Search Results (680)

Continuous healthcare monitoring systems generate non-stationary physiological data streams, where evolving statistical properties and patterns often invalidate static models and fixed user classifications. To address this challenge, we propose drift-aware adaptive architecture that integrates concept drift detection into a distributed edge–cloud data analytics pipeline. In the proposed design, a concept drift is elevated from a maintenance signal to the primary mechanism governing user-state adaptation, model evolution, and inference consistency. Within the proposed system, the edge tier performs low-latency inference and preliminary drift screening under strict resource constraints, while the cloud tier executes advanced drift detection and validation, orchestrates user reclassification and model retraining, and manages model evolution. A feedback loop synchronizes edge and cloud operations, ensuring that detected drift triggers appropriate system transitions, either reassigning a user to an updated state category or initiating targeted model updates. This architecture reduces reliance on static group assignments, improves personalization, and preserves model fidelity under evolving physiological conditions. We analyze the drift types most relevant to healthcare data streams, evaluate the suitability of lightweight and cloud-grade drift detectors, and define the system requirements for stability, responsiveness, and clinical safety. Evaluation across 21 concurrent users demonstrates that drift-aware adaptation reduced prediction MAE by 40.6% relative to periodic retraining, with an end-to-end adaptation latency of 66 ± 37 s. Hierarchical cloud validation reduced the false-positive retraining rate from 88.9% (edge-only triggering) to 27.3%, while maintaining uninterrupted inference throughout all adaptation events. Full article

The development of complex products is challenged by diverse requirements, interdisciplinary coupling, intricate behaviors, and prolonged lifecycles. Traditional document-based systems engineering methods exhibit deficiencies in requirement validation, architectural verification, and cross-disciplinary integration, struggling to support early-stage verification and validation as well as interdisciplinary collaboration. To address these limitations, this paper proposes a scenario-based visual modeling method for the entire lifecycle of complex products, aiming to realize a closed-loop process epitomized by “construction as verification.” This method integrates model-based systems engineering, scenario-driven design, and multi-level visualization techniques to construct a multi-paradigm visual modeling and simulation framework driven by operational scenarios, use-case scenarios, and working-condition scenarios, each serving as the blueprint for constructing the corresponding Operational Concept, Functional/Logical, and Physical Specification Models. Concurrently, a semantic integration mechanism based on hybrid ontologies is introduced, which resolves semantic heterogeneity and facilitates model interoperability among multi-source heterogeneous models through formalized mapping. Furthermore, a simulation engine scheme based on Discrete Event System Specification is proposed to enable continuous verification from conceptual design to solution development. A case study on the braking mechanism of a high-speed train demonstrates that the proposed method can effectively support precise requirement validation, logical architectural verification, and multi-solution trade-off analysis, thereby significantly enhancing early verification capabilities and R&D efficiency. Full article

Distributed Energy Resource (DER)-integrated power grids are vulnerable to cascading effects under concurrent cyber–physical attacks, where even minor disruptions in system states accumulate and amplify over time, leading to significant system failures. Traditional static risk assessment methods are insufficient for modeling these time-varying, dynamic scenarios, particularly in the context of concurrent attacks. This paper presents a dynamic risk assessment framework leveraging time-synchronized co-simulation, which integrates power system and communication network simulations within a unified time framework. Cyber-attack actions in the communication layer are mapped to corresponding physical disturbances in the distribution network, including voltage, frequency, and power variations. Using the resulting system state evolution trajectories, a Markov Decision Process (MDP)-based state transition tree captures the progression of system risk under concurrent attacks. This framework accounts for cumulative risk across different attack paths and identifies critical nodes and high-risk propagation paths within the network. By incorporating a concurrent event detector into the MDP model, the method quantifies evolving risk dynamics, overcoming the limitations of traditional static methods. Case studies on the IEEE 13-node test feeder and IEEE 14-bus system demonstrate that concurrent attacks result in a security risk metric 2.3 times higher than single-point attacks, validating the effectiveness of the proposed approach in identifying vulnerable nodes whose compromise could lead to cascading failures, supporting the risk-aware prioritization of defensive resources. Full article

