Search Results (1,382)

Background and Clinical Significance: Brugada syndrome (BrS) is a rare inherited cardiac channelopathy, often associated with SCN5A loss-of-function mutations. Clinical presentations range from asymptomatic to malignant arrhythmias and sudden cardiac death. Physiological and pharmacological stressors affecting sodium channel function—such as pyrexia, certain medications, and possibly pregnancy—may unmask or exacerbate arrhythmic risk. However, there is limited information regarding pregnancy and obstetric outcomes. Obstetric management remains largely informed by isolated case reports and small case series. A literature review was conducted using OVID Medline and Embase, identifying case reports, case series, and one retrospective cohort study reporting clinical presentation, obstetric management, and outcomes in maternal BrS. A case is presented detailing coordinated multidisciplinary input, antenatal surveillance, and intrapartum and postpartum care to contribute to the growing evidence base guiding obstetric care in this complex setting. Case Presentation: A 30-year-old G2P0 woman with asymptomatic BrS (SCN5A-positive) was referred at 31 + 5 weeks’ gestation for multidisciplinary antenatal care. Regular review and collaborative planning involving cardiology, anaesthetics, maternal–fetal medicine, and obstetrics guided a plan for vaginal delivery with continuous cardiac and fetal monitoring. At 38 + 0 weeks, the woman presented with spontaneous rupture of membranes and underwent induction of labour. A normal vaginal delivery was achieved without arrhythmic events. Epidural block with ropivacaine and local anaesthesia with lignocaine were well tolerated, and 24 h postpartum monitoring revealed no abnormalities. Conclusions: This case adds to the limited but growing literature suggesting that with individualised planning and multidisciplinary care, pregnancies in women with BrS can proceed safely and without complication. Ongoing case reporting is essential to inform future guidelines and optimise maternal and fetal outcomes. Full article

Background: Family caregivers are a vital yet often under-recognized part of the healthcare system. They provide essential emotional, physical, and logistical support to individuals with illness, disability, or frailty, and their contributions improve continuity of care and reduce system strain. However, many healthcare and social service providers are not equipped to meaningfully engage caregivers as partners. In Alberta, stakeholders validated the Caregiver-Centered Care Competency Framework and identified the need for a three-tiered education model—Foundational, Advanced, and Champion—to help providers recognize, include, and support family caregivers across care settings. This paper focuses on the development and early evaluation of the Advanced Caregiver-Centered Care Education modules, designed to enhance the knowledge and skills of providers with more experience working with family caregivers. The modules emphasize how partnering with caregivers benefits not only the person receiving care but also improves provider effectiveness and supports better system outcomes. Methods: The modules were co-designed with a 154-member interdisciplinary team and grounded in the competency framework. Evaluation used the first three levels of the Kirkpatrick–Barr health workforce education model. We analyzed pre- and post-surveys from the first 50 learners in each module using paired t-tests and examined qualitative feedback and SMART goals through inductive content analysis. Results: Learners reported a high level of satisfaction with the education delivery and the knowledge and skill acquisition. Statistically significant improvements were observed in 53 of 54 pre-post items. SMART goals reflected intended practice changes across all six competency domains, indicating learners saw value in engaging caregivers as partners. Conclusions: The Advanced Caregiver-Centered Care education improved providers’ confidence, knowledge, and skills to work in partnership with family caregivers. Future research will explore whether these improvements translate into real-world practice changes and better caregiver experiences in care planning, communication, and navigation. Full article

Objectives: Surface-Guided Radiation Therapy (SGRT) has been widely adopted in breast cancer radiotherapy, particularly for improving setup accuracy and motion management. Recently, its application in lung cancer has attracted growing interest due to similar needs for precision. This study investigates the feasibility and clinical utility of SGRT in lung cancer treatment, focusing on its effectiveness in patient setup and real-time motion monitoring under frameless immobilization conditions. Materials and Methods: A total of 204 treatment records from 17 patients with primary lung cancer who underwent radiotherapy at Korea University Guro Hospital between October 2024 and April 2025 were retrospectively analyzed. Patients were initially positioned using the Identify system (Varian) in the CT suite, with surface data transferred to the treatment room system. Alignment was performed to within ±1 cm and ±2° across six degrees of freedom. Cone-beam CT (CBCT) was acquired prior to treatment for verification, and treatment commenced when the Distance to Correspondence Surface (DCS) was ≤0.90. Setup deviations from the Identify system were recorded and compared with CBCT in three translational axes to evaluate positioning accuracy and PTV displacement. Results and Conclusions: The Identify system was shown to provide high setup accuracy and reliable real-time motion monitoring in lung cancer radiotherapy. Its ability to detect patient movement and automatically interrupt beam delivery contributes to enhanced treatment safety and precision. In addition, even though the maximum longitudinal (Lng) shift reached up to −1.83 cm with surface-guided setup, and up to 1.78 cm (Lat) 5.26 cm (Lng), 9.16 cm (Vrt) with CBCT-based verification, the use of Identify’s auto-interruption mode (±1 cm in translational axes, ±2° in rotational axes) allowed treatment delivery with PTV motion constrained within ±0.02 cm. These results suggest that, due to significant motion in the longitudinal direction, appropriate PTV margins should be considered during treatment planning. The Identify system enhances setup accuracy in lung cancer patients using a surface-guided approach and enables real-time tracking of intra-fractional errors. SGRT, when implemented with systems such as Identify, shows promise as a feasible alternative or complement to conventional IGRT in selected lung cancer cases. Further studies with larger patient cohorts and diverse clinical settings are warranted to validate these findings. Full article

