Search Results (914)

Background: Patient activation is associated with both health outcomes and the utilization of healthcare resources. Since various factors influence activation levels among older ill adults, further exploration of this topic is needed. Specifically, we aim to examine the extent to which changes over time in self-rated symptoms of depression are associated with changes in patient activation and to what extent self-rated health status and satisfaction of basic psychological needs (autonomy, relatedness, and competence) have a mediation effect. Methods: A longitudinal and correlational design was employed in which two hundred and seven participants with heart failure or chronic obstructive pulmonary disease were recruited from two hospitals in the middle of Sweden. The sample used in this study is the same as that used in a randomized controlled trial. A questionnaire was administered at baseline, and at 30-, 90-, and 180 days post-discharge, involving ratings of depression, patient activation, self-rated health, and satisfaction of basic psychological needs (autonomy, relatedness, and competence). As the results from the original study showed no difference between the two randomized groups in patient activation, the analysis in this study was conducted using a combined sample in which the intervention and control groups were merged. For estimation of the direct effects and the components of indirect effects, we employed multilevel modeling using a linear mixed model, and to test mediation, the stand-alone program RMediation was used. Results: Over time, increases in depressive symptoms were associated with reduced patient activation, with this relationship mediated by declines in relatedness and competence. No evidence was found showing that autonomy or self-rated health had a mediation effect. Conclusions: The results indicate that older chronically ill individuals may benefit from interventions targeting psychological mediators to improve and sustain activation. Full article

Background: Infective endocarditis (IE) requires 4–6 weeks of intravenous antimicrobial therapy, and timely transition to outpatient parenteral antimicrobial therapy (OPAT) allows clinically stable patients to complete treatment outside the hospital. Because OPAT requires home infusion services or post-acute facility placement that typically depend on coverage, insurance status may strongly influence length of stay (LOS); national data on this association in IE remain limited. Methods: We performed a retrospective cross-sectional analysis of the 2016–2019 National Inpatient Sample (NIS) using ICD-10-CM codes I33 and I38 to identify adult IE hospitalizations. Patients were classified as insured (Medicare, Medicaid, or private insurance) or uninsured (self-pay or no charge). Outcomes included mean and prolonged LOS (>14 and >28 days), in-hospital mortality, discharge against medical advice (AMA), and hospitalization costs. Comparisons used chi-square and Student’s t-tests with appropriate NIS survey weighting. Multivariable Gamma regression (LOS, cost) and logistic regression (binary outcomes) were performed, adjusting for age, sex, race/ethnicity, income quartile, injection drug use (IDU), Elixhauser Comorbidity Index, and hospital characteristics, with an insurance × IDU interaction term. Results: Of 87,211 weighted IE hospitalizations, 81,667 (93.6%) were insured and 5544 (6.4%) were uninsured. Uninsured patients were younger (mean age 40.1 vs. 59.4 years) with lower comorbidity burden but higher injection drug use (IDU) prevalence (38.7% vs. 15.5%). Mean LOS was longer among the uninsured (15.5 vs. 12.4 days, p < 0.001); LOS > 14 days occurred in 35.8% vs. 26.6%, and LOS > 28 days in 18.5% vs. 9.2% (both p < 0.001). AMA discharge was four-fold higher among the uninsured (22.2% vs. 5.5%, p < 0.001), while unadjusted in-hospital mortality was similar (9.0% vs. 9.4%, p = 0.32). LOS and AMA disparities persisted in both IDU and non-IDU subgroups, with a six-fold AMA disparity among non-IDU patients (15.2% vs. 2.5%). Based on multivariable analysis, uninsured status remained independently associated with prolonged LOS > 28 days (adjusted odds ratio [aOR] 1.46, 95% CI 1.30–1.65), AMA discharge (aOR 3.51, 95% CI 3.10–3.97), and—after accounting for age and comorbidity differences—higher in-hospital mortality (aOR 1.25, 95% CI 1.10–1.43). Conclusions: Uninsured adults hospitalized with IE experienced longer stays, markedly higher AMA rates, and—after adjustment for age and comorbidity—higher in-hospital mortality than insured patients. These findings are consistent with nonclinical barriers to discharge—particularly limited OPAT and post-acute care access—and suggest that the younger, less comorbid profile of uninsured patients masks an underlying outcome disparity. The results identify uninsured IE patients as a population that may benefit from alternative care models and policy reforms expanding safe post-acute antimicrobial therapy. Full article

