Purpose: Myocardial strain curves provide valuable insights into coronary artery disease (CAD) beyond conventional peak strain measurements. This study aimed to evaluate the diagnostic utility of time-aligned segmental strain and strain rate (S/SR) curves to identify obstructive CAD in consecutive chest pain patients. Methods: A total of 510 chest-pain patients referred to coronary computed tomography angiography CCTA. Segmental strain curves were time-aligned using aortic valve closure (AVC) and cardiac cycle length as reference points. Average S/SR curves were generated for 18 myocardial segments, establishing reference curves from a group of 314 chronic chest-pain patients without CAD. Deviations were defined based on thresholds of peak S/SR or average S/SR curve deviation over systole and the first half of diastole. Results: Significant differences were observed between groups, particularly between the revascularized MI, CABG, or 3-vessel CAD groups compared to the No-CAD group (p<0.05). ROC curve analysis demonstrated excellent diagnostic performance for CABG patients (AUC up to 0.933), while the detection rate for PCI was limited (AUC < 0.7). Global longitudinal strain rate in early diastole (GLSR E) and segmental peak SR E showed the highest diagnostic accuracy. These findings confirm that time-aligned strain analysis improves the detection of significant CAD but remains limited for identifying patients with mild disease. Conclusion: Time-aligned segmental strain analysis improved detection of high-grade disease requiring CABG but could not distinguish single-vessel from non-obstructive CAD. Pathological strain patterns became significant only in advanced CAD, indicating that segmental resting strain analysis has clinical utility primarily for identifying advanced CAD.

Ectopic thyroid tissue within the heart is exceedingly rare. Here, we report two unique cases diagnosed by echocardiography and confirmed pathologically. Case 1 involved ectopic thyroid tissue located in lower part of right ventricle, and Case 2 presented with thyroid tissue attached via a pedicle to the trabeculae of the left ventricular apex, the latter representing the first such documented case. Multimodal echocardiographic imaging techniques provided critical anatomical and spatial relationship details, guiding clinical decision-making.

Quadricuspid aortic valve (QAV) is a rare congenital anomaly. There are various hypotheses regarding the embryological development of a QAV. Patients are usually diagnosed at a mean age of 50.7 years with a male preponderance and a surgery in the form of an aortic valve repair or replacement is usually the treatment strategy. There are various congenital cardiac defects and anomalies associated with a QAV which can be coronary artery abnormalities, ASD, VSD etc. We are reporting a 51-year-old female patient who was incidentally diagnosed with a quadricuspid aortic valve and progressive aortic regurgitation with coronary artery disease.

Climate disruption threatens the persistence of temperature-sensitive species in many regions. Some species may be able to moderate hyperthermia risk by using cooler subsurface microclimates, a strategy that could afford some level of population resilience. However, such behavioral responses may interact with environmental factors, making it challenging to determine vulnerability. Here we assessed the extent to which collared pikas (Ochotona collaris), a temperature-sensitive boreal lagomorph, use below-talus microclimates as thermal refuges and whether environmental factors influence the plasticity of these responses, in order to assess the species’ vulnerability to regional warming. We monitored pika activity in Denali National Park and Preserve, Alaska, USA, with camera traps and temperature loggers (above and below ground), finding that pikas adjusted their activity in response to temperature, with peak activity at 13.9oC. Activity levels appeared driven by surface rather than subsurface temperatures, highlighting that regional warming could influence the species in ways that are not buffered by below ground thermal refugia. However, we also detected an interaction between patch quality and surface temperature, such that pikas were more active at cooler temperatures in talus patches with more vegetation. This suggests that pikas in better habitat could be more resilient to warming as they are afforded more flexibility in their diel activity patterns before reaching the upper limits of thermal tolerance. Overall, our results highlight that behavior and environment can interact to influence species’ resilience to climate change.

