The increasingly recurrent urban floods pose significant risks to underground spaces and their users. Often essential in these scenarios, stairs present unique challenges during floods as they serve as pathways for evacuation and for the incoming water. With most of the prior studies focusing on studying a single individual, the impact of group dynamics on flooded stairs remains underexplored. This study addresses this gap investigating how these dynamics influence evacuation efficiency and safety through a 3D numerical analysis. This research introduces realistic human body dummies along the stairs to simulate various pedestrian arrangements under a discharge of 0.423 m 3/s. Hydrodynamic forces and Momentum of Flow (MF) and Specific Force Per Unit Width (SFPUW) safety criteria are calculated to evaluate hazardous conditions. Pedestrian arrangements include a single individual at different positions, as well as tandem and side-by-side arrangements. Results revealed significant variations in the water-dragging forces based on positions and grouping dynamics. Notably, compared to isolated cases, side-by-side arrangements exhibited increased water-exerted force on both side-by-side and downstream individuals, while tandem configurations showed reductions in dragging forces on trailing pedestrians. The affectation of forces diminished when the separation between them increased. This study highlights potential bottlenecks, evaluates evacuation strategies, and provides insights to enhance safety protocols in underground infrastructure during flood events, contributing to urban resilience and flood risk mitigation strategies.

Forest restoration is a proven method to rehabilitate eroded soil. However, how the soil microenvironment of forest restoration affects microbial communities and soil fertility at the aggregate scale remains unclear, hindering the ecological well-being of development in the degraded lands in the Xishuangbanna region. To address this, soil samples were collected from a tropical primary forest (tropical rainforest, RF), an artificial monoculture forest (rubber monoculture, RM), and two restored forests (JRM: natural restoration of RM; JRC: natural restoration of RM with Camellia sinensis intercropping) and analyzed for soil physicochemical properties and microbial communities. Our results indicated that restored forest soils have higher levels of soil fertility compared to RM (i.e., SOC: 1.74–2.03 times; TN: 1.51–1.70 times; TP: 1.48–1.52 times), and the soil fertility increased as the size of soil aggregates decreased. The microbial alpha diversity and the complexity of microbial networks were higher in the restored forests than in RM. Microbial alpha diversity and co-occurrence network complexity increased as soil aggregate size decreased. These changes were significantly correlated with pH, electrical conductivity (EC), and soil fertility. Compared with fungi, bacterial network complexity was significantly associated with most soil fertility factors, and bacterial r-strategists increased in restored forests compared with RM. In addition, the random forest model and partial least squares path model further confirmed that forest types ( P < 0.05; total effect: 0.16) rather than soil aggregates ( P > 0.05; total effect: –0.07) significantly positively influenced soil fertility by inducing soil pH, EC, and bacterial communities but not fungal communities. These results suggest that forest restoration can foster conducive soil conditions that enhance the growth of soil microbes, especially the bacterial community, to participate in soil nutrient cycling and accumulation. However, JRC exhibited greater potential for increasing soil fertility than JRM, although both restorations played comparable roles in improving microbial community characteristics. In conclusion, the results of this study suggest that forest restoration in abandoned rubber plantations plays an essential role in improving soil fertility, but this depends on the restored forest communities and soil microbial community characteristics.

Background: The ”internal and external crosstalk” between skin barrier dysfunction and immune inflammatory response is the main pathogenesis of atopic dermatitis (AD), with the Th2 immune inflammatory response being the main link. Migration of circulating lymphocytes to inflammatory sites is essential for the immune response. Although AD is characterized by lymphocyte infiltration into the dermis, its skin-homing effect remains poorly defined. Methods: In this study, we induced an AD mouse model using DNFB to observe the skin barrier function changes and examine the Th2 immune inflammatory response. Additionally, we analyzed the homing of Th2 cells from peripheral blood to the skin and the gene and protein expression of key homing molecules. Furthermore, we explored the relationship between skin-homing and AD. Results: In the AD mouse model, skin barrier damage was observed, along with the skin-homing of Th2 lymphocytes and related immune inflammatory responses. Correlation analysis showed a significant positive correlation between the levels of homing cells and homing molecule proteins in peripheral blood and the protein levels of skin Th2 immune cells and transcription factors. Additionally, there was a significant linear relationship between the gene levels of homing molecules and AD symptoms. Conclusions: This study found that AD mice mainly exhibited skin barrier damage and Th2 cell immune responses, along with the phenomenon of skin-homing of Th2 lymphocytes, which can exacerbate AD symptoms. By intervening in the skin-homing of Th2 lymphocytes, AD symptoms can be effectively improved, and recurrences could be prevented.

