updated criteria for the National Health Surveillance Agency (ANVISA) of food-grade PET-PCR resins. Finally, the review explores future prospects for using PET-PCR in the food and beverage packaging sector, assessing its environmental impacts and potential technological advancements to enhance its sustainability and safety. Full article

This paper addresses the time-dependent vehicle routing problem with drones in vehicle-restricted zones and no-fly zones (TDVRPD-VRZ-NFZ). The optimization model considers the impacts of vehicle-restricted zones, no-fly zones, and time-dependent road networks on delivery paths. The objective is to minimize the total cost, including vehicle dispatch costs, energy consumption costs for vehicles and drones, and time-window penalty costs. The model is verified for correctness using Gurobi. In response to the problem’s characteristics, a hybrid genetic algorithm and variable neighborhood search with a learning mechanism (HGAVNS-LM) is proposed to solve the problem. The algorithm starts by generating the initial population using a combination of logistic mapping and reverse learning. It then improves the genetic operators and variable neighborhood search operators to optimize the initial population. To improve the algorithm’s performance, an individual elite archive is used for knowledge learning, and a self-learning mechanism is established to dynamically adjust the algorithm’s key parameters. The solution obtained by HGAVNS-LM shows a deviation of −0.2% to −0.3% compared to Gurobi, but it saves 99.68% in solving time. Compared to the genetic neighborhood search algorithm and the hybrid genetic algorithm, the improvement rates are 5.1% and 13.0%, respectively. Through the analysis of multiple sets of test cases, it is concluded that time-varying road networks, vehicle-restricted zones and no-fly zones, and different detour rules all affect delivery costs and delivery plans. The research results provide a more scientific theoretical basis for logistics companies to customize delivery solutions. Full article

Smart cities aim to enhance the quality of life by advancing infrastructure, leveraging technology, and promoting sustainability, balancing environmental, societal, and economic needs for long-term efficiency. Given resource scarcity and environmental regulations, advanced supply chains play a crucial role in developing smart cities by adopting the circular economy concept, which emphasizes maximizing resource efficiency through recycling and remanufacturing. This study delves into the competition between two types of supply chains in the context of reverse logistics: the hybrid supply chain, which utilizes a dual channel including traditional and e-channels for collecting used products, and the traditional supply chain, which relies solely on a traditional channel. Both supply chain models are actively involved in remanufacturing and recycling used products, and each considers varied policies, including incentive-based policies, advertising investments, the acceptance return quality level, the return processing time, and transportation investments, to enhance their performance. Specifically, this research has two primary objectives: (1) evaluating the economic and environmental outcomes across three competitive scenarios, and (2) analyzing the impact of varied policy settings on these outcomes. These objectives frame the analysis of optimal incentive values, return rates, and profitability across the Nash equilibrium and Nash–Stackelberg structures, providing insights into both the strategic and policy dimensions of supply chain operations. The findings indicate that a hybrid supply chain in this case achieves higher return rates and profitability, highlighting the success of its dual-channel strategy and associated policies. Regarding economic goals, both supply chains achieve the highest profits under the Nash–Stackelberg traditional supply chain leadership structure. However, for environmental goals, the traditional supply chain favors Nash equilibrium for higher return rates, while the hybrid supply chain prefers Nash–Stackelberg with traditional leadership. These scenario-specific results emphasize the importance of aligning economic and environmental goals through tailored strategies. A sensitivity analysis, supported by Pareto prioritization, identifies the return quality level and processing time as critical for the hybrid supply chain, and advertisement investments and the return processing time as key for the traditional supply chain. These insights suggest that H-SCs should prioritize stricter quality standards, efficient inspection protocols, and automation (e.g., AI or optical scanning) to improve the quality and processing time efficiency. Meanwhile, T-SCs should focus on advertising traditional channels by emphasizing faster processing time and less restrictive quality standards, while adopting automated time management strategies similar to H-SCs to enhance engagement and profitability. These findings show that by integrating smart city internet-based initiatives and managing related policies, supply chains can enhance circular economy objectives by optimizing both the economic and environmental performance, ultimately fostering more resilient and sustainable supply chains. Full article

