Search Results (814)

Background: Bimekizumab, secukinumab, and ixekizumab are IL-17-targeting biologics approved for the treatment of moderate-to-severe plaque psoriasis. While secukinumab and ixekizumab selectively inhibit IL-17A, bimekizumab targets both IL-17A and IL-17F, potentially providing greater anti-inflammatory efficacy. This study aimed to compare the real-world effectiveness, safety, and tolerability of these agents in a Polish dermatology center between 2019 and 2024. Methods: We conducted a retrospective analysis of 98 patients meeting at least one of the following criteria: PASI ≥ 10, BSA ≥ 10, DLQI ≥ 10, or involvement of special areas with inadequate response or contraindications to ≥2 systemic therapies. Patients with prior exposure only to IL-17 inhibitors were excluded. PASI, BSA, and DLQI scores were recorded at baseline, week 4, and week 12. Due to differences in dosing schedules, outcomes were aligned using standardized timepoints and exponential modeling of continuous response trajectories. Mixed-effects ANOVA was used to assess the influence of baseline factors (age, BMI, PsA status) on treatment outcomes. Adverse events were documented at each monthly follow-up visit. Results: Bimekizumab showed the greatest effect size for PASI reduction (Hedges’ g = 3.662), followed by secukinumab (2.813) and ixekizumab (1.986). Exponential modeling revealed a steeper response trajectory with bimekizumab (intercept = 0.289), suggesting a more rapid PASI improvement. The efficacy of bimekizumab was particularly notable in patients who were previously treated with IL-23 inhibitors. All three agents demonstrated favorable safety profiles, with no serious adverse events or discontinuations. The most frequent adverse events were mild and included upper respiratory tract infections and oral candidiasis. Conclusions: This real-world analysis confirmed that IL-17 inhibitors effectively improved PASI, BSA, and DLQI scores in moderate-to-severe psoriasis. Bimekizumab demonstrated the most rapid early improvements and a higher modeled likelihood of complete clearance, without significant differences at week 12. All agents were well tolerated, underscoring the need for further individualized, large-scale studies. Full article

In the wake of the continuous development of the international strategic petroleum reserve system, the tonnage and quantity of oil tankers have been increasing. This trend has driven the expansion of offshore oil exploration and transportation, resulting in frequent incidents of ship oil spills. Catastrophic impacts have been exerted on the marine environment by these accidents, posing a serious threat to economic development and ecological security. Therefore, there is an urgent need for efficient and reliable methods to detect oil spills in a timely manner and minimize potential losses as much as possible. In response to this challenge, a marine radar oil film segmentation method based on feature fusion and the artificial bee colony (ABC) algorithm is proposed in this study. Initially, the raw experimental data are preprocessed to obtain denoised radar images. Subsequently, grayscale adjustment and local contrast enhancement operations are carried out on the denoised images. Next, the gray level co-occurrence matrix (GLCM) features and Tamura features are extracted from the locally contrast-enhanced images. Then, the generalized least squares (GLS) method is employed to fuse the extracted texture features, yielding a new feature fusion map. Afterwards, the optimal processing threshold is determined to obtain effective wave regions by using the bimodal graph direct method. Finally, the ABC algorithm is utilized to segment the oil films. This method can provide data support for oil spill detection in marine radar images. Full article

