Search Results (12,227)

Introduction: Mothers of children with disabilities may experience substantial and prolonged psychophysical burden, which can negatively affect psychological well-being, health-related quality of life, and physical functioning. This study describes the protocol of a pilot and feasibility study evaluating the feasibility and acceptability of two distinct non-pharmacological interventions—craniosacral therapy (CST) and respiratory training (RT)—in mothers of children with disabilities. Methods and Analysis: This completed, retrospectively registered, three-arm, parallel-group, non-randomized controlled pilot and feasibility study enrolled 32 mothers, allocated by enrolment timing and project logistics to craniosacral therapy (CST; n = 12), respiratory training (RT; n = 10), or no-intervention control (CG; n = 10). The interventions lasted 8 weeks. Feasibility outcomes included recruitment, consent, retention, attendance/adherence, outcome completeness, fidelity indicators, withdrawals, and reported adverse events; acceptability was assessed indirectly because no dedicated acceptability instrument was administered. Clinical outcomes were exploratory. Analyses estimated pre–post change and between-group differences, with confidence intervals reported where supported by the analyses. Recruitment occurred from May to December 2025, follow-up ended on 30 April 2026, and outcome data were analyzed before submission. Ethics approval preceded enrolment (2-XII/2024); registration was retrospective (ANZCTR ACTRN12626000148370; 5 February 2026). Discussion: This pilot and feasibility study provides a structured framework for evaluating CST and RT in mothers of children with disabilities. The study is intended to inform methodological procedures, outcome selection, and the design of a future adequately powered randomized controlled trial rather than establish the clinical effectiveness or safety of either intervention. Full article

Oxidative stress contributes to pulmonary hypertension (PH), but acute redox responses within the pulmonary circulation remain poorly characterized. In this prospective, open-label, single-arm pilot study, 15 patients with PH underwent one 50 min session of remote ischemic conditioning (RIC) during right heart catheterization. Pulmonary arterial (PA) blood was collected immediately before and after RIC. The prespecified primary biomarker family comprised reduced glutathione (GSH) response and the oxidized glutathione-to-GSH (GSSG/GSH) ratio in PA blood-cell and plasma fractions. PA blood-cell GSH response increased (mean paired difference, 118; 95% CI, 83–152; Holm-adjusted p < 0.001), whereas the blood-cell GSSG/GSH ratio decreased (−0.64; 95% CI, −0.81 to −0.46; Holm-adjusted p < 0.001). Plasma glutathione measures were not significant after multiplicity adjustment. PA lactate, the prespecified secondary endpoint, decreased by 0.45 mmol/L (95% CI, 0.20–0.71; p = 0.002). All participants completed RIC without clinically evident acute adverse events. These preliminary findings identify acute PA blood-cell glutathione and metabolic changes associated with RIC; however, the single-arm design precludes causal inference, and confirmation in randomized sham-controlled studies is warranted. Full article

Background and Objectives: Exercise is increasingly used in supportive care for lung cancer, but its effects on depressive symptoms remain uncertain. This systematic review and meta-analysis synthesized randomized evidence. Materials and Methods: Four electronic databases were searched for reports published from January 2000 to July 2026. Eligible studies enrolled adults with lung cancer and compared a structured exercise-based intervention with usual care or an eligible active rehabilitation comparator. One depression result per independent trial was selected using documented rules for assessment time, outcome format, and multiple intervention arms. A random-effects model used REML with Hartung–Knapp inference. Results: Seventeen studies met the eligibility criteria; 15 independent trials (1041 participants) contributed to the primary synthesis. The pooled effect favored exercise (Hedges’ g = −0.75, 95% CI −1.18 to −0.32; p = 0.002), but heterogeneity was considerable (τ² = 0.4582; τ = 0.6769; I² = 87.1%; H² = 7.76; Q(14) = 74.11, p < 0.001) and the 95% prediction interval crossed the null (−2.27 to 0.76). The direction remained favorable in all sensitivity analyses, although exclusion of two influential studies attenuated the pooled effect to −0.49 and reduced I² to approximately 0%. Exploratory subgroup and study-level moderator analyses did not identify a stable explanation for heterogeneity. Certainty was very low after downgrading for risk of bias, inconsistency, and indirectness. Conclusions: Exercise-based interventions may reduce depressive symptom scores in some adults with lung cancer, but confidence in the magnitude and transferability of the average effect is limited. The evidence does not establish efficacy for major depressive disorder or identify an optimal modality, dose, or delivery format. Full article

