Under weak grid scenarios, wide variations of grid impedance distort resonance characteristics of LCL-type grid-connected inverters. Digital control delays introduce phase lag, which easily causes damping polarity reversal in conventional capacitor-current-feedback active damping strategies. From the perspective of impedance stability, this paper reveals that control delays produce frequency-dependent resistive components in equivalent damping impedance. The analytical boundary of positive-negative resistance transition is derived, which dominates the weak-grid adaptability of inverters. Accordingly, an impedance reshaping strategy based on phase-lead delay compensation is proposed. Embedded in the feedback loop, the phase-lead network extends the valid positive-resistance frequency region and decouples the inherent coupling between LCL resonance frequency and sampling frequency. The critical frequency is lifted from [Formula: see text] to above [Formula: see text], and the system maintains a stability margin over 45° within 0-10 mH grid inductance range. A quasi-proportional-resonant cascaded current regulator is further designed to suppress background harmonic interference. Simulation and experimental tests on a 5 kW prototype verify the superior performance. When grid inductance steps from 0 to 8 mH, grid-connected current THD remains below 2.8%, and transient response completes within two fundamental cycles. This study provides theoretical guidance and practical solution for stable grid integration of high-penetration renewable energy systems.
The paper introduces an innovative integrated high-thermal insulated placebo warming acupuncture device.The device includes a true warming moxibustion unit and a sham warming moxibustion unit, both of which are visually identical and consist of isolation bowl, aluminum nitride plate and tripod, with the tripod equipped with sterile double-sided silicone rubber pads. During the operation of warming acupuncture technique, the true warming acupuncture moxibustion unit generates heat conduction, and the needle tip can be inserted into the skin, while the sham unit provides thermal insulation and its blunt needle tip is lifted immediately after contacting the skin, which merely simulates the sensation of skin penetration, so as to obtain the blinding of subjects, and simultaneously isolate the effects of acupuncture and moxibustion.Twenty healthy subjects were recruited and divided into the true warming moxibustion group (10 cases) and the sham warming moxibustion group (10 cases). The true warming moxibustion unit and the sham warming moxibustion unit were respectively used for moxibustion at the Shousanli (LI10) point on the right side. YM-HW-I medical infrared thermography system was used to capture infrared thermal images of the right upper limb of the healthy subjects to observe the changes in the surface temperature of the area where Shousanli (LI10) is located. The results showed that compared with baseline (before warming acupuncture operated), in the true warming moxibustion group, the temperature at the right Shousanli (LI10)increased during the initial 9 minutes following the operation, and the mean temperature in the area within a diameter of 1 cm rose from the first 1 minute to 8 minutes after needling (P<0.05). In the sham warming moxibustion group, except that the temperature at the acupoint and the mean temperature in the area within the diameter of 1 cm was elevated after the first 3 minutes following needling and after the first 4 minutes respectively (P<0.05), the increase of temperature at the other time points was not significant (P>0.05). These findings indicate that the sham warming moxibustion device can effectively isolate most of the heat generated during moxibustion combustion, block the photothermal effects of moxibustion and basically eliminates its therapeutic effects, thereby meeting the design requirements of placebo warm needling device. 介绍一款创新设计的一体式高隔热安慰温针灸装置。该装置包括真温灸器与假温灸器，两者外观完全一致，均由隔离碗、氮化铝板及三角脚撑组成，三角脚撑配备带无菌双面胶垫的硅橡胶脚蹼。施温针灸时，真温灸器导热，针尖可以刺入皮肤；假温灸器隔热，钝头针尖抵皮肤后立即抬起，仅模拟针刺破皮感，以对受试者设盲，同时隔绝针刺与艾灸效应。招募20例健康受试者，分为真温针灸组（10例）和假温针灸组（10例），分别使用真温灸器、假温灸器于右侧手三里施灸，采用YM-HW-I医用红外热像仪拍摄健康受试者右上肢红外热成像图，观察右侧手三里穴区域体表温度变化。结果显示：与温针灸前比较，真温针灸组健康受试者在温针灸第0～9分钟时右侧手三里穴点温度、第1～8分钟时直径1 cm区域内平均温度均升高（P<0.05）；假温针灸组除温针灸第3分钟时右侧手三里穴点温度、第4分钟时直径1 cm区域内平均温度升高外（P<0.05），其余时间点均无明显升高（P>0.05）。表明假温灸器能有效隔绝艾灸燃烧时的大部分热量，阻断艾灸的光热效应，基本排除其治疗效果，从而满足安慰温针灸的设计要求。.
