Introduction: Since 2019, a rapid learning health system for Quebec’s Early Intervention Services for psychosis named SARPEP (Système Apprenant Rapide pour les programmes de Premiers Épisodes Psychotiques) operates to bridge the evidence-practice gap across the province. Despite strong stakeholder support and government recommendations, peer support services remained poorly available. To address this gap, since 2023, the PAIRPEP project was co-developed to support and evaluate the implementation of peer support and family peer support. This paper describes the co-designed study protocol, embedded within this learning health system. Methods: This participatory, mixed-methods study aims to examine the PAIRPEP intervention implementation longitudinally over 3 years across 12 Early Intervention Services and its impact on multiple stakeholders. Informed by the Medical Research Council framework for complex interventions, the project includes a co-designed (with multiple stakeholders) multimodal capacity-building program with specific components developed to overcome barriers to peer support and family peer support integration. Quantitative questionnaires are collected every four months from clinicians and continuously from youth and families (questionnaires, satisfaction surveys) using the learning health system electronic platform. Focus groups are conducted annually over three years with eight stakeholder groups. The analysis integrates findings using thematic synthesis and joint displays to assess convergence and divergence across methods and perspectives. Results and conclusion: This protocol paper outlines the study’s co-design, procedures, and anticipated contributions. Embedding large-scale innovative intervention implementation (such as peer support) within an RLHS can foster real-time feedback, iterative refinement, and inform clinical practice and policies.

Objective The study aimed to evaluate the incidence, risk factors, and maternal-fetal outcomes of patients with PRAKI. Design Prospective cross-sectional observational study. Setting Nigeria Population Prgnant women attending anenatal clinic and labour ward of two referal hosiptal in Nigeria. Methods Study conducted among 841 women admitted to the Obstetrics and Gynecology wards of two large referral hospitals in Nigeria, between 1 st October 2022 and 30 th March 2023. Multivariate logistic regression analysis was performed to determine independent predictors of PRAKI. Main Outcome Measures Multivariate logistic regression analysis was performed to determine independent predictors of PRAKI. Results The mean age ± standard deviation (SD) of respondents was 27.8 ± 6.7 years. The prevalence of PRAKI was 11.4%, with the majority (55.2%) being in KDIGO stage 1. The most common risk factors for PRAKI were pre-eclampsia (24%), postpartum hemorrhage (16.7%), sepsis (15.6%), and eclampsia (14.6%). The overall maternal and perinatal mortality rates were 7.4 % and 21.9 %, respectively. PRAKI was independently associated with the use of traditional medications (adjusted odds ratio, aOR =1.94; 95% CI: 1.18, 3.18), history of pregnancy-induced hypertension (aOR = 2.61; 95% CI: 1.49-4.59), and an established diagnosis of hypertension (aOR = 2.53; 95% CI: 1.42, 4.50). Conclusion PRAKI is common in women presenting for care in our setting and is associated with significant maternal and perinatal mortality. The important risk factors for development of PRAKI in our study population include hypertensive disorders of pregnancy, established diagnosis of hypertension, postpartum hemorrhage, and sepsis.

