Articles

Lifecycle architectures for rental fleets couple pricing, vehicle assignment, maintenance scheduling and disposal timing, and the profit they add over revenue-based scoring has two sources that behave differently. Mileage steering changes the odometer reading at which a vehicle reaches disposal, and decision-focused forecast training reduces ranking regret at that point. Both sources matter only where the cost-optimal disposal mileage lies within a band around an odometer mark at which wholesale prices drop. The band half-width equals the residual-value forecast error divided by the slope of the retention margin. On realized retirements of midsize sedans at one enterprise rental operator, 28.2% of vehicles fall inside the band. Coupling adds $206 to $228 per vehicle there and $7 to $13 elsewhere, differences indistinguishable from zero. Mileage steering supplies 60.7% of the premium and survives a step-aware forecaster; the decision-focused component falls from $67.60 to $8.20 once the forecaster learns the price drops. Richer telematics raise profit by $86 to $118 per vehicle in every cell, so architecture and data are separable contributions. Operators can restrict the cost of coupling to vehicles inside the band.

Fleet management systems increasingly fold a vehicle's predicted mechanical condition into the same decision that assigns it to a delivery, a route, or a shift, treating the health signal as one more input alongside distance and time windows. This article derives the condition under which that practice improves fleet-level outcomes instead of relocating cost from one part of the fleet to another. Two bodies of prior work bear on the question without meeting: optimization research that couples maintenance forecasts with routing decisions treats forecast reliability as fixed, while cost-benefit research on prognostics quantifies how forecast error erodes value only up to the maintenance-scheduling decision. Reading the two together yields a closed-form breakeven inequality linking a diagnostic classifier's recall and false-positive rate to the ratio between a missed-failure cost and a false-exclusion cost, scaled by the fleet's base fault rate. Applied to published component-level classifier performance and to two documented vehicle telemetry regimes, the inequality holds comfortably for every heavy-duty component category under baseline operating costs, producing a positive net benefit at each, but flips sign for a constrained on-board-diagnostic regime once exclusion cost and base fault rate shift toward values realistic for a tightly scheduled light-duty fleet, generating a measured net loss per dispatched vehicle. The result identifies fleet heterogeneity in sensing infrastructure as the variable that determines whether condition-aware dispatch pays for itself.

Background: Type 2 diabetes requires sustained self-care, yet the relationship between specific self-care behaviors and quality of life may vary across populations and care contexts. Evidence focused on Filipino men remains limited. Objective: To describe dietary, exercise, medication, and glucose-monitoring adherence and examine their relationships with quality of life among Filipino men with type 2 diabetes in Manila, Philippines. Methods: This quantitative cross-sectional study analyzed questionnaire data from 31 adult Filipino men with type 2 diabetes. Seven adapted diabetes self-care items assessed diet, exercise, medication use, and home glucose monitoring. Quality of life was assessed with the World Health Organization Quality of Life-BREF. Descriptive statistics and two-tailed Pearson correlations were used. Results: Overall self-care adherence was moderate (M = 3.00). Dietary adherence (M = 3.11) and exercise adherence (M = 3.02) were moderate, whereas the combined medication and glucose-monitoring domain was low (M = 2.57). Mean quality of life was moderate (M = 3.11). Diet (r = -.002, p = .99), exercise (r = .31, p = .09), and medication/glucose-monitoring adherence (r = -.006, p = .97) were not significantly correlated with quality of life. Conclusion: The findings identify actionable gaps in structured exercise, medication-taking, and glucose monitoring but do not support a statistically significant relationship between measured self-care adherence and quality of life. Larger, analytically robust studies should examine clinical, psychological, social, and economic determinants alongside self-care.