Excessive or improper nitrogen (N) fertilization can disrupt calcium (Ca) nutrition in apple trees and induce Ca-related physiological disorders, yet its effects on Ca availability and partitioning remain unclear. This study evaluated the impact of different N fertilization regimes on soil Ca availability, Ca partitioning, and Ca bioavailability in fruit tissues of 10-year-old 'Fuji' apple trees, using Ca fractionation analysis combined with multi-criteria decision-making (TOPSIS). High N applied as a single dose (H1) significantly reduced soil water-soluble and exchangeable Ca, while increasing Ca oxalate (CaOx) accumulation in fruit pedicels, particularly at maturity. Although total CaOx in fruit flesh decreased, its relative proportion increased, indicating enhanced Ca sequestration. In contrast, split application of moderate N (M3) maintained more stable soil Ca availability, reduced CaOx accumulation, and improved Ca allocation to fruit tissues. Integrated evaluation ranked treatments as M3 > M1 > H3 > H1. Overall, moderate and split N fertilization reduced Ca sequestration into CaOx, enhanced Ca availability, and improved Ca distribution in fruit tissues, providing a physiological basis for optimizing N management to mitigate Ca-related disorders and improve fruit quality.
Cloud detection algorithms in remote sensing imagery exploit spectral and spatial characteristics, either independently or synergistically, to facilitate the discrimination between cloud and underlying surfaces. Individual cloud detection methods manifest unique operational advantages but suffer from inherent limitations, such as bright surface misclassification and thin cloud omission, leading to unstable performance across heterogeneous landscapes. A critical research gap exists in how to systematically integrate complementary strengths of multiple deep learning models while mitigating their individual weaknesses. To address this gap, this paper proposes a novel ensemble framework based on multiple deep learning models, using an F1-score-weighted fusion strategy. The framework first evaluates three representative deep learning-based detection algorithms (CD-SLCNN, SRMF-CD, CNN-TransNet) on Landsat-8 imagery, then derives algorithm-specific weights from their F1-scores on a validation set to produce a weighted probabilistic fusion. Quantitative comparisons on a hold-out test set show that the proposed method outperforms standard ensemble baselines: it improves F1-score by 4.7% points over majority voting and by 1.9% points over bayesian model averaging, while also reducing misclassification and omission errors across heterogeneous landscapes. The proposed F1-weighted ensemble thus provides a robust and accurate solution for large-scale cloud detection.
Facial and neck skin laxity due to aging represents a major aesthetic concern among women. Despite this, most patients prefer non-invasive treatments that may offer natural results, minimal downtime, and low risk of complications. Advanced monopolar radiofrequency (RF) technology addresses these needs through continuous low-temperature epidermal cooling, enabling safe delivery of maximal energy (140 W) to superficial and mid-dermal layers and facial retaining ligaments without burns, lesions, or discomfort. This protocol presented a novel ligament-focused approach for adults aged 35 years or older with mild-to-moderate facial and/or neck skin sagging. Applying 1,000 shots in one session across facial, submental, and neck regions, targeting ligaments and fibrous septa, the protocol was delivered in a hashtag pattern with 50% overlap at energy levels 8-10. Clinical observations demonstrated an improvement in skin thickness, texture, elasticity, facial and neck contour, and wrinkle reduction, achieving lifting effects with minimal/no pain and high patient satisfaction. Reapplication is recommended after six months to optimize and maintain the results and, for moderate and severe cases, we recommend a combination of new monopolar RF with fillers or microfocused ultrasound. In conclusion, the protocol offers versatile skin rejuvenation by promoting collagen remodeling and contraction of fibrous septa and ligaments, providing a good alternative treatment for facial aging with an interesting balance between results and comfort.