In alpine grasslands, nutrient limitation, especially nitrogen limitation, is a known factor. The application of nitrogen fertilizer is commonly used to restore degraded grasslands. However, the effects of nitrogen types, levels, and time scales on plant species diversity and the driving mechanisms of ecosystem multifunctionality remain poorly understood. To address this gap, our study focused on slightly degraded alpine grasslands in the Three Rivers Source Region. We conducted a six–year nutrient addition experiment using three different types of nitrogen fertilizers ((NH 4) 2SO 4, KNO 3, and CH 4N 2O). We analyzed changes in biodiversity, vegetation productivity, and ecosystem functionality following nitrogen addition. Our findings showed that short-term nitrogen addition enhanced species diversity and aboveground biomass. Under short–term nitrogen addition, species diversity showed a linearly negative correlation with ecosystem multifunctionality, whereas no correlation was observed under long–term nitrogen addition. Through structural equation model, it was determined that under short-term nitrogen addition, where nitrogen forms and levels primarily affect species richness by increasing species acquisition rates. In contrast, long-term nitrogen addition impacted species diversity through increased species loss rates, with no effect on ecosystem multifunctionality. These findings offer crucial evidence regarding the mechanisms of nitrogen addition on plant communities and ecosystems, providing valuable theoretical support for the ecological restoration of degraded alpine grasslands.

The study aimed to evaluate the three-year trend of ASM use by comparing older versus newer ASMs through TDM requests. A retrospective analysis involved 122 patients who received 448 ASMs over three years. Significant portion of the sample comprised older ASMs (252 out of 448, 56.25% (95% C.I. 46-65%)). Older ASMs were more frequently tested than newer ones (p<0.01), with a noticeable shift towards newer ASMs. Monotherapy and polytherapy differed significantly (p<0.05), with polytherapy trending. The most frequent combination in polytherapy was phenytoin and levetiracetam. The maximum was five ASMs, seen in 2 out of 74 polytherapy cases. Eighteen percent of referrals cited therapeutic failures, with four ADRs documented at therapeutic levels. The trend analysis revealed increased use of newer ASMs from 2019 to 2021. TDM requests were higher for older drugs, with most epilepsy patients treated with multiple AEDs achieving satisfactory seizure control and minimal adverse drug reactions.

Based on Chinese Longitudinal Healthy Longevity Survey (CLHLS) data during 2008-2021, this paper combines it with socio-economic factors at the county/city level and uses the truncated Tobit model to examine the impact of regional economic differences on end-of-life (EOL) medical and nursing costs of the elderly in China. The results show that: (1) There is a U-shaped relationship between counties’ GDP per capita and EOL medical expenses. The law also applies to the effects of GDP per capita on self-paid medical cost and on nursing expenses. (2) Eastern counties’ GDP per capita lie in the upward range of the U-shaped curve while western and central regions are still in the declining range. (3) Along with the counties’ economic development, the aging population will place a heavy burden on social security system. (4) Savings accumulated during economic development makes more non-healthy elderly surviving with illness. The overall health level of the elderly in economically developed areas is lower than that in economically backward areas.

