Search Results (744)

Background: Patient-specific splints have become an integral component of virtual surgical planning in orthognathic surgery. However, transferring the virtually planned condylar position into the intraoperative setting remains technically challenging and typically requires labor-intensive manual modification of splint geometries. The aim of this study was to develop and describe an open-source Blender add-on that automates the generation of patient-specific splint extensions for condyle positioning and to evaluate its technical feasibility in a proof-of-concept clinical setting. Methods: A Python-based add-on for the open-source 3D modelling software Blender was developed to automate the generation of condyle-positioning splint extensions from stereolithography (STL) models exported by a commercial virtual surgical planning system. The software architecture and processing pipeline comprise facilitated data import, coordinate normalization, extension generation, Boolean processing, optional manual refinement, and STL export for additive manufacturing. The workflow was applied in three patients undergoing bilateral sagittal split osteotomy. Postoperative correspondence between the planned and achieved mandibular positions was assessed using translational and rotational transformation parameters together with qualitative surface distance heatmaps provided by the planning software. Results: The proposed add-on successfully generated patient-specific splint extensions in all three proof-of-concept cases while automating manual modelling steps. All splints were successfully manufactured and applied intraoperatively without redesign. Postoperative evaluation demonstrated good agreement between the virtually planned and achieved mandibular positions, with only small translational and rotational deviations. Descriptive statistical analysis supported the technical feasibility and reproducibility of the proposed workflow. Conclusions: The presented open-source Blender add-on provides a reproducible and extensible workflow for automated generation of patient-specific condyle-positioning splint extensions. The proposed approach successfully integrates virtual surgical planning with additive manufacturing and demonstrates technical feasibility in a proof-of-concept clinical setting. The software establishes a foundation for future validation studies in larger patient cohorts and illustrates the potential of open-source tools to improve transparency, reproducibility, and accessibility in digital orthognathic surgery workflows. Full article

Fault-tolerant distributed systems are implemented in safety-critical applications where a system failure could cause severe damage and threaten human lives. To guarantee their flawless operation, their dependability attributes must be embedded early and continuously throughout system design, rather than treating them as an afterthought. This paper presents a conceptual framework for integrating the approach of adjustable reliability into the System Development Life Cycle (SDLC). The approach of adjustable reliability provides a way to distribute structural hardware redundancy and achieve the system reliability required by the application. The proposed framework shifts reliability from a design add-on to a core architectural decision variable in the design of dependable distributed systems. Opportunities and challenges involved are discussed, and some future research directions are outlined. Full article

We study an agent who tracks several independent, unobserved, slowly drifting states and is paid by how well a chosen action matches each state but who can process only a bounded amount of information per period. The payoff environment is deliberately symmetric—quadratic matching losses, Gaussian drift, Gaussian observation noise—and the agent’s objective contains no asymmetry: we treat both the risk-neutral (linear) objective and the long-run log-growth (Kelly) objective. Within this symmetric environment, we show that the value of attentionis sharply asymmetric in the sign of the agent’s surprise. Because the matching payoff is maximized when action equals state, a surprisingly low payoff is strong evidence of a state mismatch that is worth correcting, whereas a surprisingly high payoff is evidence either of noise or of a match already achieved—in both cases carrying little decision-relevant information. We prove (Theorem 1) that the posterior expected mismatch, and hence the value of information, is strictly decreasing in the realized payoff, negligible for good surprises and rising steeply for bad ones, with a correspondingly asymmetric slope. We then show that an information-constrained agent optimally adopts a threshold attention policy (Theorem 2), which, under one explicit and standard bridge—that valuation inherits attention weight, as in salience and rational-inattention theories of choice—projects onto a reference-dependent value function with a kink at the expected payoff and a loss-side slope strictly steeper than its gain-side slope (Corollary 1): precisely the signature of loss aversion. The mechanism supplies the structure of loss aversion—its sign, its reference point, and how it varies with the environment—while its magnitude is one calibrated parameter that places the implied coefficient in the empirical range. Risk aversion follows as a corollary (Theorem 3): the kink induces first-order risk aversion over small symmetric gambles, inverting the usual hierarchy in which (second-order) risk aversion is primitive, and loss aversion is an add-on. The mechanism is immune to the Rabin calibration critique. Simulations benchmark the myopic policy against the computed optimum, map the mechanism’s robustness across noise tails, and locate the implied coefficient; we close with extensions to endogenous gain-seeking in convex (“gold-rush”) environments, population heterogeneity through learned priors, and a reading of hedonic affect as the Lagrange multiplier that prices a scarce attentional resource. Full article