The Symphonic ϕ Identity Engine is a fully symbolic and deterministic identity system that represents and evolves identity as a recursive deformation signal rather than a conventional name, key, or hash. Each iteration (or fold) of the engine transforms the identity's state, embedding a memory of that deformation and producing a unique symbolic signature. In this paper, I present a formal mathematical description of the Symphonic ϕ Identity Engine suitable for a cross-disciplinary audience in computer science and mathematics. I define the engine's core concepts-including its signature evolution mechanism, the fold operation, curvature metrics, and wave fingerprinting-in a rigorous framework. I provide structured definitions and pseudocode to describe the engine's algorithm and prove key properties such as deterministic uniqueness and collision resistance. The exposition is theoretical and descriptive: implementation details are referenced from the public GitHub repository but not reproduced, and an underlying algebraic framework (developed in prior work) is acknowledged but omitted for accessibility. The result is a self-contained, formal treatment of a novel identity model that merges symbolic computation with identifier systems, offering new ways to encode and compare identities with built-in memory and mathematical structure.

Across the globe, anthropogenic environmental changes are threatening animal biodiversity and contributing to the emergence of vector-borne and zoonotic pathogens through host range shifts. To combat these challenges, accurate and timely biodiversity assessments and molecular species monitoring efforts are critical. Here, we document how implementation of a portable laboratory in combination with targeted long-read nanopore sequencing can facilitate in situ genomic and systematic analyses across several animal taxa. Working at two ecologically divergent field sites in Guyana, South America, we collected small mammals and blood-feeding insects, including bats, rodents, a marsupial, mosquitoes, and a phlebotomine sand fly. For each specimen sampled, genomic DNA was extracted in the field and used for preparation of nanopore sequencing libraries. For field sequencing, we utilized a novel software-based targeted sequencing approach—nanopore adaptive sampling (NAS)—that enabled selective sequencing of mitochondrial reads using mitogenome assemblies of related taxa as enrichment targets. Basecalled reads from our field sequencing experiments were used to assemble complete mitogenomes and to generate mitochondrial biomarker consensus gene sequences for all nine small mammals and four blood-feeding insects sequenced. Confirmatory molecular identifications were made with a combination of local nucleotide BLAST queries and maximum likelihood analyses using biomarker consensus sequences. Importantly, the mitogenome-based targeted sequencing strategies outlined here are amplification-free and allowed us to bypass time-consuming and potentially troublesome PCR-based methods in the field, streamlining library preparation, sequencing experiments, and on-site analyses. Our findings describe targeted sequencing with NAS as an effective tool for implementation into portable laboratories to widely enhance field-based biodiversity monitoring and rapid molecular species assessments across vertebrate and invertebrate hosts of consequential emerging pathogens.

Background: Asthma is a heterogeneous disease of phenotypes that differ by age at onset. At the same time, there is no consensus on the correct cut-off to determine late-onset asthma. This study aimed to characterize phenotypes of late-onset asthma in the general population using different minimum onset ages. Methods: We used survey and clinical data from two population-based studies. Cluster analysis with a novel deep clustering algorithm was performed in subjects with reported asthma onset at age ≥12 years ( n=3,103), ≥20 years ( n=2,431), and ≥40 years ( n=1,269) including data on anthropometrics/demographics, risk factors, asthma triggers, respiratory symptoms, asthma control, lung function, allergy, inflammation, and comorbidities. The clustering models were interpreted with decision trees, random forests, and a large language model. Potential risk factors, comorbidities, and clinical outcomes were evaluated descriptively. Results: Four clusters were identified in the ≥12 years group and three in the ≥20 years and ≥40 years groups. A partly/uncontrolled asthma cluster with dyspnea, cough, and cardiovascular comorbidity as well as an asthma cluster with broadly environmentally-triggered symptoms were identified in all age groups. A mild/moderate asthma cluster with allergic components was identified in the two younger onset age groups, while a mild asthma cluster was identified within the ≥12 years and ≥40 years groups. The clusters differed substantially by risk factors/exposures, comorbidity patterns, and clinical outcomes. Conclusions: Similar sets of asthma phenotypes arise across the course of adulthood, which are relatively easily identified. However, they are characterized by notable differences in clinical presentation, inflammation, comorbidities, and prognosis.