Title: Bezafibrate for Severe Refractory Intrahepatic Cholestasis of Pregnancy: A Case Report and Literature ReviewErika Gandelsman*\RL1,3, Randa Taher*\RL2,3, Rinat Gabbay-Benziv\RL1,3, Fadi Abu Baker\RL2,3*Equal contribution1The Department of Obstetrics and Gynecology; Hillel Yaffe Medical Center, Hadera, Israel. 2the Department of Gastroenterology; Hillel Yaffe Medical Center, Hadera, Israel.3The Ruth and Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, IsraelCorrespondence: Rinat Gabbay-Benziv, MDDepartment of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera, Israel, 38100Tel: +972-4-6304313, Fax: +972-4-6314916E-mail: rinatg@technion.ac.ilRunning title: Severe Refractory ICP and Fibrate ResponseType of article: Case report and review of the literatureWord count: 1193 wordSummary Intrahepatic cholestasis of pregnancy (ICP) is a pregnancy-specific liver disorder associated with pruritus and elevated bile acids, posing significant fetal risks, particularly when total bile acids (TBA) exceed 100 μmol/L. We present a rare case of a 33-year-old patient with early-onset, severe ICP characterized by TBA levels exceeding 400 μmol/L and resistance to multiple lines of standard therapy. Despite ursodeoxycholic acid (UDCA), rifampin, and cholestyramine treatment, the patient’s response remained suboptimal. At 23 weeks, bezafibrate was initiated, resulting in marked clinical and biochemical improvement, culminating in the normalization of liver enzymes, bile acids, and bilirubin levels. This case highlights the limitations of current ICP therapies and supports further exploration of fibrates as a promising treatment in refractory cases.Introduction Intrahepatic cholestasis of pregnancy \RL)ICP\RL( is the most common hepatic disorder unique to pregnancy, with a reported prevalence of 0.2-2% depending on geographic and ethnic factors(1). It typically presents in the second or third trimester with maternal pruritus and elevated serum total bile acids (TBA), with spontaneous resolution postpartum. Although maternal outcomes are generally benign, ICP carries significant fetal risks—including spontaneous preterm birth, meconium-stained amniotic fluid (MSAF), and stillbirth—especially when TBA concentrations exceed 100 μmol/L(2–4).Ursodeoxycholic acid (UDCA) remains the first-line treatment, with demonstrated efficacy in alleviating maternal symptoms and improving liver function tests (5), though its effect on fetal outcomes remains unproven(6). In treatment-refractory cases or those with severe disease (TBA >100 μmol/L), additional therapies such as rifampin, cholestyramine, and therapeutic plasma exchange (TPE) may be considered (Hague et al., 2021; Ozkan et al., 2015). Fibrates, well-established in the management of other cholestatic liver diseases, have only recently been explored as a potential therapeutic option for ICP (9). This report describes a case of refractory, early-onset ICP with extreme bile acid elevation and progressive hyperbilirubinemia, successfully managed with bezafibrate.Case Presentation A 33-year-old gravida 4 para 3 woman presented at 19+3 weeks of gestation with generalized pruritus. She had an unremarkable medical and obstetric history with three term uncomplicated vaginal deliveries. She denied taking any medications and had no known history of liver disease. Laboratory testing revealed AST 150 IU/L, ALT 169 IU/L, ALP 148 IU/L, GGT 30 IU/L, total bilirubin 1.8 mg/dL, and markedly elevated TBA of 301 μmol/L. Her platelet count, blood pressure, and urinalysis were normal with no clinical,laboratory or fetal evidence of preeclampsia. A thorough investigation included a liver ultrasound and MRCP which were concluded as normal. Viral hepatitis serologies (HAV, HBV, HCV, HEV, CMV, EBV, HSV), autoimmune markers (ANA, AMA, LKM, ASMA), and metabolic parameters, including ceruloplasmin and immunoglobulin levels, were unremarkable.A diagnosis of ICP was established, and UDCA (15 mg/kg/day) was initiated in combination with cholestyramine. Following a few days of treatment, cholestyramine was discontinued due to intolerance. By 21 weeks of gestation, TBA levels rose to 401 μmol/L, AST to 249 IU/L, ALT to 320 IU/L, and bilirubin to 4.2 mg/dL. Rifampin (150 mg twice daily) was introduced, and UDCA was increased to 20 mg/kg/day. Liver transaminases showed partial improvement, and TBA decreased to 250 μmol/L. However, bilirubin continued to rise, reaching 8.7 mg/dL at 23+4 weeks, prompting rifampin discontinuation.Genetic-indicated amniocentesis revealed markedly turbid amniotic fluid. This unexpected finding raised clinical concern for potential meconium-staining or bile acid-related discoloration.Given the persistence of severe pruritus and ongoing biochemical deterioration, and following the exclusion of autoimmune and other hepatic pathologies, bezafibrate 400 mg daily was initiated. Within 18 days, TBA levels fell below 10 μmol/L, liver enzymes normalized within 3 weeks, and bilirubin decreased progressively to normal levels. The pruritus resolved completely. The patient continued bezafibrate and high-dose UDCA, and delivered a healthy infant at 36+5 weeks of gestation without complications.Discussion This case represents an unusually severe and early presentation of ICP, with TBA levels >400 μmol/L, marked transaminase elevation, and progressive hyperbilirubinemia. The initial treatment with high-dose UDCA, rifampin, and cholestyramine failed to achieve adequate biochemical or symptomatic control. The turning point was the introduction of bezafibrate, which resulted in rapid and sustained improvement across all clinical and laboratory parameters.The association between elevated serum TBA and adverse perinatal outcomes is well documented, However, there is a paucity of data on the highest-risk group—patients with TBA levels exceeding 150–300 μmol/L. Most existing studies analyze risks using broader categories, such as TBA ≥100 μmol/L, but do not provide outcome stratification at more extreme levels. In fact, the literature contains very few detailed reports of maternal or fetal outcomes in ICP patients with TBA above 300 μmol/L(2–4,10–12). This case contributes to bridging that gap by highlighting the importance of assessing both bile acid concentrations and liver function indices in predicting perinatal outcomes.Furthermore, while TBA levels are a critical marker, the presence and severity of liver dysfunction—reflected in markedly elevated transaminases, progressive hyperbilirubinemia, and signs of synthetic impairment—may carry independent prognostic value. Severe hepatic involvement in ICP can worsen maternal morbidity and may be associated with increased fetal risk (2,3). These observations support the need for a broader clinical approach that includes close monitoring of hepatic indices alongside bile acids to better stratify risk and guide management.Table 1 summarizes key studies evaluating fetal and neonatal outcomes in severe ICP based on TBA levels. A threshold of ≥100 μmol/L