Search Results (77)

External ear canal (EEC) stenosis, often associated with cholesteatoma, carries a high risk of postoperative restenosis despite surgical intervention. While individualized implants offer promise in preventing restenosis, the high morphological variability of EECs and the lack of standardized definitions hinder systematic implant design. This study aimed to characterize individual EEC morphology and to develop a validated automated segmentation system for efficient implant preparation. Reference datasets were first generated by manual segmentation using 3D Slicer^TM software version 5.2.2. Based on these, we developed a customized plugin capable of automatically identifying the maximal implantable region within the EEC and measuring its key dimensions. The accuracy of the plugin was assessed by comparing it with manual segmentation results in terms of shape, volume, length, and width. Validation was further performed using three temporal bone implantation experiments with 3D-Bioplotter©-fabricated EEC implants. The automated system demonstrated strong consistency with manual methods and significantly improved segmentation efficiency. The plugin-generated models enabled successful implant fabrication and placement in all validation tests. These results confirm the system’s clinical feasibility and support its use for individualized and systematic EEC implant design. The developed tool holds potential to improve surgical planning and reduce postoperative restenosis in EEC stenosis treatment. Full article

A primary expectation of college is that students in all majors and disciplines will learn content, skills, and knowledge that support individual growth, job placement, or continued academic endeavors. In short, being a student implies an expectation to learn. Effective learning directly impacts student academic success, and this success has downstream effects on student retention and graduation rates. However, the process of learning is often taken for granted, and, too often, student learning is not successful because students have not received any guidance on the methods of effective learning. Across higher education, students are often left on their own to learn about learning, and their improvised methods frequently involve ineffective techniques such as cramming for exams or rereading assigned materials without deeper engagement. To counter such observations, the University of Iowa implemented a campus-wide learning framework, Learning at Iowa. The initiative is grounded in empirically validated practices from the cognitive and learning sciences, which have been organized around the Three Ms: mindset, metacognition, and memory. This article briefly reviews the relevant literature supporting each of the Three Ms and then discusses the implementation of the framework with students, student-facing staff, and instructors and how the framework supports effective educational practices. Full article

Background/Objectives: The introduction of composite attachments has greatly improved orthodontic aligner therapy, through better force delivery, more predictable movements, and enhanced retention. This in vitro study aims to present and investigate an innovative digital protocol for aligner attachment fabrication incorporating the latest 3D technology used in dentistry. Methods: A virtual attachment measuring 2.5 × 2 × 2 mm was designed using computer-aided design (CAD) software (Meshmixer, Autodesk Inc., San Francisco, CA, USA) and exported as an individual STL file. The attachments were fabricated using a digital light processing (DLP) 3D printer (model: Elegoo 4 DLP, Shenzhen, China) and a dental-grade biocompatible resin. A custom 3D-printed placement guide was used to ensure precise positioning of the attachments on the printed maxillary dental models. A flowable resin was applied to secure the attachments in place. Following attachment placement, the models were scanned using a laboratory desktop scanner (Optical 3D Smart Big, Open Technologies, Milano, Italy) and three intraoral scanners: iTero Element (Align Technology, Tempe, AZ, USA), Aoral 2, and Aoral 3 (Shining 3D, Hangzhou, China). Results: Upon comparison, the scans revealed that the iTero Element exhibited the highest precision, particularly in the attachment, with an RMSE of 0.022 mm and 95.04% of measurements falling within a ±100 µm tolerance. The Aoral 2 scanner showed greater variability, with the highest RMSE (0.041 mm) in the incisor area and wider deviation margins. Despite this, all scanners produced results within clinically acceptable limits. Conclusions: In the future, custom attachments made by 3D printing could be a valid alternative to the traditional composite attachments when it comes to improving aligner attachment production. While these preliminary findings support the potential applicability of such workflows, further in vivo research is necessary to confirm clinical usability. Full article