This study presents a novel encryption method for RGB (Red–Green–Blue) color images that combines scrambling techniques with the logistic map equation. In this method, image scrambling serves as a reversible transformation, rendering the image unintelligible to unauthorized users and thus enhancing security against potential attacks. The proposed encryption scheme, called Bit-Plane Representation of Quantum Images (BRQI), utilizes quantum operations in conjunction with a one-dimensional chaotic system to increase encryption efficiency. The encryption algorithm operates in two phases: first, the quantum image undergoes scrambling through bit-plane manipulation, and second, the scrambled image is mixed with a key image generated using the logistic map. To assess the performance of the algorithm, simulations and analyses were conducted, evaluating parameters such as entropy (a measure of disorder) and correlation coefficients to confirm the effectiveness and robustness of this algorithm in safeguarding and encoding color images. The results show that the proposed quantum color image encryption algorithm surpasses classical methods in terms of security, robustness, and computational complexity. Full article

Background and Objectives: Postoperative delirium (POD) is a transient but significant complication in geriatric patients following hip or femur surgery. POD occurs in 19–65% of patients after hip surgeries, with notable risks associated with augmented morbidity, mortality, and prolonged hospitalization. The perioperative administration of benzodiazepines, particularly midazolam, is associated with an increased incidence of POD. Remimazolam, a novel ultra-short-acting benzodiazepine, has potential benefits, such as hemodynamic stability and ease of reversal, but its effect on POD occurrence remains unclear. Materials and Methods: This retrospective study investigated patients who were aged 65 years old and older who underwent hip or femur surgery. Following the application of exclusion criteria, 502 patients were grouped according to whether anesthesia was maintained with remimazolam (R group) or sevoflurane (S group). Data regarding patients’ baseline characteristics, anesthetic details, and postoperative outcomes, including the incidence of POD, were gathered and analyzed. Propensity score matching and logistic regression were conducted to identify factors associated with POD and compare outcomes between the two groups. Results: Among the 502 patients, POD was observed in 161 (32%). The POD incidence was not statistically significantly different between the groups (p = 1.000). A multivariable logistic regression analysis indicated that remimazolam was not a determinant of POD (p = 0.860), whereas being male and polypharmacy were (p = 0.022; p = 0.047). Initial disparities in age and comorbid conditions between the groups were rectified through matching, demonstrating that remimazolam had a similar POD risk to sevoflurane. Conclusions: This study showed that remimazolam did not exacerbate the risk of POD in elderly patients undergoing hip or femur surgery. Remimazolam is a reliable anesthetic option for this vulnerable demographic. Also, this study’s results indicated that polypharmacy and being male are POD risk factors, suggesting that meticulous perioperative medication management may help alleviate the risk of POD. Full article

Objective: To unveil the efficacy and ferroptosis-related mechanisms of Atractylodes Macrocephala Koidz (AMK) against Alzheimer’s disease (AD), which is the most widespread neurodegenerative disease. Methods: Gene set variation analysis (GSVA) scores were used to investigate the relationship between ferroptosis and AD. Logistic regression with seven feature selections and a deep learning model were utilized to identify potential targets of AMK based on transcriptomic data from multiple tissues. A transcriptome-wide association study (TWAS), summary-data-based mendelian randomization (SMR), and mendelian randomization (MR) were utilized to validate the causal relationship between target genes and AD risk. A single-gene gene set enrichment analysis (GSEA) was employed to investigate the biological pathways associated with the target genes. Three molecular docking strategies and a molecular dynamics simulation were employed to verify the binding domains interacting with AMK. Furthermore, the anti-AD effects of AMK were validated in a zebrafish AD model by testing behavior responses, apoptosis, and the deposition of beta-amyloid (Aβ) in the brain. Ultimately, real-time qPCR was used to verify the ferroptosis-related targets, which was identified via multi-omics. Results: Ferroptosis is an important pathogenic mechanism of AD, as suggested by the GSVA scores. AMK may exert its anti-AD activity through targets genes identified in the brain (ATP5MC3, GOT1, SAT1, EGFR, and MAPK9) and blood (G6PD, PGD, ALOX5, HMOX1, and ULK1). EGFR and HMOX1 were further confirmed as target genes mediating the anti-AD activity of AMK through TWAS, SMR, and MR analyses. The GSEA results indicated that EGFR may be involved in oxidative phosphorylation-related pathways, while HMOX1 may be associated with lysosome and phagosome pathways. The results of three molecular docking strategies and molecular dynamics simulations implied that the kinase domain of EGFR and the catalytic domain of HMOX1 played pivotal roles in the interaction between AMK and the targets. In a zebrafish model, AD-like symptoms including motor slowness and delayed responses, neuronal apoptosis, and plaque deposition in the brain, were significantly improved after AMK treatment. Accordingly, AMK reversed the abnormal expression of egfra and hmox1a, two core targets genes involved in ferroptosis. Conclusions: AMK significantly alleviated AD-like symptoms through the modulation of EGFR and HMOX1, which might reduce lipid peroxidation, thereby suppressing ferroptosis. This study provided evidence supporting the efficacy and therapeutic targets associated with ferroptosis in AMK-treated AD, which aid in the development of therapeutic interventions. Full article