is consistently associated with increased risks of stillbirth, spontaneous preterm delivery, meconium-stained amniotic fluid, and neonatal unit admission. However, no published study to date has systematically examined outcomes in women with TBA above 300 μmol/L, and only a few have addressed the 150–300 μmol/L range in any detail.While UDCA remains the gold standard treatment for ICP, its impact on fetal outcomes remains uncertain (13). Second-line agents such as rifampin may be used for symptom relief but their use is limited by potential hepatotoxicity and concerns about rising bilirubin, as observed in this case (7). In this context, fibrates offer a mechanistically sound alternative. Through PPAR-α activation, they reduce bile acid synthesis and promote bile flow. Bezafibrate is now recommended as first-line pharmacologic therapy for moderate to severe cholestatic pruritus in primary sclerosing cholangitis and is increasingly used in other cholestatic liver diseases—though clinical experience is largely confined to non-pregnant populations. A large cohort study found no malformation risk with short-term fibrate use in pregnancy (14).Grady et al. recently reported two cases of ICP managed with fenofibrate after UDCA failure, both demonstrating substantial clinical and biochemical responses (9). This current case is, to our knowledge, the first published report of bezafibrate use in ICP. The rapid resolution of pruritus and normalization of bile acids and bilirubin following its initiation strongly support its anticholestatic effect.The use of bezafibrate was also considered in light of the patient’s rising bilirubin levels, which are atypical in ICP and more commonly associated with hepatic dysfunction or drug-induced liver injury. Following extensive exclusion of alternative etiologies and in the absence of liver biopsy (deferred due to pregnancy), the favorable response to bezafibrate further supports a cholestatic mechanism.This case underscores the need for expanded therapeutic options for patients with severe, treatment-refractory ICP. While additional data are needed on the safety of fibrates during pregnancy, the present report and others suggest a favorable benefit-risk ratio in select cases, particularly where maternal or fetal risk is high. The absence of complications in this case and a term delivery support the careful consideration of bezafibrate in similar scenarios.Conclusion This case describes a rare and severe form of ICP with extreme TBA levels elevation and marked liver injury, unresponsive to standard therapies. The dramatic and sustained improvement following bezafibrate introduction highlights its potential role in managing refractory ICP. This experience supports the consideration of fibrates as part of a broader, individualized approach. A multidisciplinary strategy remains essential to optimizing maternal and fetal outcomes. Further research is needed to establish the safety, efficacy, and optimal timing of fibrate use in pregnancy.DeclarationAuthor Contributions: EG and RT contributed equally to data collection, manuscript drafting, and literature review. RGB supervised the clinical management and manuscript preparation. FAB provided hepatology consultation and contributed to the discussion and literature analysis. All authors reviewed and approved the final manuscript.Conflicts of interests: All authors declare no conflict of interests.Funding: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.Acknowledgements: We thank the patient and her family for their trust and cooperation throughout the management and publication process.Ethical Statement: This case report was conducted in accordance with institutional policies. Written informed consent was obtained from the patient for publication of this report and accompanying dataReferences1. Williamson C, Geenes V. Intrahepatic cholestasis of pregnancy. Obstetrics and Gynecology. 2014;124(1):120–33.2. Ovadia C, Seed PT, Sklavounos A, Geenes V, Di Illio C, Chambers J, et al. Association of adverse perinatal outcomes of intrahepatic cholestasis of pregnancy with biochemical markers: results of aggregate and individual patient data meta-analyses. The Lancet. 2019 Mar 2;393(10174):899–909.3. Geenes V, Chappell LC, Seed PT, Steer PJ, Knight M, Williamson C. Association of severe intrahepatic cholestasis of pregnancy with adverse pregnancy outcomes: A prospective population-based case-control study. Hepatology. 2014;59(4):1482–91.4. Brouwers L, Koster MPH, Page-Christiaens GCML, Kemperman H, Boon J, Evers IM, et al. Intrahepatic cholestasis of pregnancy: Maternal and fetal outcomes associated with elevated bile acid levels. Am J Obstet Gynecol. 2015 Jan 1;212(1):100.e1-100.e7.5. Ovadia C, Sajous J, Seed PT, Patel K, Williamson NJ, Attilakos G, et al. Ursodeoxycholic acid in intrahepatic cholestasis of pregnancy: a systematic review and individual participant data meta-analysis. Lancet Gastroenterol Hepatol. 2021 Jul 1;6(7):547–58.6. Chappell LC, Bell JL, Smith A, Linsell L, Juszczak E, Dixon PH, et al. Ursodeoxycholic acid versus placebo in women with intrahepatic cholestasis of pregnancy (PITCHES): a randomised controlled trial. The Lancet. 2019 Sep 7;394(10201):849–60.7. Hague WM, Callaway L, Chambers J, Chappell L, Coat S, de Haan-Jebbink J, et al. A multi-centre, open label, randomised, parallel-group, superiority Trial to compare the efficacy of URsodeoxycholic acid with RIFampicin in the management of women with severe early onset Intrahepatic Cholestasis of pregnancy: the TURRIFIC randomised trial. BMC Pregnancy Childbirth. 2021 Dec 1;21(1).8. Ozkan S, Ceylan Y, Ozkan OV, Yildirim S. Review of a challenging clinical issue: Intrahepatic cholestasis of pregnancy. World J Gastroenterol. 2015 Jun 21;21(23):7134–41.9. Grady J, Clifford C, Treadwell MC, Parikh ND, Satishchandran A. Use of fenofibrate for intrahepatic cholestasis of pregnancy. J Hepatol. 2023 Aug;79(2):e84–6.10. Kawakita T, Parikh LI, Ramsey PS, Huang CC, Zeymo A, Fernandez M, et al. Predictors of adverse neonatal outcomes in intrahepatic cholestasis of pregnancy. In: American Journal of Obstetrics and Gynecology. Mosby Inc.; 2015. p. 570.e1-570.e8.11. Rook M, Vargas J, Caughey A, Bacchetti P, Rosenthal P, Bull L. Fetal outcomes in pregnancies complicated by intrahepatic cholestasis of pregnancy in a Northern California cohort. PLoS One. 2012 Mar 5;7(3).12. Sarker M, Zamudio AR, DeBolt C, Ferrara L. Beyond stillbirth: association of intrahepatic cholestasis of pregnancy severity and adverse outcomes. Am J Obstet Gynecol. 2022 Sep 1;227(3):517.e1-517.e7.13. Chappell LC, Bell JL, Smith A, Linsell L, Juszczak E, Dixon PH, et al. Ursodeoxycholic acid versus placebo in women with intrahepatic cholestasis of pregnancy (PITCHES): a randomised controlled trial. The Lancet. 2019 Sep 7;394(10201):849–60.14. Kay HY, Jang HY, Kim IW, Oh JM. Fibrates and risk of congenital malformations: a nationwide cohort study in South Korea. Arch Gynecol Obstet. 2024 Oct 1;310(4):1967–73.