Water management is a critical challenge for uranium processing operations in arid regions, where industrial activities depend heavily on limited groundwater resources. This study evaluates the performance of the filter cloth washing water recycling circuit at the Aïr Mining compagny (SOMAÏR) uranium processing plant in Niger and identifies the principal factors limiting continuous water reuse. The investigation combined operational water-flow monitoring, historical production records, field sampling from Pit 3, physicochemical characterization of recycled water, suspended-solids determination, and particle-size analysis. Under normal operating conditions, the recycling circuit achieved an average recycling efficiency of 57.5%, corresponding to approximately 850 m³/day of industrial water savings. The recycled water exhibited a density of 0.994 g/cm³, pH of 2.53, oxidation- reduction potential of 480 mV, and suspended-solids concentration of 2052 mg/L. Particle-size analysis showed that approximately 97.6% of the suspended particles were smaller than 200 μm, allowing a substantial fraction of solids to bypass the 250 μm vibrating-drainer screen and accumulate in Decanter 1. Progressive sediment accumulation, together with screen deterioration and mechanical limitations, reduced clarification capacity and ultimately interrupted the recycling circuit. Engineering measures including improved fine-particle separation, optimization of screen aperture, systematic screen maintenance, improved sludge removal, and continuous monitoring are therefore proposed. These measures could enhance recycling reliability, reduce freshwater consumption, and improve water- management sustainability at SOMAÏR.

Background: Hypertensive disorders of pregnancy are a leading cause of maternal and perinatal morbidity and mortality, with a disproportionate burden in low- and middle-income settings such as Bangladesh. This study assessed knowledge and attitude regarding hypertension prevention among pregnant women at a private hospital in Dhaka and their association with socio-demographic characteristics. Methods: A descriptive cross-sectional study was conducted among 122 pregnant women attending antenatal care at Ashulia Women and Children Hospital, Dhaka, using systematic random sampling. Data were collected via face-to-face interviews using a pre-tested, bilingual, structured questionnaire (10-item knowledge and 10-item attitude scales; Cronbach's alpha 0.814 and 0.795). Scores were dichotomized as low (≤50%) or high (>50%). Chi-square tests examined associations with socio-demographic variables (p<0.05). Results: Overall, 50.8% of women had high knowledge and 60.7% had a favorable attitude toward hypertension prevention; 63.9% had a high combined perception score. Knowledge was significantly associated with age (χ²=18.177, p<0.001), highest among women aged 20-29 years. Attitude was significantly associated with number of children (χ²=9.545, p=0.023), most favorable among women with two children. Education and occupation showed no significant association with either. Gaps persisted around dietary intervention, organic foods, and bed rest, despite high perceived importance of prevention (81.1%) and social media influence (81.1%). Conclusion: Knowledge and attitude toward hypertension prevention were moderate to favorable, with age and family size as the key socio-demographic correlates. Age-specific and family-inclusive education, potentially via social media, may be more effective than broadly targeted interventions.

Background: Hospital-acquired infections (HAIs) caused by multidrug resistant (MDR) bacteria are a major public health problem especially in resource-limited settings. Local data on antimicrobial resistance (AMR) are crucial to inform empirical therapy and infection prevention. Objectives: To identify bacterial pathogens causing HAIs, determine their AMR profiles and independent risk factors for MDR infections in a tertiary hospital in Erbil City, Iraq. Materials and Methods: A cross-sectional study was done at Hawler Teaching Hospital between January and June 2026. Standard microbiological methods were used to analyse 200 clinical specimens from patients with HAIs (≥48 hr after admission). Antimicrobial susceptibility testing was performed according to CLSI 2024 guidelines. MDR was defined as nonsusceptibility to at least one agent in three or more antimicrobial classes. Multivariate logistic regression was used to assess independent risk factors. Results: Bacterial growth was obtained in 149 of 200 specimens (74.5%). The major pathogens were Escherichia coli (31.5%), Klebsiella pneumoniae (23.5%), Staphylococcus aureus (21.5%), Pseudomonas aeruginosa (14.1%) and Acinetobacter baumannii (6.1%). In total, 69.1% of the isolates were MDR, with the highest rates in K. pneumoniae (80.0%) and A. baumannii (77.8%). Independent predictors of MDR infection were previous antibiotic use (AOR=4.45), ICU admission (AOR=3.92), and hospitalization >7 days (AOR=3.10). Conclusion: This study documented a significant burden of MDR-HAIs in Erbil City and determined modifiable clinical risk factors. The findings provide evidence to support antimicrobial stewardship, infection prevention and AMR surveillance in Iraqi healthcare settings.