Background/Objectives: Mandibular kinematics are increasingly central to the construction of the digital dental avatar, and can be recorded with two categories of devices: dedicated jaw motion analysers and intraoral scanners with motion-tracking modules. Few studies have compared these categories on the same patients. This pilot study compared the Zebris JMA and Medit i700 in a paired-cohort design, using an open-source Blender-based framework developed for the uniform analysis of their XML exports. Methods: A prospective, observational, paired-cohort study was conducted on 17 adults recorded with both systems by a single operator. A custom Python 3.11 add-on for Blender 4.5 LTS and Blender4Dental 1.1.99, developed within the study, supported the analytical workflow. A common anatomical origin between the two systems was first validated by comparing the occlusal contact area at MIP. At each threshold, the two systems were then compared on the directional decomposition (X, Y, Z components) of the mandibular displacement along the anatomical axes. Agreement was evaluated using paired t-tests or Wilcoxon signed-rank tests, Bland–Altman analysis, Pearson or Spearman correlation coefficients, and the intraclass correlation coefficient. Results: Validation at maximum intercuspation showed near-perfect agreement between the two workflows (Pearson r = 0.997; ICC(2,1) = 0.997). During protrusion, the dominant displacement component shifted to the anteroposterior axis. SVD residuals were smaller for Medit (~0.003–0.004 mm) than for Zebris (~0.024–0.046 mm; p < 0.001), but were interpreted only as internal rigid-body fitting residuals rather than accuracy metrics. Conclusions: Zebris JMA and Medit i700 yielded similar scalar displacement values under the threshold-based frame-selection procedure, but showed systematic differences in directional decomposition. Full article

Background/Objectives: Post-stroke spasticity is a common and disabling complication that impairs functional recovery. Acupuncture is used as a complementary intervention in stroke rehabilitation, but evidence for specific techniques, including acupoint-to-acupoint penetrating acupuncture (AAPA), remains limited. This study evaluated the adjunctive effects and safety of AAPA applied to limb acupoints in patients with post-stroke spasticity receiving conventional care. Methods: A systematic review and meta-analysis of randomized controlled trials was conducted. Nine databases and five clinical trial registries were searched from inception to June 2026. Trials compared AAPA plus conventional care with conventional care alone. The primary outcome was post-treatment spasticity severity. Risk of bias was assessed using RoB 2, and evidence certainty using GRADE. Results: Sixteen studies involving 1170 participants were included. Adjunctive AAPA significantly reduced Modified Ashworth Scale scores (SMD = −0.91, 95% CI: −1.23 to −0.59). Motor function, gait, balance, activities of daily living, and neurological deficits were also improved. However, most studies had a high overall risk of bias, no trial used a sham acupuncture comparator, and substantial heterogeneity was observed for several outcomes. The certainty of evidence for all GRADE-assessed clinical outcomes was very low. Conclusions: The findings suggest possible add-on benefits of AAPA when used with conventional post-stroke care, but the current evidence should be interpreted cautiously and is insufficient to support definitive clinical recommendations. Rigorous multicenter trials in diverse rehabilitation settings with standardized outcomes, systematic safety assessment, and longer follow-up are needed. Full article