Background/Objectives: The use of GLP-1 RAs has dramatically increased with expanded indications for diabetes mellitus and obesity. Delayed gastric emptying due to these medications can lead to increased residual gastric content (RGC). While previous studies have focused on Esophagogastroduodenoscopy (EGD), few have specifically analyzed the impact of GLP-1 RAs on residual gastric content in patients undergoing concurrent colonoscopy with adequate bowel preparation. Methods: A retrospective, case–control study was conducted at Shanghai East Hospital from January 2023 to June 2025. Adult patients with increased RGC were identified as cases. Controls without increased RGC were randomly selected at a 1:2 ratio, matched for age and sex. Multivariable logistic regression was used to assess the independent association between GLP-1 RAs use and increased RGC. Results: Among 131,255 procedures screened, 3746 patients were included (1257 with increased RGC and 2489 controls). GLP-1 RAs users had higher odds of increased RGC in both unadjusted [OR 15.20 (95% CI 5.98–38.61)] and adjusted analyses [aOR = 13.31 (95% CI 5.07–34.93)]. Other significant risk factors for RGC included diabetes-related complications [aOR = 8.89 (3.15–25.12)]. Interestingly, among the enrolled patients who used GLP-1 RAs and underwent concurrent colonoscopy, 19 of the 22 patients (86.4%) exhibited increased RGC, whereas only 3 (13.6%) did not. Conclusions: Perioperative use of GLP-1 RAs is associated with an increased residual gastric content in patients undergoing EGD alone or with concurrent colonoscopy. There was no aspiration event related to residual gastric content. Our study highlights the need for vigilant preoperative assessment and individualized periprocedural management in patients on GLP-1 RAs undergoing endoscopic procedures, despite having standardized adequate bowel preparation. Full article

Background: Deletion of the MTAP gene at chromosome 9p21.3 defines a therapeutically actionable molecular subset of cancers due to synthetic lethal vulnerability to PRMT5 and MAT2A inhibition. The real-world prevalence and genomic context of MTAP deletion in diverse solid tumors remain incompletely characterized. Methods: We retrospectively analyzed 579 solid tumor specimens subjected to next-generation sequencing-based copy-number profiling. The prevalence of MTAP deletion and its co-occurrence with CDKN2A and CDKN2B were evaluated, and genomic deletion patterns across chromosome 9 were systematically assessed. Results: MTAP deletion was detected in 14 cases (2.4%, 95% confidence interval [CI], 1.45–4.02%), with enrichment in sarcoma, pancreatic cancer, and urothelial carcinoma. Concurrent CDKN2A loss was observed in 92.9% of MTAP-deleted tumors, and 64.3% showed additional CDKN2B loss, indicating a coordinated focal deletion event at 9p21.3. Statistical analyses confirmed strong genomic associations between MTAP and neighboring tumor suppressor genes. Across the full cohort, deletion frequency peaked at the 9p21 locus, and among MTAP-deleted tumors, co-deletion frequency decreased with increasing genomic distance. All MTAP-deleted tumors were microsatellite stable and low tumor mutational burden (TMB-low). Conclusions: Our findings demonstrate that MTAP deletion is an infrequent but genomically coherent event in solid tumors, characterized by a canonical 9p21 co-deletion pattern. This real-world analysis underscores the importance of comprehensive genomic profiling to identify patients who may benefit from emerging MTAP-directed therapies. Full article