Background/Objectives: Consumption of New Zealand blackcurrant extract for 7 days has shown to reduce slowing of sprint speed in recreationally active males. Acute caffeine consumption has shown to improve repeated-sprint performance in a fatigued state. Thus, combined intake of New Zealand blackcurrants and caffeine may provide an additive or a synergistic effect to improve repeated-sprint performance, especially in fatigued individuals. Our study investigated the individual and additive effect of acute intake of New Zealand blackcurrant powder and caffeine on high-intensity intermittent running performance. Methods: Fourteen recreationally active males participated in a double-blind, randomised controlled crossover trial consisting of four experimental arms: placebo (PLA), New Zealand blackcurrant powder (NZBP), caffeine (CAFF), and NZBP + caffeine (NZBP + CAFF). Participants reported to the laboratory fasted and consumed a standardised breakfast with the study intervention 1 h before the exercise trial. Speed and distance covered for walking, sprinting, running, and jogging were assessed using the modified Loughborough Intermittent Shuttle Test (m-LIST). Blood lactate and free fatty acids (FFAs) levels, and perceptual measures (feeling scale, felt arousal scale and ratings of perceived exertion) were also assessed. Results: Caffeine intake increased average sprint speed (p = 0.045, η² = 0.345) and reduced sprint time (p = 0.030, η² = 0.463) during the m-LIST protocol. Ratings of perceived exertion were lower with caffeine intake (p = 0.014, η² = 0.381), while blood lactate concentration was higher (p = 0.001, η² = 0.761). Serum free fatty acids concentrations increased over time (p < 0.001, η² = 0.900), with a significant NZBP × time interaction (p = 0.005, η² = 0.433). No significant effects of NZBP alone or caffeine × NZBP interactions were observed for sprint performance outcomes. Conclusions: Acute NZBP did not improve repeated-sprint performance, either alone or when combined with caffeine. In contrast, caffeine-containing treatments were associated with improved sprint performance and lower perceived exertion. These findings suggest that caffeine, rather than NZBP, was responsible for the observed ergogenic responses, with no evidence of an additive benefit from acute combined supplementation. Full article

Adversarial patch attacks pose a tangible physical-world threat to traffic sign recognition in autonomous driving systems. Current state-of-the-art defenses based on image reconstruction require dual-model deployment and add per-frame inference latency, making them impractical for resource-constrained embedded platforms such as mass-produced ADAS systems and aftermarket dashcams. This paper proposes a two-component defense that separates detection from mitigation. PatchGuard-Freq leverages frequency-domain analysis to detect attacked images with high accuracy, while adversarial fine-tuning enables the detector to recover most of its detection performance under attack without adding any inference module or architectural change. Experimental results show that the approach is effective in the latency regime targeted by this study: on the evaluated stop-sign and nine-class LISA benchmarks, under the evaluated detection placement (a fresh $110\times 110$ patch at a uniformly random position), the detector achieves AUC = 1.0 with zero false positives across all four dataset configurations and all combined frequency variants, while the frequency-only arm of the ablation separates the data only where the patch covers almost the entire input, and adversarial fine-tuning recovers attacked mAP@0.5 on the COCO stop-sign test set from 19.4% to 68.4% on the $110\times 110$-patch configuration while degrading clean mAP by only about 0.7 points. We further show that PatchGuard-Freq is vulnerable to adaptive (defense-aware) attacks and introduce defense-aware training that restores detection of such attacks to 100% without increasing false alarms. This work characterizes the complementary relationship between reconstruction-based and robustness-based paradigms in the accuracy–efficiency design space under the evaluated conditions: the former suits compute-unconstrained scenarios while the latter serves latency-constrained deployments. All quantitative results were obtained on desktop-grade GPUs; embedded-platform latency, memory, and energy were not measured, and the embedded discussion is limited to hardware-independent parameter and FLOP counts. Full article

