Articles

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.

<b>Background:</b> 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. <b>Objective:</b> 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. <b>Methods: </b>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. <b>Conclusion:</b> 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.

<b>Background:</b> <i>Gallibacterium</i><i> </i><i>anatis</i> is an opportunistic pathogen, mainly associated with infections in poultry. Infections in humans have only been described four times (in France and China). <b>Case presentation:</b> 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 <i>Gallibacterium</i><i> </i><i>anatis</i> was isolated from the blood, besides an <i>Escherichia coli</i>. Identification of the <i>G. </i><i>anatis</i> 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 <i>E. coli</i> bacteremia, it is conceivable that <i>G. </i><i>anatis</i> entered the bloodstream through bacterial translocation from the gastrointestinal tract. <b>Conclusion:</b><b> </b>This case highlights the importance of advanced identification techniques and awareness of rare pathogens in clinical practice. <i>Gallibacterium</i><i> </i><i>anatis</i>, particularly drug-resistant strains, may represent a potential infectious agent and should therefore be considered in diagnostic work-up.

This study investigates whether the Feedback Literacy Scale (FLS) can be developed and validated to measure student teachers’ feedback literacy in teacher education in Myanmar. Based on the Feedback Literacy Scale (FLS) by Yildiz et al. (2020) [1], the Student Feedback Literacy Scale (SFLS) developed by Liao (2021) [2], and the Student Feedback Literacy (SFL) scale by Woitt et al. (2023) [3], the Feedback Literacy Scale was validated. Firstly, the item pool for the feedback literacy scale contained 76 items. The participants of this study were 1550 from 360 first-year, 367 second-year, 378 third-year and 445 fourth-year student teachers. The exploratory factor analysis resulted in a four-factor structure, and the final confirmatory factor analysis indicated acceptable model fit. The final scale demonstrated strong internal consistency and acceptable validity and reliability for use with Myanmar student teachers in teacher education. Therefore, the Feedback Literacy Scale (FLS) was found to be valid and reliable for measuring feedback literacy of student teachers of the teacher education program in Myanmar. This study indeed helps student teachers, school administrators and education policymakers improve their understanding of feedback and application of feedback in their learning for future professional teaching in the Myanmar teacher education program.

We have reported novel solid-cancer treatment modality of nano-thermal ablation therapy using two medical devices of 100kHz electromagnetic field radiator and heat-generating nanoparticles of MCL particle [1]. External 100kHz electromagnetic field radiation induced heat generation of MCL particle in tumor tissue and caused tumor specific cytotoxicity and blood vessel disruption [1]. MCL particle was designed to be about 100nm diameter and to move within tumor tissue by composing heat-generating magnetite (Fe<SUB>3</SUB>O<SUB>4</SUB>) with neutral and cationic lipids [1]. However, concerning 100kHz radiator, rational concept of its performance and specification was not fully discussed. Purpose of this seminar is to describe significance of 100kHz magnetic flux density for rational designing, specification and usage of the radiator, referring to our unpublished data during 2004~2025. At first, our calibration method of 100kHz magnetic flux density was shown, and then its application to density distribution analysis of our radiators HTS-5010H and Hi-Heater 5010 was described. And, based on density distribution profile of Hi-Heater 5010 radiator, effective density at tumor locus in the standard treatment condition of the therapy was confirmed 15mT. Based on the recorded data of clinical research using HTS-5010H radiator, safety radiation condition toward groin, breast, thigh, neck, chest and arm were shown with density distribution in patient bodies. With all respect, quoting MFH<SUP>®</SUP>300F (100kHz) radiator [2], availability of three types radiators for various target cancers was discussed on the basis of effective tumor density and mitigation of normal tissue heating. According to Design Control Guidance of medical device [3], design process of the radiator was exemplified by drafted documents of design input and output.

<i>Roseomonas</i><i> mucosa</i> is a slow-growing, pink-pigmented, Gram-negative coccobacillus historically considered an opportunistic pathogen in severely immunocompromised oncology patients. However, recent genomic and clinical data demonstrate its primary reservoir is the human skin microbiome, facilitating an evolving epidemiology. We report a case of <i>R. mucosa</i> bacteremia in a 69-year-old woman with short bowel syndrome (SBS) and total parenteral nutrition (TPN) dependence. This case supports an emerging pattern: <i>R. mucosa</i> is increasingly identified in "device-compromised" hosts. Furthermore, this pathogen may present without elevated host-response biomarkers and exhibits intrinsic resistance to empiric broad-spectrum beta-lactams, complicating early management.

