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22 pages, 2107 KiB  
Article
Feedback Tracking Constraint Relaxation Algorithm for Constrained Multi-Objective Optimization
by Yuling Lai, Junming Chen, Yile Chen, Hui Zeng and Jialin Cai
Mathematics 2025, 13(4), 629; https://doi.org/10.3390/math13040629 - 14 Feb 2025
Viewed by 306
Abstract
In practical applications, constrained multi-objective optimization problems (CMOPs) often fail to achieve the desired results when dealing with CMOPs with different characteristics. Therefore, to address this drawback, we designed a constraint multi-objective evolutionary algorithm based on feedback tracking constraint relaxation, referred to as [...] Read more.
In practical applications, constrained multi-objective optimization problems (CMOPs) often fail to achieve the desired results when dealing with CMOPs with different characteristics. Therefore, to address this drawback, we designed a constraint multi-objective evolutionary algorithm based on feedback tracking constraint relaxation, referred to as CMOEA-FTR. The entire search process of the algorithm is divided into two stages: In the first stage, the constraint boundaries are adaptively adjusted based on the feedback information from the population solutions, guiding the boundary solutions towards neighboring solutions and tracking high-quality solutions to obtain the complete feasible region, thereby promoting the population to approach the unconstrained Pareto front (UPF). The obtained feasible solutions are stored in an archive and continuously updated to promote the diversity and convergence of the population. In the second stage, the scaling of constraint boundaries is stopped, and a new dominance criterion is established to obtain high-quality parents, thereby achieving the complete constrained Pareto front (CPF). Additionally, we customized an elite mating pool selection, an archive updating strategy, and an elite environmental selection truncation mechanism to maintain a balance between diversity and convergence. To validate the performance of CMOEA-FTR, we conducted comparative experiments on 44 benchmark test problems and 16 real-world application cases. The statistical IGD and HV metrics indicate that CMOEA-FTR outperforms seven other CMOEAs. Full article
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8 pages, 5067 KiB  
Proceeding Paper
An Efficient Criterion for Evaluating Fatigue Strength Improvement Through the Stop-Hole Technique
by Bruno Atzori, Luca Vecchiato and Giovanni Meneghetti
Eng. Proc. 2025, 85(1), 4; https://doi.org/10.3390/engproc2025085004 - 13 Feb 2025
Viewed by 166
Abstract
This study investigates the effect of a non-zero fillet radius, ρ, on the fatigue behaviour of notched components under uniaxial loading. A new diagram is introduced, which discusses the relationship between the notch tip radius and the fatigue limit. It also identifies [...] Read more.
This study investigates the effect of a non-zero fillet radius, ρ, on the fatigue behaviour of notched components under uniaxial loading. A new diagram is introduced, which discusses the relationship between the notch tip radius and the fatigue limit. It also identifies a critical radius, ρ**, precisely marking the transition from sharp to blunt notch behaviour. Additionally, its application to the “stop-hole” technique is considered, where both material properties and geometric characteristics are analysed, demonstrating that introducing a fillet radius can improve fatigue resistance. Full article
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28 pages, 5741 KiB  
Article
From Waste to Value: Extraction of Protease Enzymes from Brewer’s Spent Yeast
by Marie Schottroff, Klara-Marie Jaeger, Ana Malvis Romero, Mark Schneeberger and Andreas Liese
Foods 2025, 14(3), 503; https://doi.org/10.3390/foods14030503 - 5 Feb 2025
Viewed by 782
Abstract
This study investigates the potential of additive-free extraction techniques to produce a proteolytically active yeast extract for use in the food industry. Brewer’s spent yeast, a by-product of the brewing industry, is utilized as a feedstock, and thus a new route for its [...] Read more.