Purpose: To present the findings of our preliminary experience using daily image-guided radiotherapy (IGRT) supported by implanted fiducial markers (FMs) in the radiotherapy of the vaginal cuff, in a cohort of post-surgery endometrial cancer patients. Methods: Patients with vaginal cuff cancer requiring adjuvant radiation with external beams were enrolled. Five patients underwent radiation therapy targeting the pelvic disease and positive lymph nodes, with doses of 50.4 Gy in twenty-eight fractions and a subsequent stereotactic boost on the vaginal vault at a dose of 5 Gy in a single fraction. One patient was administered 30 Gy in five fractions to the vaginal vault. These patients underwent external beam RT following the implantation of three 0.40 × 10 mm gold fiducial markers (FMs). Our IGRT strategy involved real-time 2D kV image-based monitoring of the fiducial markers during the treatment delivery as a surrogate of the vaginal cuff. To explore the potential role of FMs throughout the treatment process, we analyzed cine movies of the 2D kV-triggered images during delivery, as well as the image registration between pre- and post-treatment CBCT scans and the planning CT (pCT). Each CBCT used to trigger fraction delivery was segmented to define the rectum, bladder, and vaginal cuff. We calculated a standard metric to assess the similarity among the images (Dice index). Results: All the patients completed radiotherapy and experienced good tolerance without any reported acute or long-term toxicity. We did not observe any loss of FMs during or before treatment. A total of twenty CBCTs were analyzed across ten fractions. The observed trend showed a relatively emptier bladder compared to the simulation phase, with the bladder filling during the delivery. This resulted in a final median Dice similarity coefficient (DSC) of 0.90, indicating strong performance. The rectum reproducibility revealed greater variability, negatively affecting the quality of the delivery. Only in two patients, FMs showed intrafractional shift > 5 mm, probably associated with considerable rectal volume changes. Target coverage was preserved due to a safe CTV-to-PTV margin (10 mm). Conclusions: In our preliminary study, CBCT in combination with the use of fiducial markers to guide the delivery proved to be a feasible method for IGRT both before and during the treatment of post-operative gynecological cancer. In particular, this approach seems to be promising in selected patients to facilitate the use of SBRT instead of BRT (brachytherapy), thanks to margin reduction and adaptive strategies to optimize dose delivery while minimizing toxicity. A larger sample of patients is needed to confirm our results. Full article

Due to the limited endurance of UAVs, especially in scenarios involving large areas and dense target nodes, it is challenging for multiple UAVs to complete diverse tasks while ensuring timely execution. Toward this, we propose a cross-platform system consisting of an aircraft carrier (AC) and multiple UAVs, which makes unified task planning for included heterogeneous platforms to maximize the efficiency of the entire combat system. The carrier-based UAV swarm mission planning problem is formulated to minimize completion time and resource utilization, taking into account large-scale targets, multi-type tasks, and multi-obstacle environments. Since the problem is complex, we design a decoupled framework to simplify the solution by decomposing it into two levels: upper-level AC path planning and bottom-level multi-UAV cooperative mission planning. At the upper level, a drop point determination method and a discrete genetic algorithm incorporating improved A* (DGAIIA) are proposed to plan the AC’s path in the presence of no-fly zones and radar threats. At the bottom level, an improved differential evolution algorithm with a market mechanism (IDEMM) is proposed to minimize task completion time and maximize UAV utilization. Specifically, a dual-switching search strategy and a neighborhood-first buying-and-selling mechanism are developed to improve the search efficiency of the IDEMM. Simulation results validate the effectiveness of both the DGAIIA and IDEMM. An animation of the simulation results is available at simulation section. Full article