Cryptic species, characterized by their elusive behaviours and/or morphological similarities to other taxa, are underrepresented in global conservation efforts, often due to challenges in detection and monitoring. These species are frequently classified as data deficient, limiting our understanding of their population dynamics, ecological roles, and vulnerabilities to threats such as habitat loss and climate change. This knowledge gap is exacerbated by the inadequacy of traditional monitoring methods, which rely on direct observation or morphological analysis that often fail to address the unique challenges posed by cryptic taxa. Staple technologies, including environmental DNA, acoustic monitoring, and telemetry, have advanced efforts to study these species. However, their application is hindered by logistical barriers, such as high costs and resource demands, as well as ethical concerns surrounding invasive techniques and inequitable researcher access in biodiversity-rich but economically constrained regions, thus influencing the credibility and replicability of research. Furthermore, many of these tools have been designed for larger, more conspicuous species, perpetuating biases in global conservation science. This review highlights the persistent gaps in knowledge about cryptic species and critiques the limitations of common methodologies. It underscores the need for integrative, multidisciplinary approaches tailored to the behavioural and ecological complexities of these species. By addressing inequities in access to technology, fostering collaborative research frameworks, and advocating for open-source innovation, the scientific community can work toward more inclusive and effective conservation strategies. Ultimately, this commentary aims to provoke critical reflection on the ethical and logistical challenges of cryptic species monitoring, calling for a shift toward scalable, accessible, and species-appropriate solutions. Bridging these gaps is not only vital for advancing ecological understanding but also for safeguarding some of the planet’s most vulnerable and enigmatic species before they are lost to extinction.

The development of obsessive‒compulsive disorder (OCD), a common psychiatric disorder with multiple dimensions, is closely related to parenting styles. Theoretical studies suggest that perfectionism may play a mediating role, but this has not been confirmed in patients with varied OCD symptoms, and the differences in the roles of positive and negative perfectionism remain unknown. The aim of this study was to investigate the mediating role of perfectionism between parenting styles and various obsessive‒compulsive symptoms in patients with OCD. A total of 181 patients with OCD and 138 healthy controls completed questionnaires measuring obsessive-compulsive symptoms, parenting styles, and perfec­tionism. The results revealed a positive correlation between negative perfectionism scores and negative parenting style scores, with higher scores predicting more severe obsessive‒compulsive symptoms. Negative perfectionism mediated the relationship between negative parenting styles and obsessive‒compulsive symptoms. In contrast, the mediating role of positive perfectionism was not significant. These findings elucidate the mechanisms underlying the occurrence of various obsessive‒compulsive symptoms and offer new ideas for OCD interventions. These results suggest that perfectionism may play an important role in the relationship between obsessive‒compulsive symptoms and parenting styles, shedding light on possible mechanisms behind obsessive‒compulsive symptoms, and offering possible treatment targets.

Background Eating disorders (ED) are pervasive and severe mental illnesses affecting up to 15% of females and 5% of males internationally with rates sharply rising in recent decades. Alongside the increasing prevalence, pressures on ED services have surged since the COVID-19 pandemic. The impact of this changing workload on ED clinicians and their wellbeing has not recently been investigated. This scoping review examines recent literature on ED clinicians’ experiences, needs, and wellbeing to identify areas for future research and intervention. The goal is to improve clinician support, quality of life, and patient outcomes. Methods Following PRISMA guidelines, eight databases and grey literature sources were searched for studies published from 2014 to 2024. Papers were assessed for quality and risk of bias, and mixed-methods data were analyzed using narrative synthesis. Results Sixty-three studies, encompassing 3,152 multidisciplinary ED clinicians, were included. Clinicians worked across diverse settings with patients of varied presentations. Analyses suggest that whilst job satisfaction amongst ED clinicians is high and attitudes are generally positive, workplace demands and stressors have a negative impact on clinician wellbeing. Several areas require clearer guidance and further clinician training. Clinicians’ affect is mixed, and an ‘emotional rollercoaster’ is experienced at work. Many clinicians mention a lack of resources as a frustrating obstacle to an optimally operating service. Conclusions Clinicians experience working with ED patients as emotionally challenging and occasionally fatiguing, but attitudes are generally positive. However, clinicians are hindered by organizational factors and a lack of resources, including those pertaining to staffing and training.