Between 27% and 46% of small and medium enterprises that successfully scale revert to their prior operational size within three years, a rate that is structurally amplified in vehicle-based businesses where capital is concentrated in depreciating physical assets and competitive differentiation occurs primarily on price and service reliability rather than product innovation. This article examines the conditions under which entrepreneurial management functions as a genuine strategic asset in small and medium vehicle-based businesses, rather than as a dispositional attribute of owner-managers that is orthogonal to firm performance. The analysis identifies a systematic misfit between the dominant theoretical frameworks, specifically dynamic capabilities theory and the five-dimension entrepreneurial orientation model, and the operational context of vehicle-based SMEs. Drawing on a critical synthesis of 13 empirical and theoretical sources, the article argues that dynamic capabilities yield measurable performance returns only under conditions of high environmental dynamism, a threshold that asset-intensive transport markets do not reach, and that the entrepreneurial orientation-performance relationship in this sector is mediated by competitive positioning through contractual and regulatory foresight rather than by innovativeness or risk-taking. Three sector-specific mechanisms are identified through which entrepreneurial management converts into competitive advantage: the institutionalization of operationally scripted routines that free management bandwidth for strategic positioning decisions; proactive regulatory compliance that generates first-mover advantages in fleet certification and route licensing; and the development of decision-support infrastructure that enables analytically grounded fleet renewal and platform coopetition choices. The article concludes that the standard EO measurement instrument requires sector-specific reweighting before it can reliably predict performance outcomes in vehicle-based SMEs, and that longitudinal firm-level data from commercial transport markets represent the most tractable foundation for that instrument's development.

This review of research from 2010 to 2025 shows that while interprofessional education (IPE) effectively reshapes how students approach patient safety—boosting both their collaborative attitudes and communication skills—it still struggles to bridge the gap between the classroom and the bedside. While models like high-fidelity simulation show promise, there is a distinct lack of hard evidence linking this training to actual changes in clinical behavior or improved patient health. Moving forward, the field needs to overcome practical hurdles like scheduling conflicts and rigid medical hierarchies by shifting focus from student feedback to real-world clinical outcomes, eventually folding IPE into a more standardized, integrated medical curriculum.

<b>Background: </b>Cystatin C (CysC) predicts adverse outcomes in heart failure (HF), yet its prognostic value relative to underlying renal function remains undefined. We aimed to determine the association between serum CysC and 1-year readmission risk in HF patients stratified by chronic kidney disease (CKD) status. <b>Methods:</b> This retrospective cohort study analyzed 2,008 hospitalized HF patients. Based on CKD status, patients were categorized into non-CKD and CKD groups. Serum CysC levels were analyzed as both continuous variable and in tertiles. The association with 1-year readmission was assessed using multivariable Cox proportional hazards models. <b>Results:</b> Overall, each 1 mg/L increase in CysC was independently associated with an 11% higher risk of re-admission (adjusted HR: 1.11, 95% CI: 1.01-1.23, p=0.003). A significant interaction with CKD status was found (p=0.003). In the non-CKD group, elevated CysC (>1.98 mg/L) was associated with a 51% increased risk (adjusted HR: 1.51, 95% CI: 1.18-1.92, p=0.001), with a non-linear threshold effect identified at 0.998 mg/L. Conversely, no significant association was observed in CKD patients (adjusted HR: 0.96, 95% CI: 0.82-1.12, p=0.576). <b>Conclusions:</b> Elevated serum CysC is a potent predictor of 1-year readmission in HF patients without CKD, but not in those with established CKD. Its prognostic utility is therefore highly dependent on renal context, highlighting its greatest value in patients without advanced renal dysfunction.