The Ministry of Land, Infrastructure, and Transport conducted a demonstration project targeting pilot areas to commercialize drone delivery services in urban areas and to present a standard model. In this study, flight data on drone delivery routes in Ulju and drone hovering in Yeosu were collected and analyzed for flight safety. Since there are no domestic or international regulations on the stability of drone flight, we were given the task of analyzing whether drone path flight should be maintained within a 10 m error range from the planned path line by the Korea Transportation Safety Authority and whether hovering works while satisfying the left and right radius errors and altitude errors within 3 m. Accordingly, the drone flight path data analyzed in Ulju met the criteria of up to 1.07%, and the hovering data analyzed in Yeosu met the criteria of less than 3% for the entire section data. Therefore, the drone flight stability evaluation analyzed in this paper is considered to have been passed. Based on the results of this study, is the data are expected to serve as a cornerstone for establishing guidelines for drone delivery flight data analysis regulations. Full article

This narrative review explores the integration of theranostics and artificial intelligence (AI) in neuro-oncology, addressing the urgent need for improved diagnostic and treatment strategies for brain tumors, including gliomas, meningiomas, and pediatric central nervous system neoplasms. A comprehensive literature search was conducted through PubMed, Scopus, and Embase for articles published between January 2020 and May 2025, focusing on recent clinical and preclinical advancements in personalized neuro-oncology. The review synthesizes evidence on novel theranostic agents—such as Lu-177-based radiopharmaceuticals, CXCR4-targeted PET tracers, and multifunctional nanoparticles—and highlights the role of AI in enhancing tumor detection, segmentation, and treatment planning through advanced imaging analysis, radiogenomics, and predictive modeling. Key findings include the emergence of nanotheranostics for targeted drug delivery and real-time monitoring, the application of AI-driven algorithms for improved image interpretation and therapy guidance, and the identification of current limitations such as data standardization, regulatory challenges, and limited multicenter validation. The review concludes that the convergence of AI and theranostic technologies holds significant promise for advancing precision medicine in neuro-oncology, but emphasizes the need for collaborative, multidisciplinary research to overcome existing barriers and enable widespread clinical adoption. Full article

This study investigates the optimization of urban parcel delivery by integrating logistics vehicles and onboard drones within a static road network. A centralized delivery hub is responsible for coordinating both modes of transport to minimize total vehicle operation costs and customer waiting times. A simulation-based framework is developed to accurately model the delivery process. An enhanced Ant Colony Optimization (ACO) algorithm is proposed, incorporating a multi-objective formulation to improve route planning efficiency. Additionally, a scheduling algorithm is designed to synchronize the operations of multiple delivery bikes and drones, ensuring coordinated execution. The proposed integrated approach yields substantial improvements in both cost and service efficiency. Simulation results demonstrate a 16% reduction in vehicle operation costs and an 8% decrease in average customer waiting times relative to benchmark methods, indicating the practical applicability of the approach in urban logistics scenarios. Full article

While the explosive growth in e-commerce stresses urban logistics systems, city planners lack of fine-grained data in order to anticipate and manage the resulting freight flows. Using a three-stage analytical approach combining descriptive zonal statistics, hotspot analysis and different regression modeling from univariate to geographically weighted regression, this study integrates one year of parcel deliveries from a leading courier with open spatial layers of land-use zoning, census population, mobile-signal activity and household income to model last-mile demand across different land use types. A baseline linear regression shows that residential population alone accounts for roughly 30% of the variance in annual parcel volumes (2.5–3.0 deliveries per resident) while adding daytime workforce and income increases the prediction accuracy to 39%. In a similar approach where coefficients vary geographically with Geographically Weighted Regression to capture the local heterogeneity achieves a significant raise of the overall R² to 0.54 and surpassing 0.70 in residential and institutional districts. Hot-spot analysis reveals a highly fragmented pattern where fewer than 5% of blocks generate more than 8.5% of all deliveries with no apparent correlation to the broaden land-use classes. Commercial and administrative areas exhibit the greatest intensity (1149 deliveries per ha) yet remain the hardest to explain (global R² = 0.21) underscoring the importance of additional variables such as retail mix, street-network design and tourism flows. Through this approach, the calibrated models can be used to predict city-wide last-mile demand using only public inputs and offers a transferable, privacy-preserving template for evidence-based freight planning. By pinpointing the location and the land uses where demand concentrates, it supports targeted interventions such as micro-depots, locker allocation and dynamic curb-space management towards more sustainable and resilient urban-logistics networks. Full article