A Rare Case of Antiphospholipid Syndrome in a 28-year-old Male with Discoid Lupus ErythematosusMohammad Rasel1*, Sujan Kumar Das1, Farzana Islam1, Iffat Zahan11 Shaheed Suhrawardy Medical College Hospital, Dhaka, Bangladesh.*Corresponding author E-mail: raselmohammad03@gmail.comSujan Kumar Das: sujankumardassh11@gmail.comFarzana Islam: farzanabarira@gmail.comIffat Zahan: iffatzahan47@gmail.comManuscript type: Case reportKeywords: Antiphospholipid syndrome, Discoid lupus erythematosus, Acute digitalischemia, Lupus anticoagulant, Male.Funding information: The authors received no financial support for authorship, and/or publication of this case report.Conflict of interest: All the authors of this manuscript have no conflict of interest.Data availability statement: Data sharing is not applicable to this article as no datasets were generated or analyzed during the current study.Ethical approval: Ethics approval is not required for de-identified single case reports based on institutional policies.Consent: Written informed consent was obtained from the patient to publish this case report in accordance with the journal’s patient consent policy. A copy of the written consent is available for review by the editor-in-chief of this journal on request.

Introduction. Penile girth enhancement is achieved using a variety of fillers, including autologous fat injection, silicone, collagen, hyaluronic acid, polylactic acid (PLA), polymethylmethacrylate, and dextran. While PLA has a good filling effect due to its bio-stimulatory properties, it may cause complications in a certain percentage of cases. Case Presentation. We describe