With the exponential growth of log data in the digital age, the need for effective and secure log management has become essential for organizations. Conventional log storage systems are known to struggle with challenges related to data security and privacy. As log files often contain sensitive data, any leakage may result in security violations and compliance issues. In this article, a Blockchain-based system is proposed, integrating a RoBERTa- based sensitivity classifier with a layered circled blockchain mechanism to ensure secure and efficient log storage. The system begins with the aggregation of logs from local systems, which are then processed using a pre-trained RoBERTa model to determine their sensitivity. Non-sensitive logs are stored in the Ethereum public blockchain to maintain transparency and permanence, while sensitive logs are stored in a Hyperledger private network to ensure confidentiality. A layered circled blockchain mechanism is proposed to dynamically compute the optimal chain length for log storage, facilitating the creation of terminal and progressive blocks. The system is evaluated based on key performance indicators, including chain length, transaction throughput (TPS), and log sensitivity classification accuracy. Experimental results demonstrate that log security is enhanced and privacy-preserving storage is ensured, and overall performance is improved.

not-yet-known not-yet-known not-yet-known unknown Introduction: Despite increased research on menopause in the UK, there is a scarcity of research published on the experiences of Black women going through menopause. Studies suggest that culture, race, and ethnicity influence how menopause is experienced. Evidence shows that Black women face racial health inequalities in the UK. Therefore, this study aimed to explore the menopause experiences of Black women in the UK. Methods: The interpretive phenomenological analysis (IPA) study design was used to explore Black women’s lived experience of menopause in the UK. Purposive sampling was then used to select the five participants who were included in this study. In-depth interviews were used for data collection and IPA was used for data analysis Findings: Three main themes emerged from the study following data analysis. The themes are: unprepared, coming to terms; and acceptance and cultural shift. The findings show that participants had less knowledge about menopause before they started experiencing the symptoms. Strategies used to cope with menopause include humour, dietary and lifestyle changes. A cultural shift towards viewing menopause as a transformative phase at mid-life which should not to be stigmatised as a taboo subject was identified. Conclusion: Menopause is a challenging experience for Black women in the UK in many ways. A more diverse approach to symptom management could ensure Black women feel more supported by the healthcare services that are available in the UK.