The pectoralis major (PM) muscle is commonly used in reconstruction because of its robust vascular supply from the thoracoacromial artery, although vascular dominance varies among individuals. Transcatheter arterial embolization is effective for hemostasis but may risk ischemia when a dominant pedicle is compromised. We describe a case of delayed PM muscle necrosis after selective arterial embolization for traumatic chest wall hemorrhage. A 76-year-old man with diabetes mellitus, pancreatic head carcinoma under chemotherapy, and polymyalgia rheumatica treated with prednisolone for a prolonged period (7 mg/d) developed acute right chest pain after lifting approximately 30 kg of hay. Computed tomography showed a large subcutaneous and subpectoral hematoma (123.9 × 115.7 × 66.0 mm) without extravasation. On day 10, computed tomography demonstrated active bleeding from branches of the thoracoacromial artery and lateral thoracic artery. Selective embolization of 1 branch of each artery was performed using a 1:3 mixture of N-butyl-2-cyanoacrylate (Histoacryl, B. Braun, Melsungen, Germany) and Lipiodol (Lipiodol, Guerbet, Villepinte, France), without coil embolization. Several weeks later, wound breakdown occurred; operative exploration revealed extensive PM muscle necrosis. Debridement and negative-pressure wound therapy were followed by delayed primary closure on day 113, with complete healing at 6 months. Selective embolization of branches supplying the PM muscle can rarely result in severe muscle necrosis, particularly in patients with reduced ischemic tolerance. Awareness, surveillance for delayed deep ischemia, and staged reconstruction are essential.
Heterogeneous hydrogels capable of complex, programmable deformation are highly desirable for soft actuators, yet general strategies that simultaneously impart structural anisotropy, rapid responsiveness, and mechanical robustness remain limited. Here, a gradient anisotropic natural rubber-poly(N-isopropylacrylamide) (NR-PNIPAM) composite hydrogel is developed through a simple one-pot polymerization strategy by coupling pH-regulated colloidal stability with gravity-directed redistribution of natural rubber latex particles. Under an optimized pH window, NR nanoparticles gradually migrate during gelation and are fixed as a continuous gradient within the PNIPAM network, generating built-in structural asymmetry for nonuniform deformation. Meanwhile, NR nanoparticles act as soft reinforcing domains to improve mechanical strength, while water-soluble graphene nanosheets provide efficient photothermal conversion for remotely-controlled near-infrared (NIR)-responsive actuation. Benefiting from this synergistic design, the hydrogel exhibits programmable bending and localized folding with high actuation rates of 129° s-1 and 46° s-1, respectively, along with a tensile strength of 0.32 MPa and an active lifting capability exceeding 70 times its own weight. The material further enables biomimetic gripping and lifting under NIR stimulation. This work establishes a general route to robust gradient hydrogels by integrating colloidal regulation, structural anisotropy, and photothermal actuation, offering a versatile platform for high-performance soft intelligent systems.
The COVID-19 pandemic had heterogeneous effects on the mental health of children and adolescents according to individual experiences, with some consequences persisting beyond the lifting of restrictions. We aimed to examine whether the perceived impact of the COVID-19 pandemic was associated with 2022-2025 trajectories of mental health difficulties in children and adolescents, and to identify associated risk and protective factors. Data was drawn from the population-based SEROCoV-KIDS cohort study conducted in Geneva, Switzerland. The multidimensional perceived impact of the pandemic, as well as potential socio-demographic, health, family, social, and behavioral risk and protective factors were parent-reported at baseline, in 2022. Mental health difficulties were collected annually between 2022 and 2025. Generalized mixed effects models were used to estimate mental health trajectories by pandemic impact, and to assess risk and protective factors. Of 1907 children aged 2-17 years, 9.3% and 7.9% had experienced a negative and positive pandemic impact, respectively, while most of them were not or minimally affected (82.8%). Compared to their unaffected peers, negatively impacted children had more mental health difficulties in 2022 (incidence rate ratio [IRR]: 1.51; 95% confidence interval [CI] 1.34-1.70) and improving trends between 2022 and 2025 (IRR: 0.98; 95% CI 0.95-1.01). An average-to-poor financial situation was related to a milder mental health response to a negative impact in 2022 (IRR: 0.64; 95% CI 0.46-0.89). A positive pandemic impact tended to be associated with higher difficulties in 7-12 year old children in 2022 (IRR: 1.36; 95% CI 0.98-1.89), with stable trends over time. About 5 years after the onset of COVID-19, the lasting mental health difficulties presented by children with a negative perceived impact of the pandemic had largely improved. Although globally reassuring, these findings call for proactive measures to prevent such long-term consequences on youth mental health in the event of future crises.