Urban bus fleets worldwide face urgent decarbonization requirements, with Germany targeting net-zero emissions by 2050. Current electrification research often addresses individual components—energy consumption, scheduling, or charging infrastructure—in isolation, lacking integrated frameworks that capture complex system interactions. This study presents “eflips-X”, a modular, open-source simulation framework that integrates energy consumption modeling, battery-aware block building, depot–block assignment, terminus charger placement, depot operations simulation, and smart charging optimization within a unified workflow. The framework employs empirical energy models, graph-based scheduling algorithms, and integer linear programming for depot assignment and smart charging. Applied to Berlin’s bus network—Germany’s largest—three scenarios were evaluated: maintaining existing blocks with electrification, exclusive depot charging, and small batteries with extensive terminus charging. Electric fleets need 2.1–7.1% additional vehicles compared to diesel operations, with hybrid depot-terminus charging strategies minimizing this increase. Smart charging reduces peak power demand by 49.8% on average, while different charging strategies yield distinct trade-offs between infrastructure requirements, fleet size, and operational efficiency. The framework enables systematic evaluation of electrification pathways, supporting evidence-based planning for zero-emission public transport transitions. Full article

Orthonectids are a group of highly simplified worm-like parasites that are placed within Lophotrochozoa by multigene mitochondrial and nuclear phylogenies. However, their exact position within Lophotrochozoa is uncertain due to the high rate of molecular evolution and putative long branch attraction artifacts. To examine the phylogenetic placement of orthonectids, we applied an alternative approach that takes into account rare evolutionary events (gene order rearrangements in mitochondrial DNA and individual changes in mitochondrial proteins) with an assessment of their probabilities based on a reference sequence database (RefSeq, NCBI). This approach strongly supports the branching of orthonectids among annelids, but does not conclusively resolve their position among the annelid taxa. Full article

Background/Objectives: The percutaneous insertion of an external ventricular drain (EVD) is a common neurosurgical procedure that is crucial in managing acute brain injuries because of the drain’s role in monitoring intracranial pressure and draining cerebrospinal fluid. The primary indication is acute hydrocephalus, which often results from subarachnoid hemorrhage, intracranial hemorrhage, traumatic brain injury, stroke, or infection. Standard EVD placement targets the frontal horn of the lateral ventricle. However, complications such as hemorrhage, infection, and catheter occlusion frequently arise, with occlusion rates ranging from 19% to 47%. Occlusion can lead to increased intracranial pressure, necessitating interventions such as saline flushes or fibrinolytic drug administration. The placement of an EVD is a very specific choice that must be tailored to the individual patient, often in scenarios in which multiple interpretations of the data are possible: the question of which patient is eligible for EVD placement may be subjective. Intraventricular fibrinolysis (IVF) with urokinase-type plasminogen activator (uPA) or tissue-type plasminogen activator is used with the aim of lysing intraventricular clots and preventing EVD occlusion. Despite numerous studies, conclusive evidence on their efficacy is lacking. The CLEAR III trial confirmed the safety of IVF but showed uncertain benefits in neurological outcomes. Given the limited literature on uPA, this study evaluates its intrathecal administration for the prevention of EVD occlusion. Not all therapies are appropriate for all patients, and customizing strategies is often the right way to get the best result. Methods: This retrospective study analyzed 20 patients with EVDs receiving intrathecal uPA. The patients had a mean age of 56.4 years, with 95% presenting with hydrocephalus and 80% presenting with intraventricular hemorrhage. uPA dosages varied (25,000–100,000 IU), with an average of 3.9 doses per patient. Results: IVF effectively maintained EVD patency in 95% of cases. One patient experienced asymptomatic bleeding, while four (20%) developed post-treatment infections, the development of which was potentially influenced by the prolonged duration of EVD retention (>21 days). Analysis of Graeb scores showed faster clot resolution with early uPA administration. A higher initial Graeb score correlated with increased total uPA load but not with mortality or discharge outcomes. Although infection rates were slightly higher than in CLEAR III, multiple confounding factors, including duration of EVD retention and bilateral placement, were present. Conclusions: This study supports the feasibility and safety of intrathecal uPA administration for management of EVD occlusion in certain contexts. The appropriate choice in the context of ‘personalized medicine’ must necessarily consider the risk–benefit ratio. Full article