Background: The free latissimus dorsi (LD) muscle flap remains a workhorse for large soft-tissue defects. Its pedicle, however, must be followed proximally into the axilla—into the immediate vicinity of the lymphatics that drain the arm—and whether this compromises upper-extremity drainage has never been settled. The few studies that examined lymphoedema after LD surgery relied on questionnaires and were confined to breast reconstruction, where axillary clearance and irradiation offer a sufficient explanation for anything they found; the harvest itself has never been isolated. Methods: We identified every patient who underwent free LD muscle flap reconstruction for defect coverage at our institution between September 2017 and December 2022 and examined those who attended a standardized cross-sectional follow-up. None had undergone axillary lymph node dissection, sentinel node biopsy, or axillary irradiation, and none had received cervical or supraclavicular irradiation ipsilateral to the donor side. A single examiner measured upper-arm and forearm circumference bilaterally, 10 cm proximal and 10 cm distal to the medial epicondyle. Patients whose flap had been transferred to an upper limb were excluded, because in them the tape measures the flap rather than the donor site. The contralateral limb served as the intra-individual control. The primary endpoint was the mean side difference in upper-arm circumference with its 95% confidence interval. Results: Forty-one patients (25 women, 16 men; mean age 54.4 ± 16.5 years; mean follow-up 14.4 ± 12.0 months, range 3–48) were included. Upper-arm circumference averaged 27.88 ± 3.26 cm on the donor side and 27.77 ± 3.65 cm contralaterally—a difference of +0.11 cm (95% CI −0.28 to +0.50; p = 0.57). Forearm values were 23.82 ± 2.89 cm and 23.94 ± 3.07 cm (−0.12 cm; 95% CI −0.47 to +0.23; p = 0.49). Two of 41 patients (4.9%; exact 95% CI 0.6–16.5%) crossed the conventional 2 cm threshold at the upper arm—and exactly as many crossed it in the opposite direction, with the donor limb the smaller of the two. Side difference bore no relation to time since surgery. Conclusions: Free LD muscle flap harvest showed no detectable difference in arm circumference at two standardized levels in patients who had never undergone axillary lymphadenectomy. The upper-arm mean difference is compatible with no more than a 0.5 cm increase, and threshold crossings occurred equally often in both directions. Circumference is a coarse surrogate that cannot detect subclinical (International Society of Lymphology [ISL] stage 0) lymphoedema; within that limit, these data give no support for avoiding the flap on lymphatic grounds. Full article

Background/Objectives: Paget–Schrotter syndrome (PSS), or primary axillary-subclavian vein thrombosis, is an uncommon but clinically important form of upper extremity deep vein thrombosis. It often affects young, physically active patients and may initially be interpreted as a musculoskeletal disorder. This scoping review, combined with a contemporary primary care case, aimed to map the reported clinical presentation, diagnostic delay, and initial misdiagnosis of classic PSS. Methods: The review was conducted using the Arksey and O’Malley framework and reported in accordance with the PRISMA extension for scoping reviews (PRISMA-ScR). PubMed was searched for English-language publications from 1 January 2000 to 1 March 2026. Eligible reports described effort-induced thrombosis involving the axillary and/or subclavian venous segment. Secondary upper extremity deep vein thrombosis, non-effort thrombosis, pseudo-PSS, isolated distal venous thrombosis, and reports without extractable patient-level presentation data were excluded. Data were charted descriptively. Results: Among 1954 screened records, 143 studies met inclusion criteria and contributed 165 published patients. Together with the present case, the synthesis included 166 patients. Median age was 28 years, and 73.5% were male. Arm swelling (95.2%), pain (80.1%), cyanosis or discoloration (69.9%), and venous distension (70.5%) were the most frequent presenting features. Diagnostic delay was reported in 27.3% of patients with reported data, whereas initial misdiagnosis was reported in 21.7% of included patients. Musculoskeletal injury or muscle strain was the most common initial misdiagnosis, accounting for 66.7% of misdiagnosed cases. Pulmonary embolism was reported in 24.7% of patients, although this reported frequency is likely influenced by case-report publication bias, selective imaging, and preferential reporting of more severe presentations, and should not be interpreted as a population-level risk estimate. Conclusions: PSS should be considered in young or otherwise low-risk patients with unilateral arm swelling after strenuous or repetitive upper extremity activity. Greater awareness of this clinical presentation in primary care and general emergency settings may reduce diagnostic delay and post-thrombotic morbidity. Full article