Atrial fibrillation remains the most frequent sustained arrhythmia, particularly in the elderly population, and is associated with increased risks of stroke, heart failure, and reduced quality of life. While catheter ablation is widely used for rhythm control, its efficacy is limited in persistent and long-standing atrial fibrillation. Over the past two decades, minimally invasive surgical strategies have emerged as effective alternatives, aiming to replicate the success of the Cox-Maze procedure while reducing surgical trauma. This overview critically summarizes the current minimally invasive techniques available for atrial fibrillation treatment, including mini-thoracotomy ablation, thoracoscopic ablation, and hybrid procedures such as the convergent approach. These methods offer the potential for durable sinus rhythm restoration by enabling direct visualization, transmural lesion creation, and left atrial appendage exclusion, with lower perioperative morbidity compared to traditional open surgery. The choice of energy source plays a key role in lesion efficacy and safety. Particular attention is given to the technical steps of each procedure, patient selection criteria, and the role of left atrial appendage closure in stroke prevention. Hybrid strategies, which combine epicardial surgical ablation with endocardial catheter-based procedures, have shown encouraging outcomes in patients with refractory or long-standing atrial fibrillation. Despite the steep learning curve, minimally invasive techniques provide significant benefits in terms of recovery time, reduced hospital stay, and fewer complications. As evidence continues to evolve, these approaches represent a key advancement in the surgical management of atrial fibrillation, deserving integration into contemporary treatment algorithms and multidisciplinary heart team planning. 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

Accurate and spatially consistent rainfall estimation is essential for hydrological modeling and flood risk mitigation, especially in mountainous tropical regions with sparse observational networks and highly heterogeneous rainfall. This study presents a comparative analysis of six radar–gauge merging methods, including three statistical approaches—Quantile Adaptive Gaussian (QAG), Empirical Quantile Mapping (EQM), and radial basis function (RBF)—and three geostatistical approaches—external drift kriging (EDK), Bayesian Kriging (BAK), and Residual Kriging (REK). The evaluation was conducted over the Huong River Basin in Central Vietnam, a region characterized by steep terrain, monsoonal climate, and frequent hydrometeorological extremes. Two observational scenarios were established: Scenario S1 utilized 13 gauges for merging and 7 for independent validation, while Scenario S2 employed all 20 stations. Hourly radar and gauge data from peak rainy months were used for the evaluation. Each method was assessed using continuous metrics (RMSE, MAE, CC, NSE, and KGE), categorical metrics (POD and CSI), and spatial consistency indicators. Results indicate that all merging methods significantly improved the accuracy of rainfall estimates compared to raw radar data. Among them, RBF consistently achieved the highest accuracy, with the lowest RMSE (1.24 mm/h), highest NSE (0.954), and strongest spatial correlation (CC = 0.978) in Scenario S2. RBF also maintained high classification skills across all rainfall categories, including very heavy rain. EDK and BAK performed better with denser gauge input but required recalibration of variogram parameters. EQM and REK yielded moderate performance and had limitations near basin boundaries where gauge coverage was sparse. The results highlight trade-offs between method complexity, spatial accuracy, and robustness. While complex methods like EDK and BAK offer detailed spatial outputs, they require more calibration. Simpler methods are easier to apply across different conditions. RBF emerged as the most practical and transferable option, offering strong generalization, minimal calibration needs, and computational efficiency. These findings provide useful guidance for integrating radar and gauge data in flood-prone, data-scarce regions. Full article

Participation in horse-related activities frequently involves relocating horses from the home stable to an activity venue, which might require local, regional, or international travel. In these circumstances, horses are exposed to unfamiliar surroundings and experience changes to their daily routines, which could have negative welfare impacts. An online survey was conducted in 2021 to ask experienced horse sector participants about the horse management practices that they perceived worked well and provided for positive horse welfare when undertaken at venues. Qualitative analysis identified four themes: ‘managing venues’, ‘monitoring fitness to participate’, ‘maintaining a healthy equine digestive system’, and ‘using horse behaviors to inform decision-making’. The findings indicate that activity-related individuals selected practices that assisted horses to adapt to venue surroundings, remain calm, and stay healthy. The co-authors propose that experienced participants recognize that practices include both provisions (inputs) and outcomes (the horse’s subjective experiences), resonating with the Five Freedoms and Five Domains models. For horse activity organizations proposing to implement the Five Domains model, the findings indicate that reviewing practices and implementing updates is timely and achievable. The authors propose that continuously updating practices will contribute to safeguarding horses and maintaining the sector’s social license to operate. Full article