Deep learning enables precise environmental predictions and simulations across spatial and temporal scales. However, reliable uncertainty estimation with generative capabilities remains crucial for actionable forecasting and simulation, yet robust and simple quantification methods remain challenging. Recently, engression, a generative approach for model-agnostic training and uncertainty quantification, has been proposed. We evaluate its feasibility for environmental time-series modeling, specifically applying it to rainfall-runoff prediction using long short-term memory (LSTM) networks. As a benchmark, we use quantile regression, a generalization of the mean absolute error (MAE). Our results show that engression-LSTM is an effective and easy-to-use method for generative modeling, outperforming quantile regression in uncertainty quantification. Furthermore, qualitative analysis of the generated runoff time series indicates high dynamic fidelity. These findings highlight engression-LSTM as a promising approach for incorporating uncertainty into environmental time-series modeling.

Case Report: A mirror within: Open appendectomy in a patient with Situs Inversus Totalis And Acute Appendicitis

IntroductionA common iliac artery aneurysm is characterized by a localized enlargement of the artery that exceeds 1.5 cm in diameter (1). Acute appendicitis is the most prevalent abdominal surgical emergency, though its identification and treatment continue to be challenging for surgeons (2). The co-existence of these two medical conditions is highly uncommon and typically indicates a severe clinical situation, requiring timely diagnosis and appropriate intervention (3). In this report, we describe the successful management of a patient diagnosed with both appendicitis and a common iliac artery aneurysm simultaneously.