<b>Background: </b>In Systemic lupus erythematosus (SLE), a chronic multisystem autoimmune disease, central nervous system infections are uncommon, affecting about 1% of cases. However, diagnosis is often challenging due to overlapping autoimmune and infectious features, nonspecific neurological symptoms, and limited diagnostic specificity, which may delay appropriate treatment and worsen outcomes. <b>Case Report:</b> An 80-year-old male with a five-year history of systemic lupus erythematosus (SLE) presented with a two-day history of generalized weakness that subsequently progressed to recurrent focal seizures and later to generalized seizures accompanied by a profound decline in consciousness. Despite adequate administration of antiepileptic and sedative therapy, persistent seizure activity was observed. Meningitis Panel evaluation confirmed herpes simplex virus type 1 (HSV-1) encephalitis, complicated by severe systemic inflammation, anemia, thrombocytopenia, renal dysfunction, and respiratory acidosis findings indicative of multi-organ failure. Magnetic resonance imaging of the brain revealed bilateral asymmetric hyperintense lesions involving the insular regions, medial temporal lobes, and frontal cortices, consistent with viral encephalitis. The patient underwent comprehensive intensive care management, including intravenous antiviral, antimicrobial, corticosteroid, and supportive therapies. However, his clinical condition progressively deteriorated, culminating in death on the fourth day of hospitalization. <b>Discussion: </b>This case illustrates the diagnostic and therapeutic complexity of herpes simplex virus type 1 (HSV-1) encephalitis in a patient with systemic lupus erythematosus (SLE), a rare but fatal complication. In immunocompromised individuals, atypical clinical and cerebrospinal fluid findings may obscure diagnosis and delay treatment. Immunosuppressive therapy and underlying immune dysregulation further increase vulnerability to opportunistic infections and multi-organ failure. Early recognition of viral encephalitis in SLE patients with acute neurological symptoms is therefore crucial to optimize outcomes. <b>Conclusion:</b> Encephalitis in SLE is a rare but serious complication with overlapping autoimmune and infectious features. Early recognition and timely antiviral immunosuppressive therapy are essential to improve outcomes.

<b>Objective: </b>Kratom (Mitragyna speciosa) has emerged as a widely accessible nonprescription substance that is being utilized in the United States. Kratom is commonly used for self-management of pain, psychiatric symptoms, and opioid withdrawal. Veterans receiving care within the Veterans Health Administration (VHA) represent a high-risk population due to elevated rates of chronic pain, post-traumatic stress disorder (PTSD), and substance use disorders (SUDs). Despite increasing prevalence, kratom use remains underrecognized and is not routinely assessed in clinical practice. This narrative review studies the pharmacology, patterns of use, and clinical implications of kratom among Veterans and proposes a standardized screening framework for implementation within the VHA. This will help to align with the patient centered care delivered to our Veterans related to mental health conditions often concurrent with substance use, pain management, and opioid safety. <b>Methods:</b> A targeted narrative review of the literature was conducted using PubMed, Google Scholar, and relevant federal agency reports. Search terms included “kratom,” “Mitragyna speciosa,” “substance use disorder,” “opioid withdrawal,” and “Veterans.” Articles were selected based on relevance to pharmacology, epidemiology, adverse effects, and clinical implications. Findings were synthesized and interpreted using DSM-5-TR substance use disorder criteria. <b>Results:</b> Kratom exhibits partial agonist activity at μ-opioid receptors, producing dose-dependent stimulant and opioid-like effects. According to the National Institutes of Health's National Library of Medicine, mu-opioid receptors, found in the brain and spinal cord, are primarily responsible for pain relief and other opioid-like effects such as euphoria and respiratory depression. Veterans frequently use kratom to self-manage pain, mood symptoms, and opioid withdrawal (Garcia-Romeu et al., 2020; Grundmann, 2017). Kratom use is associated with dependence, withdrawal, and increased risk of polysubstance use (Post et al., 2019). Detection remains limited due to lack of standardized screening tools and the absence of detection in routine toxicology panels. <b>Conclusions:</b> Given the rising incidence of kratom use among Veterans and associated clinical risks, implementation of a standardized screening within the VHA is an appropriate intervention. Incorporating DSM-5-TR-informed criteria into structured assessments can help improve early identification, enhance patient safety, and support evidence-based treatment strategies.

Consumption of fruit which is rich in phenolic compounds and has high antioxidant activity, prevents risk factors of various diseases. Numerous researches confirm that plants rich in such substances reduce the risks of cancer, heart diseases and hypertension. In view of the above, the goal of the research is to study prospective peach varieties in Georgia and compare them in terms of their total polyphenols content and antioxidant activity, determine the correlation between total polyphenols content and antioxidant activity during the storage of fruits. We have studied the total polyphenols content and antioxidant activity in peach fruit of different varieties before and during the storage. The conducted research showed a strong positive correlation between total polyphenols and antioxidant activity. During the storage the total polyphenols and antioxidant activity have decreased in peaches of both varieties. This change can be generalized and considered a common pattern. However, the genotype of a variety affects the strength of correlation.