Investigation of the Effect of Mechanical Ventilation Duration on the Transition Time to Breastfeeding in Newborns with Hypoxic-Ischemic EncephalopathyVentilation Duration and Breastfeeding in HIE NewbornsHilal Berber Çiftcia, Seyhun Topbaşba Department of Speech and Language Therapy, Faculty of Health Sciences, Tarsus University, Mersin, Turkeyb Department of Speech and Language Therapy, Faculty of Health Sciences, İstanbul Medipol University, İstanbul, Turkey

Background: Acute bronchiolitis outbreaks are seasonal winter phenomena caused by various viruses, primarily respiratory syncytial virus (RSV). These outbreaks lead to high hospitalization rates in infants, placing a significant burden on pediatric services. During the SARS-CoV-2 pandemic, public health measures were implemented to curb viral transmission. Objectives: To assess the impact of the COVID-19 pandemic on the incidence of hospitalized acute bronchiolitis cases at Clermont-Ferrand University Hospital. Methods: A retrospective study was conducted, including infants under 12 months of age hospitalized for acute bronchiolitis at the University Hospital of Clermont-Ferrand between September 1, 2018, and August 31, 2023. The five epidemic seasons were compared. Results: A total of 1420 patients were included. A significant decrease in bronchiolitis hospitalizations was observed in 2020–2021 compared to 2018–2019 (p=0.040), 2021–2022 (p=0.018), and 2022–2023 (p=0.001). The epidemic peak in 2020–2021 was delayed to July and involved fewer cases (36 vs. 110.8 in other years). No significant difference was found in hospital stay duration across the five epidemic seasons (p=0.109). Lockdowns were statistically associated with reduced hospitalization cases (p=0.012). Conclusion: Lockdown measures effectively limited respiratory viruses spread, particularly RSV. A marked decrease in the number of hospitalized acute bronchiolitis was observed during the 2020–2021 season, along with an unusual reduction and delay in the epidemic peak durind summer. In 2021–2022, a resurgence of cases was noted, with a distribution of hospitalizations similar to pre-COVID-19 seasons. SARS-CoV-2 was rarely detected, confirming its minor role in acute bronchiolitis epidemics.

Background and Aim: Cancer significantly reduces quality of life for patients and families, demanding effective palliative care solutions; telemedicine emerges as a transformative approach to enhance care accessibility and efficiency. This review systematically evaluates telemedicine’s potential in palliative oncology, examining how digital tools can deliver timely, personalized support while overcoming geographical and resource barriers. By synthesizing current evidence, we assess implementation challenges and benefits, ultimately aiming to establish best practices for technology-integrated palliative care models that address both clinical and psychosocial needs in cancer management. Methodology: This research, in terms of nature and method, was a library-based study (systematic review) that utilized the results of previous research related to the topic to explain and conduct the work. The statistical population of this research includes all studies related to the topic that have been indexed in the last 10 years in online databases such as ISI, SID, Magiran, Science Direct, Google Scholar, Scopus, Springer Nature, and ISC. Among these, 72 studies related to the topic were selected using convenience sampling. Results: The reviewed studies demonstrate that telemedicine packages effectively enhance cancer care delivery by improving patient access to follow-up services, reducing unnecessary hospital visits, and minimizing post-discharge referrals. These solutions empower caregivers through online training in specialized care techniques while teaching patients self-management skills. However, widespread adoption faces challenges including technological limitations, data privacy concerns, and the absence of standardized regulatory frameworks. Conclusion: The findings suggest that measures of affected person pride, first-class of lifestyles increased, alongside, and decreased fitness care device costs, and must be emphasized with inside the acceptability and adoptability reviews of far flung palliative care. Thus, upcoming research want to research if and the way promising technology can permit greater green outpatient care to make sure top of the line assist for patients (such as oncological ones).