Background: Medical students who volunteer during armed conflict may help sustain overwhelmed health services while experiencing concurrent social, academic, psychological, and physical consequences. However, no context-sensitive instrument has been available to assess these multidimensional benefits and burdens in active conflict settings. This study primarily aimed to develop and conduct an initial psychometric evaluation of the Volunteering Impact Scale (VIS) among medical students volunteering in Gaza and, secondarily, to characterize their volunteering experiences. Methods: A cross-sectional survey was conducted among 169 medical students who volunteered in hospitals in Gaza during the ongoing war. An initial 28-item pool was generated from a focused literature review, relevant theoretical frameworks, and consultations with Gaza-based medical students and clinicians. A multidisciplinary team reviewed the items for relevance, clarity, redundancy, and contextual appropriateness. Following item refinement and psychometric evaluation, the final 16-item VIS comprised five domains: social impact, mental burden, physical burden, academic development, and wellbeing and fulfillment. Its structure was assessed using exploratory factor analysis with principal axis factoring and Promax rotation, followed by confirmatory factor analysis. Internal consistency and convergent and discriminant validity were also examined. Domain scores and their associations with participant, volunteering, and war-exposure characteristics were subsequently analyzed. Results: Exploratory factor analysis revealed a five-factor structure explaining 51.2% of the variance. Parallel analysis favored three factors, whereas a theoretically informed five-domain solution was retained for further evaluation. Primary factor loadings ranged from 0.23 to 0.89. Most items met the prespecified loading criterion of 0.40; however, three Social items demonstrated weaker loadings and were retained provisionally because of their conceptual relevance to the construct. Confirmatory analysis provided support for the proposed measurement structure (RMSEA = 0.059, SRMR = 0.075, CFI = 0.911, and TLI = 0.888). Cronbach’s alpha coefficients ranged from 0.64 to 0.75, and discriminant validity was supported by heterotrait–monotrait ratios below 0.85. Participants reported perceived social (M = 4.31/5), academic (M = 4.19), and wellbeing-related (M = 3.96) benefits. Mean reverse-scored Mental and Physical scores were 2.71 and 2.60, respectively, with lower scores indicating greater burden. Longer volunteering was associated with greater physical strain but also with stronger academic and wellbeing outcomes. Conclusions: The VIS demonstrated a conceptually coherent five-domain structure and promising initial psychometric properties for assessing the concurrent benefits and burdens of healthcare volunteering in a war-affected setting. Further validation in independent and more diverse samples is required. The findings also indicate that volunteer programs should combine meaningful clinical participation with structured supervision, recovery time, role rotation, and context-sensitive psychosocial support. Full article

Spatial interference among the shearer cutting drum, ranging arm, and hydraulic-support face guard is a practical safety risk in fully mechanized coal mining faces, where dust, water mist, weak illumination, and metal multipath reflections limit vision- and LiDAR-based perception. This study develops a 4D millimeter-wave radar point cloud sensing method for face guard segmentation and cutting-interference warning. Radar point clouds were extracted from ROS bag data, converted to frame-level point cloud files, manually labeled, and processed using a joint passthrough-radius filtering strategy. A PointNet++ semantic segmentation network was modified with radar feature augmentation and class-aware neighborhood sampling to identify sparse face guard points from background structures. The segmented face guard points were fitted by an axis-aligned 3D bounding box, and the minimum distance from shearer dangerous regions to the box was used to classify safe, warning, and dangerous states. On a 2160-frame labeled dataset, the final segmentation model reached 99.126% precision, 97.477% recall, and 96.608% IoU at epoch 100. Static pose, dust-condition, and dynamic sequence tests further verified that the proposed sensing pipeline can provide continuous face guard localization and distance-based interference monitoring under representative experimental conditions. Full article

