Search Results (502)

Ensuring software quality during development requires effective regression testing. However, test suites in open-source libraries often grow large, redundant, and difficult to maintain. Most traditional test suite optimization methods treat test cases as atomic units, without analyzing the utility of individual instructions. This paper presents an intelligent method for test case synthesis using a Q-learning agent. The agent learns to construct compact test cases by interacting with an execution environment and receives rewards based on branch coverage improvements and simultaneous reductions in test case length. The training process includes a pretraining phase that transfers knowledge from the original test suite, followed by adaptive learning episodes on individual test cases. As a result, the method requires no formal documentation or API specifications and uses only execution traces of the original test cases. An explicit synthesis algorithm constructs new test cases by selecting API calls from a learned policy encoded in a Q-table. Experiments were conducted on two open-source C++ libraries of differing API complexity and original test suite size. The results show that the proposed method can reach up to 67% test suite reduction while preserving branch coverage, confirming its effectiveness for regression test suite minimization in resource-constrained or specification-limited environments. Full article

Background: Nemaline myopathy is a rare congenital neuromuscular disease associated with progressive weakness and frequent respiratory complications. In emergency situations, families often serve as the first and only responders. The aim of this study is to explore how parents in Spain care for children with nemaline myopathy during emergency situations, focusing on the clinical responses performed at home and the organizational challenges encountered when interacting with healthcare systems. Methods: A qualitative phenomenological study was conducted with 17 parents from 10 families belonging to the Asociación Yo Nemalínica. Semi-structured interviews were performed via video calls, transcribed verbatim, and analyzed using Giorgi’s descriptive method and ATLAS.ti software (version 24). Methodological rigor was ensured through triangulation, reflexivity, and member validation. Results: Four themes were identified. First, families were described as acting under extreme pressure and in isolation during acute home emergencies, often providing cardiopulmonary resuscitation and respiratory support without professional backup. Second, families managed ambiguous signs of deterioration using clinical judgment and home monitoring tools, often preventing fatal outcomes. Third, parents frequently assumed guiding roles in emergency departments due to a lack of clinician familiarity with the disease, leading to delays or errors. Finally, the transition to the Pediatric Intensive Care Unit was marked by emotional distress and rapid decision-making, with families often participating in critical choices about invasive procedures. These findings underscore the complex, multidisciplinary nature of caregiving. Conclusions: Parents play an active clinical role during emergencies and episodes of deterioration. Their lived experience should be formally integrated into emergency protocols and the continuity of care strategies to improve safety and outcomes. Full article

Background: Anhedonia, defined as the diminished capacity to experience pleasure, represents a core negative symptom in first-episode psychosis (FEP) with profound implications for functional outcomes and long-term prognosis. Despite its clinical significance, comprehensive understanding of anhedonia prevalence, underlying mechanisms, and optimal intervention strategies in early psychosis remains limited. Objectives: To systematically examine the prevalence and characteristics of anhedonia in FEP patients, explore neurobiological mechanisms, identify clinical correlates and predictive factors, and evaluate intervention efficacy. Methods: Following PRISMA 2020 guidelines, we conducted comprehensive searches across PubMed, Embase, PsycINFO, and Web of Science databases from January 1990 to June 2025. Studies examining anhedonia and negative symptoms in FEP patients (≤24 months from onset) using validated assessment instruments were included. Quality assessment was performed using appropriate tools for study design. Results: Twenty-one studies comprising 3847 FEP patients met inclusion criteria. Anhedonia prevalence ranged from 30% at 10-year follow-up to 53% during acute phases, demonstrating persistent motivational deficits across illness trajectory. Factor analytic studies consistently supported five-factor negative symptom models with anhedonia as a discrete dimension. Neuroimaging investigations revealed consistent alterations in reward processing circuits, including ventral striatum hypofunction and altered network connectivity patterns. Social anhedonia demonstrated stronger associations with functional outcomes compared to other domains. Epigenetic mechanisms involving oxytocin receptor methylation showed gender-specific associations with anhedonia severity. Conventional antipsychotic treatments showed limited efficacy for anhedonia improvement, while targeted psychosocial interventions demonstrated preliminary promise. Conclusions: Anhedonia showed high prevalence (30–53%) across FEP populations with substantial clinical burden (13-fold increased odds vs. general population). Meta-analysis revealed large effect sizes for anhedonia severity in FEP vs. controls (d = 0.83) and strong negative correlations with functional outcomes (r =·−0.82). Neuroimaging demonstrated consistent ventral striatum dysfunction and altered network connectivity. Social anhedonia emerged as the strongest predictor of functional outcomes, with independent suicide risk associations. Conventional antipsychotics showed limited efficacy, while behavioral activation approaches demonstrated preliminary promise. These findings support anhedonia as a distinct treatment target requiring specialized assessment and intervention protocols in early psychosis care. Full article