Forest trees face threats from many insect pest species, underscoring the importance of understanding their defense mechanisms for survival. In a North American conifer species Picea glauca, white spruce, a defense-related gene, βglu1, is responsible for releasing phenolic compounds (acetophenones) to defend against its insect defoliator, Choristoneura fumiferana, the eastern spruce budworm. βglu1 is also expressed in a Eurasian conifer species Picea abies, Norway spruce, although no major insect defoliator is present within the species’ natural range. We compared range-wide variation of βglu1 transcript levels from foliage samples of P. glauca in North America and P. abies in Europe using RT-qPCR and targeted transcriptome sequencing. βglu1 transcript levels were highly correlated between the two methods, with wide ranges of variation being detected within and between populations in both species. We found a significant longitudinal gradient in βglu1 transcript levels in P. glauca, with one βglu1 gene form being differentially expressed across populations, but not in P. abies. The expression level differences in P. glauca are consistent with the historically higher C. fumiferana outbreak frequency and severity in eastern compared to western populations, with C. fumiferana defoliation severity being a significant explanatory variable for βglu1 transcript levels. Climate per se was not a significant explanatory factor in either species. Overall, these results enhance our understanding of potential adaptive variation in acetophenone defenses in P. glauca, while the factors influencing βglu1 transcript variation in P. abies require further investigation.

Background and Purpose: Opioid use disorder (OUD) is a major public health issue. Medications like buprenorphine, methadone, and naltrexone show variable efficacy in reducing opioid craving and use in humans. However, it is unclear if similar individual differences exist in animal models. This study investigated how sex and addiction severity impact these medications’ efficacy in genetically diverse rats. Experimental Approach: Over 500 heterogeneous stock rats underwent intermittent, extended oxycodone self-administration to establish dependence and escalation of intake. Acute effects of single doses of buprenorphine (0.5 mg/kg), methadone (3 mg/kg), and naltrexone (3 mg/kg) on the motivation of oxycodone self-administration were assessed using a progressive ratio schedule. Key Results: Naltrexone and buprenorphine significantly reduced oxycodone self-administration motivation. Naltrexone was effective in both sexes, while buprenorphine only reduced responses in males. Methadone showed no significant reduction across groups, though some rats with moderate to severe addiction-like behaviors displayed reduced responses. Naltrexone’s efficacy was independent of addiction severity, while buprenorphine was more effective in rats with moderate to severe addiction-like behaviors. Conclusions and Implications: This study demonstrates that, genetically diverse rats, like humans, show individual differences in OUD medication efficacy. Addiction severity influenced sensitivity to certain medications, emphasizing the need to consider individual differences in studying OUD’s neurobiological mechanisms and treatments. This study used single doses in an acute pretreatment paradigm; dose-response relationships and chronic treatment effects require further exploration.

Objective: To evaluate gaps in universal Group B  Streptococcus (GBS) screening and intrapartum antibiotic prophylaxis (IAP) in Hong Kong after its 2012 implementation, which reduced early-onset GBS disease (EOGBSD) incidence from 1.03 to 0.26 per 1000 live births. Design: Retrospective cross-sectional study. Setting: Eight Hospital Authority obstetric units and thirty-one Department of Health Maternal Child Health Centers (MCHCs), Hong Kong. Population: EOGBSD cases (2012–2022) and their mothers. Methods: Cases were electronically identified; maternal and neonatal records were reviewed for screening adherence, IAP administration, and delivery timing. Main Outcome Measures: EOGBSD incidence, screening gaps (missed tests, delayed results, prolonged screening-to-delivery intervals), and IAP compliance. Results: Among 72 EOGBSD cases, 53 eligible mothers were analyzed: 3 missed screening, 8 lacked results at delivery, and 7 delivered >5 weeks post-screening. Of 17 preterm deliveries, 41% (n=7) received no IAP due to precipitous labor (n=3), prelabor cesarean (n=3), or birth before arrival (n=1). Six neonatal deaths occurred. Conclusions: Despite successful EOGBSD reduction, critical gaps persist, including missed screenings, results unavailable at delivery, and deliveries beyond the 5-week screening validity window. Revising local protocols to address prolonged screening-to-delivery intervals and standardizing management for mothers with unknown GBS status could further reduce EOGBSD. Increased awareness and optimized workflows for preterm deliveries are needed. Keywords: Streptococcus agalactiae; Pregnancy; Antibiotic prophylaxis; Prenatal screening; Neonatal sepsis