Background: Proton beam therapy (PBT) is a valuable alternative to photon radiotherapy of CNS tumors in children and adolescents. While most recent studies deal with the outcome or long-term side effects of PBT, the aim of this study was to investigate the feasibility of PBT with a particular focus on the acute toxicity of a simultaneous radiochemotherapy (sPBCT). Patients and methods: We enrolled 199 children [median age 7.4 years (range, 0.9–17.9)], who received altogether 200 courses of PBT/sPBCT at initial diagnosis (n = 121) or at relapse (n = 79) with sPBCT in 52 (26%) courses. Data collection to PBT/sPBCT was based on the medical records and the KiProReg (Registry study of Standard Proton Therapy in Children at West German Proton Therapy Center) with a primarily descriptive-statistical and logistic regression analysis. Results: During PBT/sPBCT a total of n = 704 adverse events (AEs, mean 3.4 per course) were observed. Eighty-seven of them were graded as high-grade adverse events (HGAEs, Common Terminology Criteria for Adverse Eventº ≥3 (CTCAE)) which occurred in 67 (33.5%) PBT/sPBCT courses. HGAEs were in particular hematotoxicity (n = 43; 64.1%) and infections (n = 18; 26.8%). A significantly higher rate of HGAEs was documented in patients treated with sPBCT (n = 33/52; 63.5%) compared to those with PBT only (n = 34/148; 23.0%) (p = 0.001). In children with sPBCT, 15 (28.8%) patients could not receive the recommended dose or schedule of the planned chemotherapy (CTx) due to HGAEs, with the rate of planned CTx courses performed being significantly lower in patients receiving intensive intravenous CTx (p < 0.001). Interruptions of PBT and of simultaneous CTx were both significantly associated with the occurrence of infections [Odds ratios 3.002 (95% CI 1.005–8.971, p = 0.049) and 3.905 (95% CI 1.005–15.174, p = 0.049)]. Total discontinuation of treatment did not occur. Conclusions: Concurrent CTx during proton therapy is associated with a significant increased risk for HGAE occurrence and therapy interruptions requiring individual dose and schedule adjustments dependent on CTx intensity, very experienced interdisciplinary teams as well as intensive care and in-/out-patient oncology facilities on site. Full article

Left-ventricular non-compaction (LVNC) is a recently classified cardiomyopathy that involves abnormal trabeculations inside the left ventricle, most commonly located in the ventricular apex. There are 9 distinct types of non-compaction cardiomyopathy that can impact both the left and right ventricles with subtypes involving mostly pediatric patients with concurrent congenital heart disease (CHD), to individuals in late adult-staged ages. LVNC affects the population with an estimated range of incidence from 0.014% to 1.3% and the disease can be diagnosed with the utilization of imaging studies such as transthoracic echocardiography (TTE). LVNC can also impact and lead patients to develop heart failure with estimated prevalence that can reach to 3–4% during their lifetime. LVNC often leads to complications such as heart failure, arrhythmias, and thromboembolic events and without adequate medical management and pharmacological therapies this can progress and lead to worsening cardiac function, sudden cardiac arrest, and even death. There are no strict guidelines organized for screening and monitoring for LVNC in patients except with the inclusion of having a high suspicion in patients without other cardiac abnormalities. Thus, more advanced clinical research and the establishment of diagnostic protocols needs to be standardized in order to further investigate the causes, prognostic factors and therapeutic modalities of patients with LVNC. The field of LVNC cardiomyopathy is expanding but better understanding of the pathophysiology and genetic influence of this cardiac disease is vital for the precision treatment and personalized care of LVNC. Full article