Floating tidal platforms provide a flexible solution for offshore tidal–stream energy exploitation, but their wave-induced motions may affect platform stability, turbine operation and power performance. Integrating wave energy converters (WECs) with a floating tidal platform provides a potential approach to absorb wave energy and modify platform motions. However, the dynamic role of a WEC array attached to a floating tidal platform remains insufficiently understood, especially with respect to array layouts, power take-off (PTO)-induced coupling and absorbed power. This study investigates the effects of WEC array layout on the motion response and absorbed power of a catamaran-type floating tidal platform under irregular wave excitation. Three representative WEC array layouts, namely longitudinal, transverse and hybrid arrangements, were compared with a baseline platform without WECs. A coupled numerical model was established by combining frequency-domain radiation-diffraction analysis and time-domain simulations of mooring system and PTO dynamics based on ANSYS AQWA 2023R2. The hydrodynamic model was verified through code-to-code comparisons with OrcaWave 11.6, and the PTO power model was checked against published numerical results. The results show that the WEC array layout has a significant influence on both platform response and power absorption. Among the investigated layouts, the transverse array provides the most effective overall motion suppression, with average reductions of 36.83% in heave responses and 52.62% in pitch responses compared with the baseline platform. Frequency-domain results indicate that pure multi-body hydrodynamic interaction has a limited influence on the platform response amplitude operators (RAOs) and wave-excited forces, whereas time-domain results reveal much stronger layout-dependent responses once PTO coupling was included. The WECs’ absorbed power was strongly affected by the geometric relationship between the PTO rotation plane and the dominant platform motion plane. When these two planes were aligned in coplanarity, platform motion enhances the relative PTO rotation and increases output power. These findings indicate that, for floating tidal platforms with relatively small displacement, WEC arrays should be treated as distributed dynamic subsystems rather than only as energy-harvesting add-ons. The results can provide useful guidance for the layout design and coupled dynamic assessment of floating hybrid tidal–wave energy converters (HTWEC). Full article

Kazakh automatic speech recognition (ASR) presents a persistent challenge for large-scale multilingual models. This paper presents a systematic evaluation of 27 ASR pipeline configurations (three ASR models × three VAD methods × three post-processing strategies) on the Kazakh Speech Dataset (KSD), examining the contribution of model fine-tuning, voice activity detection (VAD) preprocessing, and large language model (LLM) post-correction and benchmarking the resulting pipelines against two non-Whisper foundation models. Language-specific fine-tuning reduces Word Error Rate (WER) from 43.20% (generic Whisper-large-v3) to 11.88% (Kazakh fine-tuned Whisper-turbo), a 31.32-percentage-point absolute reduction (72.5% relative; p < 0.001, bootstrap test); the effect persists after controlling for model size (generic Whisper-large-v3-turbo, 18.92%, vs. the same architecture after fine-tuning, 11.88%; p < 0.001). VAD preprocessing consistently degrades performance. Zero-shot post-correction with general-purpose LLMs yields no benefit and adds substantial latency: Gemma-2-9B and Qwen2.5-7B raise WER by 5.5 and 7.2 percentage points at real-time factors of 0.52 and 0.30, and a larger 32B model still degrades accuracy (+10.8 points), indicating that scale is not the limiting factor. Among all systems evaluated, a larger multilingual foundation model, SeamlessM4T-v2 (9.72% WER), outperforms the fine-tuned Whisper, showing that for Kazakh model coverage matters more than pipeline engineering. Character-level error analysis identifies systematic confusion between Kazakh-specific and Russian Cyrillic characters as a dominant error source. These findings establish that, for Kazakh under the evaluated conditions, model choice dominates pipeline add-ons: fine-tuning is essential, VAD and zero-shot LLM correction consistently hurt, and a strong multilingual model sets the best result; we further discuss the extent to which these conclusions extend to typologically similar Kipchak-Turkic languages. Full article

Severe treatment-resistant asthma (STRA) in children is often sustained by type 2 inflammation and eosinophil-dependent airway disease that persists despite optimized inhaled therapy and the mitigation of modifiable factors. This review summarizes the clinical and translational evidence on monoclonal antibodies targeting the interleukin-5 (IL-5) axis (anti-IL-5 and anti-IL-5Rα) available in pediatric severe asthma. PubMed/MEDLINE was searched up to January 2026 for English-language studies in patients aged 0–18 years addressing mepolizumab and benralizumab, including randomized trials, high-quality observational studies, meta-analyses, and international guidance. Mepolizumab has the most robust pediatric data, showing consistent reductions in exacerbations and blood eosinophils, and improvements in symptom control and quality of life, with safety broadly comparable to adults. The pediatric evidence for benralizumab is more limited but shows rapid eosinophil depletion, improved outcomes in selected children, and acceptable safety; further trials are ongoing. Overall, IL-5–directed biologics represent a key add-on option for carefully selected children with severe eosinophilic asthma, while pediatric-specific predictors of response, comparative effectiveness, and standardized long-term monitoring and stopping criteria remain priorities. Full article