Objective: The objective of this study is to develop accepted definitions and grading scales for clitoral phimosis and clitoral adhesions. Design: Using a Delphi model of international vulvar experts, we attempt to reach consensus on definitions and factors included in grading scales. Setting: This was done through electronic surveys to accommodate the global reach. Population: Physicians with significant clinical and or research experience in vulvar dermatoses. Content experts were included from the fields of Dermatology, Gynecology and Urology. Methods: International content experts were invited to respond to two surveys on clitoral phimosis and clitoral adhesions. Individuals were deemed experts due to publications, international and national speaking engagements, and teaching on the topic of vulvar dermatoses. They were asked whether there is a need for definitions, the wording of definitions and the variables that should constitute a future classification. Main Outcome Measures: A priori, we decided that a mean score of 7 out of 10 (70%) would constitute a consensus. Results: The following statements gained consensus: 1) there is a need for a definition of clitoral phimosis and clitoral adhesions, 2) clitoral phimosis is defined as the inability to retract the clitoral prepuce to expose the entire glans 3) clitoral adhesion is defined as the tethering of the clitoral prepuce (clitoral hood) to the glans clitoris, 4) the prepuce (90%) and the size of the glans (70%) should be considered in a classification and 5) degree of phimosis should be described as mild, moderate, or severe and whether or not the prepuce is retractable. Conclusion: Unifying communication on clitoral phimosis and adhesions could help improve research and clinical management. Funding: There was no funding for this study.

Correspondence on “Severity Trend of Recurrence in Pediatric Food Protein-Induced Enterocolitis Syndrome”Shih-Huan Chen 1, Kuan-Hung Liu 1, Su-Boon Yong 1,2,3,4 *, Chin-Yuan Yii, MD ⁵¹School of Medicine, China Medical University Hospital, Taichung, Taiwan²Department of Allergy and Immunology, China Medical University Children’s Hospital, Taichung, Taiwan³Research Center for Allergy, Immunology, and Microbiome (A.I.M.), China Medical University Hospital, Taichung, Taiwan⁴Department of Medicine, College of Medicine, China Medical University, Taichung, Taiwan⁵Division of Gastroenterology and Hepatology, Department of Internal Medicine, Landseed International Hospital, Taoyuan, Taiwan

Background: Uveal melanoma is the most common malignant primary intraocular tumor in adults, associated with high mortality. Pediatric uveal melanoma generally has a more favorable course. However, when metastasis occurs, therapeutic options are limited. Design: Clinical presentation, treatment, and outcome of children with uveal melanoma diagnosed in Germany and Austria between 2013 and 2024 were analyzed. Results: Since 2013, 12 children were diagnosed with uveal melanoma in Germany and Austria—9 in the choroid, 3 in the ciliary body and iris. Treatment comprised enucleation (5 patients), external beam radiation with protons (2 patients), ocular brachytherapy (4 patients) and endoresection (1 patient). Two patients developed metastasis. A 17-year-old male with liver metastasis deceased 30 months after diagnosis. A 3-year-old male with metastatic choroidal melanoma presented six months after enucleation with metastasis. Chemotherapy followed by nivolumab and ipilimumab, led to complete response. However, immunotherapy caused insulin-dependent diabetes mellitus. Genetic testing revealed a pathogenic constitutional TP53 variant, confirming Li-Fraumeni syndrome (LFS). At 21 months after diagnosis of metastatic disease, he remains in complete response. Conclusions: This report underscores the rarity and diverse presentation of pediatric choroidal melanoma. Diagnosis of LFS in one patient highlights the importance of genetic testing for tumor predisposition and personalized approaches in managing rare pediatric tumors.