Title: Rate (and rhythm)-limiting steps in newly diagnosed atrial fibrillationAuthors: Romil Patel DO, Jeremiah Wasserlauf MD, MS, FHRSInstitution: Division of Cardiology, Endeavor Health – Northshore University HealthSystema, University of Chicago Pritzker School of MedicinebOriginal paper: Contemporary Study of New Onset Atrial Fibrillation Treatment Strategies at a Large Academic Tertiary Care CenterManuscript ID: JCE-24-1123.R1Atrial fibrillation (AF) is the most common sustained arrhythmia worldwide that affects approximately 1 in 4 adults over the age of 40, leading to impaired quality of life and complications that include heart failure, stroke, and increased mortality (1). Management strategies include stroke prevention, rate control, and rhythm control.This study by Zghaib et al. included 24,990 patients with a new diagnosis of AF between 2018 and 2023 who were retrospectively included via the TriNetX database. Initial treatment lines were initiated within 4 weeks of diagnosis as either rate-control, rhythm-control, or neither. Following 4-weeks, alternative therapy lines could be initiated during patient follow-ups. This study answers an important question on how ‘real life’ treatment is determined for newly diagnosed AF rather than presumptions of following guidelines.In this observational study, by the end of follow-up, 17,860 of the 24,990 patients at this tertiary care center were treated with either rate control only (9,760 patients) or neither rate nor rhythm control (8,100 patients).  The other 7,130 patients (29% of the total population studied) underwent rhythm control by the end of the follow-up period; 4,610 patients received anti-arrhythmic drug therapy only, and 2,530 patients underwent an ablation procedure with or without anti-arrhythmic drug therapy. When assessing patients who received any treatment, whether rate or rhythm control, these patients were younger and had a higher burden of pre-existing comorbidities such as heart failure, ischemic heart disease, and hypertension but not prior strokes. When looking at rhythm control as the therapy received, these patients were also younger but had fewer comorbidities.The authors of this study showed that in ‘real-life’ practice, most patients received only rate control or neither rate nor rhythm control with incident AF. From the entire patient population, 71% received rate control or neither rate nor rhythm control, while 29% underwent rhythm control with either anti-arrhythmic drugs or catheter ablation by the end of follow-up. This study brings forth a need to streamline patients to AF programs quickly following new diagnosis to promote earlier initiation of AF therapy, including early rhythm control.In the 2000s and 2010s, treatment for atrial fibrillation evolved drastically with the adoption of catheter ablation as a second line, and thereafter, in appropriate candidates, as a guideline-based first-line treatment strategy. Earlier studies such as AFFIRM and RACE demonstrated non-inferiority of rate control to rhythm control, while CABANA failed to show a significant reduction in death, stroke, or cardiac arrest with catheter ablation compared to anti-arrhythmic drug therapy (2,3,4). However, as catheter ablation for AF improved, including a shift towards earlier treatment, the role of rate and rhythm control evolved in parallel. In 2020, EAST-AFNET 4 showed that in patients with a new diagnosis of AF, early rhythm control was associated with reduced hospitalizations, stroke, heart failure, and cardiovascular mortality (5). Early intervention for AF prevents cardiac remodeling, improving overall clinical outcomes and disease progression (6). Treatment paradigms have accordingly shifted to recognize maintenance of sinus rhythm as a disease-modifying therapy in AF.There are several limitations to this study by Zghaib et al. One is that patients were studied before the 2020 EAST-AFNET 4 trial, which may limit the generalizability of the study relative to current practice. Additionally, in this database and retrospective analysis, symptom burden could not be obtained for patients, meaning symptoms’ impact on referral status was not assessed. Finally, as patients were followed for a varying duration of 6 months to 6 years from AF diagnosis, the study may underrepresent patients who went on to have rhythm control after the completion of the follow-up period.The authors should be commended for this large study of physician management of new AF diagnosis. Future studies are needed to determine how management has changed in the era of early rhythm control, and the extent to which specialized care pathways targeting earlier treatment of AF can ameliorate outcomes, cost, and be scaled broadly across practice settings.ReferencesChugh, S. S., Havmoeller, R., Narayanan, K., Singh, D., Rienstra, M., Benjamin, E. J., Gillum, R. F., Kim, Y. H., McAnulty, J. H., Jr, Zheng, Z. J., Forouzanfar, M. H., Naghavi, M., Mensah, G. A., Ezzati, M., & Murray, C. J. (2014). Worldwide epidemiology of atrial fibrillation: a Global Burden of Disease 2010 Study. Circulation , 129 (8), 837–847. https://doi.org/10.1161/CIRCULATIONAHA.113.005119Wyse, D. G., Waldo, A. L., DiMarco, J. P., Domanski, M. J., Rosenberg, Y., Schron, E. B., Kellen, J. C., Greene, H. L., Mickel, M. C., Dalquist, J. E., Corley, S. D., & Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) Investigators (2002). A comparison of rate control and rhythm control in patients with atrial fibrillation. The New England journal of medicine , 347 (23), 1825–1833. https://doi.org/10.1056/NEJMoa021328Van Gelder, I. C., Groenveld, H. F., Crijns, H. J., Tuininga, Y. S., Tijssen, J. G., Alings, A. M., Hillege, H. L., Bergsma-Kadijk, J. A., Cornel, J. H., Kamp, O., Tukkie, R., Bosker, H. A., Van Veldhuisen, D. J., Van den Berg, M. P., & RACE II Investigators (2010). Lenient versus strict rate control in patients with atrial fibrillation. The New England journal of medicine , 362 (15), 1363–1373. https://doi.org/10.1056/NEJMoa1001337Packer DL, Mark DB, Robb RA, et al. Effect of Catheter Ablation vs Antiarrhythmic Drug Therapy on Mortality, Stroke, Bleeding, and Cardiac Arrest Among Patients With Atrial Fibrillation: The CABANA Randomized Clinical Trial. JAMA.  2019;321(13):1261–1274. doi:10.1001/jama.2019.0693Kirchhof, P., Camm, A. J., Goette, A., Brandes, A., Eckardt, L., Elvan, A., Fetsch, T., van Gelder, I. C., Haase, D., Haegeli, L. M., Hamann, F., Heidbüchel, H., Hindricks, G., Kautzner, J., Kuck, K. H., Mont, L., Ng, G. A., Rekosz, J., Schoen, N., Schotten, U., … EAST-AFNET 4 Trial Investigators (2020). Early Rhythm-Control Therapy in Patients with Atrial Fibrillation. The New England journal of medicine , 383 (14), 1305–1316. https://doi.org/10.1056/NEJMoa2019422Melanie A Gunawardene, Stephan Willems, Atrial fibrillation progression and the importance of early treatment for improving clinical outcomes, EP Europace , Volume 24, Issue Supplement_2, June 2022, Pages ii22–ii28, https://doi.org/10.1093/europace/euab257