Background: The potential sustainability perspective of RFID technology in business needs more exploration. This study investigated how RFID technology could enhance competitive advantage (CA) within the pharmaceutical supply chain (PSC) and identified implementation barriers and solutions. Methods: Data were collected through an online survey from 58 professionals working in PSC roles, addressing three research questions. Results: Key areas for RFID adoption were identified as distribution (72.40%), warehousing (53.40%), reverse logistics (48.30%), and manufacturing (24.10%). Major concerns included the high cost of RFID devices (60.34%), limited industry understanding of RFID applications (58.62%), and the cost of supporting software (44.83%). RFID technology has the potential to improve CA by reducing costs and enhancing reliability, with budget and project management addressing the financial barriers. Conclusions: Insights from PSC practitioners provided a valuable empirical perspective, contributing both theoretically and practically to the limited existing literature on RFID in PSCs, specifically indicating where RFID can be used, what the expected key benefits are, and the expected challenges businesses need to overcome. This research benefits various PSC stakeholders, especially those focused on last-mile distribution by enhancing competitive advantages and creating and maintaining long-lasting business performance sustainability. Full article

Background: Disruptions in epigenetic mechanisms regulating placentation, particularly imbalances in the levels of small non-coding RNAs, contribute to various pregnancy complications, including preeclampsia (PE) and placenta accreta spectrum (PAS). Given that abnormal trophoblast differentiation, invasiveness, and angiogenesis—reduced in PE and excessive in PAS—are central to the pathogenesis of these conditions, this study aimed to identify universal circulating piRNAs and their targets. Methods: Small RNA deep sequencing, quantitative reverse transcription combined with real-time polymerase chain reaction, magnetic bead-based multiplex immunoassay, ELISA, and Western blotting were employed to quantify circulating piRNAs and proteins in the blood serum of pregnant women during the 11th–14th weeks of gestation. Results: Statistically significant negative correlations were identified between PE- and PAS-associated piRNAs (hsa_piR_019122, hsa_piR_020497, hsa_piR_019949, and piR_019675) and several molecules, including Endoglin, IL-18, VEGF-A, VEGF-C, Angiopoietin-2, sFASL, HB-EGF, TGFα, and Clusterin. These molecules are involved in processes such as angiogenesis, inflammation, the epithelial–mesenchymal transition, cell proliferation, adhesion, and apoptosis. A first-trimester pregnancy screening algorithm was developed using logistic regression models based on Clusterin concentration and the levels of hsa_piR_020497, hsa_piR_019949, piR_019675, and hsa_piR_019122. Conclusions: The proposed screening tool for early pregnancy monitoring may enable the prediction of PE or PAS in the first trimester, allowing timely interventions to reduce maternal and perinatal morbidity and mortality. Full article