This study investigates the potential of additive-free extraction techniques to produce a proteolytically active yeast extract for use in the food industry. Brewer’s spent yeast, a by-product of the brewing industry, is utilized as a feedstock, and thus a new route for its valorization is proposed. Four methods of releasing these components while maintaining their intrinsic bioactivity are investigated: thermal autolysis, ultrasonication, cell milling and high-pressure homogenization. Thermal yeast autolysis resulted in the highest release of protease activity, with 2.45 ± 0.05 U/gdm after 3 h incubation at 45 °C. However, autolysis poses challenges for automation, and thus a stop criterion, due to the lack of in-line enzyme activity assays,. While glass bead treatment gave the highest reproducibility, ultrasonication and high-pressure homogenization resulted in comparably high protease activities in the BSY extracts produced. Both methods, in the form of a cell mill and high-pressure homogenizer, are cell disruption methods that are already employed on an industrial scale. It has now been demonstrated that these methods can be used to produce proteolytically active yeast extracts from a previously considered waste stream. Full article
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18 pages, 5464 KiB  
Article
Study on Surfactants for the Removal of Water from Deliquification Natural Gas Wells to Enhance Production
by Dorota Kluk, Teresa Steliga, Dariusz Bęben and Piotr Jakubowicz
Energies 2024, 17(23), 5924; https://doi.org/10.3390/en17235924 - 26 Nov 2024
Viewed by 444
Abstract
A major problem in natural gas production is the waterlogging of gas wells. This problem occurs at the end of a well’s life when the reservoir pressure becomes low and the gas velocity in the well tubing is no longer sufficient to bring [...] Read more.
A major problem in natural gas production is the waterlogging of gas wells. This problem occurs at the end of a well’s life when the reservoir pressure becomes low and the gas velocity in the well tubing is no longer sufficient to bring the gas-related fluids (water and gas condensate) up to the surface. This causes water to accumulate at the bottom of the gas well, which can seriously reduce or even stop gas production altogether. This paper presents a study of the foaming of reservoir water using foaming sticks with the trade names BioLight 30/380, BioCond 30, BioFoam 30, BioAcid 30/380, and BioCond Plus 30/380. The reservoir waters tested came from near-well separators located at three selected wells that had undergone waterlogging and experienced a decline in natural gas production. They were characterised by varying physical and chemical parameters, especially in terms of mineralisation and oil contaminant content. Laboratory studies on the effect of foaming agents on the effectiveness of foaming and lifting of reservoir water from the well were carried out on a laboratory bench, simulating a natural gas-producing column using surfactant doses in the range of 1.5–5.0 g/m3 and measuring the surface tension of the water, the volume of foam generated as a function of time and the foamed reservoir water. The performance criterion for the choice of surfactant for the test water was its effective lifting in a foam structure from an installation, simulating a waterlogged gas well and minimising the dose of foaming agent introduced into the water. The results obtained from the laboratory tests allowed the selection of effective surfactants in the context of foaming and uplift of reservoir water from wells, where a decline in natural gas production was observed as a result of their waterlogging. In the next stage, well tests were carried out based on laboratory studies to verify their effectiveness under conditions typical for the production site. Tests carried out at natural gas wells showed that the removal of water from the bottom of the well resulted in an increase in natural gas production, ranging from 56.3% to 79.6%. In practice, linking the results of laboratory tests for the type and dosage of foaming agents to the properties of reservoir water and gas production parameters made it possible to identify the types of surfactants and their dosages that improve the production of a given type of natural gas reservoir in an effective manner, resulting in an increase in the degree of depletion of hydrocarbon deposits. Full article
(This article belongs to the Special Issue Subsurface Energy and Environmental Protection 2024)
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28 pages, 12630 KiB  
Article
Satellite Image Restoration via an Adaptive QWNNM Model
by Xudong Xu, Zhihua Zhang and M. James C. Crabbe
Remote Sens. 2024, 16(22), 4152; https://doi.org/10.3390/rs16224152 - 7 Nov 2024
Viewed by 728
Abstract
Due to channel noise and random atmospheric turbulence, retrieved satellite images are always distorted and degraded and so require further restoration before use in various applications. The latest quaternion-based weighted nuclear norm minimization (QWNNM) model, which utilizes the idea of low-rank matrix approximation [...] Read more.