Multiple gouty tophi in the handsXinyi Liu1,2, Yanchun Zhou1, Weiwei Bian11 Department of Nursing, Shanghai Ninth People’s Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China2 School of Nursing, Shanghai Jiao Tong University School of Medicine, Shanghai, ChinaCorrespondence: Weiwei Bian (13764962456@163.com)Keywords: arthritis, gout, tophi

Background: Elicit AI aims to simplify and accelerate the systematic review process without compromising accuracy. However, research on Elicit’s performance is limited. Objectives: To determine whether Elicit AI is a viable tool for systematic literature searches. Methods: We compared the included studies in four systematic reviews to those identified searching with Elicit. We calculated sensitivity, precision and observed patterns in Elicit’s performance. Results: Elicit had an average of 39.6% precision (26.7% - 46.2%) which was higher than the 7.55% average of the original reviews (0.65% - 14.7%). However, the sensitivity of Elicit was poor, averaging 37.9% (25.5% - 69.2%) compared to 93.5% (87.2% - 98.0%) in the original reviews. Elicit also identified some included studies not identified by the original searches. Discussion: At the time of this evaluation, Elicit did not search with high enough sensitivity to replace traditional literature searching. However, the high precision of searching in Elicit could prove useful for preliminary searches, and the unique studies identified mean that Elicit can be used by researchers as a useful adjunct. Conclusion: Whilst Elicit searches are currently not sensitive enough to replace traditional searching, Elicit is continually improving, and further evaluations should be undertaken as new developments take place.

Title:

Alveolar capillary dysplasia with misaligned pulmonary veins (ACD-MPV) is one of the major cause of neonatal interstitial lung disease causing persistent pulmonary hypertension of the newborn, although literature shows that symptoms can present later in infancy. Two patients were recently diagnosed with ACD at our Institution; we found out that a structured review and description of all the aspects of the disease was lacking. We considered published articles from 2018 to 2024. Final population analyzed: 149 patients, including our 2 cases. From each case report we extrapolated: clinical presentation, radiologic reports, genetic and histopathological features, treatment, and outcome. Pregnancy and birth are usually uneventful. Respiratory failure due to PAH during neonatal period is typical, but later presentation is possible (feeding problems, failure to thrive). Abdominal malformations are associated. Radiological exams rule out other causes of hypoxemia, but a final diagnosis of ACD requires genetic or histological confirmation. The unique curative therapy is lung transplant; intensive support therapy (mechanical ventilation, vasoactive and pulmonary vasodilator drugs) is invariably needed. ECMO is described in 44 patients and should be considered when medical therapy and mechanical ventilation are insufficient. Average survival without lung transplant is 21 months, but it is reduced to 4 months if outliers are excluded. 10 described patients received lung transplant; average survival was 81 months; 6 of them were alive at time of publication. Improvements in intensive support therapy can improve clinical conditions and survival to transplant target weight. Studies on genetic targets are in progress.

Acetylcholine plays a role in the immune system with notable anti-inflammatory properties. Xanomeline, a muscarinic acetylcholine receptor agonist, was recently approved for schizophrenia, marking the first therapy of its kind. Evidence suggests two molecular subtypes of schizophrenia: one characterized by reduced muscarinic receptor expression (muscarinic receptor-deficit schizophrenia, MRDS), and another marked by elevated immune markers, such as Interleukin-6 (IL-6), indicating immune activation. While IL-6 was consistently found to be upregulated in schizophrenia, findings on muscarinic receptor expression have been inconsistent.To explore the relationship between muscarinic receptor genes and IL6 expression, we conducted a systematic meta-analysis of CHRM1-5 and IL6 in postmortem brain samples of patients with schizophrenia. Following PRISMA guidelines, seven independent datasets met our inclusion criteria, comprising 295 samples (151 schizophrenia,144 controls). Our analysis revealed overall CHRM1-5 genes downregulation, with significant downregulation of CHRM1 and CHRM2, alongside upregulation of IL6. Notably, CHRM1 expression showed significant negative correlations with IL6 and its receptors, suggesting an overlap between MRDS and the immune-activated schizophrenia subgroup. This subgroup may benefit from personalized therapies, including Xanomeline or immune system modulators. Further research is required to confirm these findings and investigate targeted treatments.