Background: In this work, we examine determinants of staff departure rates in the NHS, a critical issue for workforce stability and continuity of care. High turnover, particularly among clinical staff, undermines service delivery and incurs substantial replacement costs. Methods: Here, we analyse a unique dataset derived from Electronic Staff Records at Ashford and St. Peter’s NHS Foundation Trust, using a machine learning approach to move beyond traditional survey-based methods, to assess propensity to leave. Results: In addition to established predictors such as salary and length of service, we identify drivers of increased risks of staff exits, including the distance between home and workplace and, especially for medical staff, cost centre vacancy rates. Conclusions: These findings highlight the multifactorial nature of staff retention and suggest the potential of local administrative data to improve workforce planning, for example, through hyperlocal recruitment strategies. Whilst further work will be required to assess the generalisability of our findings beyond a single Trust, our analysis offers insights for NHS managers seeking to stabilise staffing levels and reduce attrition through targeted interventions beyond pay and tenure. Full article

The COVID-19 pandemic has highlighted critical vulnerabilities in urban logistics systems, particularly in last-mile delivery. To enhance logistics resilience and efficiency, the Korean government has initiated an innovative project that repurposes idle spaces in subway vehicle bases within the Seoul Metropolitan Area into logistics centers. This study proposes a comprehensive multi-criteria evaluation framework combining the Analytic Hierarchy Process (AHP) and the Technique for Order Preference by Similarity to Ideal Solution (TOPSIS) to assess the suitability of ten candidate sites. The evaluation criteria span four dimensions, facility, geographical, environmental, and social factors, derived from the literature and expert consultations. AHP results indicate that geographical factors, especially proximity to urban centers and major logistics facilities, hold the highest weight. Based on the integrated analysis using TOPSIS, the most suitable locations identified are Sinnae, Godeok, and Cheonwang. The findings suggest the strategic importance of aligning infrastructure development with spatial accessibility and stakeholder cooperation. Policy implications include the need for targeted investment, public–private collaboration, and sustainable logistics planning. Future research is encouraged to incorporate dynamic data and consider social equity and environmental impact for long-term urban logistics planning. Full article

Anal cancer is a rare malignancy with rising incidence. Definitive treatment with radiation and concurrent chemotherapy represent the standard of care for patients with non-metastatic disease. Advances in radiation delivery through the use of intensity-modulated radiotherapy have significantly reduced the toxic effects of treatment. Adaptive radiotherapy (ART) has emerged as a strategy to further enhance treatment precision and individualize therapy in response to patient-specific changes during the course of chemoradiotherapy. The rationale for ART in anal cancer stems from the recognition that significant anatomic and tumor changes can occur throughout the 5–6-week treatment course, including tumor shrinkage, weight loss, and variable rectal/bladder filling. This review discusses the role of ART in contemporary anal cancer management. We overview the principles of ART, delineate the technical workflows (including both computed tomography (CT) and MR-guided approaches), and examine how adaptive techniques are applied in treatment planning and delivery. We also review the clinical evidence to date, including dosimetric studies and emerging clinical trial data on ART in anal cancer, particularly its impact on outcomes and toxicity. Full article

Background/Objectives: This study aims to present a structured clinical workflow for offline adaptive Biology-guided Radiotherapy (BgRT) using the RefleXion X1 PET-linac system, addressing challenges introduced by inter-treatment anatomical and biological changes. Methods: We propose a decision tree offline adaptation framework based on real-time assessments of Activity Concentration (AC), Normalized Target Signal (NTS), and bounded dose-volume histogram (bDVH%) metrics. Three offline strategies were developed: (1) preemptive adaptation for minor changes, (2) partial re-simulation for moderate changes, and (3) full re-simulation for major anatomical or metabolic alterations. Two clinical cases demonstrating strategies 1 and 2 are presented. Results: The preemptive adaptation strategy was applied in a case with early tumor shrinkage, maintaining delivery parameters within acceptable limits while updating contours and dose distribution. In the partial re-Simulation case, significant changes in PET signal necessitated a same-day PET functional modeling session and plan re-optimization, effectively restoring safe deliverability. Both cases showed reduced target volumes and improved OAR sparing without additional patient visits or tracer injections. Conclusions: Offline adaptive workflows for BgRT provide practical solutions to address inter-fractional changes in tumor structure and function. These strategies can help maintain the safety and accuracy of BgRT delivery and support clinical adoption of PET-guided radiotherapy, paving the way for future online adaptive capabilities. Full article