Due to channel noise and random atmospheric turbulence, retrieved satellite images are always distorted and degraded and so require further restoration before use in various applications. The latest quaternion-based weighted nuclear norm minimization (QWNNM) model, which utilizes the idea of low-rank matrix approximation and the quaternion representation of multi-channel satellite images, can achieve image restoration and enhancement. However, the QWNNM model ignores the impact of noise on similarity measurement, lacks the utilization of residual image information, and fixes the number of iterations. In order to address these drawbacks, we propose three adaptive strategies: adaptive noise-resilient block matching, adaptive feedback of residual image, and adaptive iteration stopping criterion in a new adaptive QWNNM model. Both simulation experiments with known noise/blurring and real environment experiments with unknown noise/blurring demonstrated that the effectiveness of adaptive QWNNM models outperformed the original QWNNM model and other state-of-the-art satellite image restoration models in very different technique approaches. Full article
(This article belongs to the Special Issue Image Processing from Aerial and Satellite Imagery)
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20 pages, 3504 KiB  
Article
On the Estimation of Logistic Models with Banking Data Using Particle Swarm Optimization
by Moch. Fandi Ansori, Kuntjoro Adji Sidarto, Novriana Sumarti and Iman Gunadi
Algorithms 2024, 17(11), 507; https://doi.org/10.3390/a17110507 - 5 Nov 2024
Viewed by 614
Abstract
This paper presents numerical works on estimating some logistic models using particle swarm optimization (PSO). The considered models are the Verhulst model, Pearl and Reed generalization model, von Bertalanffy model, Richards model, Gompertz model, hyper-Gompertz model, Blumberg model, Turner et al. model, and [...] Read more.
This paper presents numerical works on estimating some logistic models using particle swarm optimization (PSO). The considered models are the Verhulst model, Pearl and Reed generalization model, von Bertalanffy model, Richards model, Gompertz model, hyper-Gompertz model, Blumberg model, Turner et al. model, and Tsoularis model. We employ data on commercial and rural banking assets in Indonesia due to their tendency to correspond with logistic growth. Most banking asset forecasting uses statistical methods concentrating solely on short-term data forecasting. In banking asset forecasting, deterministic models are seldom employed, despite their capacity to predict data behavior for an extended time. Consequently, this paper employs logistic model forecasting. To improve the speed of the algorithm execution, we use the Cauchy criterion as one of the stopping criteria. For choosing the best model out of the nine models, we analyze several considerations such as the mean absolute percentage error, the root mean squared error, and the value of the carrying capacity in determining which models can be unselected. Consequently, we obtain the best-fitted model for each commercial and rural bank. We evaluate the performance of PSO against another metaheuristic algorithm known as spiral optimization for benchmarking purposes. We assess the robustness of the algorithm employing the Taguchi method. Ultimately, we present a novel logistic model which is a generalization of the existence model. We evaluate its parameters and compare the result with the best-obtained model. Full article
(This article belongs to the Special Issue New Insights in Algorithms for Logistics Problems and Management)
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18 pages, 2990 KiB  
Article
Identification of Risk Factors for Bus Operation Based on Bayesian Network
by Hongyi Li, Shijun Yu, Shejun Deng, Tao Ji, Jun Zhang, Jian Mi, Yue Xu and Lu Liu
Appl. Sci. 2024, 14(20), 9602; https://doi.org/10.3390/app14209602 - 21 Oct 2024
Viewed by 1000
Abstract
Public transit has been continuously developing because of advocacy for low-carbon living, and concerns about its safety have gained prominence. The various factors that constitute the bus operating environment are extremely complex. Although existing research on operational security is crucial, previous studies often [...] Read more.