Groundwater is a critical yet understudied resource in Peru, where surface water has traditionally dominated national assessments. This study provides the first country-scale analysis of groundwater storage (GWS) variability in Peru from 2003 to 2023 using satellite gravimetry data from the Gravity Recovery and Climate Experiment (GRACE) and GRACE Follow-On (GRACE-FO) missions. We used the GRACE Data Assimilation-Data Mass Modeling (GRACE-DA-DM GLV3.0) dataset at 0.25° resolution to estimate annual GWS trends and evaluated the influence of El Niño–Southern Oscillation (ENSO) events and anthropogenic extraction, supported by in situ well data from six major aquifers. Results show a sustained GWS decline of 30–40% in coastal and Andean regions, especially in Lima, Ica, Arequipa, and Tacna, while the Amazon basin remained stable. Strong correlation (r = 0.95) between GRACE data and well records validate the findings. Annual precipitation analysis from 2003 to 2023, disaggregated by climatic zone, revealed nearly stable trends. Coastal El Niño events (2017 and 2023) triggered episodic recharge in the northern and central coastal regions, yet these were insufficient to reverse the sustained groundwater depletion. This research provides significant contributions to understanding the spatiotemporal dynamics of groundwater in Peru through the use of satellite gravimetry data with unprecedented spatial resolution. The findings reveal a sustained decline in GWS across key regions and underscore the urgent need to implement integrated water management strategies—such as artificial recharge, optimized irrigation, and satellite-based early warning systems—aimed at preserving the sustainability of the country’s groundwater resources. Full article

Underactuated systems, such as the Cart–Pole and Acrobot, pose significant control challenges due to their inherent nonlinearity and limited actuation. Traditional control methods often struggle to achieve stable and optimal performance in these complex scenarios. This paper presents a novel stable reinforcement learning (RL) approach for underactuated systems, integrating advanced exploration–exploitation mechanisms and a refined policy optimization framework to address instability issues in RL-based control. The proposed method is validated through extensive experiments on two benchmark underactuated systems: the Cart–Pole and Acrobot. In the Cart–Pole task, the method achieves long-term balance with high stability, outperforming traditional RL algorithms such as the Proximal Policy Optimization (PPO) in average episode length and robustness to environmental disturbances. For the Acrobot, the approach enables reliable swing-up and near-vertical stabilization but cannot achieve sustained balance control beyond short time intervals due to residual dynamics and control limitations. A key contribution is the development of a hybrid PPO–sliding mode control strategy that enhances learning efficiency and stabilities for underactuated systems. Full article

Through the testimony of a Tangier female citizen who grew up in the “prolific multilingual Spanish-French-Darija context of international Tangier”, this article analyzes the web of beliefs projected onto both the inherited and local languages within her linguistic repertoire. Starting from the daily realities in which she was immersed and the social networks that she formed, we focus on the representations of communication and her affective relationship with the host societies. The analysis starts from the most immediate domestic context in which Spanish, in its variant Jaquetía (a dialect of Judeo-Spanish language spoken by the Sephardic Jews of northern Morocco) was displaced by French as the language of instruction. After an initial episode of reversible attrition, we witnessed various phenomena of translanguaging within the host society. Following the binomial “emotion-interrelational space”, we seek to discern the affective contexts associated with the languages of a multilingual childhood, and which emotional links are vital for maintaining inherited ones. This shift towards the valuation of the affective culture implies a reorientation of the gaze towards everyday experiences as a means of research in contexts of language contact. Full article