This study investigates the spatial and temporal dynamics of shoreline deformation along the San Bartholomeo River over 30 years (1995–2025) using an integrated geospatial approach. The research combines Interferometric Synthetic Aperture Radar (InSAR) and Digital Shoreline Analysis System (DSAS) techniques to quantify both vertical land motion and horizontal shoreline change. Results reveal a decline in land area from 32.622 km² (56.65%) in 1995 to 30.284 km² (52.59%) in 2025, alongside an increase in water body extent, indicating progressive shoreline retreat. Shoreline change rates varied significantly, with erosion reaching −8.04 m/yr and accretion up to 16.73 m/yr. Net Shoreline Movement (NSM) and Shoreline Change Envelope (SCE) analyses further highlighted zones of persistent erosion and high variability. InSAR-derived deformation patterns confirmed the presence of subsidence contributing to shoreline instability. The findings demonstrate that a combination of hydrodynamic forces, sediment imbalance, and anthropogenic activities drives shoreline deformation in the study area. This study contributes to improved shoreline monitoring by integrating vertical and horizontal deformation metrics, providing a robust framework for sustainable shoreline management in deltaic environments.

Heterotaxy syndrome comprises a group of congenital anomalies resulting from disrupted left-right axis patterning during embryonic development, leading to an abnormal arrangement of the thoracic and abdominal organs [1]. It is a rare condition, with an estimated prevalence of approximately 1 per 10,000 live births, and is frequently associated with complex congenital heart defects, making it a life-threatening disorder with significant morbidity and mortality [1]. Clinically, heterotaxy syndrome is classified into right atrial isomerism (Ivemark syndrome) and left atrial isomerism. Ivemark syndrome represents the most severe form and is primarily characterized by asplenia, complex cardiovascular anomalies, and abnormal positioning of the thoracoabdominal organs [2]. In this condition, paired organs exhibit right-sided morphology bilaterally, commonly accompanied by functionally univentricular physiology, extensive septal defects, dextrocardia, and extracardiac malformations such as intestinal malrotation and congenital absence of the spleen [2,3]. Asplenia is a hallmark feature that markedly increases susceptibility to overwhelming bacterial infections, while the associated congenital heart defects account for the high morbidity and mortality observed during the neonatal period [2]. Herein, we report the case of a male neonate with clinical and imaging findings consistent with Ivemark syndrome who experienced a rapidly progressive and fatal clinical course during the first week of life. A comprehensive review of the available literature identified only a limited number of published cases and scarce documented evidence. Therefore, this case report is supported primarily by the currently available international literature.

This study utilized a qualitative approach to completely ascertain Junior High School Social Studies teachers’ knowledge, strategies and tools used in formative assessment. This study employed a qualitative approach. The study, which was based on a qualitative paradigm, used a phenomenological research methodology to investigate the lived experience and acuity of formative assessment procedures. A selected sample of nine (9) Junior High School Social Studies teachers was chosen based on their academic credentials and professional teaching experience. A focus group discussion was employed to gather data, which was then thematically examined in light of the research questions. The results showed that the participants had a robust knowledge and were adept at using formative assessment strategies and tools in Social Studies lesson. It was recommended that pre-service and in-service teachers should be allowed to use formative assessment techniques sparingly. The National Teaching Council seminars ought to focus on how Junior High School Social Studies teachers can effectively use formative assessment techniques to enhance instruction.

This study presents a physics-based parametric optimization framework for thermoelastic energy harvesting from cyclic temperature variations using a cylindrical AISI 4340 steel rod. The model couples thermoelastic force and displacement, Euler buckling and yielding constraints, lumped-capacitance heat transfer, and mass-power multi-objective optimization. The feasible design space was evaluated as a function of rod diameter, length, temperature change, and load-transfer parameter. The results show that Euler buckling governs the practically relevant portion of the design space at moderate temperature changes, whereas yielding becomes increasingly restrictive at higher thermal loads. The Pareto-optimal solutions exhibit a clear mass-power scaling law, with the analytical prediction P_avg ∝ m^2/3 closely reproduced by the numerical fit (n = 0.66717, R² = 0.999999). Under the baseline condition λ = 0.50, the maximum-power design produces approximately 0.16624 W, while a distance-to-ideal criterion identifies a substantially lighter compromise design with m = 223.0 kg and P_avg = 0.09231 W. Refined optimization gives λ_opt = 0.473 and P_max = 0.170454 W, indicating a power penalty of only 2.47% when the simpler λ = 0.50 condition is used. Grid-refinement tests show changes below 0.006% in maximum power and below 0.5% in the compromise-design mass between the 250 × 250 and 500 × 500 grids. The results establish compact scaling and optimization rules for balancing structural stability, thermal response, mass, and average mechanical power in thermoelastic energy-harvesting elements.