Public transit has been continuously developing because of advocacy for low-carbon living, and concerns about its safety have gained prominence. The various factors that constitute the bus operating environment are extremely complex. Although existing research on operational security is crucial, previous studies often fail to fully represent this complexity. In this study, a novel method was proposed to identify the risk factors for bus operations based on a Bayesian network. Our research was based on monitoring data from the public transit system. First, the Tabu Search algorithm was applied to identify the optimal structure of the Bayesian network with the Bayesian Information Criterion. Second, the network parameters were calculated using bus monitoring data based on Bayesian Parameter Estimation. Finally, reasoning was conducted through prediction and diagnosis in the network. Additionally, the most probable explanation of bus operation spatial risk was identified. The results indicated that factors such as speed, traffic volume, isolation measures, intersections, bus stops, and lanes had a significant effect on the spatial risk of bus operation. In conclusion, the study findings can help avert dangers and support decision-making for the operation and management of public transit in metropolitan areas to enhance daily public transit safety. Full article
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19 pages, 6156 KiB  
Article
Thermal Conductivity Measurement System for Functional and Structural Products
by Nikolai S. Morozov, Viktor Yu. Gubin, Dmitriy V. Vakhrushin, Maxim S. Konstantinov, Roman A. Minushkin, Alexandra V. Gracheva, Sergei N. Chebotarev and Viktor V. Avdeev
Processes 2024, 12(10), 2219; https://doi.org/10.3390/pr12102219 - 11 Oct 2024
Cited by 1 | Viewed by 995
Abstract
An automated system for measuring the thermal conductivity of functional and structural materials was developed. The main building blocks of the setup are the following: heating unit and cooling unit creating a heat flux gradient in the test sample; thermal resistances for temperature [...] Read more.
An automated system for measuring the thermal conductivity of functional and structural materials was developed. The main building blocks of the setup are the following: heating unit and cooling unit creating a heat flux gradient in the test sample; thermal resistances for temperature registration and control; and thermal pads for better contact between parts of the setup and the sample. The effect of the thermal conductivity of thermal pads and thermal resistances on the distribution of thermal fields in the developed setup was studied by computer modelling. A control software for the measuring setup was developed based on the hardware implementation of the steady-state Fourier’s law-based method for the determination of thermal conductivity. The stopping criterion for the setup control software is the equality of heat fluxes in the heating and cooling units, as well as the stability of the thermal conductivity coefficient readings. The testing and calibration of the device were carried out using a sample of pure aluminum (99.999 wt.% Al). It was found that the experimental value of the thermal conductivity coefficient of the aluminum sample at room temperature (T = 22 °C) is <λ> = 243 ± 3 W/m·K. This value of the thermal conductivity coefficient is consistent with the literature data and experimental values obtained by the laser flash method, which ranges within λ = 210–260 W/m·K. Full article
(This article belongs to the Section Materials Processes)
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16 pages, 1825 KiB  
Article
Long-Term Amendment with Sewage Sludge: Effects on Nutrient Value and Trace-Metal Content in Different Parts of Maize Plants
by Francesc Camps-Sagué, Àngela Dolores Bosch-Serra, Alicia Daniela Cifuentes-Almeida, Montserrat Maria Boixadera-Bosch and Francesc Domingo-Olivé
Appl. Sci. 2024, 14(18), 8105; https://doi.org/10.3390/app14188105 - 10 Sep 2024
Viewed by 634
Abstract
Agricultural soils play a key role in the achievement of a circular nutrient economy. The use of sewage sludges as fertilizers is important for such an achievement, assisting in the maintenance of soil health and nutritional crop value. This study was established, after [...] Read more.
