Search Results (5,666)

Background/Objectives: Cervical radiculopathy is a frequent cause of pain, often leading to disability, reduced quality of life, and significant healthcare utilization. Cervical epidural steroid injections are widely used, though safety concerns have been reported. Ultrasound-guided cervical retrolaminar block (RLCB) is a potential alternative. The purpose of this study was to evaluate the long-term clinical trajectory after ultrasound-guided cervical retrolaminar block, including pain outcomes, patient-reported improvement, and the rate of subsequent cervical spine surgery. Methods: This is a retrospective cohort analysis that was conducted at the Pain and Spine Surgery units in a single center. : We included 121 patients with cervical radiculopathy treated between January 2020 and September 2022 (mean age 49.4 ± 11.1 years; 51.2% male). All patients underwent RLCB. s: Primary outcome measures were subsequent cervical decompressive surgery and composite pain response (≥2-point absolute and ≥50% relative NRS reduction). Secondary outcome measures included recurrence, analgesic use, global rating of change (GRC), satisfaction, willingness to repeat, and safety. Baseline data was extracted from records; structured follow-up interviews were conducted at two years. Results: At two years, 9.1% required surgery, and 57.9% achieved composite pain response; 74.4% reported ≥2-point NRS reduction. GRC scores showed improvement (mean 5.0 ± 3.4), with 37% reporting “very much better.” Satisfaction was high, with 70.2% willing to repeat. Pain recurred in 71.1% but persisted in 28.9%. No major complications occurred; minor events were reported in 6.6%. Outcomes were less favorable in patients with pre-injection pain duration ≥1 year. p. Conclusions: In this retrospective cohort, cervical RLCB was associated with sustained patient-reported improvement, high satisfaction, and a 9.1% observed subsequent surgery rate at two years. These findings are hypothesis-generating and require confirmation in prospective controlled studies. Full article

A Q-switched pulsed laser based on a coupled 7-core Yb-doped fiber with a cavity based on a fiber Bragg grating array has been demonstrated with a maximum energy of microsecond pulses up to 15 μJ at a 1 kHz repetition rate. The lasing spectrum is hybridized so that the laser line maxima of each core are nearly the same, having a negligible spread relative to each other, which is much lower than the wavelength shifts between individual FBGs in the cores. At the same time, the generated power is nearly the same in all the cores. However, when increasing the power beyond the stimulated Raman scattering threshold, the supermodes are destroyed so that the spectra in the cores become increasingly different and less stable, and the output power is mainly concentrated in one of the cores, whereas the pulse shortens significantly to a sub-microsecond duration (300 ns), with damped oscillations appearing at the beginning. The new regimes we demonstrated of the multicore fiber laser are promising for creating powerful pulsed radiation sources with a narrow spectrum. Full article

Namibia’s rural communities continue to experience limited and unreliable electricity access despite the potential of the country’s exceptional solar, wind, and biomass renewable energy resources. Conventional grid extension remains financially and technically impractical for dispersed off-grid settlements, underscoring the need for cost-effective, renewable-based alternatives. This paper presents a resource-driven design and multi-objective optimization framework for Hybrid Renewable Energy Systems (HRESs) tailored to Namibia’s off-grid communities. The proposed model integrates solar PV, wind turbines, biomass generators, and hydrogen-based fuel cells with a hybridized energy storage consisting of batteries, supercapacitors, and hydrogen tanks. Using the Non-dominated sorting Genetic Algorithm-II (NSGA-II), the system simultaneously minimizes Total Life Cycle Cost (TLCC), Levelized Cost of Electricity (LCOE), Loss of Power Supply Probability (LPSP), carbon dioxide (CO₂) emissions, and Wasted Renewable Energy (WRE). The framework is applied to three rural villages, Oluundje, Ombudiya, and Onguati, using high-resolution, site-specific renewable resource datasets and community-level load forecasts. The results demonstrate that resource-aligned configurations substantially improve system reliability (up to 99.28%), reduce LCOE (0.0023–0.0811 USD/kWh), and optimize dispatch behaviour across seasonal variations. Storage hybridization further enhances stability by balancing transient and long-duration deficits. Compared to existing diesel mini-grids, the optimized HRESs achieve markedly superior techno-economic and environmental performance. The proposed framework offers a scalable, adaptable, and policy-ready tool for accelerating sustainable rural electrification in Namibia. Full article