Background: The rising prevalence of diabetes mellitus and its adverse effects on pregnancy outcomes have made pre-pregnancy care (PPC) a critical component of diabetes management among women of reproductive age. Diabetes poses significant risks during pregnancy, but PPC provides an opportunity to prevent complications. Despite these benefits, Nigerian women of childbearing-age living with diabetes still miss out on these advantages due to poorly defined and imperfect integration of PPC into the country’s healthcare system by Health Birth professionals (HBPs). Therefore, their understanding of PPC and the integration of PPC into routine diabetes management practices for childbearing women is essential. The study, therefore, aims to explore HBPs’ provision of PPC for women with pre-existing diabetes in Lagos, Nigeria. Methodology: A qualitative exploratory research design was conducted at two tertiary health institutions in Lagos. A total of 20 participants were purposively selected among doctors and nurse/midwives. The data collected through in-depth semi-structured interviews were transcribed verbatim and analyzed thematically. The trustworthiness of this study was established following the criteria of trustworthiness (credibility, dependability, transferability, and conformability), authenticity was added based on the research worldview. Result: Five themes and eleven subthemes emerged from the analysis. The main themes were clinical importance of PPC for women with diabetes, pregnancy-intention screening for diabetic women, PPC as standard care practice for women with diabetes, raising awareness of PPC, and the enablers of PPC provision. Conclusion: The study emphasized the clinical significance of PPC for women with diabetes; the need for pregnancy-intention screening among diabetic women; the need to make PPC a standard of care for women with diabetes; the importance of raising awareness; and the enablers of PPC. The study highlighted the significance of PPC and the factors that would facilitate its integration PPC into Nigeria's healthcare system. The provision of PPC for women of childbearing potential living with diabetes, as it is key to improving obstetric outcomes and reducing the risks associated with diabetes in pregnancy. It would also be beneficial for leaders at various levels of healthcare institutions to seek the necessary regulatory approvals from the Nigerian government to establish PPC.

The number 12 is a superior highly composite number divisible by 2, 3, 4, and 6. Analyzing natural numbers through their prime factorization reveals striking patterns and symmetries. The duodecimal system, based on 12, provides a natural framework for structuring natural numbers into periods and groups with similar properties. These structures offer an intuitive perspective on the behavior of the divisor and sigma functions and on residue-class constraints relevant to Goldbach-type decompositions. Furthermore, they help to interpret observed patterns in prime gaps, accounting for the prominence of certain gaps and suggesting empirical trends. This article does not claim new theorems in analytic number theory. Its contribution is a unified mod‑12 framework that brings together several classical facts and makes certain structural regularities visually and arithmetically explicit.

We investigated how targeted reactivation of cortical memory engrams during sleep influences systems consolidation of contextual fear memory. Using a mouse model of contextual fear conditioning (CFC), we tagged retrosplenial cortex (RSC) neurons activated during learning with channelrhodopsin-2 (ChR2) via a c-Fos-based TRAP system. Twenty-four hours post-training, animals received optogenetic stimulation of these RSC engram cells selectively during non-rapid eye movement (NREM) sleep or REM sleep. Immediately after, hippocampal activity was transiently blocked (muscimol infusion) to test hippocampal dependence. We found that NREM-specific reactivation of RSC engrams preserved contextual fear recall despite hippocampal inactivation, whereas REM stimulation or no stimulation failed to rescue memory. These results indicate that engram reactivation during NREM accelerates the transfer of memory to cortical storage. We present high-level diagrams of experimental workflow and results, and report a timeline of revisions. Abbreviations and keywords are provided. This comprehensive revision addresses all reviewer comments and renders the manuscript submission-ready.