Background/Objectives: Community hospitals can be a valuable and cost-effective resource for elderly people, especially in rural areas. Their aim is to promote self-reliance, prevent unnecessary hospital admissions, and facilitate rapid recovery after acute illness. The widespread adoption of intermediate care facilities helps alleviate hospital overcrowding by preventing clinical deterioration through advanced and continuous nursing care. An intermediate care unit was established in a rural area of central Italy. This study aims to describe the impact of a community hospital on patients’ functional status from admission to discharge, describing a real-life model. Methods: This single-center descriptive study examines trends in the quality of care provided. Data were retrieved from anonymized electronic clinical records. Statistical analyses were performed using descriptive statistics, paired t-tests, and Pearson correlation coefficients. Results: A total of 532 residents (mean age 80.7 ± 13.2 years; 61% female) were admitted to the community hospital between January 2022 and September 2025. The mean length of stay was 15.2 ± 7.6 days, with a mean improvement in Modified Barthel Index score of 5.24 ± 7.95 (p < 0.05). Most patients (81.8%) were discharged home, while 6.0% required hospitalization. No readmissions were recorded in 2025. Clinical risk events occurred only in 1.2% of the total. Nursing specialization increased during the study period, correlating with improved patient outcomes (R = 0.88). Conclusions: This descriptive cross-sectional study in a rural nurse-led intermediate care unit found relatively short lengths of stay, high rates of home discharges and modest, but statistically significant, improvements in functional autonomy. Full article

Global shifts in energy policy have contributed to an increase in electricity generation from renewable sources, which introduces unique issues with volatility and grid reliability. Robust grid-scale energy storage methods must fill the gap between generation and consumption. Flywheel energy storage (FES) is a mechanical technology that utilizes the stored kinetic energy of a rotating body, but is typically only suited for shorter-term frequency regulation due to significant windage losses. In this work, a novel Python 3.13-based simulation and optimization tool is presented and used to optimize geometric design parameters for efficiency, energy density, and other metrics. The simulation utilizes a 1 degree-of-freedom, multi-regime fluid friction model with a time-marching algorithm. The optimization functionality utilizes pyswarms, a particle swarm optimization package, with adjustable search parameters and cost functions to evaluate simulation results. Optimization parameters include geometric parameters of rotor radius, shaft radius, airgap width, and airgap height; material properties of mass and moment of inertia; and initial angular velocity. An optimal initial angular velocity is found for a particular geometry, lasting 30 times longer until self-discharge versus the worst values. This work can inform the design of flywheel systems to minimize windage losses and promote the technology’s utility for longer-term energy storage. Full article

Based on the Infinite State Representation (ISR) of the Riemann–Liouville integral, the energy stored in a fractional-order integrator is revisited, together with the energy dissipated through Joule losses. Using an idealized ultracapacitor model based on the Constant Phase Element (CPE), i.e., a fractional-order capacitor, theoretical expressions for the stored and dissipated energies during current charging of the CPE are derived. Numerical simulation of the fractional integrator over a frequency interval {ω_min, ω_max} validates a realistic CPE model, in which low-frequency modes correspond to energy storage, while high-frequency modes account for self-discharge and the origin of dissipated energy. This theoretical study leads to the definition of a new ultracapacitor model composed of an internal resistor and the previous realistic CPE, whose frequency-distributed representation enables prediction of the internal state variables and, consequently, the State of Charge. Full article