Flywheel energy storage systems (FESSs) offer millisecond-level response speed, making them highly suitable for providing system inertia/frequency support in emergency grid scenarios. However, the FESSs often have limited energy capacity due to their high capacity cost, which necessitates a comprehensive consideration between remaining stored energy and sustained support capability. Thus, this paper proposes a virtual synchronous generator (VSG) control strategy based on a multi-time-step model predictive control (MPC) that considering flywheel’s state of charge (SOC), which provides both emergency frequency support and autonomous flywheel energy recovery within a single integrated framework. First, a multi-time-step MPC with the objective function aiming for both fast frequency response and smooth power output is introduced to compensate the reference power generated by the VSG strategy. Second, an SOC-adaptive frequency weight function is designed and incorporated into the objective function to balance the frequency deviation and the inertia/frequency support duration. Furthermore, an SOC self-recovery strategy is developed, allowing the flywheel to autonomously adjust its SOC to the desired range when the FESS is not participating in frequency regulation. Finally, the proposed strategy is verified through comprehensive simulations on various scenarios, demonstrating that it can efficiently and rapidly meet the frequency regulation demands when the SOC is sufficient, as well as achieve the balances between the frequency regulation performance and the support continuity when the SOC is insufficient. Full article

As energy demand continues to increase, the environmental impact of conventional petroleum-based sources has become a growing concern. Biofuels offer a sustainable alternative, with crude glycerol from biodiesel production showing promise for methane production via anaerobic digestion. To optimize methane production, the application of ultrasound as a pretreatment method has been investigated. This study introduces the novel use of ultrasound pretreatment to enhance methane yield from crude glycerol and improve anaerobic digestion efficiency. This work explores the relationship between ultrasound-pretreated crude glycerol and methane production while also assessing the role of reactor operational parameters in determining the final generated volume. The main purpose of this study is to determine how ultrasound duration and process conditions affect biogas performance and to identify an optimal strategy for maximizing methane output from this biodiesel by-product. Chemical oxygen demand (COD) increased from 29.1 to 45.1 g L⁻¹ after 30 min of ultrasound, representing a 55% rise due to enhanced organic matter disintegration. Methane generation improved markedly with pretreatment duration, increasing from 520 mL (10 min) to 1440 mL (15 min) and reaching 13,185 mL after 30 min in the laboratory reactor. The methane volume obtained in 22 days from glycerol subjected to a 30 min ultrasound pretreatment using a 1% glycerol mixture reached an impressive 16,224 mL. Full article

Background/Objectives: Adult epilepsy is clinically heterogeneous, and individual clinical predictors may not fully capture the multidimensional burden associated with drug-resistant epilepsy (DRE). This study aimed to identify latent clinical phenotypes in adults with epilepsy and examine their cross-sectional associations with DRE and broader disease burden. Methods: This regional observational cohort study used a source database of 1100 patients with epilepsy. After excluding two patients aged <18 years, the adult analytic cohort included 1098 patients. Complete-case latent class analysis (LCA) was performed in 1054 patients using age at onset, disease duration, seizure type, seizure frequency, serial seizures/status, postictal confusion, neurological status, neuroimaging category, and number of antiseizure medications. Model selection was based on statistical fit, class size, and clinical interpretability. Internal clinical validation outcomes included DRE, quality of life, cognitive screening, and stigma scores. Post hoc characterization described the classes by epilepsy etiology, derived epilepsy type, and seizure categories aligned with current terminology. Results: A three-class solution was selected, with class sizes of 314, 465, and 275. DRE prevalence increased stepwise across classes: 5.7%, 14.2%, and 33.1%, respectively (p < 0.001). In adjusted analysis, Class 2 had higher odds of DRE than Class 1 (odds ratio 2.70, 95% confidence interval 1.56–4.67), while Class 3 showed the strongest association (odds ratio 8.19, 95% confidence interval 4.15–16.16; both p < 0.001). Higher-burden classes showed lower quality-of-life and cognitive scores and higher stigma scores. Conclusions: LCA identified three clinically interpretable, burden-enriched phenotypic profiles associated with a stepwise gradient in DRE and broader multidimensional disease burden. These cross-sectional profiles may provide a useful framework for describing clinical heterogeneity in adult epilepsy and generating hypotheses for future validation studies. Full article