Objectives: To evaluate the potential role of hysteroscopic subendometrial autologous platelet-rich plasma application in a patient with refractory thin endometrium after multiple high-quality embryo transfers. Methods: We report the case of a 45-year-old female with a 9-year history of infertility, 15 previous IVF cycles, 8 frozen embryo transfers with a persistently thin endometrium of <7mm. After the exclusion of intrauterine pathology via diagnostic hysteroscopy, leukocyte-poor PRP was activated with calcium gluconate and injected into the subendometrial region. A comparison of endometrial thickness, as well as uterine and subendometrial arterial blood flow before and after PRP application was made. Results: In the subsequent cycle, endometrial thickness increased to 8.2 mm, Doppler vascular parameters improved, and a euploid frozen embryo transfer resulted in a clinical pregnancy and live birth. This case supports further investigation of hysteroscopic subendometrial PRP in selected patients. Conclusion: The regenerative characteristics of PRP in optimizing blood flow should be considered crucial to improving the microcirculation of the endometrial basal layer and subsequent tissue remodeling.

Oral and maxillofacial surgery has moved over the past two decades toward auditable systems of verification, as implant-based rehabilitation, digitally guided planning, and multi-operator procedures have multiplied the interfaces at which small deviations can escalate into irreversible harm. This narrative review examines that transformation through two recent monographs that occupy sequential positions in the field's move toward standardization. The first documents the contemporary technique base for regenerative and reconstructive procedures and its associated complication profile; the second converts that technique base into an explicit protocol architecture covering identity verification, planning-data validation, guidance-system tolerance, and documentation. The central claim of the second monograph, that checklist-based verification is the most consistently supported safety intervention available to the specialty, is corroborated here against an independent literature search; its treatment of digital and robotic precision, which frames accuracy as a governable tolerance rather than an inherent property of any device, likewise holds up against the accuracy literature. At the same time, several clinically consequential questions that this framework does not fully resolve, most notably the value of routine antibiotic prophylaxis in implant surgery, remain genuinely unsettled despite decades of trial evidence.

Conventional SCADA-based water utility control relies on hydraulic models recalibrated through discrete campaigns spaced months to years apart, leaving controllers to act on models that degrade silently between updates. This paper specifies and evaluates a framework that couples a gradient-calibrated hydraulic digital twin to a hierarchically decomposed reinforcement learning controller, coordinating production, transmission, and distribution decisions through Lagrangian relaxation of inter-tier coupling constraints. A differentiable hydraulic solver updates pipe roughness, demand allocation, and valve loss parameters through exact gradients of the prediction residual within a rolling 24-hour window, while a temporal fusion transformer propagates quantile demand forecasts into a risk-sensitive reward term. Evaluated on a 2,400-node benchmark network against a rule-based SCADA baseline across thirty replicated simulation runs, the framework reduced specific energy consumption from 0.58 to 0.40–0.42 kWh/m³, demand forecast error from 14.7% to 4.0–5.0% MAPE, anomaly detection latency from 4.3 hours to 0.3–0.5 hours, treatment dosing error from ±15% to ±4%, and non-revenue water from 32.1% to 21–22%. Lagrangian decomposition reduced joint action-space cardinality from a multiplicative to an additive function of per-tier size, yielding an approximately two-orders-of-magnitude reduction in effective search space for the tested topology. Parameter identifiability under sensor coverage sparser than the benchmark configuration remains untested and bounds the framework's applicability to deployments matching the assumed instrumentation density.

Background: Antimicrobial resistance (AMR) is a major global public health threat that compromises the effectiveness of antimicrobial therapy. Nurses play a critical role in antimicrobial stewardship (AMS); however, evidence regarding their knowledge, attitudes, and practices (KAP) in the Philippine setting remains limited. Objective: To determine the knowledge, attitudes, and practices regarding antimicrobial stewardship among bedside nurses employed in selected tertiary hospitals in Baguio City, Philippines, and to examine the relationships between selected socio-demographic characteristics and AMS competencies. Methods: A quantitative descriptive cross-sectional correlational study was conducted among 119 bedside nurses from two tertiary hospitals in Baguio City. Data were collected using a modified, validated self-administered questionnaire. Descriptive statistics summarized respondents' characteristics and KAP scores. The Shapiro–Wilk test assessed normality. Univariate linear regression examined associations between socio-demographic characteristics and KAP outcomes. Statistical significance was set at p < 0.05. Results: Most respondents demonstrated moderate knowledge, highly positive attitudes, and favorable antimicrobial stewardship practices. Greater knowledge was significantly associated with better stewardship practices. Likewise, positive attitudes were positively associated with stewardship practices. Previous antimicrobial stewardship education and selected socio-demographic characteristics were associated with improved KAP outcomes. Conclusion: Bedside nurses demonstrated positive attitudes and favorable antimicrobial stewardship practices despite moderate knowledge levels. Strengthening competency-based antimicrobial stewardship education may enhance nurses' participation in stewardship initiatives and improve patient safety while contributing to national and global efforts to combat antimicrobial resistance.