Lumbosacral radiculopathy often presents as back pain and lower limb weakness and is frequently encountered in rehabilitation medicine. Fibrocartilaginous embolism (FCE) is an uncommon but significant vascular cause of radiculopathy. It occurs when the disc-derived fibrocartilaginous material enters the spinal vasculature, leading to embolic infarction. We present the case of a 54-year-old female who developed right lower limb weakness and sensory impairment after lifting an adult male. Lumbosacral MRI revealed infarctions involving the L3 vertebral body, right L3 dorsal root ganglion, and paraspinal muscles. CT angiography demonstrated embolic occlusion of the right third lumbar artery, and electromyography confirmed right L2-3 radiculopathy. The patient was conservatively treated with aspirin and physical therapy. Over time, the motor weakness and electromyographic amplitudes in the affected lower limb improved. To our knowledge, this is the first reported case of FCE causing isolated L2-3 radiculopathy without spinal cord infarction.
In our earlier report of headache prevalence among children (6-11 years) and adolescents (12-17) in Zambia, we defined undifferentiated headache (UdH) conventionally as mild headache lasting < 1 h. However, we recognised diagnostic uncertainties, which also occurred in our similar studies elsewhere in sub-Saharan Africa (Ethiopia and Benin). Here we use a modified definition of UdH, making new estimates of prevalence accordingly, and estimates based on these of headache-attributed burden. The study was part of the global schools-based programme conducted by the Global Campaign against Headache. In a cross-sectional survey using the standardised protocol of the global programme, the child and adolescent versions of the HARDSHIP questionnaire, translated into the local languages, were completed by pupils in mediated sessions within their classes in nine schools representative of Zambia's urban/rural divide. Headache diagnostic questions were based on ICHD-3 except for UdH, which we redefined as mild or moderate headache lasting < 1 h. Enquiry included multiple aspects of attributed burden. Of 2,759 potential participants, 2,089 (615 children [29.4%], 1,474 adolescents [70.6%]) completed questionnaires (participating proportion 75.7%). The unfeasibly high observed prevalence of migraine reported earlier (51.6%, including probable migraine) was reduced by redefining UdH to 42.9%, still highly questionable. Nonetheless, burden measures clearly distinguished migraine from tension-type headache (TTH) and UdH. Migraine headache was the most intense, most frequent and longest lasting, but proportion of time in ictal state (pTIS) was only 1.3%. However, pTIS was much greater among those with probable medication-overuse headache (7.9%) or other headache on ≥ 15 days/month (9.0%). Headache accounted for an estimated loss of 3.5% of school time in those affected, migraine having twice the impact of TTH or UdH, while H15 + accounted for > 15% of lost school time. Almost one in six parents (15.9%) lost time from their own work. Migraine had greater impact than TTH and UdH on both emotional impact and quality-of-life scores. Headache, prevalent among children and adolescents in Zambia, is associated with burdens that include lost school time, with, potentially, lifelong negative impact. These findings are of importance to national educational and health policies. Our modified definition of UdH was a step towards diagnostic veracity, but did not resolve the diagnostic difficulties among young people. Future studies might consider further modifications, but full review of the ICHD criteria for migraine in these age groups is needed.