Fever is a frequent complication in children receiving chemotherapy, primarily caused by bloodstream infections and non-infectious inflammation. Yet, the pathophysiological mechanisms remain unclear, and diagnostics are insufficient, which often results in continued antibiotic treatment despite negative blood cultures. In a nationwide study, we collected whole blood in PAXgene tubes from 168 febrile episodes in children with hematological malignancies, including 37 episodes with bacteremia, and performed single-cell RNA sequencing. We compared transcriptomic profiles between febrile children with and without bacteremia. In children with bacteremia, differentially expressed genes were related to immunoregulation and cardiac and vascular function. Children without bacteremia had distinct gene expression patterns, suggesting a viral or other inflammatory cause of fever. Several differentially expressed genes overlapped with previously published transcriptomics-based diagnostic signatures developed in immunocompetent children. In conclusion, blood transcriptomics provided novel insights into the pathophysiological mechanisms of febrile children with hematological malignancies. We found differentially expressed genes suggesting viral infections or non-bacterial inflammation as causes of fever in children with negative blood cultures, supporting early antibiotic discontinuation in children with cancer. Full article

Historical districts are the mark of the continuity of urban history and are non-renewable. Typhoon disasters rank among the most serious and frequent natural threats to China’s coastal regions. Improving the wind resilience of China’s coastal historical districts is of great significance for their protection and inheritance. Accurately analyzing the different characteristics of the influencing factors of wind resilience in China’s coastal historical districts can provide a theoretical basis for alleviating the damage caused by typhoons and formulating disaster prevention measures. This paper accurately identifies the main influencing factors of wind resilience in China’s coastal historical districts and constructs an influencing factor system from four aspects: block level, building level, typhoon characteristics, and emergency management. An IIM model for the systematic analysis of influencing factors of wind resilience in China’s coastal historical districts based on the Improved Decision Making Trial and Evaluation Laboratory (IDEMATEL), Interpretive Structural Modeling (ISM), and Matrices Impacts Croises-Multiplication Appliance Classement (MICMAC) methods is established. This allows us to explore the mechanism of action of internal influencing factors of typhoon disasters and construct an influencing factor system, in order to propose prevention measures from the perspective of typhoon disaster characteristics and the overall perspective of China’s coastal historical districts. The results show that the driving force of a building’s windproof design in China’s coastal historical districts is low, but its dependence is strong; the driving forces of block morphology, typhoon level, and emergency plan are strong, but their dependence is low. A building’s windproof design is a direct influencing factor of the wind resilience of China’s coastal historical districts; block morphology, typhoon level, and emergency plan are the most fundamental and key influencing factors of the wind resilience of China’s coastal historical districts. Full article

IoT devices with sensors and actuators are frequently deployed in environments without access to the power grid. These devices are battery powered and might make use of energy harvesting if battery lifetime is too limited. This article focuses on automatically adapting the duty cycle frequency to the predicted available solar energy so that a continuous operation of IoT applications is guaranteed. The implementation is based on a low-cost solar control board that is integrated with the Serverless IoT Framework (SIF), which provides an event-based programming paradigm for microcontroller-based IoT devices. The paper presents a case study where the IoT device sleep time is pro-actively adapted to a predicted sequence of cloudy days to guarantee continuous operation. Full article

In recent years, extreme weather events have occurred more frequently. The resulting equipment failure, renewable energy extreme output, and other extreme operation scenarios affect the smooth operation of power grids. The occurrence probability of extreme operation scenarios is small, and the occurrence frequency in historical operation data is low, which affects the modeling accuracy for scenario generation. Meanwhile, extreme operation scenarios in the form of discrete temporal data lack corresponding modeling methods. Therefore, this paper proposes a definition and generation framework for extreme power grid operation scenarios triggered by extreme weather events. Extreme operation scenario expansion is realized based on the sequential Monte Carlo sampling method and the distribution shifting algorithm. To generate equipment failure scenarios in discrete temporal data form and extreme output scenarios in continuous temporal data form for renewable energy, a Gumbel-Softmax variational autoencoder and an extreme conditional generative adversarial network are respectively proposed. Numerical examples show that the proposed models can effectively overcome limitations related to insufficient historical extreme data and discrete extreme scenario training. Additionally, they can generate improved-quality equipment failure scenarios and renewable energy extreme output scenarios and provide scenario support for power grid planning and operation. Full article