For an attentive reading of the city and to help understand the public policy of memory, we need to pay closer attention to the processes of sense-making inscribed in uncommon forms. Public art has long been recognised for its potential to transform urban spaces. While the most traditional way of conserving memory centres on formal street art, graffiti may be seen as subversive. Graffiti is considered vandalism; its role in urban memory is overlooked. The author argues that such a notion is not directly related to protecting public and private property in Cairo, but rather conflicts with the elites’ and authorities’ need to control the urban narrative, the diversity of cultural values, and political positions. The article explores the role of graffiti in Cairo by selecting numerous graffiti pieces across the city. The graffiti pieces were selected to address cultural diversity, aesthetics, and political aspects. They were selected to represent what came to be known as guerrilla memory. Graffiti pieces were classified by their objectives and analysed semiotically. Besides the political graffiti, Cairo exhibits commercial, aesthetic and religious graffiti. The different types of graffiti in Cairo tell a story about the community’s hopes, frustrations, and cultural values. This turns the city walls into memory carriers. Graffiti in Cairo plays a significant role in expressing the silenced community’s thoughts by providing a visible and tangible representation. Graffiti’s visibility and its imposition of diverse, unauthorised urban narratives explain why it is highly contested in Cairo, as it draws marginalised citizens’ voices into urban places.

Knowledge work teams operating under variable demand face a class of delivery failure that single-layer governance models cannot prevent: structural overload injected at the commitment-formation boundary, invisible to execution-layer metrics, and amplified by cognitive fragmentation that standard workflow instruments do not register. This article examines the architectural conditions under which knowledge work control systems reduce cognitive load and improve delivery predictability. Through a grouped analytical review of empirical and theoretical literature on WIP-limit governance, team cognitive load, and observability-driven telemetry, the article identifies a shared structural limitation across all three bodies of research: none models the coupling between commitment formation, execution mode, and cognitive context as a single governed system. Drawing on control systems theory, queueing dynamics, and cognitive psychology, the article argues that delivery predictability degrades not from execution inefficiency but from the absence of cross-loop coupling rules that prevent obligation surplus, flow degradation, and cognitive fragmentation from reinforcing one another. The three-loop flow architecture comprising a Commit Loop with capacity-bounded intake, a Delivery Loop with explicit Normal, Overload, and Recovery operating modes, and a Cognition Loop enforcing context-capacity constraints through a Context Token Protocol is identified as a structural response to the documented failure modes of existing frameworks. The analytical contribution is a precise specification of the boundary conditions under which WIP-limit Kanban, team-topology design, and DORA-type telemetry each remain adequate, and the condition under which none of them does.

Background: Gallibacterium anatis is an opportunistic pathogen, mainly associated with infections in poultry. Infections in humans have only been described four times (in France and China). Case presentation: We report the case of a 62-year-old non-immunocompromised male patient with a gastric bypass in his medical history, presenting with cholecystitis in whom Gallibacterium anatis was isolated from the blood, besides an Escherichia coli. Identification of the G. anatis was achieved using MALDI-TOF MS and confirmatory 16s RNA sequencing. The patient was successfully treated with piperacillin-tazobactam, resulting in clinical improvement. In the context of impaired host defenses due to acute cholecystitis with an E. coli bacteremia, it is conceivable that G. anatis entered the bloodstream through bacterial translocation from the gastrointestinal tract. Conclusion: This case highlights the importance of advanced identification techniques and awareness of rare pathogens in clinical practice. Gallibacterium anatis, particularly drug-resistant strains, may represent a potential infectious agent and should therefore be considered in diagnostic work-up.