Background Determining the safer and more effective ablation technique for atrial fibrillation (AF) remains a matter of concern. Thus, in this meta-analysis, we evaluated radiofrequency ablation (RFA) and cryoballoon ablation (CA) through randomized controlled trials (RCTs) comparing the two techniques in terms of freedom from AF, any tachyarrhythmia recurrence, stroke, phrenic nerve palsy (PNP), procedure duration, and mortality. Methods A PubMed, Scopus, Web of Science, and Cochrane literature search was conducted from inception until December 2024. RCTs comparing RFA versus CA for AF were selected. All relevant outcomes were pooled in the meta-analysis using Review Manager Software. Results We included 23 RCTs with a total of 3018 patients. Both types of ablations were comparable regarding freedom from AF and recurrence of any atrial tachyarrhythmias (RR = 0.99, 95% CI (0.90, 1.09), P = 0.90; RR = 0.94, 95% CI (0.82, 1.08), P =0.38, respectively). Likewise, both ablation techniques showed a comparable risk of stroke and mortality (RR = 0.51, 95% CI (0.26, 1.01), P = 0.05; RR = 0.27, 95% CI (0.04, 1.61), P = 0.15). Regarding safety, PNP was significantly lower with RF (RR = 0.36, 95% CI (0.24, 0.54), P < 0.00001). However, the procedure was significantly longer than CA (MD = 17.91, 95% CI (7.85, 27.98), P = 0.0005). Conclusion RFA and CA have comparable efficacy outcomes for rhythm control in AF but have unique procedural and safety profiles. The choice between these modalities should be guided by clinical context, operator expertise, and patient-specific considerations. Further research, particularly in high-risk populations and with evolving ablation technologies, is essential to refine these insights and optimize patient outcomes.

Allelopathy is the chemical interaction between plant species whereby one organism may promote or interfere with another. Accordingly, allelopathic plant species play significant roles in shaping natural ecosystems such as affecting species distribution and diversity. While a high degree of inter-species variation in allelopathic capacities is commonly reported, variation across subspecies and between dioecious sexes is limited. Here we use the ecologically important, allelopathic dwarf shrub Empetrum nigrum to assess how allelopathic capacity varies between subspecies (ssp. nigrum and ssp. hermaphroditum) and sex (ssp. nigrum male and female plants). Specifically, we test Icelandic Empetrum, as its allelopathic nature may be an influencing factor in long-term land degradation across Icelandic highlands. Allelopathic capacity of Empetrum foliar tissues was assessed as root elongation and seed germination inhibition of the palatable grass species, Festuca richardsonii. We observed a very strong allelopathic response of Empetrum, whereby the different subspecies and sexes severely inhibited Festuca root elongation, even at very low leaf density levels. Sex and subspecies related differences in allelopathic capacity was also observed, with ssp. hermaphroditum affecting Festuca seed germination more than ssp. nigrum, and male ssp. nigrum possessing a greater germination inhibitory effect compared to female plants. Our results indicate that Empetrum may differentially impact plant interactions and ecosystem processes depending on the relative abundance of Empetrum subspecies and sexes within populations.

Heat exchangers play a vital role in numerous sectors like power generation and automotive manufacturing. Enhancing the energy efficiency of these exchangers stands as a significant hurdle. Utilizing nanofluids emerges as an optimal solution to augment heat transfer rates, leveraging their superior thermal conductivity while addressing economic constraints linked with traditional heat exchanger technologies. The motivation for this study is to consider the comprehensive synergistic features of MWCNTs, SiO 2, and hybrid MWCNTs–SiO 2 EG-based nanofluids in plate heat exchangers. This was achieved by simulating a plate heat exchanger using CFD (Fluent and Gambit softwares) considering the comparison of two SiO 2, MWCNTs, and their hybrid forms at different mass concentrations. The Reynolds-Averaged Navier-Stokes (RANS) method was employed to model turbulent flows, and the nanoparticles were compared in both single-phase and two-phase states, with their properties derived from experimental studies. Moreover, Nusselt number, convective heat transfer coefficient, and pressure drop variations were computed at different Reynolds numbers. The findings indicated an increase in the Nusselt number with the incorporation of the hybrid nanofluid, achieving a maximum enhancement of 11.19% in comparison to EG at a Reynolds number of 240 and a concentration of 0.86 wt.%. Noticeably, the pressure drop remained negligible at lower Reynolds numbers, exhibiting marginal variations up to 0.3% at higher Reynolds numbers. At a concentration of 0.86 wt.% and a Reynolds number of 480, the introduction of MWCNTs, hybrid, and SiO 2 nano-additives resulted in respective increases in the heat transfer coefficient by 21.02%, 10.76%, and 2.16% and corresponding alterations in pressure drop of 0.11%, 0.04%, and 0.02%.