Tomato farming plays a major role in Ghana’s agricultural sector by contributing to food supply and serving as a source of income for many smallholder farmers. However, tomato plants are easily affected by leaf diseases that can spread quickly and reduce crop yield if not detected early. In many farming communities, disease detection is still done manually, which is often slow, inconsistent, and affected by human error. This study developed a deep learning-based system for the early detection of tomato leaf diseases using a Convolutional Neural Network (CNN) based on the VGG16 architecture. A total of 16,211 tomato leaf images, comprising healthy leaves and nine disease classes, were used for the study. The images were resized, normalized, and enhanced through data augmentation techniques such as rotation, flipping, shifting, and zooming. The model achieved its highest validation accuracy of 96.8% at epoch 16, while the final validation accuracy at epoch 20 was 94.30%, demonstrating strong performance in tomato disease classification.

<b>Background:</b> Morris syndrome, also known as androgen insensitivity syndrome (AIS), is a disorder of sex development caused by mutations in the androgen receptor gene in individuals with a 46,XY karyotype. The syndrome is typically diagnosed during adolescence due to primary amenorrhea, and early detection in childhood is uncommon. Prompt recognition is clinically important to guide multidisciplinary management and reduce the risk of gonadal malignancy.<b> Case Description:</b> We report the case of a one-year-old phenotypic female presenting with an irreducible, painful right inguinal hernia. Ultrasound suggested bilateral inguinal hernias containing ovary-like structures. During emergency surgical exploration, bilateral testes were unexpectedly identified within the inguinal canals. The testes were reduced into the abdominal cavity, and herniotomy with anterior wall repair was performed bilaterally. External genital examination revealed normally developed labia but absence of the hymenal ring and vaginal opening. The postoperative course was uneventful. Despite referral for karyotype analysis and multidisciplinary follow-up, the parents did not return for further evaluation. <b>Conclusion:</b> This case highlights the rare intraoperative diagnosis of Morris syndrome in early childhood. Awareness of AIS is essential for pediatric surgeons managing inguinal hernias in phenotypic females. Early detection allows timely planning of gonadectomy and long-term multidisciplinary management, minimizing the risk of malignant transformation of undescended testes and optimizing patient outcomes.

The following study aims to study the evolution, historical and functional dynamics of the German language in Albania, starting from its early phases of confrontation and presentation among Albanians as a language of scientific prestige and elite education, to its contemporary role as a language of certification, study, employment and professional mobility. Based on multifaceted historical sources, press materials, audiovisual media, institutional documents, unpublished interviews, personal archival funds and the narratives of the protagonists or their descendants, the authors argue that German in Albania has managed to maintain a significant weight, although disproportionate in relation to its numerical extent. In its early stages, German was associated almost exclusively with Albanology and with the orientation of the elites towards centres such as Vienna, Graz and Berlin; during socialism it survived in forms of refined state and ideological control, especially in "Radio Tirana", in the field of translation and in specific trajectories of generational formation, while after 1990 it was reformatted as a language of convertible professional and academic capital. The authors' contribution also addresses the current challenges of German studies that are mostly related to student and youth pragmatism, the competition of certification models, the pressure of the labour market and the impact of artificial intelligence on teaching and translation. From this perspective, German in Albania is shown to us today as an almost endemic phenomenon and a truly significant case of the combination between cultural history, education and human mobility.

Access to healthcare is a fundamental human right, and it is the government’s responsibility to ensure that its citizens receive reliable medical services backed up by a strong healthcare infrastructure. In recent decades, both the government and healthcare sectors have been seeking an effective solution to the rise of counterfeit pharmaceuticals, which pose a major threat to society. According to the World Health Organization's estimates, approximately 40 percent of medicines developed in low-income countries may be adulterated or denatured. Counterfeit drugs lead to economic loss in the billions worldwide, risks to patient safety, and diversion of funds towards pharmaceutical research and innovation. A decade-long strategy has been introduced by the United States Food and Drug Administration as a response to these concerns, the plan aiming to improve drug traceability throughout the supply chain process. The task of mandating the printing of barcodes and human-readable data on packaging has been designated to the Healthcare Distribution Alliance. Moreover, the FDA is also involved in helping wholesalers and pharmaceutical manufacturers to leverage blockchain technology for secure data transfer and traceability within interoperable digital networks. Preventing counterfeit medicines from making their way into the supply chain remains a major obstacle for governments and regulatory authorities. Likewise, there is an increasing emphasis on implementing stricter guidelines to avert counterfeiters and criminals from infiltrating counterfeit medicines into the market. The healthcare sector requires strong regulatory measures and secure technologies to ensure the shipment of safe, authentic drugs to patients.