Background and Objectives: During exam sessions, many students experience high levels of stress caused by the large volume of material to study, tight deadlines, and pressure to achieve top grades. This study aimed to examine the relationship between academic stress, sleep disturbances, and eating behaviors by using validated questionnaires administered to a student sample. As stress levels increased, the data revealed a higher frequency of insomnia symptoms and disordered eating, including behaviors such as compulsive eating and irregular meal patterns. Materials and Methods: This cross-sectional, correlational study was conducted on a convenience sample of 317 university students from various academic centers across Romania. Participants were recruited via online distribution of a self-administered questionnaire during a four-month period, including exam sessions. The survey included the Perceived Stress Scale (PSS), the Insomnia Severity Index (ISI), and the Eating Disorder Examination Questionnaire (EDE-Q), alongside additional items assessing perceived links between stress, sleep, and eating behaviors, and the use of medication. Data were analyzed using SPSS with Spearman correlations, t-tests, and linear regression. Results: Statistical analyses revealed significant and positive associations between perceived stress levels and insomnia, as indicated by Spearman’s correlation (p < 0.01). A similar significant correlation was identified between perceived stress and disordered eating behaviors among students. Specifically, the feeling of being overwhelmed by academic workload showed a strong positive correlation with a lack of control over eating behaviors (r = 0.568). Furthermore, linear regression analysis confirmed a significant predictive relationship between feeling overwhelmed and the tendency to eat excessively beyond initial intentions, with a standardized regression coefficient B = 0.581 (p < 0.001). A separate regression analysis focusing on exam-related stress and episodes of compulsive eating behavior demonstrated a comparable result (B = 0.573, p < 0.001), indicating a robust positive association. Additionally, independent samples t-tests demonstrated that students experiencing high levels of stress during the exam period reported significantly greater difficulties with sleep initiation and higher levels of disordered eating compared to their peers with lower stress levels. The difference in insomnia scores was highly significant (t = 11.516, p < 0.001), as was the difference in eating behavior scores (t = 10.931, p < 0.001). Conclusions: These findings underscore the need for emotional support services and effective stress management strategies, enabling students to navigate academic demands without compromising their mental or physical well-being. Full article

Reliable short-term forecasts of hepatitis B incidence are indispensable for sizing national vaccine and antiviral procurement. However, predictive modelling is complicated when surveillance streams experience reporting delays and episodic under-reporting, as has occurred in Ukraine since 2022. We address this challenge by training a deliberately compact two-layer long short-term memory (LSTM) network on 72 monthly observations (January 2018–December 2023) drawn from the Public Health Center electronic registry and evaluating performance on a strictly held-out 12-month horizon (January–December 2024). Grid-search optimisation selected a 12-month sliding input window, 64 hidden units per layer, 0.20 dropout, the Adam optimiser, and early stopping. Walk-forward validation showed that the network attained mean squared errors of 411 for acute infection and 76 for chronic infection on the monthly series. When forecasts were aggregated to the cumulative scale, the mean absolute percentage error remained below 1%. This study presents the first peer-reviewed hepatitis B forecasts calibrated on Ukraine’s registry during a period of pronounced reporting instability, demonstrating that robust accuracy is attainable without missing-value imputation. Full article

Carotid stenosis is a common pathology in clinical practice and unfortunately carries a high risk of serious cerebrovascular events. The early recognition of carotid plaque and, consequently, a careful analysis by means of multimodal imaging are the necessary steps to undertake a correct management pathway, aimed at preventing or, if not possible, reducing the risk of atherogenic phenomena responsible for cerebral infarction. In particular, the presence or absence of clinical symptoms, understood as the occurrence of events such as TIAs in the last 6 months, non-disabling strokes or repeated episodes of amaurosis fugax, and the degree of carotid stenosis, are certainly the most studied parameters, and as reported by several international guidelines, can lead to the best therapeutic strategy: whether to rely on conservative medical therapy or to resort to mechanical revascularization of the carotid stenosis. According to the recommendations of the European Society of Vascular Surgery, mechanical revascularization is recommended for stenosis > 50% in symptomatic patients and stenosis > 60% in asymptomatic patients. In contrast, the latest findings on plaque vulnerability have focused attention on individual patient characteristics and clinical comorbidities that may be responsible for plaque inflammation and should therefore be taken into consideration to decide if revascularization treatment is needed even in those subjects who present stenosis with less degree than reported as critical value. Moreover, further radiological investigations are fundamental to finding the presence of entities such as plaque ulceration, plaque neo-vascularization, fibrous caps, and intraplaque lipid core that are responsible for increased vulnerability. Medical therapy involves interventions aimed at eliminating cardiovascular risk factors by administering drugs that control the comorbidities responsible for worsening carotid stenosis. Recent studies are also evaluating the effectiveness of new plaque-modifying drugs or targeted anti-inflammatory agents in reducing the risk of plaque development and complications. Revascularization therapies, on the other hand, include surgery (CEA), the endovascular technique (CAS), and a new hybrid technique (TCAR): they are all valid alternatives for the treatment of carotid stenosis, each with specific technical difficulties, but on the whole with comparable safety profiles and risk rates of postoperative complications, although some recent emergencies have focused attention on possible short- and long-term gender-dependent outcome differences. The aim of this manuscript is to present the state of the art in the management of patients with carotid stenosis and to take a closer look at revascularization options. In our opinion, the choice of one strategy over another should therefore depend on gender, anatomical features of the patient, preoperative comorbidities, and last but not least, the experience of the center and the multidisciplinary team involved in the management of the patient. Full article