Green roofs are used as nature-based solutions for urban stormwater management and for improving the thermal performance of buildings. Their hydrological performance depends on structural properties and rainfall characteristics, but the relative importance of these factors has not been fully quantified. Therefore, this study aimed to identify the key variables controlling the hydrological effectiveness of a green roof. A conceptual model of a flat roof representing a typical single-family building in south-eastern Poland was developed in the Storm Water Management Model (SWMM), with a modeled roof area of 232 m² and 100% of the roof surface covered by the green roof LID system. A total of 24,576 simulation cases were analyzed, considering different values of soil thickness, berm height, initial saturation, vegetation-related storage, rainfall duration, rainfall probability, and rainfall temporal distribution. The hydrological response was evaluated using peak runoff reduction and cumulative runoff volume ratio determined at selected times after rainfall. Predictive models based on the eXtreme Gradient Boosting (XGBoost) algorithm were developed, and their interpretation was performed using the SHapley Additive exPlanations (SHAP) method. The main novelty of the study is its application-oriented framework combining SWMM simulations, XGBoost modeling, and SHAP explainability to distinguish the factors controlling peak runoff reduction and delayed runoff release from a green roof. The results showed that peak runoff reduction ranged from 10.97% to 100.00%, with a median of 99.91%, indicating a generally high capacity of the analyzed system to attenuate peak flow. In contrast, the cumulative runoff volume ratio increased over time, with median values rising from 0.05% immediately after rainfall to 7.91% after 24 h, confirming the significant retention and detention potential of the green roof. SHAP analysis revealed that peak runoff reduction was governed primarily by berm height, whereas cumulative runoff volume was controlled mainly by initial substrate saturation. The results confirm that different mechanisms control short-term and long-term green roof performance. Full article

Fast radio bursts (FRBs) are millisecond-duration radio transients of extragalactic origin, while ultra-high-energy cosmic rays (UHECRs; $E\gtrsim {10}^{18}$ eV) remain among the most important unresolved problems in astroparticle physics. This review examines the viability of FRBs and their central engines as sources of UHECRs within a comprehensive multi-messenger framework. We summarize the observational constraints on UHECR source populations imposed by the energy spectrum, nuclear composition, anisotropy measurements, diffuse $\gamma$-ray background, and high-energy neutrino observations, which, together, favor source classes capable of accelerating heavy nuclei with hard injection spectra, modest cosmological evolution, and sufficiently high source densities. We then review the current landscape of FRB progenitor and engine models, including magnetars, supramassive neutron stars, compact-object mergers, and accretion-powered systems, emphasizing their energetics, environments, and particle-acceleration capabilities through relativistic shocks, magnetic reconnection, magnetar wind nebulae, and direct electromagnetic acceleration by ultra-relativistic FRB pulses. We discuss how these scenarios are constrained by neutrino and $\gamma$-ray observations from IceCube, KM3NeT, and Fermi-LAT, as well as by large-scale UHECR anisotropy measurements from the Pierre Auger Observatory and Telescope Array. Finally, we examine the observational tests that will become possible in the coming decade through large samples of localized FRBs, composition-resolved UHECR measurements, next-generation neutrino observatories, and wide-field $\gamma$-ray facilities. We emphasize that FRB dispersion and rotation measures provide unique probes of the baryonic and magnetic environments relevant for UHECR acceleration and propagation, enabling a new form of multi-messenger tomography of cosmic-ray source environments and allowing the FRB–UHECR connection to become a quantitatively testable astrophysical framework. Full article