HIV drug resistance (HIVDR) presents a significant challenge to antiretroviral therapy (ART) success, particularly in resource-limited settings like Ethiopia. This cross-sectional study investigated viral suppression rates and resistance patterns among patients on second-line ART across 28 Ethiopian health facilities. Blood samples collected from 586 participants were analyzed to measure CD4 count and viral load and assess HIVDR in patients experiencing virological failure (VF) (viral load ≥ 1000 copies/mL). Demographic and clinical data were analyzed using logistic regression to identify factors associated with VF. Results showed that 13.82% of participants experienced VF, with 67.57% of genotyped samples exhibiting at least one drug resistance mutation. Resistance to nucleoside reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs), and protease inhibitors (PIs) was detected in 48.64%, 64.86%, and 18.92% of cases, respectively. Dual-class resistance was identified in 48.64% of patients, while triple-class resistance was detected in 18.92%. VF was more likely among students and those with CD4 counts below 200 cells/mm³, but less likely in patients on second-line treatment for 12 months or more. Our findings highlight a substantial HIVDR burden among patients on second-line ART with VF, emphasizing the need for comprehensive HIV care, including adherence support, regular viral load monitoring, and HIVDR testing. Full article

The clean energy transition is a paradigm shift from a carbon-intensive energy system to a renewable energy one. The new energy system requires large amounts of critical minerals, including lithium. However, the mining and extraction of these minerals introduces environmental challenges. Recycling critical minerals, a critical step for a circular economy, is a potential solution that could reduce the need for new mining, lowering the overall environmental impact. In this experimentally based work, we evaluate the lithium recycling labor- and cost-intensive preprocessing stage that is currently performed by large-scale recycling systems, reducing the efficiency and raising the costs of the downstream stages. We investigate multiple inexpensive and distributed alternatives to the preprocessing tasks that produce black mass (separation, grinding, and shredding techniques) in order to identify methods that improve the efficiency of the downstream recycling process. This work finds that shredding and grinding end-of-life batteries with equipment that can be purchased for under USD 1000 produces viable black mass for a fraction of the cost. Therefore, this work contributes toward the goal of a circular economy for battery energy storage by identifying the technical requirements and measuring the efficacy of redistributing the labor- and time-intensive preprocessing tasks to small-scale recyclers in order to enhance the efficiency of the downstream stages in the lithium-ion battery recycling reverse supply chain. Full article

This article discusses key aspects of deposit–refund system design in Poland, highlighting the importance of energy-sustainable collection logistics. The main role in this system is played by the operator responsible for collecting and transporting packaging to metering centers and recycling plants. The research focused on the optimal placement of logistics facilities to minimize energy expenditures, using the balanced center of gravity method. It took into account the distribution of collection points and the intensity of material flows to develop an efficient and environmentally friendly reverse logistics model. The most important results of the research are the development of a model for the layout of logistics facilities that minimizes energy consumption, the identification of key factors such as the location of collection points and material flows, the development of a methodology for green logistics, and practical recommendations for system designers. The proposed solutions, although innovative in Poland, are universal in nature and can be applied in other countries. The article makes an important contribution to the development of sustainable bail logistics and promotes a balanced energy transition. Full article

Obesity has become the most consequential threat to the health of Mississippians, as it is known to be associated with major chronic diseases such as type II diabetes, heart disease, and strokes. Obesity prevalence among Mississippi adolescents has been among the highest in the nation. In this study, data from Mississippi Youth Risk Behavior Surveillance System (YRBSS) 2001–2021 were obtained from the Centers for Disease Control and Prevention (CDC). YRBSS is a survey using a self-administered questionnaire to track the risk behaviors of students in grades 9 to 12. The survey packages in R were utilized for summary statistics to account for the YRBSS complex sampling design that includes stratification, clustering, and unequal probabilities of selection. Logistic regression models and Joinpoint software 5.3.0 were used for trend analysis. Obesity prevalence in Mississippi high-school students demonstrated a significant increasing trend from 2001 to 2021, as a whole or stratified by gender or race. Furthermore, Mississippi obesity prevalence among high-school students has been increasing at a greater pace compared to that of the United States. The increasing trend in obesity prevalence among Mississippi high-school students warrants urgent attention at the government, community, school, family, and personal levels. Concerted efforts must be made to fight and eventually reverse this epidemic. Full article