Southern Africa is highly sensitive to climate variability associated with the El Niño Southern Oscillation (ENSO), which strongly influences hydroclimate, vegetation dynamics, and atmospheric composition. This study examined the impacts of the 2015/16 El Niño on vegetation, meteorological conditions, and atmospheric emissions over Southern Africa using satellite observations and reanalysis data. Time-lagged cross-correlation analysis of seasonally adjusted time-series was applied to characterize synchronous and delayed interactions among vegetation indices, hydrological variables, meteorological drivers, and air-quality parameters. Bayesian causal impact analysis was further used to quantify El Niño-induced anomalies by comparing observed conditions with counterfactual scenarios representing the absence of the event. The results showed that vegetation greenness responds primarily to concurrent moisture availability, with strong positive associations between NDVI, precipitation, soil moisture, and canopy water. Moisture-related variables exert delayed influences on atmospheric composition, highlighting the role of wet scavenging and dilution. Carbonaceous aerosols (black carbon [BC] and organic carbon [OC]), particulate matter [PM_2.5], and aerosol optical depth exhibit strong synchronous coupling, indicating a dominant biomass-burning source. The causal impact analysis reveals statistically significant and sustained post-2015 increases in fire-related emissions (carbon monoxide [CO], BC, OC, PM_2.5, and aerosol optical depth [AOD]), particularly during austral winter and dry seasons. In contrast, precipitation, soil moisture, evapotranspiration, and vegetation greenness show persistent negative anomalies, reflecting widespread drought stress under elevated temperatures. Overall, the findings demonstrate that the 2015/16 El Niño amplified fire emissions while suppressing ecosystem functioning across Southern Africa, underscoring strong climate–fire–vegetation feedback with important air-quality and environmental implications. Full article

Background: Total neoadjuvant therapy (TNT) is increasingly administered in rectal cancer, but compared with concurrent chemoradiotherapy (CRT), data regarding the gastrointestinal (GI) toxicity profile and clinical predictors remain limited. Objectives: To evaluate GI toxicity associated with TNT compared with CRT and to explore clinical predictors of these adverse events (AEs). Methods: This retrospective study included 201 patients with rectal cancer treated with TNT (n = 157) and CRT (n = 44). GI AEs (nausea, vomiting, diarrhea) were graded according to CTCAE v5.0. In the analysis of factors associated with GI AEs, multiple clinical and pathological variables were included using multivariable logistic regression. Results: The composite endpoint “any GI AEs grade ≥ 1” was more frequent in the TNT group compared with the CRT group (33.1% vs. 15.9%; RR = 2.08; 95% CI 1.02–4.25; p = 0.038). Nausea was significantly more frequent in the TNT group (28.7% vs. 9.1%; RR = 3.15; 95% CI 1.20–8.30; p = 0.012), whereas vomiting (9.6% vs. 2.3%; p = 0.203) and diarrhea (17.8% vs. 9.1%; p = 0.242) did not reach statistical significance. In multivariable logistic regression, TNT (OR = 2.65; 95% CI 1.08–6.53; p = 0.032) and female sex (OR = 2.03; 95% CI 1.05–3.77; p = 0.033) were identified as independent predictors of grade ≥ 1 GI AEs. For nausea, TNT remained significant (OR = 4.37; 95% CI 1.45–13.20; p = 0.0089). Upper rectal tumor location was significantly associated with vomiting (p = 0.0054). No grade 3–4 GI AEs were observed in either treatment group. Conclusions: TNT was associated with a higher incidence of mild GI AEs, predominantly driven by nausea, without an increase in severe toxicities. TNT and female sex were identified as independent clinical predictors of an increased risk of GI AEs, while tumor location in the upper third of the rectum was associated with a higher occurrence of vomiting. Full article