Floodplain wetlands are globally important ecosystems, yet altered hydrological regimes increasingly disrupt the balance between woody and non-woody vegetation. In Australia’s regulated Murray–Darling Basin, it remains unclear whether woody plant encroachment represents a persistent shift toward terrestrialisation or a dynamic process that can be periodically reversed by flooding. This study quantified long-term patterns of woody-vegetation encroachment and retreat across 32,000 ha of mapped wetlands in the mid-Murrumbidgee River floodplain from 1988 to 2023, and assessed how hydrological variability and floodplain connectivity mediate these dynamics. Using open, analysis-ready Earth observation data from Digital Earth Australia (DEA) within the Open Data Cube (ODC) framework, we combined DEA Land Cover for transition mapping, Water Observations for hydrological masking, Landsat surface reflectance for Enhanced Vegetation Index (EVI)-based spectral plausibility testing, and the Wetlands Insight Tool for qualitative temporal context. Woody-vegetation dynamics were strongly non-linear and closely linked to alternating drought and flood phases. During the Millennium Drought (2001–2009), mapped woody-cover decline exceeded 50% of wetland area in some sub-regions, whereas the post-drought recovery interval (2008–2013) produced encroachment exceeding 40% in the most affected areas. Across the full 35-year record, mean encroachment rates ranged from 85 to 250 ha yr⁻¹ among sub-regions, summing to approximately 865 ha yr⁻¹ of woody expansion across the floodplain, while retreat rates were lower overall (approximately 634 ha yr⁻¹), resulting in a net expansion of woody cover. Local hydrological connectivity strongly mediated these responses: infrequently inundated wetlands showed persistent terrestrialisation, whereas more frequently inundated, better-connected wetlands experienced periodic flood-driven retreat. Landsat-derived EVI broadly supported the mapped transitions, indicating general consistency with canopy greening and canopy decline, supporting the ecological plausibility of the detected changes. This open DEA–ODC workflow provides a transparent, transferable framework for operational wetland monitoring and demonstrates that maintaining natural flood frequency, duration, and connectivity is essential for sustaining the resilience of regulated floodplain systems. Full article

Public open spaces (POS) in old communities are important settings for daily neighborhood life, yet many renovated POS remain underused after physical upgrading. Existing evaluations often rely on subjective perceptions, providing limited evidence on how facilities are associated with vitality. This study analyzes the associations between facility provision and POS vitality in 63 renovated POS across 11 old communities in Jiulongpo District, Chongqing, China. POS vitality is operationalized through two behavioral dimensions, use frequency and stay duration, derived from video detection and tracking using YOLOv8 and ByteTrack. Facility provision was then classified by facility type and examined in relation to the vitality indicators through descriptive analysis and Generalized Estimating Equations models. Descriptive evidence indicates substantial heterogeneity in both facility provision and POS vitality. Resting amenities and landscape elements are more commonly provided, whereas children’s facilities show the lowest provision and greater spatial selectivity. Higher use frequency and longer stay duration are concentrated in some POS. The Generalized Estimating Equations analysis further indicates that facilities are not associated with vitality in a uniform way. Children’s facilities show the strongest positive associations with both use frequency and stay duration despite their limited provision, supporting their key role in POS vitality. Landscape elements and lighting facilities are more closely associated with stay duration, highlighting the role of environmental support in sustaining longer use. In contrast, the negative associations for fitness facilities, together with the non-significant results for resting and sanitation amenities, suggest that not all facility provision translates into stronger vitality. Taken together, renovation performance should be judged not by the quantity of upgraded facilities alone, but by whether facilities support the behavioral dimensions of vitality that a POS is expected to achieve. Full article