Matching constraints in an analog integrated circuit (IC) are critical to optimizing layout performance. To extract these matching constraints accurately and efficiently from the netlist, we propose the heterogeneous matching constraint extraction graph neural network (MCE-HGCN). First, the netlist is mapped into a heterogeneous attribute multi-graph, and based on the characteristics of analog IC matching constraints, a mixed-domain attention mechanism is developed to leverage both the topology information and node attributes in the graph to characterize node embeddings. A matching classifier, implemented using the support vector machine (SVM), is then employed to classify different types of matching constraints from the netlist. Additionally, a matching filter is introduced to remove interference terms. Experimental results demonstrate that the MCE-HGCN model converges effectively with small datasets. In the matching prediction process, the mean F1 score reached 0.917 across different netlist processes and circuit types while maintaining a shorter runtime compared to other methods. Ablation experiments also show that incorporating the mixed-domain attention mechanism and the matching filter individually leads to significant performance improvements. Overall, MCE-HGCN excels at extracting matching constraints from various analog circuits and processes, offering valuable insights for placement guidance and enhancing the efficiency of analog IC layout design. Full article

Our study investigates how the sequencing of text and image inputs within multi-modal prompts affects the reasoning performance of Large Language Models (LLMs). Through empirical evaluations of three major commercial LLM vendors—OpenAI, Google, and Anthropic—alongside a user study on interaction strategies, we develop and validate practical heuristics for optimising multi-modal prompt design. Our findings reveal that modality sequencing is a critical factor influencing reasoning performance, particularly in tasks with varying cognitive load and structural complexity. For simpler tasks involving a single image, positioning the modalities directly impacts model accuracy, whereas in complex, multi-step reasoning scenarios, the sequence must align with the logical structure of inference, often outweighing the specific placement of individual modalities. Furthermore, we identify systematic challenges in multi-hop reasoning within transformer-based architectures, where models demonstrate strong early-stage inference but struggle with integrating prior contextual information in later reasoning steps. Building on these insights, we propose a set of validated, user-centred heuristics for designing effective multi-modal prompts, enhancing both reasoning accuracy and user interaction with AI systems. Our contributions inform the design and usability of interactive intelligent systems, with implications for applications in education, medical imaging, legal document analysis, and customer support. By bridging the gap between intelligent system behaviour and user interaction strategies, this study provides actionable guidance on how users can effectively structure prompts to optimise multi-modal LLM reasoning within real-world, high-stakes decision-making contexts. Full article

The earthquake-induced water level responses in the fault zone may be distinctly different, even when the underground wells are very close. How to qualitatively and quantitatively analyze the differences and controlling factors of the groundwater response to earthquakes in the fracture zone is a hot topic in seismic hydrogeology. This study utilizes three adjacent groundwater monitoring wells, located across distinct structural domains of the Dachuan-Shuangshi Fault, to systematically investigate the different sensitivities of earthquake-induced water level responses and their main influencing factors. The statistical results reveal that monitoring wells located on opposing fault blocks demonstrate higher co-seismic sensitivity compared to the well situated within the fault fracture zone. The water level co-seismic responses are governed by multiple controlling factors, rather than being dominated by individual parameters. Therefore, we employed random forest to quantitatively assess the importance of influencing factors related to hydraulic parameters, aquifer confinement, fault architecture, tidal characteristics, and barometric efficiency. The results showed that hydraulic properties and aquifer confinement are the primary factors influencing the differential sensitivity of water level co-seismic responses. In contrast, the influence of barometric efficiency on water level co-seismic responses is relatively minor. These findings provide critical insights into the understanding of the mechanism and characteristics of seismic hydrological responses in fault zones and provide support for optimizing the placement of groundwater monitoring in seismotectonic environments. Full article