Agricultural soils play a key role in the achievement of a circular nutrient economy. The use of sewage sludges as fertilizers is important for such an achievement, assisting in the maintenance of soil health and nutritional crop value. This study was established, after 23 years of a fertilization experiment, in calcareous soil under a maize monoculture. The treatments included mineral fertilization as a control (MIN, 225 kg N ha−1) and two sludge treatments, where doses followed a threshold sludge nitrogen criterion (SNC, 170 kg org-N ha−1) or a threshold soil phosphorus criterion (SPC; when the soil Olsen-P value exceeded 40–60 kg P ha−1, the sludge application was stopped). A detailed study was performed on Cd, Cu, F, Mn, Pb, and Zn soil extractable with diethylenetriaminepentaacetic acid (DTPA), as well as the nutrient and heavy metal concentration of different fractions of the maize plant (grain, cob, and the rest of the plant). Extractions were also quantified. No biomass-yield differences were observed in the different parts of the maize plant in the year of sampling. Sludges increased the soil DTPA extraction of Cd, Cu, Fe, and Zn and diminished Mn extraction, without differences in extractable Pb. The SNC, when compared with MIN, showed increased P cob concentrations, and in grain, it showed increased Fe, Cr, and Co concentrations. The SPC figures of the studied parameters were, in general, between both treatments (MIN and SNC), although Cr extractions in grain diminished vs. SNC. Based on the results, the SPC can be recommended as it also avoids excessive available-P build up. Full article
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19 pages, 1763 KiB  
Article
Generating Chaos in Dynamical Systems: Applications, Symmetry Results, and Stimulating Examples
by Nikolay Kyurkchiev, Tsvetelin Zaevski, Anton Iliev, Vesselin Kyurkchiev and Asen Rahnev
Symmetry 2024, 16(8), 938; https://doi.org/10.3390/sym16080938 - 23 Jul 2024
Cited by 5 | Viewed by 1218
Abstract
In this paper, we present a new class of extended oscillators in light of chaos theory. It is based on dynamical complex systems built on the concept of self-describing with a stopping criterion process. We offer an effective studying approach with a specific [...] Read more.
In this paper, we present a new class of extended oscillators in light of chaos theory. It is based on dynamical complex systems built on the concept of self-describing with a stopping criterion process. We offer an effective studying approach with a specific focus on learning, provoking students’ thinking through the triad of enigmatics–creativity–acmeology. Dynamic processes are the basis of mathematical modeling; thus, we can reach the goal of the above-mentioned triad by the proposed differential systems. The results we derive strongly confirm the presence of symmetry in the outcomes of the proposed models. We suggest a stochastic approach to structuring the proposed dynamical systems by modeling the coefficients that drive them by some discrete probability distribution that exhibits symmetry or asymmetry. We propose specific tools for researching the behavior of these systems. Full article
(This article belongs to the Special Issue Symmetry in Statistical Mechanics and Complex Dynamical Systems)
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13 pages, 926 KiB  
Article
Peripheral Intravenous Therapy in Internal Medicine Department—Antibiotics and Other Drugs’ Consumption and Characteristics of Vascular Access Devices in 2-Year Observation Study
by Piotr Piekiełko, Anna Mucha, Ewa Stawowczyk and Jadwiga Wójkowska-Mach
Antibiotics 2024, 13(7), 664; https://doi.org/10.3390/antibiotics13070664 - 18 Jul 2024
Viewed by 1229
Abstract
Background: The aim of the study was to characterize the procedure of peripheral intravenous therapy (IT), including the characteristics of vascular access and related complications and qualitative and quantitative analyses of drug consumption. Materials and Methods: A two-year, retrospective, single-center observational study was [...] Read more.
Background: The aim of the study was to characterize the procedure of peripheral intravenous therapy (IT), including the characteristics of vascular access and related complications and qualitative and quantitative analyses of drug consumption. Materials and Methods: A two-year, retrospective, single-center observational study was conducted. The criterion for including a patient in the study was the use of peripheral intravenous catheters (PIVCs) upon admission or during the stay at the internal medicine department (IMD). Results: The main reasons for hospitalization were exacerbations of chronic diseases for 78% of the patients and acute infections for 22%. IT was used in 83.6% of all the patients. IT was used primarily for antibiotics (5009.9 defined daily doses (DDD)). Further, 22.6% of the PIVCs stopped functioning within 24 h, more frequently in infectious patients. The main reasons for PIVC removal were leakage (n = 880, 26.6%) and occlusion (n = 578, 17.5%). The PIVC locations were mostly suboptimal (n = 2010, 59.5%), and such locations were related to leakage and occlusion (p = 0.017). Conclusions: In the IMD, most patients require the use of a PIVC, and antibiotics dominate the group of drugs administered intravenously. Up to 1/5 of peripheral intravenous catheters are lost within the first 24 h after their insertion, with most of them placed suboptimally. A properly functioning PIVC appears to be crucial for antimicrobial treatment. Full article
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23 pages, 832 KiB  
Article
Re-Orthogonalized/Affine GMRES and Orthogonalized Maximal Projection Algorithm for Solving Linear Systems
by Chein-Shan Liu, Chih-Wen Chang  and Chung-Lun Kuo 
Algorithms 2024, 17(6), 266; https://doi.org/10.3390/a17060266 - 15 Jun 2024
Viewed by 1312
Abstract
GMRES is one of the most powerful and popular methods to solve linear systems in the Krylov subspace; we examine it from two viewpoints: to maximize the decreasing length of the residual vector, and to maintain the orthogonality of the consecutive residual vector. [...] Read more.