Seawater zinc–air batteries (SZABs) stand out as promising candidates for marine and offshore energy supply. However, their practical implementation is greatly restricted by tardy oxygen reduction reaction (ORR) and oxygen evolution reaction (OER) kinetics at the air cathode, severe chloride ion-induced catalyst corrosion, and structural deterioration of traditional binder-containing electrodes in seawater media. Herein, we design and fabricate a binder-free integrated electrode consisting of carbon-supported iron phthalocyanine- modified star-like cobalt sulfide arrays directly grown on nickel foam. The optimal catalyst (0.3FePc-C/CoS) integrates the respective advantages of Fe single atoms and cobalt sulfide, exhibiting excellent ORR and OER activity, delivering a prominent half-wave potential of 0.89 V versus RHE, and exhibiting a low OER overpotential of 160 mV at 50 mA cm⁻² and robust stability in seawater. As a self-supported air cathode, the 0.3FePc-C/CoS-based battery attains a favorable open-circuit voltage reaching 1.48 V, prominent peak power density (126.4 mW cm⁻²), small charge–discharge potential polarization (0.52 V), excellent energy efficiency (68.8%) and extraordinary long-term cycling durability (>360 h). This work not only discloses a feasible synergistic modulation strategy for constructing high-performance bifunctional electrocatalysts but also provides a valuable reference for developing corrosion-resistant integrated air electrodes toward practical marine energy storage applications. Full article

Background: The study aims to compare the short-term clinical outcomes of transcatheter aortic valve implantation (TAVI) with the novel self-expandable, intra-annular Navitor valve (NAV) and the balloon-expandable, intra-annular Sapien 3 Ultra valve (S3U). Methods: From a single-center TAVI database, patients receiving NAV and S3U were identified. We applied 1:2 propensity score matching for the selected variables (gender, age, aortic valve perimeter, area, diameter, mean aortic valve gradient, EuroScore2, coronary artery disease (CAD), previous stroke and previous pacemaker implantation), resulting in 153 patients. Results: Clinical outcomes at 30 days of 51 patients with NAV [mean age: 80.4 ± 6.7 years; 51% female; mean annulus diameter: 24.1 ± 1.40 mm; EuroScore2: 3.4 ± 3.1%] and 102 patients with S3U [mean age: 79.9 ± 6.5 years (p = 0.7); 51% female (p > 0.99); mean annulus diameter: 24.1 ± 1.4 mm (p > 0.99); EuroScore2: 3.2 ± 2.7 (p = 0.7)] were analyzed according to VARC-3 recommendations. Post-TAVI aortic valve mean (S3U: 11.0 [3–27] mmHg; NAV: 7 [3–15] mmHg; p < 0.001) and maximum (S3U: 22 [6–44] mmHg; NAV: 12 [5–28] mmHg; p < 0.001) gradients at discharge were significantly lower with NAV, whereas the effective orifice area (EOA) of the aortic valve measured significantly larger with NAV (S3U: 1.5 [0.8–3.8] cm²; NAV: 2.1 [0.9–3.5] cm²; p < 0.001). Rates of no to mild paravalvular regurgitation (PVL) were 92.1% after NAV and 91.2% after S3U implantation (p = 0.15), mild to moderate PVL were 2.0% after NAV vs. 2.9% after S3U (p = 0.1) and moderate PVL were 2% after NAV and 1% after S3U (p = 0.07). None of the patients had a severe regurgitation. Severe patient–prosthesis mismatch (PPM) occurred significantly less with NAV (S3U: 14.7%; NAV: 7.8%; p = 0.002). One (1%) non-disabling stroke occurred within the S3U group and none occurred within the NAV group (p = 0.1). Life-threatening (S3U: 2.9%; NAV= 1%; p > 0.99) and major (S3U: n = 2.9; NAV: 0%; p = 0.55) bleeding events were comparable between both groups. The incidence of major (S3U: 2.9%; NAV: 2.0%; p > 0.99) vascular complications and the need for permanent pacemaker implantation (S3U: 9.8%; NAV: 11.8%; p = 0.8) were comparable in both groups. The 30-day mortality rate was 0.7% [1 in NAV group (2%), none in S3U; p = 0.3]. Conclusions: In conclusion, at 30-day follow-up, the self-expanding intra-annular Navitor valve demonstrated excellent acute safety and superior early hemodynamic performance, characterized by significantly lower transvalvular gradients and lower rates of severe PPM compared to the balloon-expandable Sapien 3 Ultra. However, whether these acute hemodynamic advantages translate into superior long-term clinical outcomes remains to be determined in long-term follow-up studies. Full article