Background/Objectives: The co-occurrence of a carotid body tumor (CBT) and papillary thyroid carcinoma (PTC) is a rare clinical event. The frequency of this dual pathology in recent reports has sparked a debate on whether it represents a true pathophysiological association or an artifact of increased diagnostic surveillance. This study aims to report the prevalence, clinicopathological characteristics, management, and outcomes of concurrent CBT and PTC in a contemporary cohort. Methods: We conducted a retrospective review of patients who underwent CBT resection at two tertiary centers between 2014 and 2024. Data on patient demographics, tumor characteristics, preoperative imaging, surgical management (single stage vs. staged), final histopathology, and clinical outcomes were collected and analyzed. Results: Overall, 32 patients with surgically resected CBTs were included. Eleven patients (34.4%) had thyroid nodules identified on preoperative imaging. The mean age of the participants was 57.2 ± 16.3 years. Females represented the majority of the population (n = 27, 84.4%). Nine patients underwent thyroid surgery with subsequent pathological confirmation. Management involved resection at two different time intervals in five cases (55.6%) and a single-stage operation in four (44.4%). On final pathology, PTC was confirmed in eight patients (25.0%). During the follow-up period, no recurrences of either tumor type were observed. Conclusions: The prevalence of concurrent PTC in patients with CBTs is significantly higher than previously reported, reaching 25% in our cohort. This incidental finding raises the possibility of surveillance bias or underlying genetic mechanisms. Management with either a single-stage or staged surgical approach was not associated with major complications. The prognosis for patients with this dual pathology is excellent and appears to be dictated by the independent characteristics of each tumor. Full article

Aerosol–cloud interactions (ACIs) remain a long-standing uncertainty in quantifying cloud microphysical properties, convection, and precipitation. There are fewer investigations into the effects of ACIs on the southwest vortex (a mesoscale circulation with a spatial scale of 300–500 km). Satellite-retrieved MODIS data (2002–2022) reveals a decreasing trend in the June–August (JJA) seasonal mean ice droplet effective radius (DER_Ice) over the Sichuan Basin (SCB) since 2013, corresponding to China’s emission reduction efforts. Concurrently, post-2013 trends exhibit a positive shift in cloud-top height (CTH) and a negative trend in cloud-top pressure (CTP), collectively indicative of intensified convective activity. This contradicts the conventional conclusion that increased anthropogenic emissions reduce droplet effective radius (DER) and intensify convection under constant cloud water content. To address this discrepancy, we simulated the precipitation event caused by the southwest vortex (SWV) during 11–14 August 2020, under distinct initial aerosol loading (clean vs. polluted), using the fully coupled WRF-ACI-Full cloud-resolving model (incorporating sophisticated aerosol parameterizations). Results show that increased aerosols reduce basin-averaged precipitation by 0.54% and updraft speed by 0.37% in the polluted case compared to the clean case, which is negligible. These findings differ from previous studies on ACI-related cloud and precipitation responses. Full article

This paper investigates the fully distributed observer-based dynamic double-event-triggered bipartite consensus tracking problem of fractional-order multi-agent systems (FOMASs) with input saturation under a directed graph. First, to address this complex challenge, a pull-based dynamic double-event-triggered mechanism (DDETM) with different event-triggered conditions and capable of operating independently is designed, which can effectively reduce communication costs and controller updates concurrently. Then, the low-gain feedback technique is used to solve the input saturation problem faced by FOMASs under a directed graph. Based on the estimated state information, a fully distributed control protocol with pull-based DDETM is proposed to ensure the achievement of bipartite consensus tracking for FOMASs. A noteworthy feature of this control protocol is its ability to achieve system stability without the need for global information. Correspondingly, the sufficient conditions for achieving bipartite consensus is obtained with the help of low gain feedback technology and Lyapunov stability theory. Moreover, the Zeno behavior is precluded. Finally, a simulation example is presented to illustrate the theoretical results. Full article