Emergency department overcrowding disproportionately affects complex patients, such as older adults and those with comorbidities, who consume significant resources and experience prolonged delays. This study integrates process mining and predictive simulation to identify key factors influencing length of stay and to propose a data-driven solution: a tailored fast-track pathway for high-risk patients. Using data from 94,489 emergency episodes, a predictive formula was developed based on clinically relevant variables, including age (>65 years); triage levels (II and III); frequent emergency department visits; need for mobility aids; and specific reasons for consultation such as dyspnea, abdominal pain, and poor general condition. Simulation results demonstrated that implementing this fast-track pathway reduces length of stay by up to 21% and emergency department saturation by 35%, even with minimal resource allocation (five beds). The manual predictive formula showed comparable prediction performance to machine learning models while maintaining transparency and traceability, ensuring greater acceptability among healthcare professionals. This approach represents a paradigm shift in emergency department management, offering a scalable tool to optimise resource allocation, improve patient outcomes, and reduce operational inefficiencies. Future multicenter validations could establish this model as an essential component of emergency department management strategies. Full article

China’s accelerating industrialization has led to worsening air pollution, characterized by recurrent haze episodes. The accurate quantification of PM_2.5 distribution is crucial for air quality assessment and public health management. Although traditional prediction models can effectively identify PM_2.5 concentration fluctuations with moderate accuracy, their dependence relies heavily on extensive ground-based monitoring station data, limiting their applicability in areas with sparse monitoring coverage. To address this limitation, this study proposes a novel algorithm for high-precision PM_2.5 concentration prediction, termed VDMS (Vision Transformer with DLSTM Multi-Head Self-Attention and Self-supervision). Based on the traditional Vision Transformer (ViT) architecture, VDMS incorporates a Double-Layered Long Short-Term Memory (DLSTM) network and a Multi-Head Self-Attention mechanism to enhance the model’s capacity to capture temporal sequence features and global dependencies. These enhancements contribute to greater stability and robustness in feature representation, ultimately improving prediction performance. Cross-validation experimental results show that the VDMS model outperforms benchmark models in PM_2.5 concentration prediction tasks, achieving a coefficient of determination (R²) of 0.93, a root mean square error (RMSE) of 4.05 μg/m³, and a mean absolute error (MAE) of 3.23 μg/m³. Furthermore, experiments conducted in areas with sparse ground monitoring stations demonstrate that the model maintains high predictive accuracy, further validating its applicability and generalization capability in data-limited scenarios. Moreover, the VDMS model adopts a modular design, offering strong scalability that allows its architecture to be adjusted according to specific requirements. This adaptability renders it suitable for monitoring various atmospheric pollutants, providing essential technical support for precise environmental management and air quality forecasting. Full article