Submental "double-chin" deformity is multifactorial and may reflect the volume and boundaries of preplatysmal fat, variability in platysmal decussation, and aging-related changes at the cervicomental angle. U-shaped cogged thread lifting is increasingly used as a minimally invasive option for submental contouring, yet the mandibular angle/antegonial notch region contains facial vessels and nerve branches that can be injured when the cannula or thread deviates into a deeper plane. To describe cadaveric anatomical observations relevant to submental U-shaped cogged thread lifting and to propose a fixation concept using a regionally condensed fibrous layer beneath the platysma near the mandibular angle (herein referred to as the "subangular deep fascia"), representing a functional fascial interface rather than a formally defined anatomical layer, to reduce off-target traversal and potential injury. Cadaveric thread simulations were performed to reproduce common U-shaped submental thread trajectories. Layer-by-layer dissections were used to identify the relationship of the simulated thread path to the platysma, facial artery/vein at the antegonial notch region, parotid tail, sternocleidomastoid muscle, and superficial sensory nerves. Representative photographs were compiled as figures. When the trajectory was directed toward a posterior mastoid fixation, the thread pathway tended to approach deeper tissue planes near the mandibular angle, placing it in close proximity to vertically ascending facial vessels; a representative specimen demonstrated direct arterial penetration. A relatively thick and resistant fibrous layer was consistently appreciable beneath the platysma near the mandibular angle, which may represent a regional fascial condensation rather than a distinct named anatomical structure, and provided a plausible alternative fixation point. Conceptually, a subangular deep fascia fixation corridor allows the thread to remain predominantly preplatysmal while limiting posterior traversal through the parotid-sternocleidomastoid region. The mandibular angle/antegonial notch region represents a critical transition zone in submental thread lifting. Anchoring within a dense subangular deep fascial layer beneath the platysma may improve procedural safety by reducing the need for deep posterior passage and by supporting a stable lifting vector. Further quantitative cadaveric mapping and prospective clinical studies are needed.
Total suspended solids (TSS) have been shown to damage the structural integrity of fish gills, impairing their function, including gas exchange. However, studies showing linkages between gill damage due to TSS and fish performance are limited. There is a large diversity of fish species inhabiting aquatic environments, and whether the TSS impact on gill function is similar across a range of species has yet to be explored. Here, we exposed multiple species, including salmonids (rainbow, brook and cutthroat trout) and cyprinids (fathead minnow and longnose dace) to a range of TSS concentrations (0-1000 mg L-1) for 4 d and assessed damages to gill structure (filament thickness, lamellae thickness, oxygen diffusion distance, lamellae length, epithelial lifting, and interlamellar distance) using confocal microscopy. All species tested showed similar gill structural damage, including thicker lamellae, longer oxygen diffusion distances, and reduced respiratory surface area, at concentrations ≥ 100 mg L-1 TSS. To assess whether gill damage corresponds to performance dysfunction, we tested the metabolic rate and swimming capacity of a salmonid (rainbow trout) and a cyprinid (fathead minnow) after exposure to 100 mg L-1 TSS using swim tunnel respirometry. Trout showed lower routine metabolic rate (RMR) and maximum metabolic rate (MMR) after TSS exposure and were unable to reach the higher swimming speeds attained by unexposed fish. Fathead minnows showed no difference in the RMR after TSS exposure, but, like trout, had a lower MMR and were unable to attain the higher swimming speed of the control fish. Both species showed a ~35% reduction in the critical swimming speed (Ucrit). These findings reveal that environmentally realistic TSS concentrations damage gill structure, impair fish swimming performance, and may compromise their ability to cope with energy-demanding activities, including additional biotic and abiotic stressors.
Predicting postoperative return to sport (RTS)/return to exercise (RTE) is challenging, particularly given the unclear impact of preexisting mood conditions. In sport/exercise participants who underwent spine surgery, the authors sought to evaluate the relationship between preoperative depression and postoperative sport/exercise participation and establish a threshold depression score predictive of RTS/RTE. A retrospective cohort study (2011-2022) was conducted of sport/exercise participants who underwent degenerative spine surgery. Moderate/severe depression was defined as a score ≥ 10 on the Patient Health Questionnaire-9 (PHQ-9). Primary outcomes were 1) RTS/RTE (yes/no), time to return (months), frequency of participation (hours and days per week); and 2) optimal PHQ-9 score predicting RTS/RTE. Secondary outcomes were patient-reported outcome measures (PROMs), including the Oswestry Disability Index (ODI) and Neck Disability Index (NDI). Multivariable regression controlled for age, sex, BMI, use of narcotics, surgical procedure, and preoperative PROM scores. Of 737 patients surveyed on sports/exercise participation, 150 (20.4%) reported preoperative sport/exercise. The mean patient age was 56.3 ± 13.8 years, and the mean follow-up was 6.0 ± 2.1 years. Thirty-four (22.7%) patients had moderate/severe depression. Common sports/exercises were hiking (55.3%), weight lifting (46.0%), and running/jogging (40.7%). Of the 150 patients, 127 (84.7%; 64.7% depressed vs 90.5% nondepressed, p < 0.001) returned to sport/exercise within 8.9 ± 3.7 months (13.0 ± 19.3 vs 8.1 ± 12.2 months, p = 0.147) postoperatively. Compared with their presymptom baseline, depressed