Objective: Maternal substance use during pregnancy is an increasing public health concern worldwide. However, data on neonatal abstinence syndrome (NAS) remain limited in many regions, including Turkey. This study aimed to evaluate the clinical and laboratory characteristics of neonates exposed to maternal substance use and to assess the association between Finnegan score severity and laboratory findings. Methods: This retrospective study was conducted in a tertiary neonatal intensive care unit. Neonates with prenatal substance exposure were divided into two groups according to their Modified Finnegan scores (<8 and ≥8). Demographic characteristics, clinical outcomes, and laboratory parameters, including acute phase reactants and liver enzymes, were compared between the groups. Maternal substance exposure was mainly determined by maternal self-report, with toxicological confirmation available in only two infants. Results: A total of 25 neonates were included. Higher Finnegan scores were associated with increased white blood cell counts, plateletcrit and liver enzyme levels (AST and ALT), although only the ALT association remained significant after correction for multiple comparisons. Infants placed under state care had longer hospital stays than those discharged to their families (p = 0.02). No mortality was observed. Conclusions: In this small retrospective cohort, greater withdrawal severity was associated with higher aminotransferase levels, particularly ALT, and longer hospitalization was observed among infants placed under state care. These findings should be regarded as preliminary and require confirmation in larger prospective multicenter studies. Full article

In this paper, we propose a self-learning digital twin (SLDT) architecture that incorporates real-time battery degradation modeling and optimum operational management for grid-scale lithium-ion battery energy storage systems (BESS). This work extends the Adaptive Real-Time Degradation Model (ARDM) framework to allow real-time updates of the parameters based only on live operational data without pre-cycling experiments and further improves its robustness under various depth-of-discharge (DoD), charging/discharging current (C-rate), and temperature conditions. The ARDM is incorporated in a real-time digital twin that maintains synchronized health, state of charge (SoC), and degradation cost predictions. The digital twin is linked to an Optimization and Control Layer (OCL), which plans the charge/discharge day-ahead in advance based on dynamic power rates. The Musical Chairs Algorithm (MCA) is used for parameter identification and scheduling due to its better convergence characteristics compared to swarm-reduction forms of benchmark optimization algorithms. Experimental validation is carried out on two commercial 48 V Li-ion modules with various cycling patterns, and sub-millipercent root-mean-square error (RMSE) is achieved in capacity-fade tracking. The economic analysis for a 5-MW/10-MWh system indicates that dynamic tariff scheduling results in about nine times greater arbitrage revenue compared to fixed rates, 41–58% higher yearly net income, and lower degradation costs. The results confirm that the SLDT is a practical and accurate platform for degradation-aware operational planning in modern smart-grid environments. Full article

In this article, the different types of self-coagulation discovered in the fluid simulations of inductively coupled plasma (abbreviated as ICP) at both the electronegative and electropositive cases are presented. Among these, the electronegative plasma sources include Ar/O₂, Ar/Cl₂, and Ar/SF₆, and the electropositive plasma source is the inertial argon plasma itself. The fluid simulation versions are not the same. Concretely, the Comsol software version 5.4 is used to simulate the Ar/O₂, Ar/Cl₂, Ar/SF₆, and the pure argon ICPs, and the self-written code of the fluid model is used to simulate the pure argon ICP as well, but in a different framework of fluid design. The types of self-coagulation refined from these fluid simulations are the physically ambi-polar self-coagulation of ions, the chemically ambi-polar self-coagulation of ions, the mono-polar self-coagulation of electrons, and the non-polar self-coagulation of argon metastable atoms. These self-coagulations are based on mass and founded through the Comsol fluid simulations, and moreover, the self-coagulation of thermal energy of electrons is founded through the self-written fluid code simulation. Based on the self-coagulations of mass and energy, together with the accompanying discharge hierarchy, we hypothesize (1) the correlation of ambi-polar self-coagulation and diffusion, (2) the mean of using the Schrodinger equation to describe the quasi-particle of anions given by self-coagulation in a certain potential barrier, (3) the analogy of the $\beta$ and ${\beta }^{+}$ decay and the asymmetry given by two types of ICP source simulation, (4) the picture of spin orientations of neutrino and anti-neutrino, and (5) the model for photon sustainment. The self-coagulation behavior is seen to be general and the interdisciplinary works of plasma physics with quantum mechanics, particle physics, nuclear physics, and optics are helpful for us to better understand the mass and energy general dynamics. Full article