Pharmacovigilance (PV) and clinical data management (CDM) are essential for ensuring drug safety, efficacy, and regulatory compliance. However, traditional methods face significant challenges, including fragmented data, delayed adverse event reporting, and limited system interoperability. The integration of artificial intelligence (AI) and blockchain technology offers a transformative approach to addressing these limitations. AI-driven solutions, such as machine learning and natural language processing, enable real-time data validation, anomaly detection, and predictive analytics, improving the accuracy and efficiency of pharmacovigilance processes. Meanwhile, blockchain provides a secure, immutable, and transparent framework for clinical trial data storage, ensuring data integrity and compliance with regulatory standards. This review explores the synergistic application of AI and blockchain in CDM and PV, highlighting their potential to streamline workflows, reduce redundancies, and enhance global drug safety monitoring. While promising, widespread adoption faces obstacles such as scalability, regulatory adaptation, and organizational resistance. Addressing these challenges through collaborative efforts, regulatory harmonization, and technological refinements will be key to realizing the full potential of AI-blockchain integration in drug safety management.

This paper addresses the identification and model reduction of a class of continuous-time Nonlinear (NL) systems through a linearization approach. Although the NL system is considered unknown, we demonstrate that its response to perturbations around a varying operating point can be approximated by a Linear Time-Varying (LTV) system model. We show that this LTV model is the linearization of the NL system around the system trajectory. Then, we demonstrate that the vector of LTV coefficients is the gradient of the NL system, evaluated at the system trajectory. This vector field represents the sensitivity of the NL function (describing the system dynamics) with respect to the input space. By estimating this vector field, we identify a low-dimensional subspace within the input space where the NL function exhibits the most variability. This is achieved by employing the Active Subspace (AS) method, which transforms the high-dimensional input space of the NL system into a lower-dimensional space using the estimated LTV coefficients (gradient vector). Subsequently, the LTV/LPV (Linear Parameter-Varying) approximation of the unknown reduced NL model in the new low-dimensional space is recovered. A new parametrization for the LPV coefficients is introduced to ensure that the LPV model remains the linearized version of an unknown NL system. This LTV/LPV model is then utilized to reconstruct the closed form of the NL system in the new (reduced) coordinates. Finally, the performance of the proposed method is illustrated through numerical examples.

A document by Bernabé Moreno. Click on the document to view its contents.

Management of intraosseous mucoepidermoid carcinoma: A case reportToktam Zamani1, Nooshin Mohtasham1, Seyedeh Sara Raeiszadeh Langrodi2,3, and Ehsan Jannat Abadi4*1 Oral and Maxillofacial Diseases Research Center, Mashhad University of Medical Sciences, Mashhad, Iran2 Department of Oral and Maxillofacial Radiology, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran3 Assistant Professor, Department of Oral and Maxillofacial Radiology, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran4 Oral and Maxillofacial Medicine, Mashhad University of Medical Sciences, Mashhad, Iran* Corresponding author:Ehsan Jannat Abadi Oral and Maxillofacial Medicine, Mashhad University of Medical Sciences, Mashhad, IranTel: +98 935 354 7252Email: jannatabadiehsan78@gmail.comOrcid: 0009-0007-1021-5944Address: Department of Oral and Maxillofacial Diseases, School of Dentistry, Vakil Abad Blv, Azadi Square