Background/Objectives: Advanced hormone receptor-positive (HR+), epidermal growth factor 2-negative (HER2−) breast carcinoma (BC) patients receive frontline therapy with cyclin-dependent tyrosine kinase 4/6 inhibitors + endocrine therapy (ET). At progression, the best management includes mutational analysis for ESR-1, allowing second-line therapy with elacestrant. The aim of this study was to evaluate the efficacy and safety of elacestrant in an Italian real-world setting. Methods: A multicenter, observational study with a mixed retrospective and prospective design was conducted in 13 medical oncology units across Italy. The study population included adult patients with HR+/HER2− locally advanced or metastatic breast cancer with an activating ESR1 mutation documented by liquid biopsy and progressing after at least one line of endocrine therapy containing a CDK4/6 inhibitor. Mutational analysis of plasma was performed using next-generation sequencing with a multigene panel that included ESR1, PIK3CA, AKT, and PTEN. The sample size was calculated according to the two-stage Simon design. Toxicity was classified according to CTCAE version 5.0 criteria. Survival analyses were conducted using the Kaplan–Meier method. Results: At the time of analysis, 39 evaluable patients were enrolled, all female and Caucasian, with a median age of 67 years (range 41–89). The efficacy analysis documented an overall ORR of 28% and a disease control rate of 56%. The median duration of response was 6+ months (95% CL: 3.5–10.6 m). Median overall survival was not reached with a median follow-up of 10 months. The toxicity profile was overall favorable: grade ≥2 asthenia was the most frequent adverse event (23%), followed by gastrointestinal toxicity, which was generally mild. No treatment-related toxicity was reported in 64% of patients. Dose reductions were necessary in 15% of cases, while permanent treatment discontinuation due to toxicity occurred in only 4%. Conclusions: The results of this Italian multicenter observational study confirm the efficacy and tolerability of elacestrant in HR+/HER2− metastatic breast cancer with ESR1 mutation, in a real-world context consistent with the data from the pivotal EMERALD study and with real-world data present in the literature. Full article

Time-Sensitive Networking (TSN) has emerged as a critical communication protocol for automotive Ethernet to support the high-bandwidth, real-time, and deterministic transmission requirements of next-generation in-vehicle networks. However, a clear and effective TSN mechanism combination tailored to the mixed and bursty traffic characteristics of automotive scenarios remains lacking. To address this issue, this paper proposes a combined TSN scheduling mechanism for automotive scenarios. The highest-priority traffic is scheduled by class-based Time-Aware Shaper (TAS), periodic bursty sensor traffic is shaped by Credit-Based Shaper (CBS), and medium-priority traffic adopts Multi-Cyclic Queueing and Forwarding (MCQF). Based on Compositional Performance Analysis (CPA), this paper derives the worst-case latency upper bound expressions for CQF streams and optimizes the schedulability analysis to reduce conservative errors. Simulation verifies that the theoretically calculated bounds cover the maximum simulation latency, and the optimized analysis reduces conservatism, with peak conservative error of 3.07% in the ring scenario and 10.59% in the automotive scenario. Compared with the strict priority and TAMCQF (a combination of TAS and Multi-CQF), the proposed mechanism combination suppresses the latency jitter of mixed traffic, mitigates long-duration blocking of medium-priority traffic caused by high-priority burst data, and provides reliable deterministic transmission guarantees for automotive in-vehicle networks. Full article

Sleep is crucial to infant development, and excessive sleep disturbances are associated with adverse outcomes for both infants and their caregivers. There is limited information on the longitudinal development of sleep (e.g., duration, fragmentation, etc.) from birth to 6 months of age. New technologies, which include real-time environmental sensing and responses, have the potential to overcome many of the traditional limitations on infant sleep monitoring. In this study, we demonstrate the feasibility of utilizing aggregated activity logs from a commercially available IoT (Internet of Things) bassinet to derive traditional sleep metrics (longest sleep stretch, total night sleep, and sleep efficiency), as well as novel metrics related to infant fussing and impacts of the bed’s ability to deliver responsive motion and sound. A total of 26,187 infants (1000–8000 per night) were included in this analysis. A data-driven approach was utilized to define the temporal boundaries of each night, divide each night into periods of sleep and fussing, and identify appropriate nights for inclusion. The derived data provide, in unprecedented resolution, a detailed longitudinal view of infant sleep in this specific population. Our results generally align with previous studies of traditional sleep metrics; however, they also demonstrate a methodological framework for descriptive or comparative monitoring of sleep and soothing, and uniquely characterize dyadic interactions that are not well-captured by traditional metrics. For example, the bassinet’s activity logs indicate not only the proportion of fussing episodes that are resolved without caregiver intervention (e.g., removal), but also reflect the delay between fussing and the need for caregiver intervention. Further evaluation of this sensor-enabled, responsive technology in relation to sleep and fussing is merited. Full article