Homelessness is a major public health concern, and successful rehousing is an important outcome for people experiencing homelessness (PEH). However, limited evidence exists on which individual factors are associated with rehousing after transitional care; this study examined characteristics associated with being rehoused at discharge from Durham Homeless Care Transitions (DHCT). We analyzed data from DHCT, a transitional care program serving PEH. Independent variables included demographic characteristics, self-efficacy, mental healthcare status, and unmet identity and communication access (ICA) needs, including lack of personal identification documentation and technology access. We performed bivariate analyses and multivariable regression to assess associations with being rehoused at discharge. In both bivariate and multivariable analyses, non-White PEH were less likely to be rehoused at discharge than White PEH. Greater unmet ICA needs were also significantly associated with lower likelihood of rehousing. These findings add to the mixed prior literature regarding racial inequities in rehousing among PEH. The concept of ICA needs has not previously been studied and may offer an actionable target for transitional care programs seeking to improve rehousing outcomes and advance equity. Full article

Solid-state batteries (SSBs) are emerging as a transformative alternative to conventional lithium-ion batteries (LIBs) for next-generation electric vehicles (EVs) by replacing flammable liquid electrolytes with solid-state materials. Compared with current LIB systems delivering approximately 160–300 Wh/kg at the pack level, SSBs are projected to achieve 400–800 Wh/kg, enabling improvements in driving range of nearly 50–100% while simultaneously reducing battery pack mass by 10–30%. These improvements directly enhance vehicle-level energy efficiency by lowering energy consumption from typical values of 150–180 Wh/km in present EVs to projected levels of 110–140 Wh/km in optimized SSB-based architectures. Furthermore, reduced internal resistance and improved electrochemical stability can increase round-trip efficiency from approximately 85–95% in conventional LIBs to values approaching 95–98% under optimized solid-state configurations. The enhanced thermal stability of solid electrolytes significantly reduces the need for active cooling systems, decreasing parasitic thermal-management energy consumption from 10–30% of total vehicle energy demand to below 5–15% in advanced SSB systems. Fast-charging capability is also substantially improved, with projected charging times decreasing from 20–40 min to approximately 10–15 min for 10–80% state-of-charge operation, while maintaining improved safety and reduced risk of thermal runaway. In addition, SSBs demonstrate projected cycle lifetimes exceeding 3000–5000 cycles, compared with 1000–2000 cycles for conventional LIBs, thereby lowering battery replacement frequency and lifecycle energy losses. This paper examines the electrochemical fundamentals, thermal behavior, charging/discharging efficiency, and vehicle-level implications of SSB technology for EV applications. Comparative analyses demonstrate that replacing LIBs with SSBs can increase EV driving range from approximately 400 km to 700–800+ km under equivalent battery mass conditions, while also improving coulombic efficiency beyond 99.5% and reducing self-discharge rates to below 1–2% per month. Current industrial case studies from Toyota, Factorial Energy, Mercedes-Benz, CATL, BYD, QuantumScape, and Samsung SDI further confirm accelerating commercialization pathways toward 2027–2030. Overall, the study demonstrates that SSBs are not merely incremental battery improvements but represent a system-level efficiency technology capable of simultaneously enhancing energy density, reducing thermal and electrical losses, extending vehicle range, accelerating charging, and improving long-term sustainability. Despite persistent challenges related to manufacturing scalability, interfacial resistance, and cost, SSBs are positioned to become a critical enabler of highly efficient, long-range, and safer electric mobility systems beyond 2030. Full article