The growing mismatch between ecosystem service (ES) supply and demand underscores the importance of thoroughly understanding their spatiotemporal patterns and key drivers to promote ecological civilization and sustainable development at the regional level in China. This study investigates six key ES indicators across mainland China—habitat quality (HQ), carbon sequestration (CS), water yield (WY), sediment delivery ratio (SDR), food production (FP), and nutrient delivery ratio (NDR)—by integrating a suite of analytical approaches. These include a spatiotemporal analysis of trade-offs and synergies in supply, demand, and their ratios; self-organizing maps (SOM) for bundle identification; and interpretable machine learning models. While prior research studies have typically examined ES at a single spatial scale, focusing on supply-side bundles or associated drivers, they have often overlooked demand dynamics and cross-scale interactions. In contrast, this study integrates SOM and SHAP-based machine learning into a dual-scale framework (grid and city levels), enabling more precise identification of scale-dependent drivers and a deeper understanding of the complex interrelationships between ES supply, demand, and their spatial mismatches. The results reveal pronounced spatiotemporal heterogeneity in ES supply and demand at both grid and city scales. Overall, the supply services display a spatial pattern of higher values in the east and south, and lower values in the west and north. High-value areas for multiple demand services are concentrated in the densely populated eastern regions. The grid scale better captures spatial clustering, enhancing the detection of trade-offs and synergies. For instance, the correlation between HQ and NDR supply increased from 0.62 (grid scale) to 0.92 (city scale), while the correlation between HQ and SDR demand decreased from −0.03 to −0.58, indicating that upscaling may highlight broader synergistic or conflicting trends missed at finer resolutions. In the spatiotemporal interaction network of supply–demand ratios, CS, WY, FP, and NDR persistently show low values (below −0.5) in western and northern regions, indicating ongoing mismatches and uneven development. Driver analysis demonstrates scale-dependent effects: at the grid scale, HQ and FP are predominantly influenced by socioeconomic factors, SDR and WY by ecological variables, and CS and NDR by climatic conditions. At the city level, socioeconomic drivers dominate most services. Based on these findings, nine distinct supply–demand bundles were identified at both scales. The largest bundle at the grid scale (B3) occupies 29.1% of the study area, while the largest city-scale bundle (B8) covers 26.5%. This study deepens the understanding of trade-offs, synergies, and driving mechanisms of ecosystem services across multiple spatial scales; reveals scale-sensitive patterns of spatial mismatch; and provides scientific support for tiered ecological compensation, integrated regional planning, and sustainable development strategies. Full article

Background: Physical exercise during pregnancy is strongly recommended due to its well-established benefits for both mother and child. However, its impact on the pelvic floor remains insufficiently studied. This study aimed to evaluate pelvic floor adaptations to a structured prenatal exercise program using transperineal ultrasound, and to assess associations with the duration of the second stage of labor and mode of delivery. Methods: This is a planned secondary analysis of a randomized controlled clinical trial (RCT) (NCT04563065) including women with singleton pregnancies at 12–14 weeks of gestation. Participants were randomized to either an exercise group, which followed a supervised physical exercise program three times per week, or a control group, which received standard antenatal care. Transperineal ultrasound was used at the second trimester of pregnancy and six months postpartum to measure urogenital hiatus dimensions at rest, during maximal pelvic floor contraction, and during the Valsalva maneuver, to calculate hiatal contractility and distensibility and to evaluate levator ani muscle insertion. Regression analyses were performed to assess the relationship between urogenital hiatus measurements and both duration of the second stage of labor and mode of delivery. Results: A total of 78 participants were included in the final analysis: 41 in the control group and 37 in the exercise group. The anteroposterior diameter of the urogenital hiatus at rest was significantly smaller in the exercise group compared to controls (4.60 mm [SD 0.62] vs. 4.91 mm [SD 0.76]; p = 0.049). No other statistically significant differences were observed in static measurements. However, contractility was significantly reduced in the exercise group for both the latero-lateral diameter (8.54% vs. 4.04%; p = 0.012) and hiatus area (20.15% vs. 12.55%; p = 0.020). Distensibility was similar between groups. There were no significant differences in the duration of the second stage of labor or mode of delivery. Six months after delivery, there was an absolute risk reduction of 32.5% of levator ani muscle avulsion in the exercise group compared to the control group (53.3% and 20.8%, respectively; p = 0.009). Conclusions: A supervised exercise program during pregnancy appears to modify pelvic floor morphology and function, reducing the incidence of levator ani muscle avulsion without affecting the type or duration of delivery. These findings support the safety and potential protective role of prenatal exercise in maintaining pelvic floor integrity. Full article