Background/Objectives: While a growing number of studies have demonstrated positive effects of adjuvant anodal transcranial direct current stimulation (tDCS) on linguistic performance in aphasia, evidence for corresponding effects on verbal and—in particular—nonverbal functional communication remains absent. This is a critical gap, given that restoring everyday communicative competence is the ultimate goal of speech and language therapy (SLT). In the present observational study, we investigated the add-on effect of anodal tDCS over language-relevant left-hemispheric areas on verbal and nonverbal functional communication in n = 34 individuals with subacute aphasia and examined the relationship between communicative and linguistic change. Methods: Participants underwent two consecutive two-week therapy phases (P1, P2), each consisting of 10 SLT sessions. Severity-specific linguistic and communicative assessments were administered before, between, and after both phases: the Aachen Aphasia Test (AAT; n = 26) combined with the Amsterdam–Nijmegen Everyday Language Test (ANELT, A-scale), and the Bielefeld Aphasia Screening Rehabilitation (BIAS-R; n = 8) combined with the Scenario Test. During P2, SLT was supplemented by online anodal tDCS. Results: Overall test performance improved significantly more in tDCS-supported P2 compared to P1 (AAT profile level, p < 0.001; BIAS-R mean percentage value (MPW), p = 0.027; ANELT A-scale raw score Version 1, p = 0.081, and version 2, p = 0.038; and Scenario Test total score, p = 0.003). Significant correlations between AAT profile level and ANELT total scores were found across all time points. Between the MPV and subtests of the BIAS-R and the Scenario total score, there was a tendency toward decreasing correlation levels from T1 to T3. Conclusions: To our knowledge, this is the first study demonstrating that adjuvant tDCS in subacute aphasia enhances not only linguistic performance but also verbal and nonverbal functional communication beyond SLT alone—assessed with standardized, performance-based, ecologically valid instruments. Full article

Rheumatoid arthritis (RA) is a systemic autoimmune disease in which persistent synovitis drives interconnected cartilage degradation, bone erosion, and functional decline. Conventional synthetic, biologic, and targeted synthetic disease-modifying antirheumatic drugs (DMARDs) remain the foundation of RA management. Hydrogel-based local therapy should therefore be positioned as an adjunct for selected joints rather than as a substitute for systemic disease control. Hydrogels provide a versatile local materials platform because their injectability, tunable crosslinking, tissue retention, stimulus-responsive release, interfacial adhesion, lubrication, and extracellular matrix-mimetic properties can be tailored to the inflamed joint microenvironment. This narrative, evidence-graded review evaluates local hydrogel therapies using two complementary frameworks: the synovium–cartilage–bone pathological axis and a materials-science chain linking composition and crosslinking to structure and properties, release and degradation, and tissue-level outcomes. Evidence is classified as direct RA evidence, transferable evidence from related disease or tissue-engineering models, or conceptual evidence from mechanistic and materials-science studies. Therapeutic outcomes are separately graded as local immunomodulation, structural protection, tissue repair, or functionally validated structural disease modification. Current preclinical evidence supports the use of hydrogels for sustained local delivery and synovial immunomodulation, while selected systems demonstrate cartilage-protective or anti-erosive effects. However, durable multitissue restoration accompanied by functional recovery remains insufficiently demonstrated. Future studies should prioritize RA-relevant long-term models, in vivo intra-articular pharmacokinetics and biodistribution, standardized structural and functional endpoints, repeat-dose safety, and evaluation as add-on therapy to systemic DMARDs. Full article