patients engaged in fewer days (2.5 ± 1.9 vs 4.2 ± 1.4 days, p = 0.011) and hours (5.1 ± 4.8 vs 10.1 ± 7.3 hours, p = 0.047) of sport/exercise weekly, compared with their presymptom baseline. Preoperative depression predicted longer time to RTS/RTE (HR 0.6, 95% CI 0.4-1.0; p = 0.043). A PHQ-9 score of 7.2 (AUC 0.71, p = 0.001) predicted failure to RTS/RTE. Preoperative depression predicted worse long-term ODI (β 15.0, 95% CI 4.2-25.8; p = 0.007) and NDI (β 17.3, 95% CI 0.94-33.7; p = 0.039) scores. Sport/exercise participants undergoing degenerative spine surgery with moderate/severe depression were less likely to return to sport/return to exercise, returned later, and failed to regain presymptom levels of participation. Even mild depression (PHQ-9 score 7-9) predicted failure to return to sport/return to exercise. To facilitate successful return to sport/return to exercise, surgeons should screen all patients for depression and consider referring those with even mild depression for preoperative psychiatric optimization.
Electroencephalography (EEG) and electromyography (EMG) are widely used for decoding motor intentions, yet unimodal approaches often suffer from low robustness and limited representational information. EEG-EMG hybrid brain-computer interfaces (BCI) can bridge cortical intention and muscular execution, but challenges remain in signal alignment, fusion modeling, and clinical generalization. To address these issues, we propose STCAFusion, a spatiotemporal cross-attention framework that integrates EEG and EMG through multi-band based dual-branch convolutional encoders and parallel temporal and spatial cross-attention modules. This design enables detailed modeling of inter-modal correlations across both time and space. We evaluate STCAFusion on a newly collected dataset of synchronous EEG-EMG recordings from 12 subjects, where the data were acquired under two paradigms (Reaching and Lifting) designed from daily functional upper-limb activities to emphasize directional and strength control. With leave-one-run-out cross-validation, STCAFusion achieves average accuracies of 84.15% and 95.22% in the two paradigms, outperforming the strongest competing EEG-EMG fusion baselines by 3.4% in the Reaching paradigm and 1.8% in the Lifting paradigm. Visualization of learned attention weights further reveals meaningful spatiotemporal EEG-EMG coupling patterns, offering insights into neural-muscular coordination patterns relevant to rehabilitation-oriented BCI design. These results highlight the potential of cross-attention-based multimodal physiological signal fusion in building reliable hybrid BCI and wearable devices for upper-limb control and rehabilitation.
Facioscapulohumeral muscular dystrophy (FSHD) is a rare, progressive genetic disorder characterized by asymmetric muscle weakness and functional decline. Although it is one of the most common muscular dystrophies, its economic burden in the United States (US) is largely unknown. This study aimed to provide an initial, conservative estimate of annual medical claims costs and identify comorbidities disproportionately affecting individuals with FSHD in the US. This retrospective, 1:5 matched case-control study analyzed de-identified claims data from Medicare and commercially insured enrollees from 2018 to 2021. Medical and prescription costs were aggregated and described as means with 95% confidence intervals. T-tests with Bonferroni correction and chi-square tests were used to compare comorbidity prevalence. The study included 383 individuals with FSHD and 1915 matched controls. The mean annual medical claims cost for the FSHD cohort was $19,370 per person with commercial insurance and $11,704 with Medicare, compared with $5250 among controls. Individuals with FSHD also incurred higher prescription claims costs in commercial and Medicare subgroups without comorbidities. The prevalence of cerebrovascular disease (10.18% vs 4.44%) and ear disorders (8.09% vs. 3.39%) was significantly greater in the FSHD cohort (P<0.05). This exploratory study provides the first US-based description of the direct medical costs of FSHD, demonstrating a substantially higher healthcare burden than that of matched controls. Because the study design likely underestimates costs, the true economic impact may be even greater. These findings establish a critical foundation for future research into the lifetime medical, nonmedical, and caregiver-related costs of FSHD, and highlight the urgent need for effective therapies and supportive care strategies. Facioscapulohumeral muscular dystrophy (FSHD) is a rare muscle disease that causes progressive weakness in the face, shoulders, upper arms, core, and legs. Over time, it can make everyday tasks such as lifting, walking, or speaking more difficult. While FSHD is one of the most common muscular dystrophies, little is known about its financial impact on people living with the condition and the healthcare system in the United States. To better understand this burden, this study evaluated medical insurance claims for individuals with FSHD and compared them with those of individuals without FSHD. We examined costs from both commercial insurance and Medicare between 2018 and 2021. Individuals with FSHD had substantially higher medical costs than those without the condition. Average annual medical claims were $19,370 for those with commercial insurance and $11,704 for those on Medicare, compared with $5250 for matched individuals without FSHD. Individuals with FSHD also had more prescriptions and were more likely to have claims for other health problems, such as stroke-related conditions and ear disorders. These results show that FSHD is associated with a meaningful financial burden on the healthcare system. Because this study was based on claims data and likely underestimates the full cost of care, the real burden may be even higher. Understanding these costs is an important first step toward improving care, planning support services, and encouraging investment in better treatments for people living with FSHD.