Background/Objectives: The vestibulo-respiratory reflex regulates the tension of the respiratory muscles, which prevents apneas and awakenings during sleep. This study aimed to determine whether functional deficits in the inner ear disturb sleep quality. Methods: We compared sleep parameters in patients with their first episode of acute inner ear deficit (Group A: sudden idiopathic vertigo attack, sudden sensorineural hearing loss), chronic functional inner ear impairment (Group B: chronic peripheral vertigo, permanent hearing loss), and in healthy individuals (Group C). Polygraphy recordings were performed twice, in Group A at the onset of acute otoneurological symptoms and the second time after their withdrawal with an interval of 1 to 13 days, in Group B after 1 to 6 days, and in Group C after 1 to 8 days. Results: In Group A during the symptomatic night, overall and central apnea-hypopnea indices were significantly higher and snoring time was longer. Group A also had higher central apnea-hypopnea index on the first night compared to healthy individuals. In chronic disorders, sleep recordings showed lower autonomic arousal index than in controls or symptomatic nights in Group A. Conclusions: These findings highlight the severity of sleep apnea indicators in Group A. Our results suggest that acute dysfunction of the inner ear substantially impacts central neuronal signaling responsible for regulating normal sleep-related breathing and leads to a deterioration in sleep quality in contrast to individuals with chronic inner ear impairments. It can also be assumed that people with chronic vertigo or hearing loss experience less interrupted sleep than healthy individuals. Full article

It has previously been shown that complex-valued electromagnetic fields can substantially increase the symmetry of Maxwell’s Equations (MEs). They are consistent with known experimental findings in classical electrodynamics and result in some interesting predictions. For example, complex MEs predict the existence of magnetic monopoles that would have escaped detection in past experimental searches for them. This paper extends the basic complex-valued MEs for use inside matter. The increased symmetry of the extended MEs is demonstrated by an electromagnetic duality transformation analogous to that of the standard MEs and a fundamentally new type of duality transform. A derived wave equation unexpectedly shows that the imaginary-valued portion of waves inside of matter propagates without attenuation or reduced speed. Demonstrating the existence of the imaginary-valued field components predicted by this theory could have substantial implications for understanding physical and biological phenomena. To illustrate this, ways in which imaginary-valued field components would contribute to existing electromagnetic field theories of consciousness are described. The ability of complex-valued fields to account for disparate phenomena (failure of past experimental searches to find magnetic monopoles; several poorly understood features of subjective time and memory) increases the probability of their existence. Full article

Background: Loneliness is both a social and a health-related problem, and among LGBT people, feelings of loneliness are often exacerbated. According to the minority stress theory, stress and loneliness can be directly related to the discrimination and stigma that are experienced over time in a heteronormative society. Exposure to social stigma causes mental health problems, stress, and loneliness, coupled with increased social and economic vulnerability. Method: The aim of this study was to conduct an exploratory analysis of homosexual men’s feelings of loneliness and their relationship with experiences of discrimination throughout their life. A qualitative methodology involving focus groups and individual interviews was utilized. Results: The results show the double or overlapping discriminations that gay men experience as a result of their age and sexual orientation and, in some cases, their HIV status, and the relationship between said discrimination and the feeling of unwanted loneliness. Exposure to such intolerance is more common among those with a reduced social network, which limits their social participation and has a negative impact on their well-being. Conclusion. The aging process of LGBT people implies a new context of intervention and research that must be addressed to prevent episodes of unwanted loneliness that negatively affect the quality of life among this demographic. Full article

Background: This study explored how health professionals construct clinical and psychological meaning based on the location of self-injury on the body, particularly in relation to concealed or visible injuries and how they might inform attributions about risk, self-injury functions, and distress. Methods: This study used qualitative thematic analysis of semi-structured interviews with 19 health professionals with experience working with self-injury, exploring perceptions and attributions about self-injury in different body locations. Results: Seven themes emerged. In some cases, staff’s attributions aligned with the findings from studies of those who self-injure, such as injuries to areas such as the neck are higher risk. Location was one factor among others, such as injury severity, that staff considered when assessing the risk of infection or suicide. Staff often viewed visible injuries as less risky and attributed them to interpersonal communicative functions, and concealed injuries to intrapersonal factors, though not all staff shared these perspectives. Some staff considered other potential drivers of injury location, including past experiences such as trauma, demographic factors, mental health diagnoses, and exposure to social influences. Some staff described the practical determinants of injury location, such as ease of access, and considered the impact of self-injury location on themselves and their colleagues. Conclusions: Injury location can influence staff perceptions of risk, self-injury functions and distress, underscoring the need for individualized assessment and formulation of each self-injury episode to ensure appropriate risk management. Staff training should be adapted to address injury location to improve understanding, raise awareness of related attributions, and enhance the development of clinical skills. Organizations should support staff in their role due to the potential emotional impact of working with individuals who self-injure and are at risk of suicide. Future research should investigate whether location-based attributions are associated with unintended clinical consequences, such as inaccuracies in risk assessment and formulation. Full article