Background/Objectives: Following centuries of systematic eradication, grey wolf (Canis lupus) populations across Europe have experienced a significant recovery over recent decades, which leads to concerns regarding, among others, anthropogenic hybridization. In Greece, the genetic status of the wolf population is largely unknown to date. Here, we genetically monitor and test for wolf–dog hybridization events in a recently established wolf population in the Parnitha Protected Area, in close vicinity to the capital city of Greece. Methods: One hundred and twenty-four wolf scat samples were genotyped at 20 canine-specific autosomal microsatellite loci and compared to available reference tissue samples from wolves and free-ranging dogs. Results: A minimum of 31 unique wolf individuals were identified, structured into at least three packs. No wolf–dog hybrids were detected in the study area. To validate the accuracy of the microsatellite analysis, an ancestry informative 93-SNP panel was applied to non-invasive wolf DNA samples from the study area, confirming the absence of hybrids among them. However, a possible wolf–dog hybrid was detected among reference wolf samples collected in Northern Greece, where individuals with atypical morphological traits are observed. The estimated census population size was in accordance with concurrently obtained camera trapping data, while heterozygosity values were low. Conclusions: This research represents the first systematic effort in Greece to genetically monitor wolves recently established in a protected area. It highlights the need for targeted management strategies based on genetic data to ensure balanced long-term conservation of wolves in peri-urban areas. Full article

This systematic review focuses on the effect of concurrent high-intensity interval training (HIIT) and resistance training on musculoskeletal function in adult individuals. Four electronic databases (PubMed, Web of Science Core Collection, Scopus, and PsycINFO) were searched for controlled trials in older or middle-aged adults, in recreationally exercising adults, and in athletic or tactical populations, which completed parallel HIIT and resistance training and described musculoskeletal responses to the intervention up to 30 November 2025. A total of 18 trials fulfilled the eligibility criterion and were synthesized narratively across the domains of maximal strength, explosive performance, neuromuscular activity, muscle morphology and architecture, tendon-related outcomes, and adherence and safety. Most 8- to 12-week interventions maintained two to three weekly resistance sessions and were designed in time-effective HIIT formats, increasing or preserving maximal strength in older subjects as well as younger ones that were trained. Explosive performance metrics, including both jump and sprint tasks, were usually preserved or even improved by the maintenance of the power-oriented component in resistance-based exercise sessions. The limited electromyography data indicated improved neuromuscular activation during submaximal tasks, particularly in older subjects, whereas some studies reported subtle increases or maintenance of muscle size and selective architectural patterns during application of progressive loading. Tendon-specific adaptations are difficult to measure, as imaging was seldom available, but functional tasks influenced by the muscle–tendon unit have been studied in multiple studies. Adherence was good, and adverse events were rare in all studies. Overall, the evidence suggests that well-designed concurrent HIIT and resistance training programs can improve or maintain musculoskeletal performance, although the magnitude and expression of these adaptations vary according to population characteristics and intervention design. Importantly, by integrating neuromuscular, morphological, and performance-related outcomes across diverse adult populations, this review provides a musculoskeletal-centered synthesis that extends prior concurrent training reviews beyond cardiorespiratory or interference-focused perspectives. Full article

As Large Language Models (LLMs) become increasingly integrated into web environments, they introduce complex microarchitectural noise that challenges existing hardware security mechanisms. This paper investigates the impact of concurrent web-based LLM workloads on the detection accuracy of Spectre attacks. Firstly, we constructed a representative dataset by executing multiple web-accessible LLMs (e.g., DeepSeek, Kimi, Doubao and Qwen) alongside Spectre attacks, capturing the specific interference patterns introduced by these AI workloads. Experimental analysis reveals that traditional Hardware Performance Counter (HPC)-based detectors, relying primarily on branch prediction and Last-Level Cache (LLC) events, suffer significant accuracy degradation due to the masking effects of LLM-induced noise. To address this limitation, we then propose a novel Spectre attack detector Spec-LAMP via augmenting conventional HPC feature sets with the L1D Miss Pending event. This new metric specifically captures unresolved speculative memory dependencies, a distinctive characteristic of Spectre attacks that remains discernible even under web-accessible LLM interference. Comparative statistical analysis demonstrates that incorporating this event significantly enhances the separability between malicious and benign executions. Finally, experimental results show that our proposed feature augmentation effectively restores detection performance, increasing average accuracy from 85.15% to 98.43% and demonstrating superior robustness compared to traditional approaches in realistic web-based LLM scenarios. Full article