The blood-brain barrier (BBB) plays a crucial role in the onset and progression of neurodegenerative diseases, particularly in the pathophysiology of Parkinson’s disease (PD). Under normal physiological conditions, the BBB maintains the barrier function between the central nervous system (CNS) and the peripheral circulation, precisely regulating molecular transport to prevent the infiltration of pathogens and harmful substances into the brain. However, BBB disruption may lead to the accumulation of neurotoxic substances, ultimately resulting in irreversible neuronal damage. In PD, BBB impairment has been implicated as a contributing factor to α-synuclein (α-syn) aggregation, oxidative stress, and chronic neuroinflammation, collectively accelerating neurodegeneration. This review focuses on BBB alterations associated with PD, integrating multimodal imaging techniques and clinical studies to systematically analyze its pathological characteristics. By thoroughly examining BBB changes in PD patients, this study aims to identify potential therapeutic targets and provide novel insights for optimizing diagnostic and intervention strategies. A comprehensive understanding of the structural and functional changes of the BBB in PD will facilitate the development of more precise diagnostic approaches and innovative therapeutic strategies.

In recent years, biochar materials have attracted considerable attention in the field of electromagnetic wave absorption. This is due to the fact that they are a renewable resource, inexpensive and environmentally friendly. However, there is still a need to optimize their performance. Subsequently, the asymmetric diffusion at the alloy/oxide interface was induced by heat treatment and Kirkendall effect, and hollow magnetic particles were in situ generated on the porous substrate of biochar. Using biochar with a pyrolysis temperature of 800 °C, the obtained CoFe@CoFe 2O 4/C-800 composite exhibits excellent wave absorption properties: an optimum reflection loss of -71.4 dB is obtained at a thickness of 2.70 mm; when the thickness is reduced to 1.70 mm, the effective absorption bandwidth extends to 5.68 GHz, covering a large part of the Ku band. Mechanistic studies show that the excellent broadband absorption properties of the material are due to the unique hollow heterostructure. Through the dielectric-magnetic double loss synergy, multi-stage polarization effect and optimized impedance matching mechanism, the efficient dissipation of electromagnetic energy is realized. This work offers a novel concept for the development of eco-friendly, high-performance electromagnetic wave-absorbing materials.

Organic fluorescent materials (OFMs), characterized by their unique molecular structures and exceptional optical properties, have demonstrated significant potential in diverse applications such as bioimaging, sensors, and display technologies. Nevertheless, the reliance on chemists’ intuition and experience in the traditional design of OFMs, coupled with the high cost and lack of scalability of conventional methods such as fluorescence detection and density functional theory (DFT) calculations, makes it difficult to keep up with the rapid development of the field. The advent of machine learning (ML) has introduced transformative possibilities, enabling data-driven exploration of the intricate relationships between molecular structures and fluorescence properties. Herein, we review the applications of ML in the innovative design of OFMs with an emphasis on the workflow of modeling, optical property prediction, and OFMs design. We also discuss the critical role of data curation and feature engineering in enhancing model performance. Our review provides an overview of commonly used models and assesses their efficacy. We critically examine key challenges such as database construction, model interpretability, and generalization ability, trying to provide a comprehensive framework that advances the integration of ML in the research of organic fluorescent materials, thereby facilitating the development of next-generation materials.

We prove results on unique continuation at the boundary for the solutions of real analytic elliptic partial differential equations of the form n i,j=1 aij(x) ∂ 2 u ∂x i ∂x j + n k=1 b k (x) ∂u ∂x k + c(x)u = 0 This work is motivated by and generalized the main results of , [5],[6], X.Huang et al in ,[12], [11] and M.S Baouendi and L.

The unit commitment and economic dispatch problems are crucial aspect of power system operation and management. Economic dispatch (ED) involves the optimal allocation of power generation from multiple sources to meet the electrical demands at minimal costs, while unit commitment (UC) entails deciding which generating unit should be online (committed) and which should be offline over a specific time horizon to meet forecasted electricity demand. These problems are considered difficult optimization problems due to the number/type of variable and constraints present. This paper presents a literature survey of classical optimization techniques applied to the UC and ED problems. Comparative numerical results for some standard benchmark problems showcase the performance differences among these methods. Future research directions are identified and discussed, paving the way for solutions with better accuracy, computational efficiency and, ease of implementation.