The increasing use of unmanned aerial vehicles (UAVs) and other moving objects in civilian environments has created a growing need for reliable radar-based object classification systems, while deep learning (DL) models achieve high classification accuracy on range–Doppler (RD) radar data, their deployment on resource-constrained embedded platforms remains challenging due to computational and latency constraints. This work addresses that gap as a hardware–software co-design problem: the contribution is the system-level optimization and characterization of the deployment rather than the design of a new network architecture. This paper presents the deployment and system-level characterization of an adopted multiscale decision fusion convolutional neural network (MDF-CNN) for radar-based object classification on the Xilinx Kria KR260 platform. The network processes preprocessed stacked RD frames of size $11\times 61\times 3$ and classifies targets into cars, drones, and people using the publicly available RDRD dataset. The Floating-Point (FP32) reference model achieves 97.06% classification accuracy. For efficient embedded deployment, the model is quantized to 8-bit integer (INT8) precision using the Vitis AI framework and executed on the deep learning processing unit (DPU). The INT8 FPGA (DPU) implementation achieves 96.88% accuracy with an average classifier-stage latency of 9.24 ms per preprocessed input tensor and a throughput of 108.21 inferences per second, corresponding to a $6.2\times$ latency reduction relative to the FP32 central processing unit (CPU) baseline. The measured interval includes DPU execution and the tensor transfers between double data rate (DDR) memory and the DPU, but excludes radar acquisition, RD-map generation, target-centered cropping, temporal stacking, per-sample z-score normalization, and ARM-side INT8 input scaling. At fixed INT8 precision, the INT8 CPU implementation achieved a lower raw latency of 7.957 ms per preprocessed input tensor compared with 9.24 ms for the DPU. Power measurements show an average consumption of 4.14 W, resulting in an energy cost of 38.25 mJ per classifier inference. These figures compare two deployment configurations that differ in hardware, numerical precision, software runtime, and power-measurement boundary, and are therefore reported as a system-level comparison rather than as an attribution to any single factor. These results characterize low-latency and energy-efficient deployed MDF-CNN classifier execution on the KR260 using preprocessed radar tensors; investigation of the implementation and timing of the complete online radar-to-classification pipeline remain directions for future work. Full article

Low-switching-frequency operation is essential for high-power modular multilevel converters (MMCs), but it makes the simultaneous achievement of low harmonics, fast transient response, and reliable internal control more difficult. Conventional lookup-table selective harmonic elimination PWM (SHEPWM) preserves steady-state harmonic optimization, yet its fundamental-period pattern update limits transient flexibility; predictive pulse-pattern methods improve current or flux tracking, but do not directly coordinate the MMC execution chain from arm-level pulse displacement to physical submodule gating. This paper proposes a coordinated switching-event control scheme for SHEPWM-based MMCs. The offline harmonic-optimized pattern is used as the steady-state backbone, while selected time-stamped events are corrected online through a virtual-flux formulation. The same events are then processed by causal pulse-edge compensation, paired upper/lower-arm displacement for circulating-current suppression, and threshold-based asynchronous submodule scheduling. Simulations of startup, active-power steps, and power-flow reversal show that more than 90% of the virtual-flux error is compensated within approximately 5 ms. Device-level co-simulation reduces current THD from 1.5881% to 0.702%, and paired-event control reduces arm-current THD from 21.600% to 4.9266%. At rated steady state, the method achieves 1.25% grid-current THD with a 50 Hz average submodule switching frequency, supporting low-loss MMC operation without abandoning SHEPWM harmonic optimization. Full article

Early detection of cancer remains challenging due to the extremely low concentration of biomarkers present during initial disease stages. Dysregulation of key signaling pathways, including cyclin-dependent kinase (CDK) networks, drives uncontrolled cell proliferation and tumor progression, underscoring the need for highly sensitive, label-free biosensing technologies. Conventional analytical methods such as ELISA and PCR offer reliable detection but require complex sample preparation, fluorescent labeling, and long processing times, limiting their suitability for rapid diagnostics. This work introduces a novel label-free Biological Micro-Opto-Electro-Mechanical System (BioMEMS) platform based on an unbalanced Michelson interferometer with DBR mirrors to interrogate the minute spectral shifts induced by biomolecular interactions. A microcantilever is suspended above a silicon-on-insulator (SOI) waveguide, where the specific binding of biomarkers generates compressive surface stress, causing a downward deflection that reduces the cantilever-to-waveguide gap. This displacement modulates the effective refractive index of the sensing arm through enhanced evanescent-field coupling. The resulting phase variation is further detected through the high-sensitivity Michelson interferometric architecture, enabling ultrasensitive spectral interrogation. Numerical simulations using COMSOL Multiphysics demonstrate a narrow full width at half maximum (FWHM) of 27.6 nm, a quality factor (Q) of 53.34, and an overall sensitivity of 75.74 $\mathsf{\mu }$m/(N/m). These results highlight the potential of the proposed platform for early cancer detection and precise monitoring of dysregulated signaling pathways. Full article