This letter presents a K-band 4-channel hybrid-packaged phased-array receiver IC for satellite communication (SATCOM). The design utilizes wafer-level chip-scale packaging (WLCSP) technology to integrate four GaAs LNAs and a 4-channel CMOS beamformer into a single package. The GaAs IC features a 2-stage self-biased LNA and a 5th-order band-stop filter, achieving a low cascaded noise figure (NF) and high transmit (TX) rejection. The CMOS beamformer incorporates a novel direct current-mode combination technique based on a parallel switch array attenuator within the passive vector-modulated phase shifter (VMPS), reducing size and phase error. A two-stage digitally controlled current-steering variable gain amplifier (VGA) is optimized to provide a wide gain control range and high resolution. Operating across the SATCOM band of 17.7–21.2 GHz, the proposed phased-array receiver achieves a 360° phase-shifting range with 6-bit resolution and a 15.5-dB gain tuning range with 0.5-dB steps. Measured results show root mean square (rms) phase and amplitude errors of 1.3°–2° and 0.18–0.25 dB, respectively. Each channel demonstrates a state-of-the-art NF of 1.6 dB, a single-path gain of 30 dB, TX rejection of 60 dB, and a TX-band input-referred 1-dB gain compression point (IP1dB) of -10 dBm, while consuming only 46.8 mW of DC power per channel.

Responses of headwater stream networks to hydrological variability and extreme drought, including the role of geology, have not been well quantified. The effects of drainage area and subsurface conveyance capacity ( SCC ) on stream wetted cross-sectional area ( A wxs ) and probability of stream disconnection were quantified in a mountainous headwater watershed of coastal Northern California under seasonal variations and extreme drought in 2021. Field measurements of wetted characteristics, including A wxs and percentage of the reach that was dry, were made during the dry season. A wxs correlated negatively with SCC and positively with drainage area in the log-transformed regression. A wxs decreased and probability of disconnection ( P ( d ) ) increased with increasing distance from the headwaters due to high SCC in the lower reaches. Drainage area and SCC were both statistically significant predictors of A wxs , particularly in multivariate modes ( p << .01, R² = 0.4). Drainage area was more influential during wet conditions, while SCC was critical during dry periods. In logistic models, SCC was a stronger predictor of P ( d ) than drainage area ( p < 0.001). It is herein concluded that geology within this watershed is the dominant control on surface water expression during extreme drought conditions, resulting in unexpectedly decreasing wetted channel dimensions with increasing distance downstream. This dataset presents a unique opportunity to examine stream responses during critical drought conditions in a headwaters watershed that supports spawning and rearing habitat for endangered anadromous fish. Findings can help predict stream responses in similar watersheds to forecasted hydrological conditions and mitigate potential impacts to aquatic habitat.

Objective: To use routinely-collected maternity healthcare data to 1) describe the prevalence of key preconception indicators (e.g., smoking, folic acid supplement use) and 2) explore differences in prevalence by area-based level of deprivation. Design: Retrospective population-based study. Setting: Northern Ireland (NI). Population: 255,177 pregnancies recorded in the Northern Ireland MATernity System (NIMATS). Methods: Anonymised NIMATS data recorded during antenatal booking appointments (2011-2021) were accessed through the Honest Broker Service and analysed using R. Prevalences were calculated for each indicator, overall and based on deprivation quintile. Logistic regression models explored the relationships between each preconception indicator and area-level deprivation quintiles. Patient and Public Involvement and Engagement representatives helped prioritise indicators to include in the study, in conjunction with consulting the current evidence base, availability in NIMATS, and indicator modifiability. Main Outcome Measures: Preconception indicators, including behavioural factors (e.g., planned pregnancy), pre-existing health conditions (e.g., severe mental health), and area-based deprivation. Results: A high proportion of women had sub-optimal preconception indicators (e.g., 21.3% living with obesity). Women living in the most deprived quintile generally had a higher prevalence of risk factors than women in the least deprived quintile (e.g., smoking prevalence was 25.7% in the most deprived quintile and 5.6% in the least deprived quintile). Conclusions: Population-based maternity data in NI highlight many areas of women’s preconception health that require improvement and support, especially for women living in the areas of greatest deprivation. Findings are an essential reference point to inform interventions, policy, and ongoing monitoring of preconception health in NI.