Human factors remain the dominant contributor to cybersecurity incidents, yet awareness training produces only moderate and often non-durable behaviour change, and most evaluated programs are either purely digital or evaluated only at the framework level. This study addresses two gaps: the scarcity of empirical and demographically stratified evidence for multi-modal community-facing awareness programs, and the lack of an explicit account of how artificial intelligence (AI) should be integrated into such programs rather than treated as an optional add-on. We evaluate Cyber4Me, a four-stage individual-awareness intervention (community roadshows, structured training, a hackathon, and a physical–digital escape room) that is wrapped in a cross-cutting AI adaptive layer built entirely on structured performance and behaviour data baseline competency tiering, awareness–behaviour gap detection, predictive early-warning, and personalised recommendation, with no reliance on free text. Using a single-group pre–post design with 130 participants in the UK Black Country region and a multi-dimensional Likert instrument, all four competency domains (confidence, familiarity, GDPR knowledge, incident-response preparedness) improved significantly (paired-t, all $p<0.001$; large within-participant effects, Cohen’s $d\ge 1.0$). Improvement was strongly moderated by demographics: older adults gained most in familiarity, undergraduates in confidence, and lower-education participants in regulatory knowledge. The contributions are as follows: transparent and demographically stratified pre–post evidence for a multi-modal awareness program with effect sizes reported; a fitness-for-purpose comparison against contemporary analogs (KnowBe4, Proofpoint, CyberPatriot, iCAT, CAT-RWE, GPT-CSAT, escape-room studies) that treats AI as a first-class design dimension; and an articulated AI integration architecture for the framework, demonstrated offline on the cohort using only structured performance and behaviour data (no free text). In this architecture, a gradient-boosted classifier assigns participants to three baseline competency tiers at 93.1% cross-validated accuracy; these tiers differ sharply in measured improvement (ANOVA $F=68.8$, $p<0.001$; Foundational $+1.79$ vs. Applied $+0.30$ scale points), an awareness–behaviour gap segment is detected and predicted from intake signals alone (AUC $=0.73$), and a recommender routes participants to personalised follow-on tracks. As the design is single-group and self-reported, results are reported as evidence of within-participant change associated with the intervention rather than as a causal efficacy estimate, and the AI layer is demonstrated for feasibility rather than being evaluated as a separate trial arm; the scope is explicitly individual security awareness and behaviour, not technical network, IIoT, or cloud security. Full article

Background/Objectives: Nabiximols, a standardized extract of Cannabis sativa, has been approved as an add-on therapy for patients with moderate to severe spasticity associated with multiple sclerosis (MS). Moreover, current Italian treatment algorithms suggest that cannabis-based therapies may have further relevance in the management of MS. The aim of our systematic review and meta-analysis was to assess the effectiveness of nabiximols in relieving symptoms other than spasticity in adult MS patients. Methods: A systematic search was conducted in Web of Science, MEDLINE (via PubMed), Cochrane CENTRAL and Embase on September 10, 2025. Study selection was performed according to the predefined PROSPERO protocol (CRD42022329952). Data were combined into a common denominator and examined using a random-effects model with meta-regression expressed as mean difference (MD) and a 95% confidence interval (CI). Risk of bias was assessed using the Cochrane risk of bias instrument (RoB2) and the Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I) tool. Results: Of the 49 eligible articles, 25 were included in the statistical analysis (2949 patients). Significant improvements in spasm quality (MD = −16.87; 95% CI = (−29.75)–(−3.99)), bladder function (MD = −16.38; 95% CI = (−22.18)–(−10.58)), sleep disruption (MD = −15.75; 95% CI = (−22.02)–(−9.49)) and gait function (timed walk MD(s) = −5.31; 95% CI(s) = (−9.88)–(−0.74)) were observed. Time-dependency was not significant. The subject global impression of change (SGIC) improved significantly after the first month (odds ratio (OR) = 1.69; 95% CI = (1.30)–(2.18)). Conclusion: Beyond spasticity, nabiximols may represent a signal of benefit for bladder function, sleep disruption, spasm quality, and gait function in MS, in line with the “spasticity-plus” concept. However, the evidence certainty was low to very low, and these findings should be considered exploratory. Full article