Latency antibiotic therapy is an established component of expectant management after preterm prelabour rupture of membranes (PPROMs). Pooled randomised evidence from 22 trials involving 6872 women and infants shows that antibiotics prolong pregnancy, reduce chorioamnionitis (risk ratio 0.66) and reduce neonatal infection (risk ratio 0.67), without a significant reduction in perinatal mortality. The evidence supporting the therapeutic principle is stronger than the evidence defining how the therapy should be configured. This narrative review examines the three decisions an obstetrician makes at the bedside, namely, which agent, at which dose and route, and for how long, and the comparative evidence behind each. Contemporary practice descends from two protocols: the ampicillin–erythromycin regimen of the NICHD Maternal–Fetal Medicine Units Network trial and the erythromycin arm of ORACLE I. Neither was designed to identify an optimal regimen. Substitution of azithromycin for erythromycin rests predominantly on observational cohorts together with one small open-label randomised comparison that pre-specified no non-inferiority margin and is therefore pragmatic and guideline-permitted rather than confirmed by an adequately powered randomised trial. No randomised dose comparison using clinical endpoints has been performed in PPROM, although randomised pharmacokinetic data exist for azithromycin. The seven-day course derives from a trial protocol rather than from a duration-ranging study, and the two randomised duration comparisons published since 2023 point in opposite directions. Guideline agreement reflects shared historical ancestry rather than independent confirmation of optimality. Adequately powered pragmatic trials, stratified by gestational age, remain the principal unmet need. Full article

Background: Prolonged hospitalization, postoperative complications, and unplanned readmission remain major problems after major surgery. RESET evaluates a continuous perioperative pathway integrating individualized prehabilitation, coordinated inpatient care, enhanced-recovery principles, discharge planning, and transitional care in adults undergoing oncological surgery and patients aged 70 years or older undergoing non-oncological surgery. Methods: RESET is a prospective, two-center, two-arm randomized controlled study (NCT07727876). Up to 12,800 patients will be screened and approximately 8960 randomized 9:1 to RESET or standard care, including about 5740 oncological and 3220 non-oncological participants. The three primary outcomes are prolonged index hospitalization (≥14 days), unplanned readmission within 30 days after discharge, and postoperative complications within 30 days after surgery. Each outcome is evaluated separately in both clinical populations, yielding six primary hypothesis tests. Holm’s procedure will control the family-wise error rate at α = 0.01 across all six tests, with endpoint- and population-specific confirmatory conclusions. Secondary outcomes include length of stay, multidomain health status, satisfaction, adherence, organizational effectiveness, and direct healthcare costs. Conclusions: RESET will evaluate the clinical and implementation effects of an integrated perioperative pathway across two surgical populations. Full article

Mid-infrared nulling interferometry enables thermal characterization of warm exoplanets, but non-common path aberrations (NCPA) degrade starlight suppression by creating complex amplitude mismatch between interferometer arms. We investigate how architecture and NCPA spatial structure jointly determine null leakage and stability at $\mathsf{\lambda }=10.6 \mathsf{\mu }\mathrm{m}$. A unified statistical framework combines free-space propagation, a Houizot chalcogenide fiber, and a Labadie-type waveguide with extended Sauvage-type NCPA screens and adaptive optics (AO) residuals in nested Monte Carlo simulations. The mean raw null is governed mainly by the combined aberration amplitude of the two arms and depends only weakly on its allocation between them. AO residuals set leakage floors that depend on the reception configuration. Cases with similar mean raw nulls can still have different dispersions. Compared with free space, the single-mode spatial filters lower the mean leakage and reduce fluctuations, and they are less sensitive to the allocation of amplitude error between the arms. Their performance depends on modal selectivity: larger energy fractions in azimuthally symmetric radial modes are associated with poorer mean nulls and greater AO-driven fluctuations. These results show that NCPA tolerances cannot be specified by global wavefront error amplitude alone. They should also account for aberration spatial content and the modal projection imposed by the transmission architecture. Full article