Mixed ionic-electronic transfer (MIET) reactions, such as the oxygen reduction reaction (ORR) at oxide surfaces, are of paramount importance to manifold technologically highly relevant processes, and fundamental understanding must be developed to improve performance and tailor highly efficient electrodes and catalysts. Understanding such complex multi-step reactions requires the study of kinetic processes, underlying thermodynamic properties, i.e., ionic and electronic defect concentrations, and electrostatic surface effects. However, conventional techniques struggle to uncover the complete picture within the same sample/measurement. Here, we overcome this limitation by introducing bias-triggered conductivity relaxation (BCR) as a novel tool to investigate MIET reactions on oxides. It is based on alternating out-of-plane coulometric titration/polarization and in-plane electrical conductivity relaxation measurements, providing simultaneous electronic, ionic, and extraordinarily rich surface kinetics information. This innovative combination of electrical and chemical driving forces synergizes information depth, with enhanced time resolution, versatility, and speed, yet it lifts the weaknesses of the individual approaches, while remaining cost-effective and surprisingly simple. Furthermore, BCR allows to disentangle overpotential induced electrostatic modifications of the surface kinetics in a unique manner. We showcase the advantages of BCR in this work by studying the ORR in model (La, Sr)FeO3-δ thin film electrodes and reporting on their thermodynamic and kinetic properties.
Estimation of lumbar spinal loads is important for understanding low back pain, guiding ergonomic interventions, and informing surgical and rehabilitation planning. Historically, intradiscal pressure (IDP) provided one of the few internal in vivo measures of disc loading; more recently, telemetry, musculoskeletal (MS) modeling, finite element (FE) analysis, hybrid MS-FE approaches, displacement/control-based methods, and AI surrogates have expanded the toolbox for estimating spinal loads. We present a narrative perspective review based on a literature search in PubMed, Scopus, and Web of Science using terms related to spinal loads, IDP, telemeterized implants, MS modeling, FE analysis, hybrid MS-FE coupling, displacement/control-based methods, wearable/EMG-based approaches, and AI/machine learning surrogates. Human lumbar studies and methodological contributions relevant to load estimation or validation were included; animal models were excluded. Invasive approaches (needle-based IDP, discography, intra-abdominal pressure, and telemeterized implants) provide task-dependent internal pressures or forces in small, selected cohorts and now primarily serve as benchmarks for model validation. MS models estimate segmental compression, shear, and net moments from motion and EMG, with typical L4-L5 compressive forces of ∼1-2 kN in relaxed standing and ∼3-5 kN during common lifting tasks. FE and hybrid MS-FE simulations resolve how these loads are distributed across discs, facets, and ligaments and relate segmental forces to internal stresses. Displacement-driven/control-based models and emerging AI/wearable-based surrogates provide additional non-invasive pathways for task-specific lumbar load estimation. This methods-focused synthesis outlines how invasive data support MS, FE, hybrid, and AI-based approaches and highlights recurring challenges in muscle redundancy, constitutive and parameter uncertainty, limited in vivo benchmarks, and heterogeneous model reporting. Within this framework, IDP is best regarded as an internal benchmark rather than a stand-alone metric of "spinal load" which is more fully described by compression, shear, moments, and internal stresses.