Yixian Chen, Anupal Baruah, Dipsikha Devi, Sagy CohenDepartment of Geography and the Environment, The University of Alabama, Tuscaloosa, AL 35401, USACorresponding Author: Yixian Chen, ychen223@ua.edu

As a core technology in flexible electronics systems, piezoresistive sensors exhibit significant application value in frontier fields such as medical health monitoring, intelligent human-machine collaboration, and bionic robot perception. A novel flexible piezoresistive sensing material was developed by combining biomass-derived carbon aerogel (CC) with polydimethylsiloxane (PDMS). CC/PDMS composites had excellent fatigue resistance, maintaining more than 90% shape recovery and less than 3.8% residual deformation after 100,000 cycles at 30% strain. Furthermore, CC/PDMS composites exhibited excellent piezoresistive response characteristics at at different temperatures. In the temperature range from -30°C to 100°C, its resistance decreased with increasing temperature, while showing a shortened response time. The composite achieved a stable resistance response through the reversible contact of the conductive network under the action of external forces, and had a wide linear detection range, high sensitivity and effective differentiation between static pressure and dynamic deformation signals. This work established the correlation between the microscopic deformation of carbon skeleton and the macroscopic electrical behavior, and verified the stability and durability of CC/PDMS composites under complex stress conditions. The collaborative design strategy provides an innovative platform for the development of sustainable, high-performance flexible sensors with important potential applications in health monitoring and intelligent human-machine interfaces.

This letter proposes a high-precision cosecant square beamforming reflectarray using an improved hybrid Particle Swarm Optimization and Genetic Algorithm (PSO-GA) and low coupling square ring element. Firstly, a novel hybrid PSO-GA algorithm is carried out to optimize the phase distribution of the high-precision beamforming reflectarray. Then, an element is presented whose reflection phase is insensitive to different incident angles and reflection amplitude keep stable with variation of element size. By using above mentioned methods, a high-precision beamforming reflectarray is designed and analyzed, the experiment results show well-defined cosecant squared beams in the predefined direction are achieved in the frequency range from 13.1 to 14.3 GHz and have a low loss.

In solidly grounded bipolar high-voltage direct current (HVDC) grids, DC faults can cause rapid current surges due to the inherent coupling between poles, posing significant risks to system stability. Traditional traveling-wave protection methods, while unaffected by MMC control characteristics, face challenges in bipolar systems where pole-to-pole coupling complicates fault identification and necessitates extensive deployment of costly DC circuit breakers (DCCBs). To address these limitations, this paper proposes a hybrid MMC topology based on an improved dual half-bridge submodule (IDHSM) with self-clearing capability and coordinated control-protection (CCP) strategy. The IDHSM enables dynamic adjustment of activated submodule ratios through adaptive modulation coefficient, actively reducing DC voltage by 14.93% under 300-Ω fault resistance while maintaining arm current constraints. Compared with full bridge submodule (FBSM), this hybrid topology reduces IGBT counts per voltage level by 50%, lowering hardware costs. Due to its dual capacitor structure with a passive current path, IDHSM can block energy injection from the AC side during faults. According to the simulations on ±500 kV four-terminal HVDC grid, fault identification within 1 ms using modulus instantaneous average values, resolving protection sensitivity degradation caused by MMC-based current limiting. In addition, 30% reduction in DCCB breaking current (from 7.0 kA to 4.9 kA) through coordinated current limiting. The proposed strategy exhibits strong performance within the transition resistance range of 0.1-300 Ω.

Climate change may increase phenological mismatches in biotic interactions due to shifts in flowering times of plants. Most studies focussed on first flowering, the timing of entire flowering periods have hardly been studied though this information is important when evaluating phenological mismatches. Here, we explore variations in flowering curves across 263 perennial herbaceous species spanning the entire flowering period, and determine whether species-specific patterns are linked to species’ functional properties. The results clearly suggest that competitive species, early-flowering and late-flowering species tended to invest resources in single but intensive flowering events, with shorter flowering durations and more left-skewed curves (‘all-in-one’ strategy). In contrast, stress-tolerant species distributed resources over several flowering peaks (‘bet-hedging’ strategy). We conclude that information on species properties can be used to extract information on different flowering strategies, that can be used to evaluated impacts of climate change not only on flowering times but also on biotic interactions.

Article type: Research Letter for Allergy