Endometriosis is a chronic gynecological pathology marked by the aberrant proliferation of tissue analogous to the endometrial lining outside the uterine cavity. This disorder frequently engenders persistent pelvic discomfort, infertility, and an extensive array of additional manifestations, including menorrhagia, dyspareunia, and gastrointestinal anomalies. Affecting an estimated 10% of women within the reproductive age demographic globally, endometriosis continues to present as a multifaceted and formidable challenge. The precise etiology remains elusive, leading to extended diagnostic intervals and personalized, often inadequate, therapeutic approaches. The intrinsic heterogeneity of endometriosis, evident in its varied phenotypes and clinical manifestations, further complicates both precise diagnosis and efficacious treatment. Conventional management hinges on hormonal interventions, which may not be appropriate for women desiring conception or for those experiencing substantial adverse effects. While surgical procedures are accessible, they do not provide a conclusive resolution, and the probability of recurrence remains high. Progress in diagnostic methodologies, such as non-invasive biomarker analyses, combined with an expanding understanding of the molecular and immunological frameworks that underpin the condition, presents promising prospects for the development of more targeted and individualized non-hormonal treatment modalities in the near future. Full article

Mangroves form the dominant coastal plant community of low-energy tropical intertidal habitats and provide critical ecosystem services to humans and the environment. However, more frequent and increasingly powerful hurricanes and storm surges are creating additional pressure on the natural resilience of these threatened coastal ecosystems. Advances in remote sensing techniques and approaches are critical to providing robust quantitative monitoring of post-storm mangrove forest recovery to better prioritize the often-limited resources available for the restoration of these storm-damaged habitats. Here, we build on previously utilized spatial and temporal ranges of European Space Agency (ESA) Sentinel satellite imagery to monitor and map the recovery of the mangrove forests of the British Virgin Islands (BVI) since the occurrence of back-to-back category 5 hurricanes, Irma and Maria, on September 6 and 19 of 2017, respectively. Pre- to post-storm changes in coastal mangrove forest health were assessed annually using the normalized difference vegetation index (NDVI) and moisture stress index (MSI) from 2016 to 2023 using Google Earth Engine. Results reveal a steady trajectory towards forest health recovery on many of the Territory’s islands since the storms’ impacts in 2017. However, some mangrove patches are slower to recover, such as those on the islands of Virgin Gorda and Jost Van Dyke, and, in some cases, have shown a continued decline (e.g., Prickly Pear Island). Our work also uses a linear ANCOVA model to assess a variety of geospatial, environmental, and anthropogenic drivers for mangrove recovery as a function of NDVI pre-storm and post-storm conditions. The model suggests that roughly 58% of the variability in the 7-year difference (2016 to 2023) in NDVI may be related by a positive linear relationship with the variable of population within 0.5 km and a negative linear relationship with the variables of northwest aspect vs. southwest aspect, island size, temperature, and slope. Full article