Background: Dynamic risk stratification is fundamental to the modern management of pulmonary arterial hypertension (PAH). However, data on the impact of sequential add-on therapy in patients with Group 1.4 PAH—particularly in Latin American populations—remains limited. This study evaluated changes in risk classification using COMPERA 2.0 and REVEAL Lite 2 scores in patients treated with endothelin receptor antagonist (ERA) and phosphodiesterase type 5 inhibitor (PDE5i) combination therapy (macitentan + sildenafil) at a referral center in Mexico. Methods: In this single-center, retrospective cohort study, 25 patients with a confirmed diagnosis of PAH between 1st January 2022 and 31st December 2024 were evaluated at baseline and after 24 weeks of treatment. Clinical, functional, and biochemical parameters were recorded. Within-patient changes were analyzed using the Wilcoxon signed-rank test, and agreement between risk assessment tools was assessed using Spearman’s correlation coefficient. Results: At 24 weeks, patients demonstrated significant improvement in World Health Organization functional class (p = 0.002) and a significant reduction in brain natriuretic peptide levels (p = 0.003). Both COMPERA 2.0 and REVEAL Lite 2 scores showed a consistent shift toward lower-risk categories. A strong concordance between the two tools was observed. Conclusions: Sequential add-on ERA + PDE5i therapy was associated with meaningful improvement in risk stratification among patients with Group 1.4 PAH. These findings support the clinical utility of simplified, noninvasive risk assessment tools in real-world settings, particularly in resource-constrained environments. Full article

Cannabinoids are potential anticancer agents for the add-on treatment of malignant tumors. Here, the effects of the previously less-explored non-psychoactive phytocannabinoids cannabigerol (CBG) and cannabichromene (CBC) on survival, apoptosis, and mitochondrial function were assessed in A549 and H460 lung cancer cells. CBG and CBC triggered concentration-dependent cell death, autophagy, and mitochondrial apoptosis in both cell lines, with apoptosis indicated by Annexin V staining, activation of caspase-8, -9, and -3/7, loss of mitochondrial membrane potential, and elevated cytosolic levels of mitochondrial cytochrome c. CBG also upregulated ATF4, a stress-responsive transcription factor involved in autophagy and apoptotic signaling, and enhanced PARP cleavage. Both cannabinoids increased mitochondrial superoxide formation and reduced the mitochondrial oxygen consumption rate, with CBG additionally decreasing NDUFB8, a subunit of respiratory chain complex I. Pharmacological receptor modulation showed that CBG- and CBC-induced cell death occurred independently of CB₁, CB₂, TRPV1, TRPM8, and PPARγ, whereas CBG-mediated cell death relied on PPARα, which also contributed to its apoptotic effects. In summary, CBG and CBC induce apoptosis and cell death in A549 and H460 cells, with PPARα mediating the effects of CBG, highlighting its potential as a therapeutic target. Full article

This study investigates broadband vibration and mechanical shock mitigation for an aluminum (AlSi10Mg) battery pack casing by integrating mechanical metamaterial wall modifications and add-on damping structures. A 12.432 kWh underbody-type casing is designed. Two wall architectures, i.e., the star-triangular honeycomb (STH) and a novel hybrid auxetic (NHA), are implemented on three walls (top, front, and rear) of the battery pack casing. A mechanical damping (DSMS) and three biomimetic damping concepts (BWBIS, BPPIS and BBIGPS) are further compared. All designs are evaluated through simulation using random vibration analysis based on ISO 12405-2 standard, followed by shaker-based shock and random vibration experiments. Simulations show that both modified casings suppress the casing vibration by approximately ${10}^2$–${10}^6$ relative to the solid casing, and their dominant peaks shift to above 150 Hz. The NHA casing provides higher overall vibration mitigation than the STH casing (98.07% longitudinal, 95.09% vertical, and 93.60% transverse versus 97.64%, 94.00%, and 91.51%). Thus, the NHA casing is selected for fabrication. In addition, BPPIS and BBIGPS outperform BWBIS and DSMS, and thus, BPPIS is selected for fabrication due to its simpler geometry and lower mass. Experimentally, the solid-BPPIS configuration achieves the most robust random vibration attenuation across all measurement points, with average root mean square (RMS) reductions of 26.82% (vertical), 87.34% (longitudinal), and 83.60% (transverse). Shock tests reveal strong direction dependence; adding damping structures improves longitudinal and transverse shock mitigation, while vertical shock mitigation remains limited. The results provide design-level guidance on selecting wall architectures and damping layouts for practical vibration and shock protection of electric vehicle (EV) battery pack casings. Full article