Background: We examined the effects of linear position transducer placement during Smith machine (SM) and free weight (FW) full squats on the mean velocity and the load–velocity relationship in trained women. In addition, we examined the relationship between the load–velocity characteristics and jump performance, to determine which testing approach is more appropriate for both the testing and transfer of training effects. Methods: Eleven trained women were assessed for 1-RM in FW and SM full back squats. Linear position transducers (LPTs) were attached to the barbell (BAR) and to the belt (BELT) during FW and SM full back squats. The mean velocity was measured across progressively increasing loads (30–100%). The load–velocity relationships were modeled using linear regression, and the velocity values, as well as the load–velocity parameters, were compared across all conditions (SM BAR, SM BELT, FW BAR, and FW BELT). Squat jump, countermovement jump, and drop jump performance were also assessed using an optical measurement system. Results: In SM compared to FW, 1-RM was higher (92.9 ± 16.2 kg vs. 85.1 ± 14.5 kg, p < 0.05, d = 0.53). A strong agreement was observed between the FW BAR and FW BELT (Lin’s concordance correlation coefficient CCC = 0.96–0.99), as well as between the SM BAR and FW BAR (CCC = 0.95–0.97) at low-to-moderate intensities (30–70% 1-RM), suggesting that these conditions can be used interchangeably. However, the SM BELT systematically showed lower mean velocity values at 30–80% 1-RM and exhibited low agreement across all other conditions. In contrast, the FW BELT mean velocity was lower than that of the FW BAR and SM BAR only at higher intensities (>80% 1-RM). V0 and mean velocities at low-to-moderate loads (30–70% 1-RM) showed strong correlations with all jump types, with relationships gradually weakening as the load increased (r = 0.63–0.93, p < 0.05). The highest correlations were observed in the SM BAR and FW BELT conditions. Lastly, the relative strength demonstrated a consistent relationship with squat jump and drop jump performance exclusively in the FW condition (r = 0.71 and 0.72, p < 0.05). Conclusions: The FW BAR and FW BELT showed strong agreement at submaximal loads and may be used interchangeably, while the SM BELT showed a lower mean velocity and low agreement with other conditions. The load–velocity relationship parameters and mean velocity at low-to-moderate loads correlated strongly with the jump performance. Coaches and practitioners can use bar-mounted and belt-mounted LPTs interchangeably during FW squats for velocity-based training at submaximal intensities when working with trained women. Additionally, tracking the mean velocity at low-to-moderate loads provides valuable insights into lower-body explosive performance, supporting more precise and individualized training prescriptions and performance monitoring. Full article

Exploring cognitive abilities is necessary in educational contexts, where such insights shape decisions about student placement and teaching methods. Traditionally, educational assessments have been leaned on academic performance to guide decisions related to grading and student placement. This study examines the relationships among specific neuropsychological measures, namely the Event Related Potentials (ERPs), P300 waveform, reaction time, and fluid intelligence in children. Raven’s Standard Progressive Matrices (RSPM) was utilized to assess intelligence levels. Based on their RSPM scores, participants were grouped into two categories: those with “high mental abilities” and those with “average mental abilities”. It was hypothesized that children with higher RSPM scores might display reduced P300 latencies and quicker reaction times, potentially reflecting greater neural efficiency. Electrophysiological data collected using ERPs, focusing on the P300 component. The results suggest a possible association between higher intelligence scores and shorter P300 latencies and quicker reaction times, which could support the concept of neural efficiency and the significance of cognitive speed in understanding intelligence. This investigation into the neuropsychological foundations of cognitive ability in children is in the same line with studies supporting how brain activity, connectivity, and processing efficiency vary. These differences could help develop educational strategies that are more tailored to individual cognitive processing styles. Full article

Background/Objectives: Integra Dermal Regeneration Template (IDRT) has emerged as a viable reconstructive option in exposed avascular structures, such as exposed bone devoid of periosteum. This systematic review aimed at examining success rates by comparing different wound types and their characteristics, as well as the surgical methods involved. Methods: A systematic review was conducted to identify studies using IDRT in the reconstruction of defects with exposed bone devoid of periosteum. Primary outcomes of interest were IDRT and skin graft success rates, followed by patient and wound characteristics, and different surgical methods used. The results were accompanied by an illustrative case report of IDRT-based hand reconstruction after a deep burn injury. Results: The review included 40 studies, with a total of 202 individual defects. The primary indication for IDRT-based reconstruction was post-oncologic defects in the elderly population. Although surgeons mostly used burring/fenestration as a bone preparation method prior to IDRT placement, decorticated bones showed faster grafting time (23.8 vs. 27.9 days). The average success rate of IDRT was 87.54% (±25.9), with an excellent IDRT take rate (100%) observed in more than 50% of cases. In the majority of cases (95.5%), the skin graft acceptance rate was deemed to be higher than 95%, with an average graft take of 98.8%. Conclusions: The results of this review support the use of IDRT in managing complex defects involving exposed bone, offering fast coverage with good functional restoration, without any donor site morbidity. Additionally, bone preparation methods also play an important role in IDRT-based reconstruction by shortening the grafting time. Full article