GMRES is one of the most powerful and popular methods to solve linear systems in the Krylov subspace; we examine it from two viewpoints: to maximize the decreasing length of the residual vector, and to maintain the orthogonality of the consecutive residual vector. A stabilization factor, η, to measure the deviation from the orthogonality of the residual vector is inserted into GMRES to preserve the orthogonality automatically. The re-orthogonalized GMRES (ROGMRES) method guarantees the absolute convergence; even the orthogonality is lost gradually in the GMRES iteration. When η<1/2, the residuals’ lengths of GMRES and GMRES(m) no longer decrease; hence, η<1/2 can be adopted as a stopping criterion to terminate the iterations. We prove η=1 for the ROGMRES method; it automatically keeps the orthogonality, and maintains the maximality for reducing the length of the residual vector. We improve GMRES by seeking the descent vector to minimize the residual in a larger space of the affine Krylov subspace. The resulting orthogonalized maximal projection algorithm (OMPA) is identified as having good performance. We further derive the iterative formulas by extending the GMRES method to the affine Krylov subspace; these equations are slightly different from the equations derived by Saad and Schultz (1986). The affine GMRES method is combined with the orthogonalization technique to generate a powerful affine GMRES (A-GMRES) method with high performance. Full article
(This article belongs to the Special Issue Numerical Optimization and Algorithms: 2nd Edition)
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21 pages, 2219 KiB  
Article
Deep Learning Based Over-the-Air Training of Wireless Communication Systems without Feedback
by Christopher P. Davey, Ismail Shakeel, Ravinesh C. Deo and Sancho Salcedo-Sanz
Sensors 2024, 24(10), 2993; https://doi.org/10.3390/s24102993 - 8 May 2024
Viewed by 1360
Abstract
In trainable wireless communications systems, the use of deep learning for over-the-air training aims to address the discontinuity in backpropagation learning caused by the channel environment. The primary methods supporting this learning procedure either directly approximate the backpropagation gradients using techniques derived from [...] Read more.
In trainable wireless communications systems, the use of deep learning for over-the-air training aims to address the discontinuity in backpropagation learning caused by the channel environment. The primary methods supporting this learning procedure either directly approximate the backpropagation gradients using techniques derived from reinforcement learning, or explicitly model the channel environment by training a generative channel model. In both cases, over-the-air training of transmitter and receiver requires a feedback channel to sound the channel environment and obtain measurements of the learning objective. The use of continuous feedback not only demands extra system resources but also makes the training process more susceptible to adversarial attacks. Conversely, opting for a feedback-free approach to train the models over the forward link, exclusively on the receiver side, could pose challenges to reliably end the training process without intermittent testing over the actual channel environment. In this article, we propose a novel method for the over-the-air training of wireless communication systems that does not require a feedback channel to train the transmitter and receiver. Random samples are transmitted through the channel environment to train a mixture density network to approximate the channel distribution on the receiver side of the network. The transmitter and receiver models are trained with the resulting channel model, and the transmitter can be deployed after training. We show that the block error rate measurements obtained with the simulated channel are suitable for monitoring as a stopping criterion during the training process. The resulting method is demonstrated to have equivalent performance to the end-to-end autoencoder training on small message sequences. Full article
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19 pages, 11427 KiB  
Article
Stability Evaluation of a Simplified Reclaimer Using Fluid–Structure Interaction
by João Rodolfo Januário, Janes Landre Júnior and Cristiana Brasil Maia
Appl. Sci. 2024, 14(7), 2697; https://doi.org/10.3390/app14072697 - 23 Mar 2024
Viewed by 1002
Abstract
This paper describes the numerical modeling and simulation of the wind effects on an ore reclaimer structure using analytical and numerical methods. The physical model is a large machine with a height of 34 m and a width of 77 m, and due [...] Read more.