Background: The forest products industry plays a significant role in global carbon emissions, highlighting the need for sustainable practices to address the climate crisis. Reverse logistics (RL), focusing on the return, reuse, and recycling of materials, offers a promising approach to decarbonizing supply chains. However, its application within forest products supply chains remains underexplored. Methods: This study conducts a review of the literature on RL, its environmental implications, and its potential to reduce carbon emissions in forest products supply chains. Key areas examined include greenhouse gas reduction, waste management, and the promotion of circular economy principles. Additionally, the study evaluates case studies and models that integrate RL practices into forest-based industries. Results: The findings reveal that RL can significantly reduce greenhouse gas emissions by optimizing transportation routes, minimizing waste, and extending product life cycles. Incorporating these practices into forestry operations reduces the environmental impact and aligns with sustainable forestry goals. The study identifies gaps in current research, particularly regarding empirical data and the scalability of RL solutions. Conclusions: RL represents a critical strategy for decarbonizing forest products supply chains and advancing sustainable development. Future research should focus on developing standardized methodologies, enhancing technological integration, and fostering policy support to maximize its impact. These steps are essential to fully leverage RL as a tool for mitigating climate change and promoting a circular economy. Full article

Background and Objectives: The interplay of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection and Clostridioides difficile infection (CDI) poses a critical clinical challenge. The resultant inflammatory milieu and its impact on outcomes remain incompletely understood, especially among vulnerable subgroups such as elderly patients, those with diabetes, and individuals with cancer. This study aimed to characterize inflammatory markers and composite inflammatory severity scores—such as Acute Physiology and Chronic Health Evaluation II (APACHE II), Confusion, Urea, Respiratory rate, Blood pressure, and age ≥ 65 years (CURB-65), National Early Warning Score (NEWS), and the Systemic Immune-Inflammation Index (SII)—in hospitalized Coronavirus Disease 2019 (COVID-19) patients with and without CDI, and to evaluate their prognostic implications across key clinical subgroups. Methods: We conducted a retrospective, single-center study of 240 hospitalized adults with Reverse Transcription Polymerase Chain Reaction (RT-PCR)-confirmed COVID-19 between February 2021 and March 2023. Of these, 98 had concurrent CDI. We collected baseline demographics, comorbidities, and laboratory parameters including C-reactive protein (CRP), Interleukin-6 (IL-6), ferritin, neutrophil and lymphocyte counts, albumin, platelet counts, and calculated indices (C-reactive protein to Albumin Ratio (CAR), Neutrophil-to-Lymphocyte Ratio (NLR), Prognostic Nutritional Index (PNI), SII). Patients were stratified by CDI status and analyzed for inflammatory marker distributions, severity scores (APACHE II, CURB-65, NEWS), and outcomes (Intensive Care Unit (ICU) admission, mechanical ventilation, mortality). Subgroup analyses included diabetes, elderly (≥65 years), and cancer patients. Statistical comparisons employed t-tests, chi-square tests, and logistic regression models. Results: Patients with CDI demonstrated significantly higher CRP, IL-6, SII, and CAR, coupled with lower albumin and PNI (p < 0.05). They also had elevated APACHE II, CURB-65, and NEWS scores. CDI-positive patients experienced increased ICU admission (38.8% vs. 20.5%), mechanical ventilation (24.5% vs. 12.9%), and mortality (22.4% vs. 10.6%, all p < 0.05). Subgroup analyses revealed more pronounced inflammatory derangements and worse outcomes in elderly, diabetic, and cancer patients with CDI. Conclusions: Concurrent CDI intensifies systemic inflammation and adverse clinical trajectories in hospitalized COVID-19 patients. Elevations in inflammatory markers and severity scores predict worse outcomes, especially in high-risk subgroups. Early recognition and targeted interventions, including infection control and supportive measures, may attenuate disease severity and improve patient survival. Full article