Background: Chronic health conditions frequently result in gait disturbances, impacting quality of life and mobility. Smartphone-based gait analysis has emerged as a promising alternative to traditional methods, offering accessibility, cost effectiveness, and portability. This systematic review evaluates smartphone-based inertial measurement units’ validity, reliability, and sensitivity for assessing gait parameters in individuals with chronic conditions. Methods: A comprehensive literature search in Web of Science, PubMed, Google Scholar, and SportDiscus identified 54 eligible studies. Results: Validity was evaluated in 70% of the included studies, with results showing moderate-to-strong associations between smartphone apps and gold-standard systems (e.g., Vicon), particularly for parameters such as gait speed and stride length (e.g., r = 0.42–0.97). However, variability was evident across studies depending on the health condition, measurement protocols, and device placement. Reliability, examined in only 27% of the included studies, displayed a similar trend, with intraclass correlation coefficients (ICCs) ranging from moderate (ICC = 0.53) to excellent (ICC = 0.95) for spatiotemporal parameters. Sensitivity and specificity metrics were explored in 41% and 35% of the included studies, respectively, with several applications achieving over 90% accuracy in detecting gait abnormalities. Feasibility was rated positively in 94% of the included studies, emphasising the practical advantages of smartphones in diverse settings. Conclusions: The findings of this systematic review endorse the clinical potential of smartphones for remote and real-world gait analysis, while highlighting the need for standardised methodologies. Future research should adopt a more comprehensive approach to psychometric evaluation, ensuring that reliability aspects are adequately explored. Additionally, long-term studies are needed to assess the effectiveness of smartphone-based technologies in supporting the personalised treatment and proactive management of chronic conditions. Full article

The multi-faceted nature of Selective Mutism (SM), and its comorbidity with other disorders, necessitates a comprehensive assessment process. However, evaluating children with SM presents significant challenges, including difficulties in building rapport, establishing an accurate diagnosis, and conducting formal psychological and neuropsychological assessments. This paper explores the key obstacles in assessing children with SM and provides practical recommendations for overcoming these challenges. Effective strategies for reducing anxiety during assessments include extended rapport-building phases, playful and engaging interactions, and the strategic use of parental involvement. Additionally, given the variability in SM symptoms across different settings, a multi-informant and multi-method assessment approach—including clinical observation, structured interviews, and standardized parent- and teacher-report measures—is recommended. This paper also discusses adaptations for formal testing, particularly in cognitive, language, and neurodevelopmental assessments, where SM-related speech avoidance can interfere with standardized evaluations. Nonverbal assessment tools, modifications to testing environments, and alternative response formats are proposed as potential solutions. Furthermore, we highlight the importance of differentiating SM from overlapping conditions, such as autism spectrum disorder and language impairments, to ensure accurate diagnosis and intervention planning. By implementing tailored assessment strategies, clinicians and researchers can improve diagnostic accuracy and better understand the unique needs of children with SM. This, in turn, can inform individualized treatment plans, enhance educational placement decisions, and support the overall well-being of children with SM. Full article

Introduction: Percutaneous endoscopic gastrostomy (PEG) placement does not generate consensus in palliative care, given the existing doubts about whether it significantly contributes to an improvement in patient outcomes such as survival, quality of life and symptomatic control. Objective: This study explored the impact of percutaneous endoscopic gastrostomy placement on survival and quality of life in patients under community palliative care in Northern Portugal. Methods: This observational, retrospective cohort study involved 54 patients monitored by a specialized palliative care team between March 2020 and December 2023. The key outcomes assessed included the survival rates, the main diagnoses leading to PEG requests, and the influence of PEG placement on survival and the place of death. Results: The statistical analysis revealed that the survival time was significantly longer in females compared to males (p = 0.003). The main reason for PEG requests was dysphagia, especially in patients with dementia and oncological diseases. No significant correlations were found between PEG placement and the age at death, survival time, or palliative performance scores (PPS). However, the study identified a moderate positive correlation between the follow-up time and survival after PEG placement (r = 0.457, p < 0.001) and a low rate of complications (11% of patients with minor complications and none with severe complications). Conclusions: This study emphasizes the role of timely PEG placement and social support in improving patient outcomes. Additionally, patients whose PEG was requested by the study’s palliative care team demonstrated better survival outcomes compared to those referred by other teams. The findings underscore the need for individualized decision-making in PEG placement and suggest that this procedure is safe and increases patient longevity and quality of life, avoiding the high rate of complications associated with nasogastric tubes in fragile patients in need of specialized palliative care. Full article