Not all sleep loss is equal, and overlooking this limits progress in sleep and neurological disease research. We compared nine rodent sleep deprivation paradigms, gentle handling, multiple platform variants, disk-over-water, the Unpredictable Chronic Sleep Deprivation (UCSD) paradigm, novel object introduction, curling prevention by water, automated systems, and head-lifting, evaluating stress confounds, sleep stage specificity, chronicity, and neurobiological outcomes. Effects included hippocampal plasticity, prefrontal chemistry, glymphatic clearance, neuroinflammation, oxidative stress, neurogenesis, and circadian regulation, linked to Alzheimer's, Parkinson's, and psychiatric comorbidities. UCSD with caffeine produced antioxidant depletion, serotonin reduction, acetylcholinesterase upregulation, and synaptophysin loss, early neurodegeneration markers. We propose a disease-targeted framework with six translational priorities and reporting standards.
To analyze the epidemiological characteristics and incidence of mirror-image dextrocardia in pregnant women and fetuses before and after the lifting of coronavirus disease (COVID-19) control measures in China on December 7, 2022. We retrospectively collected data on the number of pregnant women who underwent prenatal ultrasound examinations and incidence of mirror-image dextrocardia in fetuses at three hospitals in Xi'an during three time periods: before the COVID-19 pandemic (January to April 2019), during the COVID-19 control measures (January to April 2022), and after the lifting of COVID-19 restrictions (January to April 2023). We then conducted an online epidemiological survey among pregnant women across China and collected the names of pregnant women with fetal mirror dextrocardia, as well as the following clinical information: age, location (province and city), gestational week at which mirror-image dextrocardia was detected, last menstrual period date, date of first pregnancy diagnosis, obstetric history, conception method, estimated due date, ultrasound diagnosis result, and genetic testing result. COVID-19-related information was also recorded. Between January and April 2019 (pre-pandemic), 9,112 pregnant women underwent prenatal ultrasound examinations at 3 hospitals in Xi'an. Between January and April 2022 (COVID-19 control measures period), 11,071 pregnant women underwent prenatal ultrasound examinations, and 1 case of fetus with mirror-image dextrocardia was identified (incidence rate, 0.9/10,000). Between January and April 2023 (after the lifting of COVID-19 restrictions), 11,516 pregnant women underwent prenatal ultrasound examinations, and 21 fetuses with mirror-image dextrocardia were detected, with an alarming incidence rate of 18.2/10,000. After the lifting of COVID-19 restrictions, the incidence of mirror-image dextrocardia in fetuses in Xi'an showed a significant increase (8-20-fold higher) compared to that observed in both the pre-pandemic and strictly controlled pandemic periods. An online investigation showed that 111 cases of fetal mirror-image dextrocardia were detected in 22 other provinces of China after the lifting of COVID-19 restrictions. All pregnant women with fetal mirror-image dextrocardia had a history of SARS-CoV-2 infection after the lifting of COVID-19 restrictions, which coincided with the early stages of embryo development, approximately 4-6 weeks after their last menstrual period. Our data showed that the increase in cases of fetal situs solitus with dextrocardia coincided temporally with the outbreak of COVID-19 in China. This temporal overlap may suggest a potential association between the two events.
Compositional data-vectors encoding relative proportions-arise across scientific domains, including ecology, geochemistry, and genomics. The features in these data often come with known hierarchical structure (e.g., taxonomies, phylogenies, ontologies), yet existing methods either ignore this structure, discard the intrinsic Aitchison geometry, are designed for binary trees, or yield incomplete coordinate systems. We describe PolyILR, a canonical orthonormal decomposition of the Aitchison tangent space aligned with any tree topology. Our construction defines a weighted local geometry at each internal node capturing full branching structure, then lifts these to a global orthonormal basis where every coordinate corresponds to a specific tree location. On microbiome and single-cell benchmarks, PolyILR yields stable, interpretable features and enables inference at multiscale tree resolution. We also establish a novel theoretical connection to softmax classifiers, suggesting possible applications to probabilistic modeling.