Background/Objectives: Chronic low back pain (CLBP) affects approximately 20% of the global population and is a leading cause of years lived with disability. Long-term, real-world evidence for inhaled cannabis in patients refractory to conventional multimodal therapy remains scarce. We assessed the five-year efficacy and safety of inhaled cannabis in CLBP patients who had documented failure of ≥1 year of opioid analgesics, anticonvulsants, antidepressants, NSAIDs, and physiotherapy, with each patient serving as their own historical control. Methods: We analyzed prospectively collected clinical data from 241 consecutive adults with treatment-refractory CLBP (mean age 49.3 ± 14.9 years; 37.8% female; mean pain duration 15.1 years) initiated on inhaled medical cannabis (predominantly smoking, THC 4–22%, CBD 2–22%) in a single-center tertiary orthopedic clinic between 2020 and 2025 (Hasharon Hospital, Rabin Medical Center, Israel; IRB protocols 0807-21-RMC and 0634-25-RMC). Year-0 outcomes during conventional therapy were compared with outcomes at Years 1–5 on cannabis. Primary outcomes were the Numeric Rating Scale (NRS), Oswestry Disability Index (ODI), and Brief Pain Inventory severity/interference (BPI-S/BPI-I). Concomitant-medication trajectories were a secondary outcome. The primary analysis was a mixed model for repeated measures (MMRM) with random intercept and slope, REML estimation, and time as a categorical fixed effect. Multiple imputation (MAR, m = 20, Rubin’s rules) was the primary missing-data approach; complete-case and tipping-point pattern-mixture sensitivity analyses were used. A multivariate Hotelling T² provided a joint test across the four correlated PROMs. Concomitant-medication discontinuation was modeled with GEE logistic regression and exact McNemar tests. Time to discontinuation was estimated by Kaplan–Meier and Cox regression. The Bonferroni-adjusted significance threshold for the four primary outcomes was α = 0.0125. BioWell gas-discharge-visualization (GDV) parameters were exploratory only. Results: Of 241 patients, 238 (98.8%) provided Year-5 data and 224 (92.9%) remained on cannabis at Year 5; only five patients (2.1%) discontinued for adverse events or inefficacy. All four primary PROMs improved markedly and durably. MMRM-estimated Year-5 minus Year-0 changes were: NRS −5.36 (95% CI −5.65, −5.07), ODI −17.68 (95% CI −19.73, −15.63), BPI-S −6.73 (95% CI −6.99, −6.47), and BPI-I −3.41 (95% CI −3.65, −3.16); all four contrasts had |z| ≥ 16.9 and p < 10⁻²⁰. MI-pooled estimates were within 0.05 of MMRM (FMI < 0.03 for all outcomes). Hotelling T² was F(4, 232) = 872.8, p < 10⁻²⁰. At Year 5, 89.2% achieved ≥30% NRS reduction, 77.2% ≥ 50%, and 93.4% met the NRS minimum clinically important difference (MCID); ODI MCID 65.6%, BPI-S MCID (≥1 pt) 98.3%, BPI-I MCID (≥1 pt) 91.3%. Concomitant opioid use fell from 100% at baseline to 4.6% at Year 5 (within-patient absolute risk reduction 95.4%, McNemar exact p = 1.16 × 10⁻⁶⁹), NSAID from 100% to 7.1%, SSRI/SNRI from 80.5% to 5.4%, and gabapentinoid from 38.6% to 2.5%. The ARR-derived NNT for opioid discontinuation was 1.05; this NNT is referenced to each patient’s own documented maximal-conventional-therapy state and is not equivalent to a between-arm randomized-trial NNT. Cannabis dose × time interaction was consistent with no pharmacological tolerance (β = −0.0044 per gram-month per year, p = 0.074). Across 1205 patient-years of cannabis exposure (calculated as 241 patients × 5 follow-up years from Year 1 through Year 5; baseline Year 0 represents pre-cannabis state and is not included in person-time on cannabis), 1338 organ-system AE events were recorded at 1.110/patient-year (Poisson 95% CI 1.05–1.17); 99.8% of graded events were mild (grade 1), with ocular (476 events, 0.40/PY), cognitive (460, 0.38/PY), and gastrointestinal (368, 0.31/PY) reactions predominating. The Year-3 retention dip reflected a documented telemedicine-clinic phenomenon during 2022–2024, with patients returning to in-person follow-up by Year 4–5. BioWell GDV discriminated NRS ≥ 4 only at chance level (BWS AUC 0.574, 95% CI 0.54–0.60; BWV AUC 0.51). Conclusions: In a treatment-refractory CLBP cohort with five-year longitudinal follow-up, inhaled cannabis was associated with large, sustained, and statistically robust improvements in pain, disability, and pain interference, accompanied by near-total displacement of opioids, NSAIDs, antidepressants, and gabapentinoids. These observational associations, although mechanically less susceptible to bias for the binary medication-discontinuation outcomes than for self-reported PROMs, cannot be interpreted causally in the absence of a concurrent randomized control arm and may reflect a combination of pharmacological effect, regression to the mean from a high pre-treatment baseline, expectancy and self-selection effects intrinsic to an actively chosen open-label therapy, and secular trends in pain reporting. The within-patient benefit-risk profile—ARR-derived NNT ≈ 1 for opioid sparing against a predominantly mild adverse-event burden—supports consideration of cannabis as a potentially clinically meaningful, opioid-sparing option in patients who have failed multimodal conventional therapy, pending confirmation in randomized comparative trials. Full article