Oral narratives play a crucial role in shaping the historical consciousness of Indigenous communities in Northeast India, where history writing is a relatively recent phenomenon. Among the Mizos, Nagas, Khasis, Kuki-Chins, and other Indigenous tribes of Northeast India, including the Bodos, the Garos, the Dimasas, or the Karbis of Assam, much of what is considered written history emerged during British colonial rule. Native historians later continued it in postcolonial India. However, written history, especially when based on fragmented colonial records, includes interpretive gaps. In such contexts, oral traditions provide complementary, and frequently, more authoritative frameworks rooted in cultural memory and collective transmission. Oral narratives, including ritual poetry, folk songs, myths, and folktales, serve as vital mediums for reconstructing the past. Scholars such as Jan Vansina view oral narratives as essential for understanding the histories of societies without written records, while Paul Thompson sees them as both a discovery and a recovery of cultural memory. Romila Thapar argues that narratives become indicative of perspectives and conditions in societies of the past, functioning as a palimpsest with multiple layers of meaning accruing over generations as they are recreated or reiterated over time. The folk narratives of the Mizos and Angami Nagas not only recount their origins and historical migrations, but also map significant geographical and cultural landmarks, such as Khezakheno and Lungterok in Nagaland, Rounglevaisuo in Manipur, and Chhinlung or Rih Dil on the Mizoram–Myanmar border. These narratives constitute a cultural understanding of the past, aligning with Greg Dening’s concept of “public knowledge of the past,” which is “culturally shared.” Additionally, as Linda Tuhiwai Smith posits, such stories, as embodiments of the past, and of socio-cultural practices of communities, create spaces of resistance and reappropriation of Indigenous identities even as they reiterate the marginalization of these communities. This paper deploys these ideas to examine how oral narratives can be used to decolonize grand narratives of history, enabling Indigenous peoples, such as the Mizos and the Angamis in North East India, to reaffirm their positionalities within the postcolonial nation. Full article

This study aims to evaluate the real-world efficacy and safety of aflibercept 8 mg intravitreal injections (IVTs) in pretreated patients with neovascular age-related macular degeneration (nAMD) throughout the first three IVTs. Background: Established anti-vascular-endothelial-growth-factor (anti-VEGF) therapies positively impact the progression of nAMD but require frequent administration, thus burdening patients and the healthcare system. Pivotal trials of the recently approved aflibercept 8 mg have demonstrated extended dosing intervals with comparable safety to standard treatments. However, real-world data is still scarce. Methods: A retrospective, single-center single-arm analysis was conducted on 22 eyes from 18 pretreated nAMD patients. Eyes were switched from other anti-VEGF agents to aflibercept 8 mg injections continuing a treat-and-extend regimen (no loading dose after switching). Treatment intervals and structural (central subfield thickness (CST); disease activity) and functional (best corrected visual acuity (BCVA)) outcomes were assessed at baseline (date of first aflibercept 8 mg injection) and at follow-up examinations until follow-up 3. Safety data, including intraocular pressure changes, were recorded. Results: Over a median follow-up of 16.6 weeks (IQR 15.1–27.0), patients switched to aflibercept 8 mg showed prolonged intervals between injections (5.5 weeks vs. 7 weeks, p < 0.001, Wilcoxon signed-rank test), reduced disease activity, stable CST, and stable BCVA. One patient experienced transient intraocular pressure elevation, which resolved without intervention. No other adverse events were observed. Conclusions: Treatment with aflibercept 8 mg appears to provide effective disease control with prolonged treatment intervals in switched nAMD patients in routine clinical practice. These findings further indicate the potential for reducing treatment burden. Full article

Organizations face significant challenges in measuring and enhancing sustainability performance across complex operational processes. Current assessment methods frequently lack granularity, real-time capability, and integration with operational data. This study addresses these gaps by developing a conceptual framework that integrates business process mining with Global Reporting Initiative (GRI) metrics. The methodology incorporates environmental, social, and economic sustainability indicators into process mining techniques through systematic metric mapping and event log enrichment. The framework enables the extraction and analysis of sustainability performance data at the process level, creating detailed heat maps that visualize resource utilization, emissions, and waste generation. An application to a Purchase-to-Pay process case study demonstrates how process variants impact sustainability metrics differently. Delays increase emissions by 16.7%, while rework increases waste generation by 41.7%. The results identify specific process bottlenecks with high environmental impact and reveal critical misalignments between economic and environmental sustainability goals. This framework provides organizations with a standardized yet flexible approach to measuring sustainability performance, bridging the gap between high-level sustainability reporting and operational processes. It enables continuous monitoring, targeted interventions, and transparent reporting across diverse industry contexts. Full article