The Heat-Affected Zone (HAZ) is one of the major parameters which determines the structural integrity in welded API 5L X52 pipelines, especially in a sour gas service containing Hydrogen Sulphide (H2S) [1]. This thorough review paper performed the analysis of different international standards including Det Norske Veritas Germanischer Lloyd DNVGL-ST-F101, American Petroleum Institute API 1104, National Association of Corrosion Engineers NACE MR0175 and American Society of Mechanical Engineers ASME B31.8. The researcher analysed the governing and regulation of Heat Affected Zone microstructure and associated properties including strength, hardness and toughness through the specifications like heat values, time between passes and Post Weld Heat Treatment (PWHT), welding specifications and qualification of welding procedures, welders and consumables [2]. By collecting and analysing the data from recent studies (2018-2025), the researchers found out that the standards focusing on prescribing strict recipes for welding and qualification procedures like DNVGL-ST-F101, including explicit heat input limits (typically 1.0-2.0 kJ/mm), obligatory post-weld heat treatment (PWHT), and rigorous consumable qualifications, perform well in Heat Affected Zone in sour gas service. The maximum hardness retirement i.e. 22 HRC (248 HV) obligated for sour media creates a critical limitation that forces optimization of welding procedures. The standards which focus on final quality or the end results rather than prescribing any specific method for producing the weld (Performance-based standards) like API 1104 remains less stringent which results in greater variation in properties around the weld i.e. the HAZ area impacting the service reliability in a worse manner during the sour media [3]. Contemporary world adopting new digital welding techniques for monitoring during weld production, prediction of the microstructural properties of HAZ based on machine learning and other advanced methods like hybrid welding processes which combines different precision welding techniques provide promising results for production of high quality and reliable welds which offer enhanced safety and reliability during sour service [4].

Conventional cyclone risk assessments in Small Island Developing States (SIDS) systematically fail to predict food system collapse locations, leading to misallocated adaptation investments. This study quantifies a fundamental exposure-impact disconnect across Vanuatu's 71 area councils: cyclone exposure explains only 14% of food security impact variance (R² = 0.14, r = 0.38), with topographic, agro-ecological, and infrastructure mediators determining the remaining 86%. Using data from five Category 4–5 cyclones (2015–2023), we constructed a Hazard Exposure Index (HEI; proximity 40%, intensity 35%, frequency 25%) and an Impact Severity Index (ISI; four equally weighted dimensions: agriculture, infrastructure, food insecurity, recovery). Regression with interaction terms reveals three mediating mechanisms. First, topographic elevation reduces ISI by 40–60% at highland area councils (>400 m) relative to coastal equivalents at comparable HEI (r = −0.54, p < 0.001). Second, crop diversity buffers medium-exposure zones (HEI 0.3–0.6; β = −0.082, p = 0.018) but provides no significant protection under extreme cyclone loading (HEI > 0.7), consistent with resilience theory stability thresholds. Third, infrastructure capacity generates "hidden hotspots": Torba province (low exposure, ISI = 0.34) required a median 18 days to reach 50% of affected households versus 6 days in Shefa (high exposure, ISI = 0.61) — a threefold differential driven solely by maritime connectivity deficits. High-exposure provinces with strong infrastructure systematically outperform low-exposure provinces with distribution network weaknesses. A Food Security Resilience Index (FSRe; range: 46–61 on a 0–100 scale) reveals stark provincial heterogeneity — Sanma as buffered regional hub (FSRe = 61) versus Tafea and Shefa as critical/fragile (FSRe 46–47) — enabling a four-category spatial typology for targeted adaptation investments under SIDS fiscal constraints. Findings demonstrate that spatially explicit integration of topography, agro-ecology, and infrastructure is essential for efficient climate adaptation planning in archipelago SIDS, with direct implications for Sendai Framework Target E national DRR strategy development and Green Climate Fund adaptation investment prioritization.