Introduction: Sleep disturbances are common as we age and have been linked to poor cognition and increased cognitive decline. Objective: We aimed to examine cross-sectional and longitudinal associations between objective sleep measures and cognition in middle-aged and older adults, including cognitively healthy (CH) individuals and those with mild cognitive impairment (MCI). Methods: Participants from the Aiginition Longitudinal Biomarker Investigation Of Neurodegeneration (ALBION) study (age > 40) underwent 7-day wrist actigraphy (Actiwatch 2). Sleep exposures included sleep duration, sleep efficiency, sleep variability, sleep onset latency, wake after sleep onset (WASO), and number of awakenings. A neuropsychological battery was administered examining memory, executive function, visuospatial ability, language, attention speed, and a global composite score. Cross-sectional associations were tested using generalized linear models (adjusted for age, sex, education). Longitudinal associations with cognitive trajectories were examined with linear mixed-effect models. Results: In total (N = 184; 65% women; mean age 65 years), average sleep duration was 7.2 h and mean sleep efficiency was at 80%. Cross-sectionally, more nightly awakenings were associated with poor memory and attention speed. In a 1.5-year follow-up, (n = 93), higher baseline sleep efficiency was associated with better memory and language performance, while longer WASO, more awakenings, and longer sleep onset latency showed nominal associations with less favorable cognitive trajectories, although these associations did not remain statistically significant after FDR correction. Time-varying analyses indicated that sleep variability showed robust non-linear associations with poorer memory trajectories over follow-up and remained significant after FDR adjustment; significant mean change in awakenings and variability appeared to intensify in later follow-up phases. The association between sleep characteristics and cognitive decline varied across follow-up time, with stronger adverse changes observed during later follow-up phases. Discussion: Objective indicators of sleep continuity, especially sleep variability, were most consistently related to domain-specific cognitive outcomes, with strongest evidence for memory over time. Sleep fragmentation and irregular sleep patterns may represent potentially modifiable targets for future strategies aimed at preserving cognitive health during aging. Full article

Background: Sorafenib remains an important treatment option for patients with radioiodine-refractory differentiated thyroid cancer (RAI-R DTC). This study evaluated real-world outcomes and prognostic factors in patients treated with sorafenib. Materials and Methods: This retrospective multicenter study included 176 patients with RAI-R DTC treated with sorafenib between 2000 and 2024 across sixteen centers. Clinical, pathological and treatment-related variables, including metastatic sites, radiotherapy, dose reduction, inflammatory markers (neutrophil-to-lymphocyte ratio [NLR] and platelet-to-lymphocyte ratio [PLR]) and pretreatment thyroglobulin (Tg), were analyzed. Progression-free survival (PFS) was evaluated using Kaplan–Meier analysis. Prognostic factors were assessed using univariate and multivariate Cox regression analyses. Results: The median follow-up duration was 24 months and the median PFS was 21 months (95% CI: 15.5–26.5). Partial response was observed in 82 patients (46.6%), stable disease in 55 (31.3%) and progressive disease in 35 (19.9%). Patients who underwent dose reduction had longer PFS than those without dose reduction (42 vs. 19 months, p = 0.030), and absence of dose reduction remained independently associated with progression risk. Patients who received radiotherapy had shorter PFS than those who did not receive radiotherapy (16 vs. 37 months, p = 0.002), and radiotherapy-related variables remained independent predictors of progression. Patients with PLR values >138.2 had shorter PFS than those with PLR values ≤ 138.2 (19 vs. 34 months, p = 0.047), although this association was not maintained in Cox regression analysis. Similarly, associations between NLR and Tg values and PFS did not reach statistical significance (p = 0.112 and p = 0.072, respectively). Hand–foot syndrome was the most common toxicity, occurring in 59 patients (33.5%), while Grade 3 hand–foot syndrome was observed in 7 patients (4.0%). Conclusions: Sorafenib provided meaningful disease control with a median PFS of 21 months in this real-world cohort. Dose reduction was associated with longer PFS, whereas radiotherapy requirement appeared to reflect a higher-risk subgroup. Toxicities were generally manageable. Full article