High-voltage short pulse generators play a critical role in medical and industrial applications. However, the presence of residual stored energy can pose significant electrical safety hazards. To mitigate these hazards, the implementation of rapid discharge mechanisms is imperative. To address the limitations of slow passive bleeders and auxiliary-dependent active circuits, and the issue of excessive size for compact pulse generators, this study proposes a self-powered, fast-response discharge topology utilizing cascaded depletion-mode NMOS transistors. The method utilizes the inherent normally-on characteristic of depletion-mode devices to ensure fail-safe activation during power loss, employing a self-biased feedback loop to regulate a constant discharge current. The theoretical models were validated through simulations and a hardware prototype testing a 1200 V/220 nF capacitor. The experimental results demonstrate the capability to successfully discharge 1200 V to a safe level within a span of one second. Additionally, the discharge time can be programmed within the range from 72 milliseconds to 1.02 s by adjusting the current-limiting resistor. In summary, the proposed topology offers a reliable, compact, and adjustable solution for high-voltage safety, addressing the limitations of conventional discharge technologies in terms of volume and speed. Full article

Decomposition of nonlinear, nonstationary multicomponent signals remains challenging for existing decomposition strategies, including frequency-based, data-driven, and subspace methods, which can suffer from mode mixing, leakage across components, and unreliable isolation of transients. Motivated by this gap, this study proposes Orthogonal Self-Similarity Decomposition (OSSD), which exploits a self-similarity structure in delay-embedded orbit geometry so that temporal organization, rather than spectrum alone, guides component construction. OSSD-Basic introduces three algorithmic novelties within a single pipeline: (1) an adaptive proxy-correlation band merging on the delay axis, (2) a dominant-component cascade that prevents energy-dominant carriers from masking weaker components, and (3) a double MGS + LS reprojection that collapses the inter-mode orthogonality index to numerical zero, regardless of merging and pruning operations. Synthetic experiments with known ground truth show that OSSD-Basic provides a parsimonious four-mode representation with exact inter-mode orthogonality (OI = 9.4 × 10⁻¹⁸), the highest reconstruction SNR among the evaluated baselines (27.14 dB), and the highest ground-truth diagonal correlation sum (3.038) among the tested methods, while using two fewer modes than EMD, VMD, and SSA. Daily streamflow forecasting on a U.S. Geological Survey discharge record further shows that augmenting OSSD-derived inputs with fractal descriptors and fractional-order differencing features yields progressive accuracy gains over the AR-ANN baseline, with R² improving from 0.855 to 0.915 at one-step-ahead and from 0.388 to 0.699 at four-step-ahead forecasting in the single-input setting, within a single-station case study on USGS 01554000. Overall, OSSD-Basic offers an interpretable multiscale decomposition with guaranteed inter-mode orthogonality and a structured feature pathway for oscillatory–transient mixtures. Full article