Background: Healthcare checklists are cognitive aids that can be referenced by clinicians to reduce medical errors and reduce deviation from established treatment protocols. Objective: To review published checklists for eclampsia, amniotic fluid embolism, uterine inversion, and magnesium toxicity, compare key components of the checklists, and develop consensus that could be used for future checklist development. Study Design: Systematic review Selection Criteria: All studies that contained a detailed checklist with specific actions related to rare obstetric emergencies were included. Rare obstetric emergencies were defined as having an estimated incidence less than 1 in 10,000. The literature search focused on amniotic fluid embolism, uterine inversion, eclampsia, and magnesium toxicity. Studies that only contained lists of medications, supplies, or data collection sheets were excluded. Data Collection and Analysis: Two authors independently extracted data from each included study and conflicts were resolved by a senior author. Main results: There were 15 included publications, with a total of 24 emergency checklists reviewed. Conclusion: There is large variation in the recommended clinical steps for checklists on rare obstetric outcomes. This comparison will aid clinicians and organizations who would develop an institution-specific checklist for amniotic fluid embolism, uterine inversion, eclampsia, and magnesium toxicity.

A document by Jessica Borger. Click on the document to view its contents.

1. IntroductionThe HELLP syndrome is characterized by elevated liver enzymes, hemolysis, and thrombocytopenia. It has a low incidence during pregnancy but a poor prognosis. Once it occurs, it often has an acute onset, develops rapidly, and seriously threatens the safety of both the mother and the fetus [1]. The combination of HELLP syndrome with rupture of subcapsular hepatic hematoma and TMA is extremely rare, and the severity of the condition escalates exponentially. Through in - depth analysis of this highly challenging case successfully diagnosed and treated in the Affiliated Hospital of Jining Medical University, this study systematically summarizes its pathogenesis, clinical characteristics, and treatment experience, aiming to provide valuable reference for clinicians and improve the understanding, diagnosis, and treatment of such diseases.

A document by Petek Eylul Taneri. Click on the document to view its contents.

As a rare congenital heart malformation, coronary artery fistula(CAF) may lead to serious complications such as myocardial ischemia. While conservative management can alleviate symptoms, surgical ligation or interventional occlusion offers a definitive cure.This article reports a unique interventional case. The medical team innovatively employed a probe-assisted delivery system to successfully perform a transthoracic occlusion procedure under real-time guidance exclusively by transesophageal echocardiography(TEE). This case demonstrates that, even in the face of complex anatomical pathways, this radiation-free, precise occlusion technique can achieve safe and effective therapeutic outcomes, providing a new and reliable option for the treatment of CAF.

An innovative visible-light-driven direct hydrogen atom transfer ( d-HAT) of Ge–H bond has been developed, wherein the photoexcited 9,10-phenanthraquinone ( PCHAT9) serves as an efficient photocatalyst for the generation of germanium-centered radicals from triphenylgermane. By employing hypervalent iodine reagents as SOMOphiles, this protocol facilitates streamlined germylation through a mechanism involving germyl radical addition followed by β-cleavage of a carboxyl radical to yield a diverse array of ethynyl-, vinyl-, nitrile-, and phenyl-functionalized germanes. The methodological leap signifies a noteworthy departure from the previous photocatalytic indirect hydrogen atom transfer ( i-HAT) relying on combined usage of PC SET with abstractors, which not only advances the methodology for creating germanium radicals in a photocatalytic fashion but also provides access to structurally novel and pharmaceutically promising organogermanium compounds that are difficult to synthesize by routine methods.