This paper describes the numerical modeling and simulation of the wind effects on an ore reclaimer structure using analytical and numerical methods. The physical model is a large machine with a height of 34 m and a width of 77 m, and due to its complexity, a simplified model was used. This study aims to investigate the influence of wind speed on the stability failure of the reclaimer and to provide a more efficient and precise stopping criterion. The simulations were performed using a two-way FSI (fluid–structure interaction) approach. An FSI analysis was performed to study the dynamic behavior of a numerical model consisting of two separate parts with contact constraints. This article also highlights the importance of FSI in improving the reliability of the stability failure. Finally, the numerical results showed differences compared to the analytical model, and the wind load limit to stability failure was observed at higher wind speeds. The structure was able to support wind velocities higher than suggested by the FEM (European Materials Handling Federation) standard without stability fails. Full article
(This article belongs to the Section Mechanical Engineering)
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18 pages, 1559 KiB  
Article
Improving Clostridioides difficile Infectious Disease Treatment Response via Adherence to Clinical Practice Guidelines
by Dalia Adukauskienė, Rytis Mickus, Asta Dambrauskienė, Tomas Vanagas and Agnė Adukauskaitė
Antibiotics 2024, 13(1), 51; https://doi.org/10.3390/antibiotics13010051 - 4 Jan 2024
Cited by 1 | Viewed by 2212
Abstract
Clostridioides difficile (C. difficile) is a predominant nosocomial infection, and guidelines for improving diagnosis and treatment were published in 2017. We conducted a single-center, retrospective 10-year cohort study of patients with primary C. difficile infectious disease (CDID) at the largest referral [...] Read more.
Clostridioides difficile (C. difficile) is a predominant nosocomial infection, and guidelines for improving diagnosis and treatment were published in 2017. We conducted a single-center, retrospective 10-year cohort study of patients with primary C. difficile infectious disease (CDID) at the largest referral Lithuanian university hospital, aiming to evaluate the clinical and laboratory characteristics of CDID and their association with the outcomes, as well as implication of concordance with current Clinical Practice Guidelines. The study enrolled a total of 370 patients. Cases with non-concordant CDID treatment resulted in more CDID-related Intensive Care Unit (ICU) admissions (7.5 vs. 1.8%) and higher CDID-related mortality (13.0 vs. 1.8%) as well as 30-day all-cause mortality (61.0 vs. 36.1%) and a lower 30-day survival compared with CDID cases with concordant treatment (p < 0.05). Among cases defined by two criteria for severe CDID, only patients with non-concordant metronidazole treatment had refractory CDID (68.8 vs. 0.0%) compared with concordant vancomycin treatment. In the presence of non-concordant metronidazole treatment for severe CDID, only cases defined by two severity criteria had more CDID-related ICU admissions (18.8 vs. 0.0%) and higher CDID-related mortality (25.0 vs. 2.0%, p < 0.05) compared with cases defined by one criterion. Severe comorbidities and the continuation of concomitant antibiotics administered at CDID onset reduced (p < 0.05) the 30-day survival and increased (p = 0.053) 30-day all-cause mortality, with 57.6 vs. 10.7% and 52.0 vs. 25.0%, respectively. Conclusions: CDID treatment non-concordant with the guidelines was associated with various adverse outcomes. In CDID with leukocytes ≥ 15 × 109/L and serum creatinine level > 133 µmol/L (>1.5 mg/dL), enteral vancomycin should be used to avoid refractory response, as metronidazole use was associated with CDID-related ICU admission and CDID-related mortality. Severe comorbidities worsened the outcomes as they were associated with reduced 30-day survival. The continuation of concomitant antibiotic therapy increased 30-day all-cause mortality; thus, it needs to be reasonably justified, deescalated or stopped. Full article
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