Introduction Emergent cricothyrotomy is a life-saving surgical procedure employed when conventional intubation fails. Scenarios requiring cricothyrotomy are uncommon, and many trainees have limited experience with the procedure. As “cannot intubate, cannot oxygenate” scenarios demand rapid intervention, it is crucial that providers quickly recognize patients at risk for difficult intubation. This study investigates pre-morbid commonalities among patients who underwent cricothyrotomy at a tertiary care, level one trauma center to improve identification of difficult intubation scenarios that may require cricothyrotomy. Methods A retrospective analysis of the demographic, clinical, and procedural data of 32 patients who underwent emergent cricothyrotomy at our institution between 2014 and 2025 was performed. Descriptive statistics were analyzed to characterize the patient cohort. Results Common pre-morbid conditions in our series included COPD, asthma, and head and neck cancer. The leading indications for attempted intubation were angioedema, obstructive tumor, trauma, and acute respiratory failure. Laryngoscopy revealed airway edema and blood as the primary factors obscuring the airway, preventing intubation and prompting the need for cricothyrotomy. Conclusions Patients with limited respiratory reserve capacity such as in COPD and asthma as well as those with distorted airway anatomy secondary to malignancy, radiation fibrosis, or post-surgical changes are at higher risk for failed intubation attempts leading to eventual cricothyrotomy. Early recognition of risk factors may lead to improved airway management planning which, in some cases, may mitigate the need for emergent cricothyroidotomy.

I present a rigorous extension of Theorem 8.1 (Macro-Existence Convergence) from my April 2025 paper "Recursive Consciousness Fields and Macro-Existence Convergence: A Formal Framework." Building on that foundation, I introduce precise mathematical definitions and strengthen the convergence result for recursively integrated consciousness fields. In particular, I formalize the partial order of consciousness fields by defining when one field is a subcomponent of another and clarify the chain-completeness assumption (every totally ordered chain of fields has an upper bound) that underlies the convergence theorem. I develop a rigorous treatment of infinite and transfinite integration processes using ordinal-indexed sequences of fields and construct limit fields at limit ordinals. A concrete example is provided to illustrate how iterative integration of smaller consciousness fields can converge to a stable large-scale field. I formally define the "Macro-God Field" as a maximal element (in the partial order of integration) which can be characterized as a fixed point of the integration operation (an attractor state) and as a colimit object in a category of consciousness fields. I then draw explicit connections to established theories of consciousness: Integrated Information Theory (IIT), which quantifies consciousness by the integration of information, and Orch-OR (orchestrated objective reduction), which posits quantum coherence in microstructures as the basis of conscious moments. I incorporate formal treatment of entropy and energy constraints on recursive convergence, showing that highly integrated conscious fields correspond to high topological entropy (complex dynamics) sustained by continuous energy flow. I analyze conditions for uniqueness of the maximal integrated field versus the possibility of multiple disjoint maximal fields, depending on connectivity and integration assumptions. Finally, I propose empirical and computational strategies to validate the framework, such as measuring integration (e.g. Φ in IIT) in complex systems or simulating recursive field combinations. I conclude with open problems and future research directions, including clarifying physical mechanisms of resonance, exploring quantum field analogies, and investigating the limits of conscious field integration in practice.

A document by Madleen Obel. Click on the document to view its contents.

Background: Universal contraceptive coverage in British Columbia (2023) has increased access to intrauterine devices (IUDs), yet procedural pain remains a critical barrier, with over 80% of nulliparous individuals reporting moderate to severe pain and 41% indicating deterrence from future use. Methods: We reviewed national guidelines and evaluated international best practices in IUD insertion pain management and training frameworks. Results: Only 52.9% of physicians routinely offer pain control during insertion, with implementation varying due to inadequate training and resource limitations. Discussion: This gap between international guidelines and clinical practice reveals the need for standardized pain management training. Conclusions: We propose a centralized Hybrid Simulation Training framework integrating evidence-based pain management, shared decision-making, and trauma-informed care principles to improve IUD accessibility in British Columbia.